Does the Risk of Recurrence of Differentiated Thyroid Carcinoma Differ by Gender?
Differentiated thyroid carcinomas (DTC) are typically diagnosed at more advanced stages in men than in women, and mortality from this disease is higher among men than women. However, it was not entirely clear whether the risk of DTC recurrence is influenced by the patient's gender independently of the disease stage at the time of diagnosis. The aim of the Canadian authors' study was to assess whether male gender is an independent risk factor for DTC recurrence.
Evaluated Population and Data
The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a registry focused on the care of patients with DTC. The authors included in their study those patients from the CANNECT registry who were diagnosed with DTC at the age of ≥ 18 years between 2000 and 2010. The study compared the manifestations, treatment, and risk of DTC recurrence according to the American Joint Committee on Cancer (AJCC) between men and women.
Results
The study included 2,595 patients, of whom 2,067 (79.7%) were women and 528 (20.3%) were men. In the sample, men were diagnosed with DTC at a more advanced AJCC stage (p < 0,001) and more advanced TNM classification stages (more advanced T stage: p < 0,001; N stage: p < 0,001; M stage: p = 0,002). There was no difference in the length of follow-up (7.7 ± 4.0 years for both women and men).
The total recurrence rate was 2.2% (n = 46) in women and 8.5% (n = 45) in men (p < 0.001). In a multivariate analysis adjusted for AJCC disease stage, men had a significantly higher risk of DTC recurrence than women (adjusted hazard ratio [HR] 2.72; 95% confidence interval [CI] 1.78–4.20; p < 0.001). Men also had a significantly higher risk of DTC recurrence than women in a multivariate analysis adjusted for TNM classification stage (adjusted HR 2.31; 95% CI 1.48–3.60; p < 0.001).
Conclusions
The results of this study confirmed that the risk of DTC recurrence is significantly higher in men than in women, regardless of the disease stage at the time of diagnosis. DTC is diagnosed at a later stage in men, but the difference in recurrence risk persists even after adjustment for disease stage. In the future, it may be necessary to consider whether the intensity and duration of follow-up after DTC treatment should take the patient's gender into account.
(epa)
Source: Zahedi A., Bondaz L., Rajaraman M. et al. Risk for thyroid cancer recurrence is higher in men than in women independent of disease stage at presentation. Thyroid 2019 Nov 13; doi: 10.1089/thy.2018.0775 [Epub ahead of print].
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