Risk Factors for Recurrence in Filipinos with Well-Differentiated Thyroid Cancer

Abstract

BackgroundThe incidence of well-differentiated thyroid cancer (WDTC) has increased in recent years. Despite its excellent prognosis, increasing morbidity from recurrent diseases continues to affect long-term outcomes. Among at-risk populations, Filipinos have the highest incidence of thyroid cancer worldwide, characterized by a highly aggressive and recurrent form of disease. Here, we sought to identify risk factors associated with disease recurrence among Filipinos with WDTC.MethodsThis retrospective cohort study examined 723 patients diagnosed with WDTC seen at Philippine General Hospital. Affected individuals were classified based on the presence or absence of disease recurrence. Multivariate logistic regression analyses were used to determine significant predictors of recurrence.ResultsMultiple risk factors, including age >45 years (odds ratio [OR], 1.44), multifocality of cancer (OR, 1.43), nodal involvement (OR, 4.0), and distant metastases at presentation (OR, 2.78), were significantly associated with a recurrence of papillary thyroid cancer (PTC). In contrast, follicular variant histology (OR, 0.60) and postsurgical radioactive iodine therapy (OR, 0.31) were protective for PTC recurrence. Distant metastases at presentation (OR, 19.4) and postsurgical radioactive iodine therapy (OR, 0.41) were associated with follicular thyroid cancer (FTC) recurrence.ConclusionLymph node metastases at presentation was the strongest predictor of recurrence in PTC, whereas distant metastases at presentation was the strongest for FTC recurrence. Among Filipinos, stratification of WDTC patients based on recurrence risk factors identified in this study will be helpful in guiding the intensity of treatment strategies and long-term thyroid cancer surveillance.

The correlations between DNA methylation and polymorphisms in the promoter region of the human telomerase reverse transcriptase (hTERT) gene with postoperative recurrence in patients with thyroid carcinoma (TC)

“…Recent studies have demonstrated that tumor size, nodal metastases, and histological type are often associated to postoperative recurrence of TC [30, 45, 46]. In addition to this, Gandolfi et al revealed that mutations in the hTERT promoter are closely associated to metastasis in papillary TC [47].…”

“…Our results also revealed that postoperative recurrence of TC was associated to pathologic types and tumor stages and that the DNA methylation levels and the rs2736100 polymorphisms of hTERT gene were associated to the tumor size, multicentricity, extrathyroidal invasion, pathologic types, lymph node metastases, and tumor stage of the recurrence group. Recent studies have demonstrated that tumor size, nodal metastases, and histological type are often associated to postoperative recurrence of TC [ 30 , 45 , 46 ]. In addition to this, Gandolfi et al revealed that mutations in the hTERT promoter are closely associated to metastasis in papillary TC [ 47 ].…”

Differentiated Thyroid Cancer in Asians

“…The authors analyzed the clinical features and recurrence rate compared to other Asian populations, including Koreans. These same authors previously reported risk factors for DTC recurrence in Filipinos at Philippine General Hospital [ 14 ].…”

Differential Expression of Non-Coding RNA Signatures in Thyroid Cancer between Two Ethnic Groups

“…In Filipino American women, a higher rate of recurrence was reported, especially in premenopausal women. The long-term survival rate was also lower in those females compared to any other ethnic group [ 7 , 8 , 12 , 13 , 14 , 15 , 16 ]. Recently, it has been found that the recurrence rate is also higher in Filipino Americans [ 7 , 10 , 12 , 15 , 16 ].…”

“…The long-term survival rate was also lower in those females compared to any other ethnic group [ 7 , 8 , 12 , 13 , 14 , 15 , 16 ]. Recently, it has been found that the recurrence rate is also higher in Filipino Americans [ 7 , 10 , 12 , 15 , 16 ]. Therefore, identifying biomarkers for the prognosis of PTC in Filipino Americans is one of the most important issues in TC health disparities for monitoring cancer progression.…”