Abstract
ObjectiveDistant metastasis in papillary thyroid microcarcinoma (PTMC) is rare but fatal, and its relationship with patient age remains unclear. The objective of this study was to examine the association between age at diagnosis and metachronous distant metastasis in PTMC.MethodsConsecutive patients who underwent thyroidectomy for PTC measuring 10 mm or less at a tertiary hospital from January 2000 to December 2016 were enrolled. Patients who had evidence of distant metastasis at diagnosis or underwent postoperative radioiodine (RAI) ablation were excluded. A Cox proportional hazards model with restricted cubic splines (RCS) was applied to examine the association between age at diagnosis and distant metastasis.ResultsA total of 4,749 patients were evaluated. The median age was 44 years (range, 8–78 years), and 3,700 (78%) were female. After a median follow-up of 65 months, 21 distant metastases (20 lung, 1 liver) were recognized. A univariate Cox proportional model using a 5-knot RCS revealed a significant overall (p = 0.01) and a potential nonlinear association (p = 0.08) between distant metastasis and age at diagnosis. In multivariate analysis, age at diagnosis, extrathyroidal extension (ETE), and lymph node metastasis (pN+) were independent risk factors for distant metastasis. Compared with the middle-aged group (30–45 years old), younger and older patients had a higher risk of distant metastasis [HR, 95% CI, p-value, age ≤ 30, 4.54 (0.91–22.60), 0.06, age > 45, 6.36 (1.83–22.13), <0.01].ConclusionAge at diagnosis is associated with metachronous distant metastasis of PTMC, and patients with younger or older age have a higher risk of distant metastasis than middle-aged patients.
Highlights
Papillary thyroid microcarcinoma (PTMC) is defined as a small papillary thyroid cancer (PTC) measuring 10 mm or less (1)
A total of 132 recurrences and 4 PTC-related deaths were identified during follow-up
Older age was significantly associated with an elevated risk of distant metastasis than aged 30–45 years [HR, 95% CI, 6.36 (1.83–22.13), p < 0.01], and risks of younger patients and the reference group (30 < age ≤ 45) were close to the significant difference [HR, 95% CI, 4.54 (0.91–22.60), p = 0.06] (Table 2)
Summary
Papillary thyroid microcarcinoma (PTMC) is defined as a small papillary thyroid cancer (PTC) measuring 10 mm or less (1). The decision-making regarding AS or immediate surgery generally depends on the tumor location, extrathyroidal extension (ETE), and presence of lymph node metastasis (LNM). According to several current guidelines of AS for PTMC, indications for immediate surgery include the presence of lymph node or distant metastasis, aggressive subtypes, suspicious invasion of important structures (recurrent laryngeal nerve or trachea) of the neck or a tumor located near these structures (6, 7). How to differentiate the small proportion of high-risk patients according to the staging system of the whole PTC is still concerning, and patient age and distant metastasis are the two most important prognostic factors related to disease-specific mortality. The objective of the present study was to examine the association between age and metachronous distant metastasis in patients with PTMC, which may provide additional information for considering treatment strategy
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