Christophe Trésallet1, Marie Seman2, Frédérique Tissier3, Camille Buffet4, Renato Micelli Lupinacci2, Hélène Vuarnesson2, Laurence Leenhardt4, Fabrice Menegaux2. 1. Department of General, Digestive and Endocrine Surgery, Pierre-et-Marie Curie University (Paris VI), Assistance Publique des Hôpitaux de Paris (APHP), Paris, France. Electronic address: christophe.tresallet@psl.aphp.fr. 2. Department of General, Digestive and Endocrine Surgery, Pierre-et-Marie Curie University (Paris VI), Assistance Publique des Hôpitaux de Paris (APHP), Paris, France. 3. Department of Pathology, Pierre-et-Marie Curie University (Paris VI), Assistance Publique des Hôpitaux de Paris (APHP), Paris, France. 4. Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Pierre-et-Marie Curie University (Paris VI), Assistance Publique des Hôpitaux de Paris (APHP), Paris, France.
Abstract
BACKGROUND: The connection between high body mass index (BMI), risk of papillary thyroid carcinoma (PTC), and the aggressiveness of PTC is still debated. We aimed to establish the relationship between excess BMI and the risk of PTC in an operative population, and the impact of obesity on histopathologic aggressiveness of PTC and on the outcome of patients. METHODS: All consecutive patients who underwent thyroid operation from June 2002 to December 2009 were reviewed in this retrospective study. BMI groupings were based on standardized categories: normal-weight, overweight, and obesity. We performed a total thyroidectomy with lymph node dissection in patients with preoperative or operative diagnosis of PTC. Radioiodine ablation was performed in every N1 patient, in case of tumor size greater than 10 mm, and if there was extrathyroidal invasion. During a median follow-up of 6.2 years, patients who were retreated by operation or (131)I were considered to have a persistent (<18 months of the initial operative treatment) or recurrent (≥ 18 months) disease. RESULTS: Of 6,684 patients who had a thyroid gland resection, we identified 1,216 (18.2%) patients with PTC. Patients who were overweight or obese were not at greater risk of PTC than normal-weight subjects. Indications for operation or radioiodine therapy were similar in the three BMI groups. During follow-up, 86 patients (7.1%) experienced persistent (4.5%) or recurrent (2.5%) disease. When excluding micro-PTCs (≤ 10 mm), we found an association between recurrent or residual locoregional thyroid cancer and BMI: 18.7% in obese patients versus 8.5% if BMI <25 kg/m(2) and 9.8% if 25 ≥ BMI < 30 kg/m(2) (P = .03). This difference was clearly marked for persistence. When adjusted for other cofounder factors, we observed that BMI was an independent factor associated with the risk of postoperative locoregional event (odds ratio 3.8, 95% confidence interval 1.6-8.8), with sex, age, lymph node metastasis, and tumor bilaterality. CONCLUSION: In macro-PTC, obese patients had an increased risk of developing a locoregional event during the follow-up, specifically a persistence of the disease. According to these results, overweight and obese patients with macro-PTC should be monitored more carefully for early detection of cancer persistence.
BACKGROUND: The connection between high body mass index (BMI), risk of papillary thyroid carcinoma (PTC), and the aggressiveness of PTC is still debated. We aimed to establish the relationship between excess BMI and the risk of PTC in an operative population, and the impact of obesity on histopathologic aggressiveness of PTC and on the outcome of patients. METHODS: All consecutive patients who underwent thyroid operation from June 2002 to December 2009 were reviewed in this retrospective study. BMI groupings were based on standardized categories: normal-weight, overweight, and obesity. We performed a total thyroidectomy with lymph node dissection in patients with preoperative or operative diagnosis of PTC. Radioiodine ablation was performed in every N1 patient, in case of tumor size greater than 10 mm, and if there was extrathyroidal invasion. During a median follow-up of 6.2 years, patients who were retreated by operation or (131)I were considered to have a persistent (<18 months of the initial operative treatment) or recurrent (≥ 18 months) disease. RESULTS: Of 6,684 patients who had a thyroid gland resection, we identified 1,216 (18.2%) patients with PTC. Patients who were overweight or obese were not at greater risk of PTC than normal-weight subjects. Indications for operation or radioiodine therapy were similar in the three BMI groups. During follow-up, 86 patients (7.1%) experienced persistent (4.5%) or recurrent (2.5%) disease. When excluding micro-PTCs (≤ 10 mm), we found an association between recurrent or residual locoregional thyroid cancer and BMI: 18.7% in obesepatients versus 8.5% if BMI <25 kg/m(2) and 9.8% if 25 ≥ BMI < 30 kg/m(2) (P = .03). This difference was clearly marked for persistence. When adjusted for other cofounder factors, we observed that BMI was an independent factor associated with the risk of postoperative locoregional event (odds ratio 3.8, 95% confidence interval 1.6-8.8), with sex, age, lymph node metastasis, and tumor bilaterality. CONCLUSION: In macro-PTC, obesepatients had an increased risk of developing a locoregional event during the follow-up, specifically a persistence of the disease. According to these results, overweight and obesepatients with macro-PTC should be monitored more carefully for early detection of cancer persistence.
Authors: Cari M Kitahara; Marjorie L McCullough; Silvia Franceschi; Sabina Rinaldi; Alicja Wolk; Gila Neta; Hans Olov Adami; Kristin Anderson; Gabriella Andreotti; Laura E Beane Freeman; Leslie Bernstein; Julie E Buring; Francoise Clavel-Chapelon; Lisa A De Roo; Yu-Tang Gao; J Michael Gaziano; Graham G Giles; Niclas Håkansson; Pamela L Horn-Ross; Vicki A Kirsh; Martha S Linet; Robert J MacInnis; Nicola Orsini; Yikyung Park; Alpa V Patel; Mark P Purdue; Elio Riboli; Kimberly Robien; Thomas Rohan; Dale P Sandler; Catherine Schairer; Arthur B Schneider; Howard D Sesso; Xiao-Ou Shu; Pramil N Singh; Piet A van den Brandt; Elizabeth Ward; Elisabete Weiderpass; Emily White; Yong-Bing Xiang; Anne Zeleniuch-Jacquotte; Wei Zheng; Patricia Hartge; Amy Berrington de González Journal: Thyroid Date: 2016-02 Impact factor: 6.568
Authors: Jonathan Mark Fussey; Robin N Beaumont; Andrew R Wood; Bijay Vaidya; Joel Smith; Jessica Tyrrell Journal: J Clin Endocrinol Metab Date: 2020-07-01 Impact factor: 5.958