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. 2014 Jan;24(1):27-34.
doi: 10.1089/thy.2013.0367. Epub 2013 Nov 14.

Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation

Yasuhiro Ito  1 , Akira Miyauchi, Minoru Kihara, Takuya Higashiyama, Kaoru Kobayashi, Akihiro Miya
Affiliations

Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation

Yasuhiro Ito et al. Thyroid. 2014 Jan.

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 (<40 years), middle-aged (40-59 years), and old patients (≥60 years). Observation periods ranged from 18 to 227 months (average 75 months).

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.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Proportion of patients in our entire series whose papillary thyroid microcarcinoma (PTMC) showed enlargement by 3 mm or more.
<b>FIG. 2.</b>
FIG. 2.
Proportion of patients in the entire series whose PTMC showed novel appearance of lymph-node metastasis.
<b>FIG. 3.</b>
FIG. 3.
Proportion of patients in the entire series whose PTMC developed into clinical disease.
<b>FIG. 4.</b>
FIG. 4.
Relationship between age and proportion of patients whose PTMC showed enlargement by 3 mm or more.
<b>FIG. 5.</b>
FIG. 5.
Relationship between age and proportion of patients whose PTMC showed novel appearance of lymph-node metastasis.
<b>FIG. 6.</b>
FIG. 6.
Relationship between age and proportion of patients whose PTMC developed into clinical disease.
See this image and copyright information in PMC

Comment in

References

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Supplementary concepts