Abstract
Considering controversial data about the relationship between body size and prognosis of differentiated thyroid cancer (DTC), the current study aimed to assess the influence of body weight, body mass index (BMI), and body surface area (BSA) on DTC. We conducted a retrospective analysis of patients' records from the Thyroid Cancer Unit, assessing body size measures, clinical and laboratory prognostic factors, and disease evolution. 337 patients, aged 45.95 ± 13.04 years old, with BMI of 27.87 ± 5.13 kg/m2 and BSA of 1.74 ± 0.18 m2 were enrolled. After 9.5 ± 6.9 years of follow-up, 87.29% of patients were disease-free and 12.71% had persistent disease; no patient had deceased. Patients aged <45 years old with extrathyroidal invasion tumor had greater baseline body weight and BSA than those without extrathyroidal invasion (median 79.5 kg versus 67 kg and 1.85 m2 versus 1.74 m2). Women with poorly differentiated tumor and patients aged ≥45 years old with distant metastasis presented greater weight loss during follow-up compared to patients without such characteristics (median −2 kg versus +1.5 kg and −3 kg versus +1 kg, respectively). The relationship between body size and DTC evolution was not observed. In conclusion, higher weight and BSA were associated with a greater chance of extrathyroidal tumor invasion in younger patients. Specific subgroups of patients with aggressive disease presented higher weight loss. Young patients with higher BSA should be carefully treated due to possible worse prognosis related to increased incidence of extrathyroid invasion. Findings related to tumor aggressiveness and weight loss in specific groups deserve further mechanistic studies.
Highlights
Differentiated thyroid cancer (DTC) is a neoplasia with raising incidence and patients usually present long survival [1, 2]
We evaluated the following clinical and histological parameters of the cancer: age at diagnosis, ethnicity, family history of DTC, smoking history, follow-up time, presence of thyroid antibodies, size and number of malignant nodules, histology type and variant, vascular and lymphatic invasion, extracapsular or extrathyroidal invasion, histological differentiation grade, metastasis to lymph nodes and to distant organs, and tumor staging according to the tumor node and metastasis system (TNM) [17]
After mean follow-up time of 9.5 ± 6.9 years, mean body mass index (BMI) increased to 28.51 ± 5.34 kg/m2 and mean body surface area (BSA) to 1.76 ± 0.18 m2
Summary
Differentiated thyroid cancer (DTC) is a neoplasia with raising incidence and patients usually present long survival [1, 2]. Excess of body weight influences tumor genesis through the effects of different hormones and cytokines, such as insulin, interleukins, and tumor necrosis factor alpha [5, 6]. Higher body mass index (BMI) is associated with the development of tumors with characteristics of higher aggressiveness [5, 7] and to higher cancer-related mortality in different kinds of malignant neoplasias [8]. Such relationship of body size measures and worse prognosis and evolution of disease is controversial in thyroid cancer [9,10,11]
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