Prognostic factors for survival and recurrence in papillary thyroid carcinoma: a retrospective study

Abstract

Background: Papillary thyroid carcinoma (PTC) accounts for 80-85% of cases and generally has an excellent prognosis. However, outcomes vary with clinicopathological factors, and identifying prognostic indicators is clinically important for tailoring treatment strategies and long-term follow-up. Regional data on prognostic factors in PTC remain limited. This study investigates the impact of patient and tumor characteristics on survival and recurrence outcomes at a single institution.

Methods: A retrospective cohort study included patients aged 18 years or older diagnosed with PTC between January 2015 and September 2023 at a secondary hospital in Riyadh, Saudi Arabia. Eligible patients had confirmed PTC with sufficient clinical records and no prior thyroid cancer treatment. The data collected included demographics, comorbidities, risk factors, baseline clinical and laboratory factors, and tumor pathology [tumor, node, metastasis (TNM) stage and variants]. Treatment details and follow-up outcomes were reviewed through electronic medical records. Patients were followed for a median of 5.45 years to assess survival, recurrence, and postoperative complications. Associations between clinical characteristics and prognostic outcomes were analyzed using Chi-squared and Fisher tests.

Results: A total of 293 patients were included (mean age at diagnosis 41.7±12.2 years); 82.2% were female. Most patients (79.1%) presented with early-stage disease, and 62.3% had the classic variant of the disease. The overall 10-year survival rate was 95.8%, and recurrence occurred in 2.1%. Patients over 50 years had more significant comorbidities than those aged 18 to 50 years, such as diabetes mellitus (P=0.001, 37.8% vs. 8.8%), hypertension (P=0.001, 31.5% vs. 6.6%), dyslipidemia (P=0.001, 32.4% vs. 3.3%), asthma (P=0.002, 20.7% vs. 8.3%), and cardiovascular disease (P=0.046, 6.3% vs. 1.7%). Additionally, PTC patients aged above 50 years had significantly more lymph node involvement (53.2%, P=0.041). Male patients had greater nodal involvement (61.5% vs. 42.1%, P=0.041), while females more frequently developed hypothyroidism (18.3% vs. 5.8%, P=0.02). Despite these adverse prognostic factors, no significant differences in recurrence or mortality were observed. Temporary postoperative hypoparathyroidism occurred in 11.6% and permanent hypoparathyroidism in 4.1%, while temporary and permanent recurrent laryngeal nerve paralysis occurred in 2.3% and 0.7%, respectively.

Conclusions: Patients with PTC in this Saudi cohort demonstrated excellent long-term outcomes, characterized by high survival rates and low recurrence rates. Older age and male sex were associated with more aggressive disease features, yet with appropriate management, outcomes remained favorable. These findings emphasize the importance of comprehensive risk assessment and reinforce the effectiveness of current treatment strategies, providing region-specific evidence to inform clinical guidelines and optimize long-term patient care.

Keywords: Papillary thyroid carcinoma (PTC); Saudi Arabia; prognostic factors; retrospective.