The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer

Abstract

IntroductionObesity is a serious health problem worldwide, particularly in developed countries. It is a risk factor for many diseases, including thyroid cancer. The relationship between obesity and prognostic factors of thyroid cancer is unclear.AimsWe sought to ascertain the relationship between body mass index (BMI) and clinicopathological features increasing the risk of poor clinical course, treatment response, and clinical outcome in patients with differentiated thyroid cancer (DTC).Subjects & methodsThe study included 1181 patients with DTC (88% women and 12% men) treated at a single center from 2000 to 2016. BMI before surgery and aggressive clinicopathological features, according to the American Thyroid Initial Risk stratification system, were analyzed. The relationship between BMI and initial risk, treatment response, and final status of the disease was evaluated, incorporating the revised 2015 American Thyroid Association guidelines and the 8th edition of the American Joint Committee on Cancer/Tumor-Node-Metastasis (AJCC/TNM) staging system. Patients were stratified according to the World Health Organization classification of BMI. Statistical analysis was performed using univariate and multivariate logistic regression analysis.ResultsMedian follow-up was 7.7 years (1–16 years). There were no significant associations between BMI and extrathyroidal extension (microscopic and gross), cervical lymph node metastasis, or distant metastasis in univariate and multivariate analyses. BMI did not affect initial risk, treatment response or disease outcome. Obesity was more prevalent in men (p = 0.035) and in patients ≥55 years old (p = 0.001). There was no statistically significant relationship between BMI and more advanced TNM stage in patients ≤55 years old (stage I vs. stage II) (p = 0.266) or in patients >55 years old (stage I–II vs. III–IV) (p = 0.877).ConclusionsObesity is not associated with more aggressive clinicopathological features of thyroid cancer. Obesity is not a risk factor for progression to more advanced stages of disease, nor is it a prognostic factor for poorer treatment response and clinical outcome.

Coexisting Germline CHEK2 and Somatic BRAFV600E Mutations in Papillary Thyroid Cancer and Their Association with Clinicopathological Features and Disease Course

“…The scope of treatment included lobectomy, total thyroidectomy, or complete thyroidectomy with central compartment lymphadenectomy. The surgical treatment procedures conducted in our center have been described previously [30]. All patients with disease stage more advanced than pT1aN0-xM0 were eligible for radioactive iodine (I-131) treatment.…”

Association between subjective symptoms and obesity and postoperative recurrence in differentiated thyroid cancer: a matched-pair analysis

“…In some studies, obesity was associated with advanced TNM stage or aggressive tumour features such as lymph node metastasis 15,31,32 . On the contrary, other studies suggested that obesity was not associated with aggressive tumour features or clinical outcomes 14,33 . The association between obesity and persistent or recurrent disease was not detected in most studies, probably because classical clinicopathological factors play a more important role, which leads to a type II error in smaller series.…”

Liver X Receptor β Related to Tumor Progression and Ribosome Gene Expression in Papillary Thyroid Cancer

“…As a result, lipid-regulating mechanisms, such as de novo lipogenesis, are important in NASH and cancer development. Thyroid cancer has also been suggested as an obesity-related cancer according to recent epidemiologic, experimental, and clinical studies [15,17,19,[23][24][25]. The mechanism by which obesity can increase the risk of thyroid cancer has remained unelucidated, although excessive intake of iodide has been suggested as one of the causes.…”

“…In addition, a high fat diet generated a more aggressive phenotype of thyroid cancer in Thrb(PV/PV)Pten(+/-) mice [22,23]. In human thyroid cancer, the body mass index has been suggested as a factor related to aggressive tumor behavior [24,25]. Moreover, an oncocytic variant of PTC was reported to be associated with obesity [26].…”