Differentiated thyroid carcinoma in Denizli region: Demographic data and clinical features from a tertiary center

Abstract

Purpose: Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy, with its incidence rising worldwide. This study aimed to evaluate the demographic and clinical characteristics of patients with DTC treated at Pamukkale University and to compare them with national and international data. In addition, the study was designed as an educational initiative, offering medical students practical experience in research methodology.
Materials and methods: A total of 299 patients (246 females, 53 males) who underwent thyroidectomy and were referred for radioiodine ablation between January 2014 and December 2021 were retrospectively analyzed. Age, sex, histological subtype, tumor size, focality, lymph node involvement, distant metastasis, and administered radioiodine activity (RAI) were collected. Statistical analyses were performed using SPSS version 25.0.
Results: The mean age at diagnosis was 47.3±14.2 years (46.9 for females, 48.9 for males), with a female-to-male ratio of 4.8:1. The classical variant of papillary thyroid carcinoma was the most frequent subtype (74.4%), followed by the follicular variant (12%) and oncocytic thyroid carcinoma (OTC) (7.4%). Regional lymph node metastases were observed in 16.4% and distant metastases in 3.0% of patients. Follicular thyroid carcinoma (FTC) was associated with a higher rate of distant metastasis compared with papillary thyroid carcinoma (PTC) (10.5% vs. 3%). Regarding treatment, 72% of patients received ≤100 mCi radioiodine, while 20% received >100 mCi.
Conclusion: Female sex and papillary histopathology are predominant in DTC. Follicular thyroid carcinoma tends to exhibit a higher propensity for distant metastasis compared with papillary thyroid carcinoma. The dual purpose of this study highlights both its epidemiological contribution and its role in training medical students in applied research methodology.

Keywords

• Differentiated thyroid carcinoma
• papillary thyroid carcinoma
• epidemiology
• medical education

Supporting Institution

No funding.

Ethical Statement

The study protocol was approved by the Pamukkale University Clinical Research Ethics Committee (approval no. 06, dated March 16, 2021)

Denizli bölgesinde diferansiye tiroid karsinomu: üçüncü basamak bir merkezden demografik veriler ve klinik özellikler

Abstract

Amaç: Diferansiye tiroid karsinomu (DTK), insidansı dünya genelinde giderek artan en sık görülen endokrin malignitedir. Bu çalışmada Pamukkale Üniversitesi’nde tedavi edilen DTK’lı hastaların demografik ve klinik özelliklerinin değerlendirilmesi ve ulusal/uluslararası verilerle karşılaştırılması amaçlanmıştır. Ayrıca çalışma, tıp öğrencilerine araştırma metodolojisi konusunda uygulamalı deneyim kazandırmayı hedefleyen bir eğitim girişimi olarak tasarlanmıştır.
Gereç ve yöntem: Ocak 2014-Aralık 2021 tarihleri arasında tiroidektomi uygulanmış ve radyoiyot ablasyonu için yönlendirilmiş toplam 299 hasta (246 kadın, 53 erkek) retrospektif olarak incelendi. Yaş, cinsiyet, histolojik alt tip, tümör boyutu, multifokalite, lenf nodu tutulumu, uzak metastaz ve uygulanan radyoiyot aktivitesi kaydedildi. İstatistiksel analizler SPSS 25.0 programı ile yapıldı.
Bulgular: Tanı yaşı ortalama 47,3±14,2 yıl olup (kadınlarda 46,9; erkeklerde 48,9) kadın/erkek oranı 4,8:1’di. Papiller tiroid karsinomu klasik varyantı en sık görülen alt tipti (%74,4), bunu folliküler varyant (%12) ve onkositik tiroid karsinomu (%7,4) izledi. Hastaların %16,4’ünde bölgesel lenf nodu metastazı, %3,0’ünde uzak metastaz saptandı. Folliküler tiroid karsinomu, papiller tiroid karsinomuna kıyasla daha yüksek oranda uzak metastaz ile ilişkiliydi (%10,5 vs %3). Tedavi açısından hastaların %72’sine ≤100 mCi, %20’sine >100 mCi radyoiyot uygulandı.

Sonuç: DTK’da kadın cinsiyet ve papiller histopatoloji baskındır. Folliküler tiroid karsinomu, papiller tiroid karsinomuna göre daha fazla uzak metastaz eğilimi göstermektedir. Çalışmanın çift yönlü amacı hem epidemiyolojik katkısını hem de tıp öğrencilerinin uygulamalı araştırma metodolojisi eğitimi açısından önemini vurgulamaktadır.

Keywords

• Diferansiye tiroid karsinomu
• papiller tiroid karsinomu
• epidemiyoloji
• tıp eğitimi

Supporting Institution

Fon desteği alınmadı.

