Patient Age Is Significantly Related to the Progression of Papillary Microcarcinoma of the Thyroid Under Observation
Top Cited Papers
- 1 January 2014
- journal article
- research article
- Published by Mary Ann Liebert Inc in Thyroid®
- Vol. 24 (1), 27-34
- https://doi.org/10.1089/thy.2013.0367
Abstract
Background: We showed previously that subclinical low-risk papillary thyroid microcarcinoma (PTMC) could be observed without immediate surgery. Patient age is an important prognostic factor of clinical papillary thyroid carcinoma (PTC). In this study, we investigated how patient age influences the observation of low-risk PTMC. Methods: Between 1993 and 2011, 1235 patients with low-risk PTMC chose observation without immediate surgery. They were followed periodically with ultrasound examinations. These patients were enrolled in this study. We divided them into three subsets based on age at the beginning of observation: young (Results: We set three parameters for the evaluation of PTMC progression: (i) size enlargement, (ii) novel appearance of lymph-node metastasis, and (iii) progression to clinical disease (tumor size reaching 12 mm or larger, or novel appearance of nodal metastasis). The proportion of patients with PTMC progression was lowest in the old patients and highest in the young patients. On multivariate analysis, young age was an independent predictor of PTMC progression. However, none of the 1235 patients showed distant metastasis or died of PTC during observation. Although only 51 patients (4%) underwent thyrotropin (TSH) suppression based on physician preference, the PTMC of all patients enrolled in this TSH suppression study, except one, were clinically stable. To date, 191 patients underwent surgery for various reasons after observation. None showed recurrence except for one in the residual thyroid, and none died of PTC after surgery. Conclusions: Old patients with subclinical low-risk PTMC may be the best candidates for observation. Although PTMC in young patients may be more progressive than in older patients, it might not be too late to perform surgery after subclinical PTMC has progressed to clinical disease, regardless of patient age.Keywords
This publication has 28 references indexed in Scilit:
- Prognostic Impact of Serum Thyroglobulin Doubling-Time Under Thyrotropin Suppression in Patients with Papillary Thyroid Carcinoma Who Underwent Total ThyroidectomyThyroid®, 2011
- Therapeutic Strategy for Differentiated Thyroid Carcinoma in Japan Based on a Newly Established Guideline Managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine SurgeonsWorld Journal of Surgery, 2010
- Biological behavior and prognosis of familial papillary thyroid carcinomaSurgery, 2009
- Invited commentaryWorld Journal of Surgery, 2007
- Extranodal Tumor Extension to Adjacent Organs Predicts a Worse Cause‐specific Survival in Patients with Papillary Thyroid CarcinomaWorld Journal of Surgery, 2007
- A therapeutic strategy for incidentally detected papillary microcarcinoma of the thyroidNature Clinical Practice Endocrinology & Metabolism, 2007
- Usefulness of Thyroglobulin Measurement in Fine‐needle Aspiration Biopsy Specimens for Diagnosing Cervical Lymph Node Metastasis in Patients with Papillary Thyroid CancerWorld Journal of Surgery, 2005
- An Observation Trial Without Surgical Treatment in Patients with Papillary Microcarcinoma of the ThyroidThyroid®, 2003
- Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancerThe American Journal of Medicine, 1994
- Latent Thyroid Carcinoma in Iceland at AutopsyPathology - Research and Practice, 1992