Abstract
BackgroundThe association between adiposity and papillary thyroid carcinoma (PTC) has been reported in several studies, but its association with aggressive clinicopathologic features is not well-recognized. Our aim is to systematically review the literature to identify whether adiposity, expressed through Body Mass Index (BMI), is related to aggressive clinicopathologic features such as tumor-node-metastasis (TNM) stage, extrathyroidal extension (ETE), lymph node (LN) metastasis and multifocality in patients with PTC.MethodsA systematic search for articles was performed using the PubMed, EBSCO, and Cochrane Library for all articles published in English until December 2020. Specific keywords such as “papillary thyroid carcinoma”, “Body Mass Index”, “clinicopathologic features” were used in the search strategy. Two independent reviewers screened all retrieved articles based on predefined inclusion and exclusion criteria. Meta-analysis was performed in the studies that reported crude and adjusted odds ratios (OR). The methodological quality was assessed using the Newcastle-Ottawa Scale.ResultsA total of 11 retrospective cohort studies involving 26,196 participants included. Our findings showed that elevated BMI was significantly associated with ETE in both overweight (OR 1.26, 95% CI: 1.09-1.44) and obesity group (OR 1.45, 95% CI:1.26-1.64). Elevated BMI was also significantly associated with multifocality in overweight patients (OR 1.17, 95% CI:1.10-1.24) and obese patients (OR 1.45, 95% CI:1.29-1.62). Also, obesity was significantly associated with increased tumor size (OR 1.77, 95% CI:1.52-2.03) and with LN metastasis (OR 1.28, 95% CI: 1.12-1.44), whereas being overweight was significantly associated with advanced TNM stage (OR 1.55, 95% CI:1.27-1.83) ConclusionOur results provide strong evidence for the association between higher BMI and ETE, multifocality, and tumor size. Further studies with a larger number of participants are required to elucidate further the association of increased BMI with advanced TNM stage and LN metastasis.
Highlights
The prevalence of thyroid carcinoma has significantly increased worldwide over the past decades, with the highest percentage of increase attributed to a rise in the incidence of papillary thyroid carcinoma (PTC) and predominantly small PTC [1,2,3]
Our findings showed that elevated Body Mass Index (BMI) was significantly associated with ETE in both overweight and obesity group as well as with multifocality in both overweight and obese patients
Obesity was significantly associated with increased tumour size and with lymph node (LN) metastasis, whereas being overweight was significantly associated with a more advanced TNM stage
Summary
The prevalence of thyroid carcinoma has significantly increased worldwide over the past decades, with the highest percentage of increase attributed to a rise in the incidence of papillary thyroid carcinoma (PTC) and predominantly small PTC [1,2,3]. According to the American Cancer Society’s 2020 estimates for thyroid cancer, there are 52,890 new cases, 12,720 in men and 40,170 cases in women [2]. This increase may be partially attributed to the more widespread use of high-resolution ultrasonography and fine-needle aspiration biopsy, resulting in the increased diagnosis of smaller tumours [6,7,8]. The association between adiposity and papillary thyroid carcinoma (PTC) has been reported in several studies, but its association with aggressive clinicopathologic features is not well-recognized. Our aim is to systematically review the literature to identify whether adiposity, expressed through Body Mass Index (BMI), is related to aggressive clinicopathologic features such as tumor-node-metastasis (TNM) stage, extrathyroidal extension (ETE), lymph node (LN) metastasis and multifocality in patients with PTC
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