Ultrasonography.  2017 Oct;36(4):355-362. 10.14366/usg.17010.

Clinical features of recently diagnosed papillary thyroid carcinoma in elderly patients aged 65 and older based on 10 years of sonographic experience at a single institution in Korea

• Kim ES
• Lee Y
• Seo H
• Son GS
• Kwon SY
• Kim YS
• Seo JA
• Kim NH
• Suh SI
• Ryoo I
• You SH

• KMID: 2393101
• DOI: http://doi.org/10.14366/usg.17010

Abstract

PURPOSE
The aim of this study was to assess the characteristics of papillary thyroid carcinoma (PTC) in patients aged 65 and older in order to predict postoperative recurrence based on the results of ultrasonographic surveillance.
METHODS
Among 1,494 patients (200 male and 1,294 female; mean age, 46.6±11.3 years) who underwent surgery for thyroid cancer at our institution between 2006 and 2015, we retrospectively enrolled 150 PTC patients (29 male and 121 female; mean age, 69.4±4.2 years). To identify the risk factors for recurrence, we analyzed age, gender, multiplicity, size, number, extrathyroidal extension (ETE) of the tumor, lymph node metastasis (LNM), type of surgery, and the dose of radioactive ablation using a Cox regression model to identify hazard ratios (HRs).
RESULTS
Among the 115 asymptomatic patients with PTCs detected by screening ultrasonography (n=86), other cross-sectional imaging modalities (computed tomography or positron emission tomography-computed tomography, n=13), or incidentally through a surgical specimen (n=16), 78 patients were confirmed to have papillary thyroid microcarcinomas (PTMCs). The other 35 patients presented with palpable neck masses (n=25), vocal cord palsy (n=9) or blood-tinged sputum (n=1). During the follow-up period (mean, 43.6 months), 17 patients (12.5%) experienced recurrence in the neck. None of the patients died due to PTC-related recurrence or distant metastasis during the follow-up period. Cox regression analysis demonstrated that tumor size (HR, 2.12; P<0.001) and LNM (central LNM: HR, 9.08; P=0.004; lateral LNM: HR, 14.71; P=0.002; both central and lateral LNM: HR, 58.41; P<0.001) significantly increased the recurrence rate. ETE, LNM, and recurrence were significantly less frequent in PTMCs than in non-PTMC (all P<0.001).
CONCLUSION
PTCs of small size and absent LNM showed significantly better prognoses in patients 65 years and older.

Keyword

Thyroid cancer, papillary; Papillary thyroid microcarcinoma; Aged; Treatment outcomes; Surgery

MeSH Terms

Aged*
Electrons
Female
Follow-Up Studies
Humans
Korea*
Lymph Nodes
Male
Mass Screening
Neck
Neoplasm Metastasis
Prognosis
Recurrence
Retrospective Studies
Risk Factors
Sputum
Thyroid Gland*
Thyroid Neoplasms*
Ultrasonography*
Vocal Cord Paralysis