Ethical Statement

Çalışma protokolü Pamukkale Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylandı (onay no: 06, 16 Mart 2021)

References

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834
2. Chen DW, Lang BHH, McLeod DSA, Newbold K, Haymart MR. Thyroid cancer. Lancet. 2023;401(10387):1531-1544. doi:10.1016/S0140-6736(23)00020-X
3. Pizzato M, Li M, Vignat J, et al. The epidemiological landscape of thyroid cancer worldwide: GLOBOCAN estimates for incidence and mortality rates in 2020. Lancet Diabetes Endocrinol. 2022;10(4):264-272. doi:10.1016/S2213-8587(22)00035-3
4. Du B, Wang F, Wu L, et al. Cause-specific mortality after diagnosis of thyroid cancer: a large population-based study. Endocrine. 2021;72(1):179-189. doi:10.1007/s12020-020-02445-8
5. Li W, Liang H, Wang W, et al. Global cancer statistics for adolescents and young adults: population based study. J Hematol Oncol. 2024;17(1):99. doi:10.1186/s13045-024-01623-9
6. T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Türkiye Kanser İstatistikleri 2018. Ankara: T.C. Sağlık Bakanlığı Yayınları; 2022.
7. Karaçavuş S, Bağlayan K, Şahin S, et al. Yozgat Bölgesinde Diferansiye Tiroid Kanseri Nedeniyle Takip Edilen Hastaların Klinik ve Demografik Özellikleri. Bozok Tıp Dergisi. 2014;4(2):26-30. doi:10.16919/btd.13528
8. Franssila KO, Ackerman LV, Brown CL, Hedinger CE. Follicular carcinoma. Semin Diagn Pathol. 1985;2(2):101-122.

9. Boucai L, Zafereo M, Cabanillas ME. Thyroid Cancer: A Review. JAMA. 2024;331(5):425-435. doi:10.1001/jama.2023.26348
10. Schlumberger M, Challeton C, De Vathaire F, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med. 1996;37(4):598-605.
11. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763
12. Kitahara CM, Sosa JA. The changing incidence of thyroid cancer. Nat Rev Endocrinol. 2016;12(11):646-653. doi:10.1038/nrendo.2016.110
13. Joseph KR, Edirimanne S, Eslick GD. Multifocality as a prognostic factor in thyroid cancer: A meta-analysis. Int J Surg. 2018;50:121-125. doi:10.1016/j.ijsu.2017.12.035
14. Manso J, Censi S, Roberti A, et al. Prognostic significance of the sum of the diameters of single foci in multifocal papillary thyroid cancer: the concept of new-old tumor burden. Ther Adv Endocrinol Metab. 2020;11:2042018820964326. doi:10.1177/2042018820964326
15. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
16. Kitahara CM, Pfeiffer RM, Sosa JA, Shiels MS. Impact of Overweight and Obesity on US Papillary Thyroid Cancer Incidence Trends (1995-2015). J Natl Cancer Inst. 2020;112(8):810-817. doi:10.1093/jnci/djz202
17. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L. Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis. N Engl J Med. 2016;375(7):614-617. doi:10.1056/NEJMp1604412
18. Harach HR, Franssila KO, Wasenius VM. Occult papillary carcinoma of the thyroid. A “normal” finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531-538. doi:10.1002/1097-0142(19850801)56:3<531::aid-cncr2820560321>3.0.co;2-3
19. Brito JP, Morris JC, Montori VM. Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours. BMJ. 2013;347:f4706. doi:10.1136/bmj.f4706
20. Pereira M, Correia G, Severo M, Veríssimo AC, Ribeiro L. Portuguese Medical Students’ Interest for Science and Research Declines after Freshman Year. Healthcare (Basel). 2021;9(10):1357. doi:10.3390/healthcare9101357
21. Ommering BWC, van Blankenstein FM, Waaijer CJF, Dekker FW. Future physician-scientists: could we catch them young? Factors influencing intrinsic and extrinsic motivation for research among first-year medical students. Perspect Med Educ. 2018;7(4):248-255. doi:10.1007/s40037-018-0440-y
22. Kharraz R, Hamadah R, AlFawaz D, et al. Perceived barriers towards participation in undergraduate research activities among medical students at Alfaisal University-College of Medicine: A Saudi Arabian perspective. Med Teach. 2016;38 Suppl 1:S12-S18. doi:10.3109/0142159X.2016.1142507
23. Chang Y, Ramnanan CJ. A review of literature on medical students and scholarly research: experiences, attitudes, and outcomes. Acad Med. 2015;90(8):1162-1173. doi:10.1097/ACM.0000000000000702