Association Between Development of Hypothyroidism and Improved Survival in Patients With Head and Neck Cancer

Abstract

To determine if the development of hypothyroidism has an effect on the outcome of advancedstage head and neck squamous cell carcinoma. Design: Retrospective database analysis. Setting: Tertiary care center. Patients: The study population comprised 155 patients with advanced-stage head and neck squamous cell carcinoma. Interventions: Patients underwent radiation therapy alone or in combination with chemotherapy and surgery when indicated. Main Outcome Measures: Kaplan-Meier analysis was used to assess survival, not adjusting for timing of the detection of hypothyroidism. The following 2 analyses were then performed to adjust for the timing of detection: (1) hypothyroidism was assessed as a time-varying covariate in a Cox proportional hazards model and (2) a landmark analysis was conducted at 9, 12, 15, 18, 21, and 24 months using the Kaplan-Meier method. Results: Of the 155 patients, 59 developed hypothyroidism, defined as a thyrotropin level greater than 5.5 mIU/L (institutional value). An unadjusted Kaplan-Meier analysis indicated that patients who develop hypothyroidism have significantly better survival than patients who do not (PϽ.001, log-rank test). After adjusting for the timing of hypothyroidism, a Cox proportional hazards analysis indicated that survival was better, but not statistically significant, for patients who developed hypothyroidism (hazard ratio, 0.62; P =.12); results from a landmark analysis supported this finding (P values ranged from .11 to .19). Conclusions: Development of hypothyroidism may be associated with improved survival and increased recurrence-free survival. Larger, prospective studies appear warranted to test the beneficial effect of hypothyroidism.

Thyroid dysfunction and tyrosine kinase inhibitors in renal cell carcinoma

“…It has been suggested that the thyroid hormone, through stimulation of other growth factors, may represent a growth-stimulating signal in several tumor types (Trentin et al 2001). Thyroid hormones may be permissive for tumor growth and may reduce survival in recurrent brain tumors (Hercbergs et al 2003) and in head and neck cancer (Nelson et al 2006). Moreover, a relationship between hypothyroidism and reduced incidence and less aggressiveness of breast cancer was demonstrated (Cristofanilli et al 2005).…”

Thyroid Function and Cancer Risk: A Prospective Population Study

“…It has therefore been suggested that thyroid function might influence cancer development (1). According to this hypothesis, thyroid hormones could stimulate tumor growth (2,3) and thus be associated with increased risk, whereas hypothyroid function could lead to a reduced risk and a more favorable prognosis in patients with cancer (1,3).…”

“…In relation to the prognosis of patients with cancer, patients with head and neck cancer who develop hypothyroidism may experience longer survival (3). In patients with breast cancer, it has been suggested that the presence of thyroid peroxidase antibodies, indicating autoimmune thyroid disease, may be associated with improved survival (9).…”

Thyroid status as prognostic marker in oncology

“…подобном клиническом наблюдении 15 он-кологических больных, получающих иммунотера-пию ИЛ-2 и LAK (lymphokine-activated killer cells), у 5 из 7 пациентов с индуцированным гипотирео-зом была достигнута полная (n = 1) или частичная (n = 4) ремиссия [36]. Ретроспективный анализ, выполненный Nelson et al (2006) на 155 больных первичным плоскоклеточным раком головы и шеи, диагностированным в период с 1989 по 1997 гг (Кливленд, Огайо, США), продемонстрировал, что тиреоидный статус коррелирует с исходами ле-чения. Так, у 75 пациентов с индуцированным в ре-зультате воздействия цитостатиков или имеющимся до начала терапии лабораторно подтвержденным гипотиреозом зарегистрирована более длительная продолжительность безрецидивного периода и до-стигнута более высокая выживаемость, а также бо-лее низкий риск развития рецидива (ОР 0,49; 95 % ДИ 0,28-0,88, p = 0,02) и смерти от злокачественно-го новообразования (ОР 0,30; 95 % ДИ 0,17-0,52, p < 0,001) [22].…”