Skip to main content
SpringerLink
Log in

Higher body mass index may be a predictor of extrathyroidal extension in patients with papillary thyroid microcarcinoma

  • Original Article
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Recently, higher body mass index (BMI) has been associated with aggressive pathologic features of papillary thyroid carcinoma. The aim of this study was to clarify the relationship between BMI and aggressive pathologic features of papillary thyroid microcarcinoma (PTMC) and to evaluate whether the BMI can be a prognostic factor of PTMC. This retrospective study included 612 PTMC patients who underwent surgical excision at a referral center between April 2006 and December 2007. Patients were grouped according to BMI (<25 or ≥25 kg/m2). Multivariable logistic regression analysis was performed to determine independent predictors of aggressive pathologic features (advanced stage, extrathyroidal extension, and lymph node metastasis), with adjustment for age, gender, tumor size, multifocality, thyroid stimulating hormone (TSH) level, and BMI (value/group). PTMC patients with a BMI ≥ 25 kg/m2 showed significantly higher prevalences of extrathyroidal extension, advanced pathologic TNM stage, and male gender, compared to those of patients with a BMI < 25 kg/m2. Lymph node metastasis and mean TSH level were not significantly different between the two BMI subgroups. In multivariable analysis, the BMI ≥ 25 kg/m2 group was positively associated with the presence of extrathyroidal extension (adjusted odds ratio 1.49, P = 0.05). Higher BMI was associated with extrathyroidal extension in PTMC patients. This study suggests that the BMI could be considered as a prognostic factor for predicting the presence of extrathyroidal extension and it may help decide the appropriate surgical extent for PTMC patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. L. Davies, H.G. Welch, Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295(18), 2164–2167 (2006). doi:10.1001/jama.295.18.2164

    Article  CAS  PubMed  Google Scholar 

  2. B.A. Kilfoy, T. Zheng, T.R. Holford, X. Han, M.H. Ward, A. Sjodin, Y. Zhang, Y. Bai, C. Zhu, G.L. Guo, N. Rothman, Y. Zhang, International patterns and trends in thyroid cancer incidence, 1973-2002. Cancer Causes Control 20(5), 525–531 (2009). doi:10.1007/s10552-008-9260-4

    Article  PubMed Central  PubMed  Google Scholar 

  3. C. Hedinger, E.D. Williams, L.H. Sobin, The WHO histological classification of thyroid tumors: a commentary on the second edition. Cancer 63(5), 908–911 (1989)

    Article  CAS  PubMed  Google Scholar 

  4. S. Noguchi, H. Yamashita, S. Uchino, S. Watanabe, Papillary microcarcinoma. World J. Surg. 32(5), 747–753 (2008). doi:10.1007/s00268-007-9453-0

    Article  PubMed Central  PubMed  Google Scholar 

  5. American Thyroid Association Guidelines Taskforce on Thyroid, N., Differentiated Thyroid, C., Cooper, D.S., Doherty, G.M., Haugen, B.R., Kloos, R.T., Lee, S.L., Mandel, S.J., Mazzaferri, E.L., McIver, B., Pacini, F., Schlumberger, M., Sherman, S.I., Steward, D.L., Tuttle, R.M.: Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid : official journal of the American Thyroid Association 19(11), 1167–1214 (2009). doi:10.1089/thy.2009.0110

  6. R. Gallicchio, S. Giacomobono, D. Capacchione, A. Nardelli, F. Barbato, A. Nappi, T. Pellegrino, G. Storto, Should patients with remnants from thyroid microcarcinoma really not be treated with iodine-131 ablation? Endocrine 44(2), 426–433 (2013). doi:10.1007/s12020-013-9935-9

    Article  CAS  PubMed  Google Scholar 

  7. J. Lee, J.H. Park, C.R. Lee, W.Y. Chung, C.S. Park, Long-term outcomes of total thyroidectomy versus thyroid lobectomy for papillary thyroid microcarcinoma: comparative analysis after propensity score matching. Thyroid 23(11), 1408–1415 (2013). doi:10.1089/thy.2012.0463

    Article  PubMed  Google Scholar 

  8. L. Wartofsky, Should patients with papillary microcarcinoma undergo radioiodine ablation? Endocrine 44(2), 278–279 (2013)

    Article  CAS  PubMed  Google Scholar 

  9. N. Neuhold, A. Schultheis, M. Hermann, G. Krotla, O. Koperek, P. Birner, Incidental papillary microcarcinoma of the thyroid–further evidence of a very low malignant potential: a retrospective clinicopathological study with up to 30 years of follow-up. Ann. Surg. Oncol. 18(12), 3430–3436 (2011). doi:10.1245/s10434-011-1663-x

    Article  PubMed  Google Scholar 

  10. C. Cappelli, M. Castellano, M. Braga, E. Gandossi, I. Pirola, E. De Martino, B. Agosti, E.A. Rosei, Aggressiveness and outcome of papillary thyroid carcinoma (PTC) versus microcarcinoma (PMC): a mono-institutional experience. J. Surg. Oncol. 95(7), 555–560 (2007). doi:10.1002/jso.20746

