Is there a relationship between patient age, tumor multifocality, and capsular invasion in papillary thyroid carcinoma? Retrospective evaluation of pathology specimens

Öz

Background/Aim: Papillary thyroid carcinoma (PTC) is the most prevalent of thyroid gland cancers. Although PTC generally is successfully treated, risk factors such as age, tumor size, thyroid capsule invasion, multifocality, and presence of metastases can negatively affect the prognosis. We aimed to assess the relationship between multifocality, capsular invasion, and patient age (≤45 vs >45 years of age) in PTC, along with other relevant tumor characteristics. Methods: In this retrospective cohort study, evaluation of pathology findings in patients with a PTC diagnosis or thyroid nodules suspicious for PTC, the frequency of multiple specimen related prognostic factors by age was compared. Only patients initially operated with papillary thyroid cancer suspicion or definite diagnosis without distant organ metastasis were included. All the other patients with recurrent disease were excluded. Results: Between 2008 and 2014, 466 patients with PTC tumors were operated. Tumors were multifocal in 62 (13.3%) patients and unifocal in 404 (86.7%). When multifocality was compared in two patient groups (≤45 years vs. >45), it was slightly higher in patients >45 years old (14.4%) vs ≤45 (11.5%; p=0.374). The multifocality rate in patients with a tumor size of >1 to ≤2 cm was significantly higher (17.5%) than in all other tumor size groupings (0.0-13.7%; p=0.002). Thyroid capsule invasion occurred in 39.1% of patients in the younger group vs 33.6% in the older group (p=0.05). Conclusion: In light of our study’s findings, including confirmation by multivariate analysis, age, as represented by the >45 year cutoff value, should not be considered an independent prognostic risk factor in planning treatment of PTC. The individual patient, tumor characteristics, and local and distant metastases status should remain the most important criteria for treatment selection and follow-up care in all patient age groups.

Anahtar Kelimeler

• Papillary thyroid carcinoma
• PTC
• Multifocality
• Age
• Capsule invasion
• Metastasis

Kaynakça

1. 1. Saravana-Bawan B, Bajwa A, Paterson J, McMullen T. Active surveillance of low-risk papillary thyroid cancer: A meta-analysis. Surgery. 2020 Jan;167(1):46-55.
2. 2. Hodgson NC, Button J, Solorzano CC. Thyroid cancer: Is the incidence still increasing? Ann Surg Oncol. 2004;11(12):1093-7.
3. 3. Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on fundamental mechanisms of thyroid cancer. Front Endocrinol. 2020;11:102.
4. 4. Sipos J, Mazzaferri EL. Thyroid cancer epidemiology and prognostic variables. Clin Oncol (R Coll Radiol). 2010 Aug;22(6):395-404.
5. 5. Gur EO, Karaisli S, Haciyanli S, Kamer E, Genc H, Atahan K, et al. Multifocality related factors in papillary thyroid carcinoma. Asian J Surg. 2019;42(1):297-302.
6. 6. Lyu YJ, Shen F, Yan Y, Situ MZ, Wu WZ, Jiang GQ, et al. Ultrasound-guided fine-needle aspiration biopsy of thyroid nodules <10 mm in the maximum diameter: does size matter? Cancer Manag Res. 2019 Feb 7;11:1231-6.
7. 7. Yuan L, Jebastin Thangaiah J, Chute DJ. The role of ultrasound-guided fine-needle aspiration of thyroid bed lesions and clinical predictors of recurrent papillary thyroid carcinoma. Am J Clin Pathol. 2021 Feb 11;155(3):389-96.
8. 8. Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer. 2005 Jun 1;103(11):2269-73.

