Thyroid Cancer Relapse Associated With Age and Metastases

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Patients aged 55 and older with extranodal extension (ENE), a metastatic lymph node ratio (LNR), and absence of an initial treatment are at higher risk for recurrence of papillary thyroid cancer (PTC), according to a retrospective study published in Frontiers in Endocrinology.¹

Identifying these risks appeared to be a “practical and convenient tool” to allow physicians to predict the potential recurrence of PTC.

A total of 955 patients with PTC between 2017 and 2020 were assessed. To be eligible, patients must have had PTC with a BRAF V600 or telomerase reverse transcriptase promoter (TERTp) mutation. The PTC recurrence rate was 3.98% (n = 38).

Patients 55 and older had a higher proportion of recurrence, with 31.58% of the recurrence-positive and 11.89% of the recurrence-negative patients aged 55 or older (P =.001). Patients in the recurrence-positive group had a higher rate of TERTp mutations (13.16% v 2.29%; P <.001). They were also significantly more likely to not have received initial treatment (55.26% v 9.92%; P <.001).

Previous studies have identified ENE and LNR as poor disease prognosticators. Regarding ENE, 28.95% of recurrence-positive patients had ENE compared with 6.98% of recurrence-negative patients (P <.001). For LNR, 34.21% of recurrence-positive patients had LNR >0.5 compared with 13.20% of the recurrence-negative patients (P <.001).

“The proposed predictive model exhibits the ability to accurately prognosticate based on existing patient characteristics, thereby surpassing the limitations of conventional research. Moreover, this model highlighted the risk of relapse among non-initial treatment patients, potentially attributable to comprehensive pathological and socioenvironmental factors. Thus, clinicians should reassess their optimistic stance on the favorable prognosis of PTC in non-primary cases, necessitating a more proactive and cautious approach for the diagnosis and management of such patients,” study authors wrote.

No significant differences in recurrence status were observed with sex, average age, vascular invasion, number of metastatic lymph nodes, BRAF V600 mutation, or aggressive subtypes.

Interestingly, while Hashimoto’s thyroiditis (HT) is associated with increased cancer risks, especially thyroid cancer,² it appeared to be somewhat protective against PTC recurrence. Only 7.89% of patients in the recurrence-positive group had HT compared with 23.83% in the recurrence-negative group (P =.037).¹

“Previous findings have suggested that HT and [nodular goiter] may restrict tumor progression through a certain mechanism and improve patient outcomes. A high proportion of tumor-infiltrating lymphocytes could explain the protective role of HT; however, the same effect of NG remains uncertain,” study authors wrote.¹

REFERENCES:
1. Li Y, Tian J, Jiang K, et al. Risk factors and predictive model for recurrence in papillary thyroid carcinoma: A single-center retrospective cohort study based on 955 cases. Front Endocrinol (Lausanne). 2023;14:1268282. Published 2023 Sep 21. doi:10.3389/fendo.2023.1268282

2. Zhang T, He L, Wang Z, et al. Risk factors for death of follicular thyroid carcinoma: A systematic review and meta-analysis. Endocrine. 2023;82(3):457-466. doi:10.1007/s12020-023-03466-9