Abstract
Background
Age is one of the important prognostic indicators of papillary thyroid cancer (PTC).
However, the distinct metastatic patterns and prognosis of age-related lymph node
metastasis (LNM) are unclear. This study aims to investigate the impact of age on
LNM.
Methods
We conducted two independent cohort studies to assess age–nodal disease association
using logistic regression analysis and a restricted cubic splines model. A multivariable
Cox regression model was utilized to test the impact of nodal disease on cancer-specific
survival (CSS) after age stratification.
Results
For this study, we included 7572 and 36,793 patients with PTC in Xiangya and SEER
cohorts, respectively. After adjustment, advanced age was linearly associated with
decreasing risk of central LNM. Patients of age ≤18 years (OR = 4.41, P < 0.001) and 19–45 years (OR = 1.97, P = 0.002) had a higher risk of developing lateral LNM than patients of age >60 years
in both cohorts. Furthermore, CSS is significantly reduced in N1b disease (P < 0.001), not N1a disease, regardless of age. The incidence of high-volume LNM (HV-LNM)
was significantly higher in patients of age ≤18 years and 19–45 years than in those
of age >60 years (P < 0.001), in both cohorts. In addition, CSS was compromised in patients with PTC
of age 46–60 years (HR = 1.61, P = 0.022) and those of age >60 (HR = 1.40, P = 0.021)
after developing HV-LNM.
Conclusions
Patient age is significantly associated with LNM and HV-LNM. Patients with N1b disease
or patients with HV-LNM of age >45 years have significantly shorter CSS. Age can,
thus, be a useful guide for determining treatment strategies in PTC.
Keywords
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Article info
Publication history
Published online: February 23, 2023
Accepted:
February 20,
2023
Received in revised form:
February 9,
2023
Received:
September 20,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
