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Matsumoto F, Ikeda K. Surgical Management of Tracheal Invasion by Well-Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13040797. [PMID: 33672929 PMCID: PMC7918429 DOI: 10.3390/cancers13040797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/25/2023] Open
Abstract
Simple Summary Tracheal invasion is a poor prognostic factor in well-differentiated thyroid cancer. Appropriate resection can improve the prognosis and maintain the patient’s quality of life. Shaving resection for superficial tracheal invasion is minimally invasive because it does not involve the tracheal lumen, despite the problematic risk of local recurrence. Window resection for tracheal mucosal and luminal invasion provides good tumor control and does not cause postoperative airway obstruction; however, the need for surgical closure of the tracheocutaneous fistula is a disadvantage of this method. Circumferential (sleeve) resection and end-to-end anastomosis are highly curative, but the risk of fatal complications, such as anastomosis dehiscence, is a concern. Abstract Well-differentiated thyroid carcinoma (WDTC) is a slow-growing cancer with a good prognosis, but may show extraglandular progression involving the invasion of tumor-adjacent tissues, such as the trachea, esophagus, and recurrent laryngeal nerve. Tracheal invasion by WDTC is infrequent. Since this condition is rare, relevant high-level evidence about it is lacking. Tracheal invasion by a WDTC has a negative impact on survival, with intraluminal tumor development constituting a worse prognostic factor than superficial tracheal invasion. In WDTC, curative resection is often feasible with a small safety margin, and complete resection can ensure a good prognosis. Despite its resectability, accurate knowledge of the tracheal and peritracheal anatomy and proper selection of surgical techniques are essential for complete resection. However, there is no standard guideline on surgical indications and the recommended procedure in trachea-invading WDTC. This review discusses the indications for radical resection and the three currently available major resection methods: shaving, window resection, and sleeve resection with end-to-end anastomosis. The review shows that the decision for radical resection should be based on the patient’s general condition, tumor status, expected survival duration, and the treating facility’s strengths and weaknesses.
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Taboni S, Paderno A, Giordano D, Albano D, Piana S, Zanetti E, Bertagna F, Grammatica A, Ghidini A, Cappelli C, Bozzola A, Baronchelli C, Nicolai P, Lombardi D. Differentiated Thyroid Cancer: The Role of ATA Nodal Risk Factors in N1b Patients. Laryngoscope 2020; 131:E1029-E1034. [PMID: 33319385 DOI: 10.1002/lary.29057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/12/2020] [Accepted: 08/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nodal involvement is frequent in patients with differentiated thyroid cancers (DTCs), but its prognostic relevance is not univocal. Some characteristics of nodal metastases can increase the risk of recurrence. We attempted to quantify the impact on survival of nodal factors included in the American Thyroid Association (ATA) risk stratification system in N1b patients with DTC. STUDY DESIGN Retrospective study. METHODS A retrospective analysis of patients affected by DTC who underwent therapeutic lateral neck dissection (ND) was performed. The impact on the prognosis of the number of positive lymph nodes (LNs), dimension of nodal metastasis, and microscopic and macroscopic extranodal extension (miENE and maENE, respectively) was investigated. RESULTS The study included 347 N1b patients who underwent 401 therapeutic lateral NDs. Mean number of positive LNs was nine, mean nodal ratio was 0.27, and mean diameter of metastasis was 15.5 mm. ENE was detected in 25.9% of patients (22.5% miENE and 3.5% maENE). In univariate analysis, the presence of maENE had an impact on disease specific survival (DSS) (P = .023); increasing number of positive LNs affected DSS and locoregional control (LRC) (P = .009 and =.006, respectively); increasing metastatic node dimension was a risk factors for overall survival, DSS, and metastases free survival (MFS) (P = .05, =.013 and =.016). In multivariate analysis, number of positive LNs and LN dimension were independent risk factors for LRC and MFS, respectively (HR 1.1, P = .028; HR 1.1, P = .026). CONCLUSIONS In our analysis on a cohort of N1b patients, the number of positive LNs and LN dimension were confirmed as independent risk factors for locoregional and distant recurrence, respectively. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1029-E1034, 2021.
