Preoperative Clinical Factors Associated With High-Risk Features Predictive of Papillary Thyroid Cancer Recurrence

While most patients with papillary thyroid cancer (PTC) have favorable outcomes, a subset present with high-risk features associated with disease recurrence, such as vascular invasion, extrathyroidal extension, aggressive histologic variants, or distant metastasis. This study examines preoperative clinical factors associated with high-risk PTC tumor characteristics predictive of disease recurrence based on the American Thyroid Association (ATA) risk stratification system.

A retrospective review of 762 patients who underwent thyroidectomy for PTC at a tertiary care institution was conducted. Clinical variables analyzed included sex, age, body mass index, hypothyroid symptoms, levothyroxine use, prior radiation exposure, family history of thyroid cancer, nodule palpability, multifocality, nodule size, nodular calcifications, echogenicity, border regularity, "taller-than-wide" shape, lymph node metastases, and serum thyroid-stimulating hormone levels. Patients were stratified into high/intermediate- and low-risk categories per the ATA risk stratification system. Univariate and binary logistic regression assessed associations between clinical factors and ATA-defined recurrence risk.

Of 762 patients, 82.3% were female, and 17.7% were male, with a mean age of 47.5 y. Based on the ATA stratification, 42.0% were classified as high/intermediate risk, and 58.0% were classified as low risk. Several clinical characteristics were significantly associated with high/intermediate-risk disease: male sex (odds ratio [OR] 1.65, P < 0.05), age <45 y (OR 1.43, P < 0.05), hypothyroid symptoms (OR 2.31, P < 0.05), nodular coarse calcifications (OR 2.01, P < 0.05), nodular microcalcifications (OR 2.71, P < 0.001), taller-than-wide nodules (OR 1.64, P < 0.05), and clinically detectable lymph node metastases (OR 3.64, P < 0.001). All other variables showed no significant association.

Several preoperative clinical and radiologic features are significantly associated with high-risk tumor characteristics predictive of PTC recurrence. Early identification of these features may support individualized risk stratification and guide surgical decision-making.