Endocrinol Metab.  2015 Sep;30(3):305-311. 10.3803/EnM.2015.30.3.305.

Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma

• Kwon H
• Kim M
• Choi YM
• Jang EK
• Jeon MJ
• Kim WG
• Kim TY
• Shong YK
• Song DE
• Baek JH
• Hong SJ
• Kim WB

• KMID: 2407081
• DOI: http://doi.org/10.3803/EnM.2015.30.3.305

Abstract

BACKGROUND
Obesity is associated with aggressive pathological features and poor clinical outcomes in breast and prostate cancers. In papillary thyroid carcinoma (PTC), these relationships remain still controversial. This study aimed to evaluate the associations between body mass index (BMI) and the clinical outcomes of patients with PTC.
METHODS
This retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size. Clinical outcomes were evaluated and compared based on the BMI quartiles.
RESULTS
There were no significant associations between BMI quartiles and primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, or distant metastasis. However, an increase in mean age was associated with an increased BMI (P for trend <0.001). Multifocality and advanced tumor-node-metastasis (TNM) stage (stage III or IV) were significantly associated with increases of BMI (P for trend 0.02 and <0.001, respectively). However, these associations of multifocality and advanced TNM stage with BMI were not significant in multivariate analyses adjusted for age and gender. Moreover, there were no differences in recurrence-free survivals according to BMI quartiles (P=0.26).
CONCLUSION
In the present study, BMI was not associated with the aggressive clinicopathological features or recurrence-free survivals in patients with PTC.

Keyword

Obesity; Thyroid neoplasms; Prognosis

MeSH Terms

Body Mass Index*
Breast
Humans
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Obesity
Prognosis
Prostatic Neoplasms
Retrospective Studies
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy

Figure

• 

  Fig. 1 Recurrence-free survivals across the body mass index (BMI) quartiles. There were no significant differences in recurrence-free survivals of papillary thyroid carcinoma patients across the BMI quartiles. The numbers of patients who remained no evidence of disease at each time point were described at the bottom.

Reference

1. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008; 371:569–578. PMID: 18280327.

2. Wolin KY, Carson K, Colditz GA. Obesity and cancer. Oncologist. 2010; 15:556–565. PMID: 20507889.

3. Marcello MA, Cunha LL, Batista FA, Ward LS. Obesity and thyroid cancer. Endocr Relat Cancer. 2014; 21:T255–T271. PMID: 24741026.

4. De Pergola G, Silvestris F. Obesity as a major risk factor for cancer. J Obes. 2013; 2013:291546. PMID: 24073332.

5. Tresallet C, Seman M, Tissier F, Buffet C, Lupinacci RM, Vuarnesson H, et al. The incidence of papillary thyroid carcinoma and outcomes in operative patients according to their body mass indices. Surgery. 2014; 156:1145–1152. PMID: 24878452.

6. Han JM, Kim TY, Jeon MJ, Yim JH, Kim WG, Song DE, et al. Obesity is a risk factor for thyroid cancer in a large, ultrasonographically screened population. Eur J Endocrinol. 2013; 168:879–886. PMID: 23513231.

7. Marcello MA, Sampaio AC, Geloneze B, Vasques AC, Assumpcao LV, Ward LS. Obesity and excess protein and carbohydrate consumption are risk factors for thyroid cancer. Nutr Cancer. 2012; 64:1190–1195. PMID: 23163848.

8. Zhao ZG, Guo XG, Ba CX, Wang W, Yang YY, Wang J, et al. Overweight, obesity and thyroid cancer risk: a meta-analysis of cohort studies. J Int Med Res. 2012; 40:2041–2050. PMID: 23321160.

9. Rinaldi S, Lise M, Clavel-Chapelon F, Boutron-Ruault MC, Guillas G, Overvad K, et al. Body size and risk of differentiated thyroid carcinomas: findings from the EPIC study. Int J Cancer. 2012; 131:E1004–E1014. PMID: 22511178.

10. Xu L, Port M, Landi S, Gemignani F, Cipollini M, Elisei R, et al. Obesity and the risk of papillary thyroid cancer: a pooled analysis of three case-control studies. Thyroid. 2014; 24:966–974. PMID: 24555500.

11. Strom SS, Wang X, Pettaway CA, Logothetis CJ, Yamamura Y, Do KA, et al. Obesity, weight gain, and risk of biochemical failure among prostate cancer patients following prostatectomy. Clin Cancer Res. 2005; 11(19 Pt 1):6889–6894. PMID: 16203779.

12. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Lancet. 1997; 350:1047–1059. PMID: 10213546.

13. Borugian MJ, Sheps SB, Kim-Sing C, Olivotto IA, Van Patten C, Dunn BP, et al. Waist-to-hip ratio and breast cancer mortality. Am J Epidemiol. 2003; 158:963–968. PMID: 14607804.

14. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010; 123:627–635. PMID: 20571870.

15. Kim HJ, Kim NK, Choi JH, Sohn SY, Kim SW, Jin SM, et al. Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer. Clin Endocrinol (Oxf). 2013; 78:134–140. PMID: 22812676.

16. Harari A, Endo B, Nishimoto S, Ituarte PH, Yeh MW. Risk of advanced papillary thyroid cancer in obese patients. Arch Surg. 2012; 147:805–811. PMID: 22914989.

17. Paes JE, Hua K, Nagy R, Kloos RT, Jarjoura D, Ringel MD. The relationship between body mass index and thyroid cancer pathology features and outcomes: a clinicopathological cohort study. J Clin Endocrinol Metab. 2010; 95:4244–4250. PMID: 20519347.

18. Kim JY, Jung EJ, Jeong SH, Jeong CY, Ju YT, Lee YJ, et al. The indices of body size and aggressiveness of papillary thyroid carcinoma. J Korean Surg Soc. 2011; 80:241–244. PMID: 22066042.

19. Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer;2010. p. 87–96.

20. Yim JH, Kim WB, Kim EY, Kim WG, Kim TY, Ryu JS, et al. The outcomes of first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma in patients who initially underwent total thyroidectomy and remnant ablation. J Clin Endocrinol Metab. 2011; 96:2049–2056. PMID: 21508143.

21. Hay ID, Hutchinson ME, Gonzalez-Losada T, McIver B, Reinalda ME, Grant CS, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery. 2008; 144:980–987. PMID: 19041007.

22. Baudin E, Travagli JP, Ropers J, Mancusi F, Bruno-Bossio G, Caillou B, et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer. 1998; 83:553–559. PMID: 9690549.

23. Appetecchia M, Scarcello G, Pucci E, Procaccini A. Outcome after treatment of papillary thyroid microcarcinoma. J Exp Clin Cancer Res. 2002; 21:159–164. PMID: 12148571.

24. World Health Organization. Obesity: preventing and managing the global epidemic: report of a WHO consultation on obesity. Geneva: World Health Organization;1997.

25. Korean Endocrine Society. Korean Society for the Study of Obesity. Management of obesity, 2010 recommendation. Endocrinol Metab (Seoul). 2010; 25:301–304.