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Affiliation(s)
- Stefano Taboni
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Giordano
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Eleonora Zanetti
- Pathology Unit, Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | | | - Alberto Grammatica
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Angelo Ghidini
- Otorhinolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Cappelli
- Endocrine and Metabolic Unit, University of Brescia, Brescia, Italy
| | - Anna Bozzola
- Department of Pathology, University of Brescia, Brescia, Italy
| | | | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
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Park H, Harries V, McGill MR, Ganly I, Shah JP. Isthmusectomy in selected patients with well-differentiated thyroid carcinoma. Head Neck 2019; 42:43-49. [PMID: 31589005 DOI: 10.1002/hed.25968] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/12/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Isthmusectomy in the treatment of well-differentiated thyroid carcinoma (WDTC) is controversial. In this study, we analyze the outcomes of WDTC managed by isthmusectomy alone. METHODS Forty-three patients treated with isthmusectomy alone were identified from an institutional database of 6259 surgically treated patients with WDTC. Patient and tumor characteristics were analyzed. Disease-specific survival (DSS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier method. RESULTS The pT classification was T1 for 41 and T2 for two patients. All were clinical N0, but 10 pts were pN1a. Using the American Thyroid Association risk stratification system, 9 patients were low-risk and 22 were intermediate-risk. One patient developed local recurrence, and two developed regional lymph node metastases; the 5- and 10-year DSS was 100.0%. The 5- and 10-year RFS was 93.1%. CONCLUSIONS Isthmusectomy alone is an acceptable procedure in selected patients with low- and intermediate-risk WDTC limited to the isthmus.
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Affiliation(s)
- Hakyoung Park
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, InJe University Busan Paik Hospital, Busan, South Korea
| | - Victoria Harries
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marlena R McGill
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
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Camargo Barros-Filho M, Barreto Menezes de Lima L, Bisarro Dos Reis M, Bette Homem de Mello J, Moraes Beltrami C, Lopes Pinto CA, Kowalski LP, Rogatto SR. PFKFB2 Promoter Hypomethylation as Recurrence Predictive Marker in Well-Differentiated Thyroid Carcinomas. Int J Mol Sci 2019; 20:E1334. [PMID: 30884810 DOI: 10.3390/ijms20061334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
Despite the low mortality rates, well-differentiated thyroid carcinomas (WDTC) frequently relapse. BRAF and TERT mutations have been extensively related to prognosis in thyroid cancer. In this study, the methylation levels of selected CpGs (5-cytosine-phosphate-guanine-3) comprising a classifier, previously reported by our group, were assessed in combination with BRAF and TERT mutations. We evaluated 121 WDTC, three poorly-differentiated/anaplastic thyroid carcinomas (PDTC/ATC), 22 benign thyroid lesions (BTL), and 13 non-neoplastic thyroid (NT) tissues. BRAF (V600E) and TERT promoter (C228T and C250T) mutations were tested by pyrosequencing and Sanger sequencing, respectively. Three CpGs mapped in PFKFB2, ATP6V0C, and CXXC5 were evaluated by bisulfite pyrosequencing. ATP6V0C hypermethylation and PFKFB2 hypomethylation were detected in poor-prognosis (PDTC/ATC and relapsed WDTC) compared with good-prognosis (no relapsed WDTC) and non-malignant cases (NT/BTL). CXXC5 was hypomethylated in both poor and good-prognosis cases. Shorter disease-free survival was observed in WDTC patients presenting lower PFKFB2 methylation levels (p = 0.004). No association was observed on comparing BRAF (60.7%) and TERT (3.4%) mutations and prognosis. Lower PFKFB2 methylation levels was an independent factor of high relapse risk (Hazard Ratio = 3.2; CI95% = 1.1–9.5). PFKFB2 promoter methylation analysis has potential applicability to better stratify WDTC patients according to the recurrence risk, independently of BRAF and TERT mutations.