    Article  CAS  PubMed  Google Scholar 

  11. M.R. Pelizzo, I.M. Boschin, A. Toniato, A. Piotto, P. Bernante, C. Pagetta, L. Rampin, D. Rubello, Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients. Eur. J. Surg. Oncol. 32(10), 1144–1148 (2006). doi:10.1016/j.ejso.2006.07.001

    Article  CAS  PubMed  Google Scholar 

  12. A.G. Renehan, M. Tyson, M. Egger, R.F. Heller, M. Zwahlen, Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 371(9612), 569–578 (2008). doi:10.1016/S0140-6736(08)60269-X

    Article  PubMed  Google Scholar 

  13. P. Brindel, F. Doyon, F. Rachedi, J.L. Boissin, J. Sebbag, L. Shan, V. Chungue, F. Bost-Bezeaud, P. Petitdidier, J. Paoaafaite, J. Teuri, F. de Vathaire, Anthropometric factors in differentiated thyroid cancer in French Polynesia: a case-control study. Cancer Causes Control 20(5), 581–590 (2009). doi:10.1007/s10552-008-9266-y

    Article  PubMed  Google Scholar 

  14. C.M. Kitahara, E.A. Platz, L.E. Freeman, A.W. Hsing, M.S. Linet, Y. Park, C. Schairer, A. Schatzkin, J.M. Shikany, A. de Berrington Gonzalez, Obesity and thyroid cancer risk among US men and women: a pooled analysis of five prospective studies. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive. Oncology 20(3), 464–472 (2011). doi:10.1158/1055-9965.EPI-10-1220

    Google Scholar 

  15. S.W. Oh, Y.S. Yoon, S.A. Shin, Effects of excess weight on cancer incidences depending on cancer sites and histologic findings among men: Korea National Health Insurance Corporation Study. J. Clin. Oncol. 23(21), 4742–4754 (2005). doi:10.1200/JCO.2005.11.726

    Article  PubMed  Google Scholar 

  16. C.L. Amling, R.H. Riffenburgh, L. Sun, J.W. Moul, R.S. Lance, L. Kusuda, W.J. Sexton, D.W. Soderdahl, T.F. Donahue, J.P. Foley, A.K. Chung, D.G. McLeod, Pathologic variables and recurrence rates as related to obesity and race in men with prostate cancer undergoing radical prostatectomy. J. Clin. Oncol. 22(3), 439–445 (2004). doi:10.1200/JCO.2004.03.132

    Article  PubMed  Google Scholar 

  17. E.E. Calle, C. Rodriguez, K. Walker-Thurmond, M.J. Thun, Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N. Engl. J. Med. 348(17), 1625–1638 (2003). doi:10.1056/NEJMoa021423

    Article  PubMed  Google Scholar 

  18. K.M. Hahn, M.L. Bondy, M. Selvan, M.J. Lund, J.M. Liff, E.W. Flagg, L.A. Brinton, P. Porter, J.W. Eley, R.J. Coates, Factors associated with advanced disease stage at diagnosis in a population-based study of patients with newly diagnosed breast cancer. Am. J. Epidemiol. 166(9), 1035–1044 (2007). doi:10.1093/aje/kwm177

    Article  PubMed  Google Scholar 

  19. A. Harari, B. Endo, S. Nishimoto, P.H. Ituarte, M.W. Yeh, Risk of advanced papillary thyroid cancer in obese patients. Arch. Surg. 147(9), 805–811 (2012). doi:10.1001/archsurg.2012.713

    Article  PubMed  Google Scholar 

  20. H.J. Kim, N.K. Kim, J.H. Choi, S.Y. Sohn, S.W. Kim, S.M. Jin, H.W. Jang, S. Suh, Y.K. Min, J.H. Chung, S.W. Kim, Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer. Clin. Endocrinol. 78(1), 134–140 (2013). doi:10.1111/j.1365-2265.2012.04506.x

    Article  Google Scholar 

  21. S.B. Edge, AJCC cancer staging manual, 7th ed. by B. Stephen Edge et al. (Springer, New York, 2010)

  22. J.Y. Kwak, E.K. Kim, J.H. Youk, M.J. Kim, E.J. Son, S.H. Choi, K.K. Oh, Extrathyroid extension of well-differentiated papillary thyroid microcarcinoma on US. Thyroid 18(6), 609–614 (2008). doi:10.1089/thy.2007.0345

    Article  PubMed  Google Scholar 

  23. D.G. Na, H.K. Lim, H.S. Byun, H.D. Kim, Y.H. Ko, J.H. Baek, Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. AJR Am. J. Roentgenol. 168(5), 1311–1316 (1997). doi:10.2214/ajr.168.5.9129432

    Article  CAS  PubMed  Google Scholar 

  24. P.W. Rosario, S. de Faria, L. Bicalho, M.F. Alves, M.A. Borges, S. Purisch, E.L. Padrao, L.L. Rezende, A.L. Barroso, Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J. Ultrasound Med. 24(10), 1385–1389 (2005)

