DIFFERENTIATED
THYROID CANCER- THE PROGNOSTIC SIGNIFICANCE OF AGE AT THE TIME OF DIAGNOSIS
The prognostic
significance of age at the time of diagnosis of thyroid cancer has been well
recognized.
In general,
the older the individual is when diagnosed, the worse the outcome. Mortality
increases progressively with increasing age. Cancer-related and overall mortality
worsen with increasing age, being worst in the oldest age group (> 71
years).
In the Previous
Edition of the AJCC/TNM, age younger than 45 years was considered as an
independent predictor of low-risk disease, but the most accurate cut-off age between
high-risk and low-risk disease remained controversial. The 8th
Edition of the AJCC/TNM raised the age cut off from 45 years of age at
diagnosis to 55 years of age. The presence of clinically significant lymph node
metastases is associated with poorer outcome in adults of all ages, but the
impact on survival in younger patients (< 55 years), even though
statistically significant, is relatively minor, while the impact on survival in
older patients is more clinically significant. It is very interesting to note that
in the 8th Edition, in patients < 55 years old, all patients are
stage I (regardless of tumor size, lymph node status, histological subtype or
the presence/ absence of extrathyroidal extension), unless they have distant
metastases in which case they are stage II. This emphasizes the importance of
age at the time of diagnosis as a prognostic factor.
In
conclusion, age exceeding 55 years itself represents an unfavorable prognostic and
high-risk factor for cancer specific death in patients with differentiated
thyroid cancer.
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