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Dong W, Nicolson NG, Choi J, Barbieri AL, Kunstman JW, Abou Azar S, Knight J, Bilguvar K, Mane SM, Lifton RP, Korah R, Carling T. Clonal evolution analysis of paired anaplastic and well-differentiated thyroid carcinomas reveals shared common ancestor. Genes Chromosomes Cancer 2018; 57:645-652. [PMID: 30136351 DOI: 10.1002/gcc.22678] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/12/2018] [Accepted: 08/03/2018] [Indexed: 02/04/2023] Open
Abstract
Foci of papillary or follicular thyroid carcinoma are frequently noted in thyroidectomy specimens of anaplastic thyroid carcinoma (ATC). However, whether ATCs evolve from these co-existing well-differentiated thyroid carcinomas (WDTCs) has not been well-understood. To investigate the progression of ATC in patients with co-existing WDTCs, five ATC tumors with co-existing WDTCs and matching normal tissues were whole-exome sequenced. After mapping the somatic alteration landscape, evolutionary lineages were constructed by sub-clone analysis. Though each tumor harbored at least some unique private mutations, all five ATCs demonstrated numerous overlapping mutations with matched WDTCs. Clonal analysis further demonstrated that each ATC/WDTC pair shared a common ancestor, with some pairs diverging early in their evolution and others in which the ATC seems to arise directly from a sub-clone of the WDTC. Though the precise lineal relationship remains ambiguous, based on the genetic relationship, our study clearly suggests a shared origin of ATC and WDTC.
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Affiliation(s)
- Weilai Dong
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Norman G Nicolson
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Jungmin Choi
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Andrea L Barbieri
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - John W Kunstman
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sara Abou Azar
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - James Knight
- Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Connecticut
| | - Kaya Bilguvar
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Connecticut
| | - Shrikant M Mane
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut.,Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Connecticut
| | - Richard P Lifton
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - Reju Korah
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Tobias Carling
- Yale Endocrine Neoplasia Laboratory, Yale School of Medicine, New Haven, Connecticut.,Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Canfarotta M, Moote D, Finck C, Riba-Wolman R, Thaker S, Lerer TJ, Payne RJ, Cote V. McGill Thyroid Nodule Score in Differentiating Benign and Malignant Pediatric Thyroid Nodules: A Pilot Study. Otolaryngol Head Neck Surg 2017; 157:589-595. [PMID: 28653562 DOI: 10.1177/0194599817715629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective The McGill Thyroid Nodule Score (MTNS) is a preoperative tool used to predict the risk for well-differentiated thyroid cancer given a specific nodule in adults. We evaluated the clinical utility of a modified pediatric MTNS with children and adolescents. Study Design Case series with chart review. Setting Tertiary care children's hospital. Subjects and Methods This is a retrospective chart review of 46 patients ≤18 years of age presenting with a solitary or dominant thyroid nodule treated with surgical resection between September 2008 and December 2015. The cumulative MTNS for each nodule was calculated and compared with the final pathology. Results Of 46 patients, 10 (21.7%) were diagnosed with well-differentiated thyroid cancer (80% papillary thyroid carcinoma, 10% follicular variant of papillary thyroid carcinoma, 10% follicular thyroid carcinoma). Malignant nodules were associated with a greater mean MTNS (benign, 5.72 ± 3.03; malignant, 16 ± 3.13; P < .05). The sensitivity, specificity, and positive predictive value of malignancy were 100%, 94.4%, and 83.3% for scores ≥10 and 80%, 100%, and 100% for scores ≥11, respectively. In nodules with indeterminate cytology (Bethesda III and IV), the pediatric MTNS showed good differentiation between benign and malignant disease, with mean scores of 7.95 and 12.5, respectively ( P = .006). Conclusion This pilot study suggests that a comprehensive scoring system may help assess the risk of malignancy in pediatric thyroid nodules and differentiate nodules with indeterminate cytology into higher- and lower-risk categories. Given these findings, larger, multi-institutional studies are warranted.