    PubMed  Google Scholar 

  25. M. Ying, A. Ahuja, C. Metreweli, Diagnostic accuracy of sonographic criteria for evaluation of cervical lymphadenopathy. J. Ultrasound Med. 17(7), 437–445 (1998)

    CAS  PubMed  Google Scholar 

  26. P.E. Andersen, J. Kinsella, T.R. Loree, A.R. Shaha, J.P. Shah, Differentiated carcinoma of the thyroid with extrathyroidal extension. Am. J. Surg. 170(5), 467–470 (1995)

    Article  CAS  PubMed  Google Scholar 

  27. E.L. Mazzaferri, S.M. Jhiang, Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am. J. Med. 97(5), 418–428 (1994)

    Article  CAS  PubMed  Google Scholar 

  28. J.A. Sipos, E.L. Mazzaferri, Thyroid cancer epidemiology and prognostic variables. Clin. Oncol. 22(6), 395–404 (2010). doi:10.1016/j.clon.2010.05.004

    Article  CAS  Google Scholar 

  29. M. Akinci, F. Kosova, B. Cetin, S. Aslan, Z. Ari, A. Cetin, Leptin levels in thyroid cancer. Asian J. Surg./Asian Surg. Assoc. 32(4), 216–223 (2009). doi:10.1016/S1015-9584(09)60397-3

    Article  Google Scholar 

  30. F. Balkan, E.D. Onal, A. Usluogullari, D. Tuzun, D. Ozdemir, S.S. Inancli, R. Ersoy, B. Cakir, Is there any association between insulin resistance and thyroid cancer? : a case control study. Endocrine 45(1), 55–60 (2014). doi:10.1007/s12020-013-9942-x

    Article  CAS  PubMed  Google Scholar 

  31. S.P. Cheng, C.W. Chi, C.Y. Tzen, T.L. Yang, J.J. Lee, T.P. Liu, C.L. Liu, Clinicopathologic significance of leptin and leptin receptor expressions in papillary thyroid carcinoma. Surgery 147(6), 847–853 (2010). doi:10.1016/j.surg.2009.11.004

    Article  PubMed  Google Scholar 

  32. L. Dossus, R. Kaaks, Nutrition, metabolic factors and cancer risk. Best Prac. Res. Clin. Endocrinol. Metab. 22(4), 551–571 (2008). doi:10.1016/j.beem.2008.08.003

    Article  CAS  Google Scholar 

  33. S.D. Hursting, L.M. Lashinger, K.W. Wheatley, C.J. Rogers, L.H. Colbert, N.P. Nunez, S.N. Perkins, Reducing the weight of cancer: mechanistic targets for breaking the obesity-carcinogenesis link. Best Prac. Res. Clin. Endocrinol. Metab. 22(4), 659–669 (2008). doi:10.1016/j.beem.2008.08.009

    Article  CAS  Google Scholar 

  34. N. Mitsiades, K. Pazaitou-Panayiotou, K.N. Aronis, H.S. Moon, J.P. Chamberland, X. Liu, K.N. Diakopoulos, V. Kyttaris, V. Panagiotou, G. Mylvaganam, S. Tseleni-Balafouta, C.S. Mantzoros, Circulating adiponectin is inversely associated with risk of thyroid cancer: in vivo and in vitro studies. J. Clin. Endocrinol. Metab. 96(12), E2023–E2028 (2011). doi:10.1210/jc.2010-1908

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. J.S. Choi, W.Y. Chung, J.Y. Kwak, H.J. Moon, M.J. Kim, E.K. Kim, Staging of papillary thyroid carcinoma with ultrasonography: performance in a large series. Ann. Surg. Oncol. 18(13), 3572–3578 (2011). doi:10.1245/s10434-011-1783-3

    Article  PubMed  Google Scholar 

  36. D.S. McLeod, K.F. Watters, A.D. Carpenter, P.W. Ladenson, D.S. Cooper, E.L. Ding, Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J. Clin. Endocrinol. Metab. 97(8), 2682–2692 (2012). doi:10.1210/jc.2012-1083

    Article  CAS  PubMed  Google Scholar 

  37. M.R. Haymart, D.J. Repplinger, G.E. Leverson, D.F. Elson, R.S. Sippel, J.C. Jaume, H. Chen, Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J. Clin. Endocrinol. Metab. 93(3), 809–814 (2008). doi:10.1210/jc.2007-2215

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Conflicts of interest

The authors have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea

    Ji Soo Choi, Eun-Kyung Kim, Hee Jung Moon & Jin Young Kwak

  2. Department of Radiology, Samsung Medical Center, Seoul, Korea

    Ji Soo Choi

Authors
  1. Ji Soo Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eun-Kyung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hee Jung Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin Young Kwak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jin Young Kwak.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Choi, J.S., Kim, EK., Moon, H.J. et al. Higher body mass index may be a predictor of extrathyroidal extension in patients with papillary thyroid microcarcinoma. Endocrine 48, 264–271 (2015). https://doi.org/10.1007/s12020-014-0293-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-014-0293-z

Keywords

Search

Navigation