Young and resilient: Unraveling papillary thyroid cancer outcomes in males under 40.

Abstract

While males present with more adverse clinicopathologic features in papillary thyroid carcinoma (PTC), younger age has previously been shown to be a favorable prognostic factor. We examined the combined effect of male sex and young age on PTC outcomes. We conducted a retrospective analysis of a prospectively maintained database of thyroid cancer surgery patients (2000-2020) at a single quaternary care institution. We included papillary thyroid carcinoma cases and excluded those with prior cancer-related thyroid surgery. We examined demographics, cancer stage, surgical outcomes, and complications by age and sex, analyzing groups below and above the age of 40years. A total of 680 patients with PTC were included. Females constituted 68% (age ≥40years: 44% and <40years: 24%) and males 32% (≥40years: 24% and <40years: 8%). A significant difference (p<0.001) of N1 disease distribution was found between the groups. N1a metastasis was greater in patients younger than 40 regardless of sex ((M<40 (15%), F<40 (15%), M≥40 (12%), and F≥40 (9%)). While, M<40 had greater N1b metastasis (36%) than all other groups (M≥40 (28%), F<40 (22%), and F≥40 (10%)). There was no significant difference in the distribution ofT stages between groups. Groups showed no differences in 30-day outcomes, recurrence at 1year, reoperation, mortality, nerve injury, or hypocalcemia. Young males with PTC face increased occurrence of nodal metastasis yet experience similar recurrence rates as their female and older counterparts. Subgroup analysis underscores the predictive role of sex and age in advanced PTC cases.