Abstract
BackgroundThe American Joint Committee on Cancer has recently revised the tumor-node-metastasis (TNM) staging system on thyroid cancer, which illustrated that the cut-off age for predicting mortality has elevated from 45 to 55 years old. We aimed to investigate the inflammation index based on hematological parameters to predict the clinical characteristics of elderly papillary thyroid cancer (PTC) patients with an inferior prognosis.MethodsWe retrospectively analyzed 558 patients newly diagnosed with PTC from January 2013 to December 2017, and 82 out of the 558 patients were over 55 years old. Receiver operating characteristic (ROC) study and univariate and multivariate logistic analysis was conducted to evaluate the diagnostic value of these preoperative inflammation indexes in PTC patients ≥ 55 years of age.ResultsElevated neutrophils were prognostic of bilaterality (area under the ROC curve (AUC) = 0.673, p = 0.023) and lymph node metastasis (AUC = 0.649, p = 0·020). Decreased mean platelet volume (MPV) and platelet distribution width (PDW) were prognostic of coexistence with Hashimoto’s thyroiditis (AUC = 0.736, p = 0.016; AUC = 0.721, p = 0.024). Elevated lymphocyte and lymphocyte-to-monocyte ratio (LMR) were prognostic of advanced TNM stage (AUC = 0.691, p = 0.029; AUC = 0.680, p = 0.040). Meanwhile, the logistic regression model further revealed that LMR ≥ 5.45 was an independent risk factor for the advanced TNM stage (odds ratio (OR) = 7.306, p = 0.036).ConclusionsThe preoperative neutrophils, lymphocytes, MPV, PDW, LMR were all prognostic. More importantly, the increased in LMR independently contributed to the advanced TNM stage of PTC patients ≥ 55 years.
Highlights
The American Joint Committee on Cancer has recently revised the tumor-node-metastasis (TNM) staging system on thyroid cancer, which illustrated that the cut-off age for predicting mortality has elevated from 45 to 55 years old
Analysis of papillary thyroid cancer (PTC) in elderly patients Receiver operating characteristic (ROC) curve analysis was conducted to predict bilaterality, lymph node metastasis, coexistence with Hashimoto’s thyroiditis, and TNM stage, respectively (Fig. 1), and the area under the ROC curve (AUC) values were evaluated in our study (Table 2)
Using the lymphocyte count and lymphocyte-to-monocyte ratio (LMR) cut-off points calculated by ROC curve analysis, the results showed that LMR ≥ 5.45 was an independent risk factor (odds ratio (OR) = 7.306, p = 0.036) for the advanced TNM stage in PTC patients
Summary
The American Joint Committee on Cancer has recently revised the tumor-node-metastasis (TNM) staging system on thyroid cancer, which illustrated that the cut-off age for predicting mortality has elevated from 45 to 55 years old. We aimed to investigate the inflammation index based on hematological parameters to predict the clinical characteristics of elderly papillary thyroid cancer (PTC) patients with an inferior prognosis. Neutrophil count, lymphocyte count, the neutrophil-to-lymphocyte ratio (NLR), the lymphocyte-to-monocyte ratio (LMR), mean platelet volume (MPV) and platelet distribution width (PDW) have been well-studied in many malignancies [9,10,11] These potentially related carcinoma markers are less involved in PTC, and even among those studies, the relationship between hematological index and metastasis or stage of PTC are inconsistent, both of which remain in dispute [12, 13]. This study set out to investigate the role of hematological indexes in predicting clinical characteristics and outcomes of PTC, in elderly patients (≥ 55 years old)
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