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Consider age in papillary thyroid cancer prognoses
Age may be the most important factor in determining a final prognosis for papillary thyroid cancer.
Researchers at the University of Pisa in Italy examined a series of papillary thyroid carcinomas to determine age-specific prognostic factors. They used data acquired from 2,709 patients who underwent thyroidectomies at the university between 2000 and 2005 to conduct the retrospective study.
Patients were stratified into three groups based on age at diagnosis: <18 years of age (group one, n=51), 19-45 years of age (group two, n=1,421) and >46 years of age (group three, n=1,237).
Tumor size was largest in group one, compared with groups two and three, though differences between groups one and two were not significant. Patients in the pediatric group also had higher thyroid capsule infiltration and a higher presence of node metastases, though in this population the tall-cell variant was less represented. – by Stacey L. Adams
Otolaryngol Head Neck Surg. 2008;138:200-203.
Micolli and colleagues report from a large retrospective series that papillary thyroid cancer in younger patients, <18 years of age, presents with larger tumors and more extensive lymph node spread compared with older patients. The finding of the more aggressive pathological feature of tall cell variant, however, was not seen in the younger patients, but only in older patients. The authors suggest that despite larger tumors and greater lymph node spread, young patients with papillary thyroid cancer generally have a good prognosis. It will be important to follow these younger patients prospectively to correlate their outcome with the initial clinical presentation, compared with the older patients.
–Gregory A. Brent, MD
Endocrine Today Editorial Board member
What the authors are saying isn’t anything new. They discuss the AMES staging system (Age, Metastases, Extent, Size) so we know that age is one of the criteria for how the system is staged. We also know that they then subdivide it below the age of 45 years, which is where the routine staging system starts—the delineation between older and younger, so to speak—and they delineate it even more by including a lower age, <18 years, and that’s a big difference. It is known that kids do well even with metastatic disease to the nodes, and they justify that. Group one is much smaller than groups two and three, and according to the researchers’ standards, the disease being less aggressive still holds up as statistically significant.
The researchers admit that one of the drawbacks to the study is short follow-up time and their maximum is seven years. With thyroid carcinoma, follow-up is conducted at 10, 15 and 20 years; their minimum is two years. They fail to address systemic metastases. They talk about lymph node, but does the presence of systemic metastases in the younger age group portend perhaps a serious prognosis? Here we’re not sure. However, they say that the younger patients, aged <18 years, tend to present with lymph nodes, and that’s certainly my experience and the literature experience and even if they do, they do well and that’s been uniformly everyone’s experience, too. Essentially, they take a very large series by a very respectable name and add credence to the well-known fact that young patients do well even with metastatic disease.
– Mark Persky, MD
Chairman, Department of Otolaryngology, Beth Israel Medical Center, New York