Differentiated thyroid cancer in patients over 60 years of age at presentation: A retrospective study of 438 patients. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Garg, Aayushi; Chopra, Saurav; Ballal, Sanjana; Soundararajan, Ramya; Bal, C.S.
• Is Part Of: Journal of geriatric oncology. Volume 6:Issue 1(2015)
• Page Start: 29
• Page End: 37
• Publication Date: 2015-01
• Subjects: Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2014.09.182
• Languages: English
• ISSNs: 1879-4068

Abstract

<abstract abstract-type="author" id="ab0005"> <title id="st0005">Abstract</title> <sec> <title id="st0010">Objectives</title> <p id="sp0005">The aim of this study is to identify the prognostic factors predicting remission and subsequent disease relapse in patients with differentiated thyroid cancer (DTC) greater than 60 years of age.</p> </sec> <sec> <title id="st0015">Materials and Methods</title> <p id="sp0010">The institute thyroid cancer database had 4370 patients with DTC, of which 447 (10%) were aged > 60. However, 9 patients were excluded due to follow-up less than 1 year. The prognostic factors in the remaining 438 patients were studied.</p> </sec> <sec> <title id="st0020">Results</title> <p id="sp0015">Among the 438 patients, 311 (71%) had only loco-regional disease (M<sub>0</sub>) and 127 (29%) had distant metastases (M<sub>1</sub>) at the time of initial presentation. The host factors predictive of distant metastases at presentation were female gender, primary tumor size (> 4 cm), follicular histology, and extra-thyroidal extension. Among M<sub>o</sub> patients, 195 (63%) achieved complete remission while only 12 (9%) M<sub>1</sub> patients did so. Average number of radioactive iodine (<sup>131</sup>I) doses administered to achieve complete remission was 2.3 (range, 1–6) and the mean cumulative dose was 3404 MBq (range, 925–46, 250 MBq). In multivariate logistic regression among M<sub>0</sub> patients, follicular histology, nodal metastases, and surgical treatment lesser than total/near-total thyroidectomy and among M<sub>1</sub> patients, site of distant metastases (skeletal and multiple sites) were independent factors predicting non-remission. Among the patients (both M<sub>0</sub> and M<sub>1</sub>) who achieved remission, factors associated with disease recurrence were primary tumor size (> 4 cm), nodal metastases, pulmonary metastases, and non-remission after first dose of radioactive iodine and were associated with greater chances of disease relapse.</p> </sec> <sec> <title id="st0025">Conclusion</title> <p id="sp0020">This study highlights that DTC in older patients behaves more aggressively than in adults age < 60 years, and identifies several prognostic factors for remission and subsequent relapse.</p> </sec> </abstract>