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Affiliation(s)
- Michael Canfarotta
- 1 School of Medicine University of Connecticut, Farmington, Connecticut, USA
| | - Douglas Moote
- 2 Division of Pediatric Radiology, Connecticut Children's Medical Center, Connecticut, USA
| | - Christine Finck
- 3 Division of Pediatric Surgery, Connecticut Children's Medical Center, Connecticut, USA
| | - Rebecca Riba-Wolman
- 4 Department of Pediatrics and Endocrinology, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Shefali Thaker
- 5 Department of Research, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Trudy J Lerer
- 5 Department of Research, Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Richard J Payne
- 6 Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, Montréal, Canada
| | - Valerie Cote
- 7 Division of Pediatric Otolaryngology-Head and Neck Surgery, Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Yin DT, Lei M, Xu J, Li H, Wang Y, Liu Z, Ma R, Yu K, Li X. The Chinese herb Prunella vulgaris promotes apoptosis in human well-differentiated thyroid carcinoma cells via the B-cell lymphoma-2/Bcl-2-associated X protein/caspase-3 signaling pathway. Oncol Lett 2017; 14:1309-1314. [PMID: 28808482 PMCID: PMC5542033 DOI: 10.3892/ol.2017.6317] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 02/07/2017] [Indexed: 01/20/2023] Open
Abstract
Prunella vulgaris (PV), a traditional Chinese herb, has been shown to be rich in bioactive chemicals and possess anti-proliferative and pro-apoptotic effects on tumor cells. The effect of PV on human well-differentiated thyroid carcinoma (WDTC), which accounts for the majority of common endocrine malignancies, remains to be elucidated. The present study aimed to investigate the function of PV on WDTC cell lines and apoptosis-associated signaling pathway activity. Additional studies demonstrated that PV may induce apoptosis in WDTC TPC-1 and FTC-133 cell lines, using the Cell Counting Kit-8 assay. Morphological changes of apoptotic cells were observed by Hoechst 33342 and acridine orange/ethidium bromide staining. In addition, ladder pattern of fragmented DNA was observed by DNA gel electrophoresis. It was also observed that PV significantly increased Bcl-2-associated X protein and caspase-3 expression, and downregulated B-cell lymphoma-2 expression in TPC-1 and FTC-133 by reverse transcription-quantitative polymerase chain reaction (P<0.05). Thus, the present results indicated that PV has the potential to be a future WDTC therapeutic agent.
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Affiliation(s)
- De-Tao Yin
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Mengyuan Lei
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Jianhui Xu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Hongqiang Li
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Yongfei Wang
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Zhen Liu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Runsheng Ma
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Kun Yu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
| | - Xianghua Li
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China.,Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, Henan 450050, P.R. China
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Do BA, Payne RJ, Bastianelli M, Mlynarek AM, Tamilia M, Hier M, Forest VI. Is age associated with risk of malignancy in thyroid cancer? Otolaryngol Head Neck Surg 2014; 151:746-50. [PMID: 25151485 DOI: 10.1177/0194599814547503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Many predictive models for risk of malignancy in well-differentiated thyroid cancer (WDTC) have been proposed, and many scoring systems for thyroid cancer prognosis have been established. Age is taken in consideration in all. Our main goal is to establish whether patients' age has a correlation with the rate of malignancy, size, and aggressiveness of the tumor. STUDY DESIGN Case series with chart review. SETTING McGill University Thyroid Teaching Hospitals. SUBJECTS AND METHODS A retrospective analysis of 1022 patients undergoing consecutive thyroidectomy was performed. The patients were divided based on age (<45 and ≥ 45 years). Data were gathered for the size of thyroid nodules, the presence of lymph node (LN) metastasis, and the final thyroid pathology, including the presence of extrathyroidal extension. RESULTS There were 396 patients younger than 45 years and 626 patients 45 years or older. The rates of malignancy were 67.2% in the first group and 68.7% in the second group (P = .111). When patients were stratified according to different age cutoffs, WDTC and LN metastasis occurred more often in patients younger than 50 years (50.2% vs 43.2%, P = .031 and 18.9% vs 14.1%, P = .0496, respectively). Micropapillary carcinoma occurred more often in patients 50 years or older (23.6% vs 16.1%, P = .0035). CONCLUSIONS Tumor behavior and rates of WDTC were similar in patients aged <45 and ≥ 45 years. Well-differentiated thyroid cancer occurred more often in patients younger than 50 years, whereas the rate of micropapillary carcinoma occurred more often in patients 50 years or older.
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Affiliation(s)
- Bao Anh Do
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard J Payne
- Department of Otolaryngology, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mark Bastianelli
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Alex M Mlynarek
- Department of Otolaryngology, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Tamilia
- Division of Endocrinology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Department of Otolaryngology, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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