PAPILLARY
THYROID CANCER-PROGNOSTIC SIGNIFICANCE OF AGE
Patient age
is a significant cutoff parameter in most staging-prognostic systems regarding
thyroid cancer. The most widely adopted staging system (Union for International
Cancer Control [UICC]) sets the cutoff
age at 55 years (in the updated [8th] version, instead of 45 years in
the previous [7th] edition). Many other prognostic systems, such as
the AMES (age, grade, extent of disease, size), the GAMES (grade, age,
metastases, extent, size), MACIS (metastases, age, completeness of surgical
resection, invasion and size) age is also included as a prognostic parameter
with older age (> 45 [in most of them] or > 50 [in some others]) causing
the elevation of the score, thereby aggravating prognosis. Interestingly, all
of these prognostic systems use only old age as a risk factors, probably
because these staging systems set their end point as the carcinoma-related
death rather that disease recurrence.
Recent research
suggests that:
·
The
rate of persistent/recurrent disease (including recurrence in the lymph nodes
of the neck) is higher in young patients (< 20 – 40 yrs) and in older
patients (> 60 years) compared to middle-aged patients (“bimodal” peaks)
·
Lymph
node metastases are more common in patients < 30 yrs. However, 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.
·
Distant
recurrence is slightly higher in patients < 30 yrs compared to middle-aged
patients and significantly elevated in patients > 60 yrs
·
Lymph-node
recurrence-free survival of the patients < 20 yrs was poorer than that of
patients aged 21 – 40 and it was significantly poorer in the patients > 60
years
·
Distant-recurrence-free
survival was poorer in patients > 60 yrs
These
findings indicate that young (< 30 yrs) and older (> 60 yrs) patients
more frequently show carcinoma recurrence compared to middle-aged patients.
Locoregional and distant recurrence are dominant in young and old patients,
respectively. It is however, 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.
Source:
1.Endocrine
Journal 61 (3) 205
2.The
Updated AJCC/TNM Staging System for Differentiated and Anaplastic Thyroid
Cancer (8th edition): What changed and why? Thyroid 2017
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