9. 9. Zheng W, Wang X, Rui Z, Wang Y, Meng Z, Wang R. Clinical features and therapeutic outcomes of patients with papillary thyroid microcarcinomas and larger tumors. Nucl Med Commun. 2019 May;40(5):477-83.
10. 10. Wang X, Tan J, Zheng W, Li N. A retrospective study of the clinical features in papillary thyroid microcarcinoma depending on age. Nucl Med Commun. 2018 Aug;39(8):713-9.
11. 11. Zambeli-Ljepović A, Wang F, Dinan MA, Hyslop T, Roman SA, Sosa JA et al. Low-risk thyroid cancer in elderly: total thyroidectomy/RAI predominates but lacks survival advantage. J Surg Res. 2019 Nov;243:189-97.
12. 12. Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, et al. (Eds.). AJCC Cancer Staging Manual (8th edition). Springer International Publishing: American Joint Commission on Cancer; 2018.
13. 13. Mazurat A, Torroni A, Hendrickson-Rebizant J, Benning H, Nason RW, Pathak KA. The age factor in survival of a population cohort of well-differentiated thyroid cancer. Endocr Connect. 2013 Sep 23;2(3):154-60.
14. 14. Kauffmann RM, Hamner JB, Ituarte, PHG, Yim JH. Greater than 60 years portends a worse prognosis in patients with papillary thyroid cancer: should there be three age categories for staging? BMC Cancer. 2018;18:316.
15. 15. Li G, Lei J, You J, Jiang K, Li Z, Gong R, et al. Independent predictors and lymph node metastasis characteristics of multifocal papillary thyroid cancer, Medicine. 2018 Feb;97(5):e9619.
16. 16. Gardner RE, Tuttle RM, Burman KD, Haddady S, Truman C, Sparling YH, et al. Prognostic importance of vascular invasion in papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 2000;126(3):309-12.
17. 17. Coburn MC, Wanebo HJ. Age correlates with increased frequency of high-risk factors in elderly patients with thyroid cancer. Am J Surg. 1995 Nov;170(5):471-5.
18. 18. Pisanu A, Reccia I, Nardello O, Uccheddu A. Risk factors for nodal metastasis and recurrence among patients with papillary thyroid microcarcinoma: differences in clinical relevance between nonincidental and incidental tumors. World J Surg. 2009 Mar;33(3):460-8.
19. 19. Ito Y, Miyauchi A, Oda H. Low-risk papillary microcarcinoma of the thyroid: A review of active surveillance trials. Eur J Surg Oncol. 2018 Mar;44(3):307-15.
20. 20. Pellegriti G1, Scollo C, Lumera G, Regalbuto C, Vigneri R, Belfiore A. Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: Study of 299 cases. J Clin Endocrinol Metab. 2004 Aug;89(8):3713-20.
21. 21. Cheema Y, Repplinger D, Elson D, Chen H. Is tumor size the best predictor of outcome for papillary thyroid cancer? Ann Surg Oncol. 2006 Nov;13(11):1524-8.
22. 22. Pelizzo MR, Boschin IM, Toniato A, Pagetta C, Piotto A, Bernante P, et al. Natural history, diagnosis, treatment and outcome of papillary thyroid microcarcinoma (PTMC): a mono-institutional 12-year experience. Nucl Med Commun. 2004;25:547­52.
23. 23. Gülben K, Berberoğlu U, Çelen O, Mersin HH. Incidental papillary microcarcinoma of the thyroid—factors affecting lymph node metastasis. Langenbecks Arch Surg. 2008;393:25-9.
24. 24. Antonaci A, Anello A, Aucello A, Consorti F, Della Rocca C, Giovannone G, et al. Microcarcinoma and incidental carcinoma of the thyroid in a clinical series: clinical behaviour and surgical management. Clin Ter. 2006;157:225­9.
25. 25. Mercante G, Frasoldati A, Pedroni C, Formisano D, Renna L, Piana S, et al.Prognostic factors affecting neck lymph node Recurrence and distant metastasis in papillary microcarcinoma of the thyroid: Results of a study in 445 patients. Thyroid. 2009;19(7):707-16.
26. 26. Lin JD, Chao TC, Hsueh C, Kuo SF. High recurrent rate of multicentric papillary thyroid carcinoma. Ann Surg Oncol. 2009 Sep;16(9):2609-16.
27. 27. Schlumberger MJ, Papillary and follicular thyroid carcinoma. N Eng J Med. 1998;338:297-306.
28. 28. Singh B, Shaha AR, Trivedi H, Carew JF, Poluri A, Shah JP. Coexistent Hashimoto's thyroiditis with papillary thyroid carcinoma: Impact on presentation, management, and outcome. Surgery. 1999 Dec;126(6):1070-6.
29. 29. Dvorkin S, Robenshtok E, Hirsch D, Strenov Y, Shimon I, Benbassat CA. Differentiated thyroid cancer is associated with less aggressive disease and better outcome in patients with coexisting Hashimotos thyroiditis. J Clin Endocrinol Metab. 2013 Jun;98(6):2409-14.