This article is more than 5 years old. Information may no longer be current.
Growth of subclinical papillary microcarcinoma inversely related to age
Click Here to Manage Email Alerts
Subclinical low-risk papillary thyroid microcarcinoma can be followed without immediate surgical intervention, with older patients potentially the ideal candidates for this observation approach, according to study data.
“Although [papillary thyroid microcarcinoma] in young patients may be more progressive than in older patients, it might not be too late to perform surgery after subclinical [papillary thyroid microcarcinoma] has progressed to clinical disease, regardless of age,” researchers wrote.
The researchers assessed 1,235 patients at Kuma Hospital in Kobe, Japan, between 1993 and 2011 who were diagnosed with papillary thyroid microcarcinoma (PTMC) and followed without initial surgical intervention. Three parameters were established for the assessment of PTMC progression: size enlargement, new appearance of lymph node metastasis and progression to clinical disease (tumor growth to at least 12 mm or incipient nodal metastasis).
Patients were periodically monitored through ultrasound examinations. The average duration of observation was 75 months.
The patients were stratified by age: young (<40 years), middle-aged (40-59 years) and old (≥60 years).
According to the study, there was an inverse relationship between patient age and size enlargement, new appearance of lymph node metastasis, and progression to clinical disease. Multivariate analysis found an independent association between young age (<40 years) and PTMC progression. Tumor size of at least 9 mm also was independently linked to progression to clinical disease.
During the observation period, none of the patients developed distant metastases or died of papillary thyroid carcinoma (PTC). Of the 51 patients who underwent a thyroid-stimulating hormone suppression regimen, the PTMC of 50 patients remained stable. After observation, 191 patients underwent surgical intervention; of these, only one had recurrence in the remnant thyroid, and there were no PTC-related deaths after surgery.
These findings suggest that most PTMCs develop when the patient is young and remain small because of slower growth activity with patient age, the researchers wrote. They hypothesized that only a small percentage of PTMCs re-establish growth activity with age and progress to clinical PTC. They said surgical intervention may be effective for all age groups in treating PTMC that has progressed to clinical disease.
“We demonstrate that subclinical low-risk PTMC can be observed without immediate surgery, and especially, old patients with PTMC might be the best candidates for observation,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts