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Young and resilient: Unraveling papillary thyroid cancer outcomes in males under 40
Caleb Hood1, Polina V Zmijewski1, M Chandler McLeod1
1The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
Insights
Young males with papillary thyroid carcinoma (PTC) have higher rates of nodal metastasis but similar recurrence compared to other groups. Sex and age are key predictors in advanced PTC.
Area of Science:
- Oncology
- Endocrinology
- Surgical Pathology
Background:
- Papillary thyroid carcinoma (PTC) shows varied clinicopathologic features by sex.
- Younger age is typically a favorable prognostic factor in PTC.
- The combined impact of male sex and young age on PTC outcomes requires further investigation.
Purpose of the Study:
- To evaluate the combined effect of male sex and young age on papillary thyroid carcinoma (PTC) outcomes.
- To analyze demographic, staging, surgical, and complication data based on age and sex.
- To identify prognostic implications of combined sex and age factors in PTC patients.
Main Methods:
- Retrospective analysis of a prospectively maintained thyroid cancer surgery database (2000-2020).
- Inclusion of papillary thyroid carcinoma (PTC) cases, excluding those with prior thyroid surgery.
- Stratification of 680 patients into age groups (<40 years and ≥40 years) and by sex.
Main Results:
- Male sex was observed in 32% of patients, with 8% being <40 years old.
- Younger patients (<40 years) exhibited a higher prevalence of N1a and N1b nodal metastasis, irrespective of sex.
- No significant differences were found in T stage, 30-day outcomes, 1-year recurrence, reoperation, mortality, nerve injury, or hypocalcemia across groups.
Conclusions:
- Young males with PTC demonstrate increased nodal metastasis but comparable recurrence rates to other demographic groups.
- Age and sex are significant predictive factors for advanced papillary thyroid carcinoma (PTC).
- Subgroup analysis highlights the importance of considering both age and sex in PTC prognostication.
Background:
While males present with more adverse clinicopathologic features in papillary thyroid carcinoma (PTC), younger age has previously been shown to be a favorable prognostic factor. We examined the combined effect of male sex and young age on PTC outcomes.
Methods:
We conducted a retrospective analysis of a prospectively maintained database of thyroid cancer surgery patients (2000-2020) at a single quaternary care institution. We included papillary thyroid carcinoma cases and excluded those with prior cancer-related thyroid surgery. We examined demographics, cancer stage, surgical outcomes, and complications by age and sex, analyzing groups below and above the age of 40 years.
Results:
A total of 680 patients with PTC were included. Females constituted 68% (age ≥40 years: 44% and <40 years: 24%) and males 32% (≥40 years: 24% and <40 years: 8%). A significant difference (p < 0.001) of N1 disease distribution was found between the groups. N1a metastasis was greater in patients younger than 40 regardless of sex ((M < 40 (15%), F < 40 (15%), M ≥ 40 (12%), and F ≥ 40 (9%)). While, M < 40 had greater N1b metastasis (36%) than all other groups (M ≥ 40 (28%), F < 40 (22%), and F ≥ 40 (10%)). There was no significant difference in the distribution of T stages between groups. Groups showed no differences in 30-day outcomes, recurrence at 1 year, reoperation, mortality, nerve injury, or hypocalcemia.
Conclusions:
Young males with PTC face increased occurrence of nodal metastasis yet experience similar recurrence rates as their female and older counterparts. Subgroup analysis underscores the predictive role of sex and age in advanced PTC cases.
