Evert F S van Velsen1, Robin P Peeters1, Merel T Stegenga1, Folkert J van Kemenade2, Tessa M van Ginhoven3, Frederik A Verburg4, W Edward Visser1. 1. Academic Center for Thyroid Diseases, Department of Internal Medicine, Rotterdam, The Netherlands. 2. Academic Center for Thyroid Diseases, Department of Pathology, Rotterdam, The Netherlands. 3. Academic Center for Thyroid Diseases, Department of Surgery, Rotterdam, The Netherlands. 4. Academic Center for Thyroid Diseases, Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Abstract
OBJECTIVE: Recent research suggests that the addition of age improves the 2015 American Thyroid Association (ATA) Risk Stratification System for differentiated thyroid cancer (DTC). The aim of our study was to investigate the influence of age on disease outcome in ATA-high risk patients with a focus on differences between patients with papillary (PTC) and follicular thyroid cancer (FTC). METHODS: We retrospectively studied adult patients with high-risk DTC from a Dutch University hospital. Logistic regression and Cox proportional hazards models were used to estimate the effects of age (at diagnosis) and several age cutoffs (per 5 years increment between 20 and 80 years) on (i) response to therapy, (ii) developing no evidence of disease (NED), (iii) recurrence, and (iv) disease-specific mortality (DSM). RESULTS: We included 236 ATA high-risk patients (32% FTC) with a median follow-up of 6 years. Age, either continuously or dichotomously, had a significant influence on having an excellent response after initial therapy, developing NED, recurrence, and DSM for PTC and FTC. For FTC, an age cutoff of 65 or 70 years showed the best statistical model performance, while this was 50 or 60 years for PTC. CONCLUSIONS: In a population of patients with high-risk DTC, older age has a significant negative influence on disease outcomes. Slightly different optimal age cutoffs were identified for the different outcomes, and these cutoffs differed between PTC and FTC. Therefore, the ATA Risk Stratification System may further improve should age be incorporated as an additional risk factor.
OBJECTIVE: Recent research suggests that the addition of age improves the 2015 American Thyroid Association (ATA) Risk Stratification System for differentiated thyroid cancer (DTC). The aim of our study was to investigate the influence of age on disease outcome in ATA-high risk patients with a focus on differences between patients with papillary (PTC) and follicular thyroid cancer (FTC). METHODS: We retrospectively studied adult patients with high-risk DTC from a Dutch University hospital. Logistic regression and Cox proportional hazards models were used to estimate the effects of age (at diagnosis) and several age cutoffs (per 5 years increment between 20 and 80 years) on (i) response to therapy, (ii) developing no evidence of disease (NED), (iii) recurrence, and (iv) disease-specific mortality (DSM). RESULTS: We included 236 ATA high-risk patients (32% FTC) with a median follow-up of 6 years. Age, either continuously or dichotomously, had a significant influence on having an excellent response after initial therapy, developing NED, recurrence, and DSM for PTC and FTC. For FTC, an age cutoff of 65 or 70 years showed the best statistical model performance, while this was 50 or 60 years for PTC. CONCLUSIONS: In a population of patients with high-risk DTC, older age has a significant negative influence on disease outcomes. Slightly different optimal age cutoffs were identified for the different outcomes, and these cutoffs differed between PTC and FTC. Therefore, the ATA Risk Stratification System may further improve should age be incorporated as an additional risk factor.
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Authors: Cristina Montero-Conde; Luis Javier Leandro-García; Ángel M Martínez-Montes; Paula Martínez; Francisco J Moya; Rocío Letón; Eduardo Gil; Natalia Martínez-Puente; Sonsoles Guadalix; Maria Currás-Freixes; Laura García-Tobar; Carles Zafon; Mireia Jordà; Garcilaso Riesco-Eizaguirre; Patricia González-García; María Monteagudo; Rafael Torres-Pérez; Veronika Mancikova; Sergio Ruiz-Llorente; Manuel Pérez-Martínez; Guillermo Pita; Juan Carlos Galofré; Anna Gonzalez-Neira; Alberto Cascón; Cristina Rodríguez-Antona; Diego Megías; María A Blasco; Eduardo Caleiras; Sandra Rodríguez-Perales; Mercedes Robledo Journal: Clin Transl Med Date: 2022-08