Clinical features of recently diagnosed papillary thyroid carcinoma in elderly patients aged 65 and older based on 10 years of sonographic experience at a single institution in Korea

Abstract

PurposeThe aim of this study was to assess the characteristics of papillary thyroid carcinoma (PTC) in patients aged 65 and older in order to predict postoperative recurrence based on the results of ultrasonographic surveillance.MethodsAmong 1,494 patients (200 male and 1,294 female; mean age, 46.6±11.3 years) who underwent surgery for thyroid cancer at our institution between 2006 and 2015, we retrospectively enrolled 150 PTC patients (29 male and 121 female; mean age, 69.4±4.2 years). To identify the risk factors for recurrence, we analyzed age, gender, multiplicity, size, number, extrathyroidal extension (ETE) of the tumor, lymph node metastasis (LNM), type of surgery, and the dose of radioactive ablation using a Cox regression model to identify hazard ratios (HRs).ResultsAmong the 115 asymptomatic patients with PTCs detected by screening ultrasonography (n=86), other cross-sectional imaging modalities (computed tomography or positron emission tomography-computed tomography, n=13), or incidentally through a surgical specimen (n=16), 78 patients were confirmed to have papillary thyroid microcarcinomas (PTMCs). The other 35 patients presented with palpable neck masses (n=25), vocal cord palsy (n=9) or blood-tinged sputum (n=1). During the follow-up period (mean, 43.6 months), 17 patients (12.5%) experienced recurrence in the neck. None of the patients died due to PTC-related recurrence or distant metastasis during the follow-up period. Cox regression analysis demonstrated that tumor size (HR, 2.12; P<0.001) and LNM (central LNM: HR, 9.08; P=0.004; lateral LNM: HR, 14.71; P=0.002; both central and lateral LNM: HR, 58.41; P<0.001) significantly increased the recurrence rate. ETE, LNM, and recurrence were significantly less frequent in PTMCs than in non-PTMC (all P<0.001).ConclusionPTCs of small size and absent LNM showed significantly better prognoses in patients 65 years and older.

The Age Threshold of the 8th Edition AJCC Classification Is Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice.&nbsp;

“…Ito et al (24), for example, revealed that there are signi cant age-speci c differences in cancer biology among indolent, clinically silent PTMC and advanced PTCin particular, the incidences of larger tumors, LNM and disease progression were estimated to be lower in older patients and higher in younger patients. Similar observations were presented by Kim et al (6), who showed that extrathyroidal extension and LNM were signi cantly less frequent in older patients with PTMC than in patients with larger PTC. They suggested, based on this nding, that older patients with clinically silent PTMC should be considered for active observation rather than surgical treatment (6).…”

“…The incidence of PTC has been shown to increase with age (2). Unlike other malignant tumors, patient age is regarded as an independent risk factor for PTC (5,6). PTC also presents a much poorer prognosis in elderly people, although the reason for this nding has not been clearly de ned (2,(7)(8)(9).…”

The Age Threshold of the 8th Edition AJCC ClassificationIs Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice.

“…Similar observations were presented by Kim et al (6), who showed that extrathyroidal extension and LNM were signi cantly less frequent in older patients with PTMC than in patients with larger PTC. They suggested, based on this nding, that older patients with clinically silent PTMC should be considered for active observation rather than surgical treatment (6). In our study, we identi ed some clinical and histopathological characteristics of PTC that, when absent, may permit clinicians to avoid aggressive therapy in older patients.…”

“…Kim et al (6) proposed that tumor size and LNM are independent predictors of recurrence in older patients with PTC. De Castro et al (29) added that tumor size, local extent (T stage) and nodal status (N stage) are also important prognostic factors in patients ≥45 years old.…”

Comprehensive evaluation of risk factors for lymph node metastasis with papillary thyroid carcinoma in Southwest China patients

“…As in PTC in general, lymph node metastasis has been reported to be a risk factor for increased tumor recurrence rates and also be closely in connection with reduced survival rate [19] . In addition, in 2018, Lutz.…”