Juan J Díez1,2, Emma Anda3, Victoria Alcazar4, María L Isidro5, Cristina Familiar6, Miguel Paja7,8, Patricia Rojas Marcos9, Begoña Pérez-Corral10, Elena Navarro11, Ana R Romero-Lluch11, Amelia Oleaga7,8, María J Pamplona12, José C Fernández-García13, Ana Megía14, Laura Manjón15, Cecilia Sánchez-Ragnarsson15, Pedro Iglesias16,17, Julia Sastre18. 1. Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain. juanjose.diez@salud.madrid.org. 2. Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. juanjose.diez@salud.madrid.org. 3. Department of Endocrinology, Hospital Universitario de Navarra, Pamplona, Spain. 4. Department of Endocrinology, Hospital Severo Ochoa, Leganés, Spain. 5. Department of Endocrinology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain. 6. Department of Endocrinology, Hospital Clínico San Carlos, Madrid, Spain. 7. Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain. 8. Department of Medicine, Universidad del País Vasco, Leioa, Spain. 9. Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain. 10. Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain. 11. Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 12. Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain. 13. Department of Endocrinology, Hospital Regional Universitario de Málaga (IBIMA), Universidad de Málaga, Málaga, Spain. 14. Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain. 15. Department of Endocrinology, Hospital Universitario Central de Asturias & Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain. 16. Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain. 17. Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. 18. Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain.
Abstract
PURPOSE: We investigated whether age at diagnosis of differentiated thyroid carcinoma (DTC) may be a risk factor for structural disease and mortality after primary treatment in aging patients. METHODS: A multicenter, retrospective analysis including patients older than 60 years at DCT diagnosis was designed. All subjects were treated by surgery with or without radioiodine adjuvant therapy and had a minimum follow-up of one year. We compared elderly patients (group 1, 60-74 years) with very old patients (group 2, ≥75 years). RESULTS: The study involved 1668 patients (74.3% women, median age 67 years, 87.6% papillary thyroid cancer, 73.3% treated with radioiodine), including 1397 in group 1 and 271 in group 2. Patients in group 2 had larger tumor size (1.8 [0.8-3.0] vs 1.5 [0.7-2.8] cm; P = 0.005), higher proportions of tumors with vascular invasion (23.8 vs 16.4%; P = 0.006), and lower proportion of lymphocytic thyroiditis (18.6 vs 24.9%; P = 0.013) than subjects in group 1. Kaplan-Meier survival analysis showed that patients in group 2 had significantly lower structural disease-free survival (DFS) and overall survival (OS) than patients in group 1 (P = 0.035 and <0.001, respectively). In multivariate Cox regression analysis, age was a risk factor significantly associated with OS. However, age was significantly associated with DFS in unadjusted analysis and in analysis adjusted by gender and risk classification variables, but not when pathological and therapy-related variables were introduced in the model. On the other hand, patients who received radioiodine had worse DFS (P < 0.001) compared to those who did not. CONCLUSION: Although age is a conditioning factor for OS, very old patients do not have a greater risk of developing structural disease throughout the follow-up than elderly patients with DTC.
PURPOSE: We investigated whether age at diagnosis of differentiated thyroid carcinoma (DTC) may be a risk factor for structural disease and mortality after primary treatment in aging patients. METHODS: A multicenter, retrospective analysis including patients older than 60 years at DCT diagnosis was designed. All subjects were treated by surgery with or without radioiodine adjuvant therapy and had a minimum follow-up of one year. We compared elderly patients (group 1, 60-74 years) with very old patients (group 2, ≥75 years). RESULTS: The study involved 1668 patients (74.3% women, median age 67 years, 87.6% papillary thyroid cancer, 73.3% treated with radioiodine), including 1397 in group 1 and 271 in group 2. Patients in group 2 had larger tumor size (1.8 [0.8-3.0] vs 1.5 [0.7-2.8] cm; P = 0.005), higher proportions of tumors with vascular invasion (23.8 vs 16.4%; P = 0.006), and lower proportion of lymphocytic thyroiditis (18.6 vs 24.9%; P = 0.013) than subjects in group 1. Kaplan-Meier survival analysis showed that patients in group 2 had significantly lower structural disease-free survival (DFS) and overall survival (OS) than patients in group 1 (P = 0.035 and <0.001, respectively). In multivariate Cox regression analysis, age was a risk factor significantly associated with OS. However, age was significantly associated with DFS in unadjusted analysis and in analysis adjusted by gender and risk classification variables, but not when pathological and therapy-related variables were introduced in the model. On the other hand, patients who received radioiodine had worse DFS (P < 0.001) compared to those who did not. CONCLUSION: Although age is a conditioning factor for OS, very old patients do not have a greater risk of developing structural disease throughout the follow-up than elderly patients with DTC.
Authors: J Jonklaas; G Nogueras-Gonzalez; M Munsell; D Litofsky; K B Ain; S T Bigos; J D Brierley; D S Cooper; B R Haugen; P W Ladenson; J Magner; J Robbins; D S Ross; M C Skarulis; D L Steward; H R Maxon; S I Sherman Journal: J Clin Endocrinol Metab Date: 2012-04-10 Impact factor: 5.958
Authors: Frederik A Verburg; Uwe Mäder; Karina Tanase; Elena-Daphne Thies; Stefanie Diessl; Andreas K Buck; Markus Luster; Christoph Reiners Journal: J Clin Endocrinol Metab Date: 2012-11-12 Impact factor: 5.958