Active surveillance is established as an alternative to surgery for papillary thyroid microcarcinomas, but inclusion criteria and mortality risk for pursuing a nonsurgical approach have not been clearly defined. To gauge the feasibility of expanding active surveillance thresholds, we investigated the effects of increasing size and age on disease-specific survival (DSS) in a large nonoperative thyroid cancer cohort, compared against a matched group of surgical patients. Papillary thyroid carcinoma patients staged T1-4N0M0 were identified in the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2015, stratified by nonsurgical and surgical management. Propensity score matching was performed to adjust for imbalances in covariates. Multivariable models were constructed using restricted cubic splines to model nonlinear relationships of age and tumor size with DSS. Overall, 1453 nonoperative patients and 54,718 surgical patients met the inclusion criteria. Collectively, increasing age and size after certain thresholds independently led to greater differences in DSS between nonsurgical and surgical patients. For younger ages (14-55 years), surgical approach compared with nonsurgical approach was not associated with any difference in the 10-year DSS among 0-4 cm cancers (99.8% vs. 100%, = 0.470), 4.1-6 cm cancers (98.8% vs. 100%, = 0.599), or >6 cm cancers (97.3% vs. 100%, = 0.718). Older patients with larger tumors (>75 years, >6 cm) demonstrated the greatest difference in DSS (48.1% vs. 91.3%, < 0.001). Similar results were found when applying propensity score matching. For age, restricted cubic spline plots showed minimal relative survival hazard in nonoperative cases beginning after age 60 years, with a change point illustrating acceleration in relative hazard beyond age 72 years. For size, relative survival hazard was observed after 2.0 cm and increased slowly with nodule growth up to an inflection point of 4.5 cm. Beyond this, mortality risk escalated with each additional year without plateau. Increasing age and size lead to progressively greater mortality risk without surgery, but only beyond certain thresholds. We define escalating gradients at which a nonsurgical approach may be deemed appropriate, and beyond which survival benefits from surgery become apparent. Such findings reconcile controversial observations regarding age and size in active surveillance and further reshape evolving treatment paradigms in thyroid cancer.
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http://dx.doi.org/10.1089/thy.2019.0060 | DOI Listing |
Updates Surg
January 2025
Department of Surgery, MacKay Memorial Hospital, 92, Chung-Shan North Road, Section 2, Taipei, 104217, Taiwan.
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) can be differentiated from invasive encapsulated follicular variant of papillary thyroid carcinoma (eFV-PTC) by the presence of a tumor capsule or blood vessel invasion in histological examination. The objective of this study was to investigate whether it is possible to distinguish between NIFTP and invasive eFV-PTC before surgery. Patients diagnosed with NIFTP and invasive eFV-PTC from 2017 to 2023 were analyzed for biochemical, ultrasonographic, and cytological features.
View Article and Find Full Text PDFDiscov Oncol
January 2025
Department of Thyroid Surgery, The First Affiliated Hospital of Jinan University, No. 613, W. Huangpu Avenue, Tianhe District, Guangzhou, 510630, China.
Background: Accurately distinguishing lymph node metastases (LNM) from papillary thyroid carcinomas (PTC) is crucial in clinical practice. The role of the immune system in PTC-LNM has attracted increasing attention. The aim of the present study was to evaluate the differential expression of 92 immune-related proteins in the serum and identify their potential diagnostic effects in patients with PTC-LNM.
View Article and Find Full Text PDFJ Clin Transl Endocrinol
March 2025
Department of Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, PR China.
Objectives: This study aimed to evaluate the diagnostic performance for medullary thyroid cancer (MTC) based on the 2017 Thyroid Imaging Reporting and Data System by the American College of Radiology (ACR TI-RADS) guideline, and the ability to recommend fine needle aspiration (FNA) for MTC.
Methods: Fifty-six MTCs were included, and 168 benign thyroid nodules (BTNs) and 168 papillary thyroid nodules (PTCs) were matched according to age. Ultrasound (US) features were reviewed according to ACR TI-RADS.
Heliyon
January 2025
Laboratory of Cancer Molecular Genetics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil.
There is compelling evidence that although the increased availability of sensitive imaging is the main cause of the increasing incidence of differentiated thyroid cancer, particularly the papillary type, there are other factors involved. Despite the acknowledged role of genetic and certain lifestyle factors, comprehensive studies delineating the interactions between multiple risk factors and the mechanistic pathways involved are scarce. A greater understanding of both modifiable and non-modifiable risk factors for thyroid cancer is critical to prevent and manage the disease and could provide a scientific basis for future research into more appropriate lifestyles and living environments for people at high risk.
View Article and Find Full Text PDFClin Transl Med
January 2025
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background: Thyroid cancer is one of the most common endocrine tumors worldwide, especially among women and the metastatic mechanism of papillary thyroid carcinoma remains poorly understood.
Methods: Thyroid cancer tissue samples were obtained for single-cell RNA-sequencing and spatial transcriptomics, aiming to intratumoral and antimetastatic heterogeneity of advanced PTC. The functions of APOE in PTC cell proliferation and invasion were confirmed through in vivo and in vitro assays.
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