Effect of Age on Presentation, Management, and Outcome of Patients with Differentiated Thyroid Carcinoma: Retrospective Study

SM Chow, CK Kwan, PCM Poon, SCK Law

Hong Kong J Radiol 2004;7:181-6

Objective: To investigate the effect of age on presentation, management, and outcome of differentiated thyroid carcinoma.

Patients and Methods: Records of a cohort of 1369 patients who presented between 1960 and 2000 to the Department of Clinical Oncology at the Queen Elizabeth Hospital with papillary or follicular thyroid carcinoma were studied after stratification into the following age groups: younger than 30 years, 30 to 45 years, 46 to 60 years, and older than 60 years.

Results: At presentation, patients older than 60 years had advanced T and M stage disease: for follicular thyroid carcinoma, 32.9% had T3 disease, 17.1% had T4 disease, and 29.3% had distant metastasis; for papillary thyroid carcinoma, 60.6% had T4 disease and 21.3% had distant metastasis. The oldest patients had the worst prognosis: after a mean follow-up of 10 years, only 45.1% of patients older than 60 years who had follicular thyroid carcinoma and 57.6% of those with papillary thyroid carcinoma were alive without disease. Within this age group, distant metastasis occurred frequently among those with follicular thyroid carcinoma (42.7%). Differentiated thyroid carcinoma was the cause of death for 25.6% of the oldest patients with follicular thyroid carcinoma and 20.8% of those with papillary thyroid carcinoma. The 10-year cause-specific survival for patients with follicular thyroid carcinoma who were younger than 30 years, aged 30 to 45 years, 46 to 60 years, and older than 60 years was 97.6%, 92.7%, 81.5%, and 67.8%, respectively; the corresponding figures for papillary thyroid carcinoma were 100%, 98.8%, 90.6% and 75.4%.

Conclusions: The prognosis of differentiated thyroid carcinoma gets worse with advancing age. Total thyroidectomy with consideration for radioactive iodine (I 131) ablation or external beam radiation therapy should be the protocol of treatment for patients of all age groups.