Advertisement

Lack of association between obesity and aggressiveness of differentiated thyroid cancer

  • G. Grani
  • L. Lamartina
  • T. Montesano
  • G. Ronga
  • V. Maggisano
  • R. Falcone
  • V. Ramundo
  • L. Giacomelli
  • C. Durante
  • D. Russo
  • M. Maranghi
Original Article

Abstract

Purpose

Aim of this study was to evaluate the association between body mass index (BMI) and aggressive features of differentiated thyroid cancer (DTC) in a prospective cohort.

Methods

Patients with DTC were prospectively enrolled at a tertiary referral center and grouped according to their BMI. Aggressive clinic-pathological features were analyzed following the American Thyroid Association Initial Risk Stratification System score.

Results

The cohort was composed of 432 patients: 5 (1.2%) were underweight, 187 (43.3%) normal weight, 154 (35.6%) overweight, 68 (15.7%) grade 1 obese, 11 (2.5%) grade 2 obese and 7 (1.6%) grade 3 obese. No single feature of advanced thyroid cancer was more frequent in obese patients than in others. No significant correlation was found between BMI, primary tumor size (Spearman’s ρ − 0.02; p = 0.71) and ATA Initial Risk Stratification System score (ρ 0.03; p = 0.49), after adjustment for age. According to the multivariate logistic regression analysis, male gender and pre-surgical diagnosis of cancer were significant predictors of cancer with high or intermediate–high recurrence risk according to the ATA system (OR 2.06 and 2.51, respectively), while older age at diagnosis was a protective factor (OR 0.98), and BMI was not a predictor. BMI was a predictor of microscopic extrathyroidal extension only (OR 1.06).

Conclusions

Obesity was not associated with aggressive features in this prospective, European cohort of patients with DTC.

Keywords

Obesity Body mass index Thyroid cancer Cancer size Aggressive cancer Advanced stage 

Notes

Acknowledgements

The study was supported by the Italian Ministry of Universities and Research (MIUR/PRIN 2015 cod. 2015B7M39T_005), the Fondazione Umberto Di Mario ONLUS and Banca d’Italia.

Author contributions

GG and LL contributed to this paper as recipients of the PhD program of Biotechnologies and Clinical Medicine of the University of Rome, Sapienza.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Thyroid cancer patient data were collected at our site, after obtaining the informed consent of the patients and approval of the local ethics committee.

Data availability

The datasets generated during and analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. 1.
    Flegal KM, Kruszon-Moran D, Carroll MD et al (2016) Trends in obesity among adults in the United States, 2005 to 2014. JAMA 315:2284–2291.  https://doi.org/10.1001/jama.2016.6458 CrossRefPubMedGoogle Scholar
  2. 2.
    Ogden CL, Carroll MD, Lawman HG et al (2016) Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA 315:2292–2299.  https://doi.org/10.1001/jama.2016.6361 CrossRefPubMedGoogle Scholar
  3. 3.
    Buscemi S, Massenti FM, Vasto S et al (2017) Association of obesity and diabetes with thyroid nodules. Endocrine.  https://doi.org/10.1007/s12020-017-1394-2 PubMedGoogle Scholar
  4. 4.
    Panagiotou G, Komninou D, Anagnostis P et al (2017) Association between lifestyle and anthropometric parameters and thyroid nodule features. Endocrine 56:560–567.  https://doi.org/10.1007/s12020-017-1285-6 CrossRefPubMedGoogle Scholar
  5. 5.
    Zhao ZG, Guo XG, Ba CX et al (2012) Overweight, obesity and thyroid cancer risk: a meta-analysis of cohort studies. J Int Med Res 40:2041–2050.  https://doi.org/10.1177/030006051204000601 CrossRefPubMedGoogle Scholar
  6. 6.
    Rinaldi S, Lise M, Clavel-Chapelon F et al (2012) Body size and risk of differentiated thyroid carcinomas: findings from the EPIC study. Int J Cancer 131:E1004–E1014.  https://doi.org/10.1002/ijc.27601 CrossRefPubMedGoogle Scholar
  7. 7.
    Han JM, Kim TY, Jeon MJ et al (2013) Obesity is a risk factor for thyroid cancer in a large, ultrasonographically screened population. Eur J Endocrinol 168:879–886.  https://doi.org/10.1530/eje-13-0065 CrossRefPubMedGoogle Scholar
  8. 8.
    Pak K, Shin S, Kim SJ et al (2017) Risk of malignancy in thyroid incidentaloma is not increased in overweight or obese patients, but in young patients. Nutr Cancer 69:580–584.  https://doi.org/10.1080/01635581.2017.1299877 CrossRefPubMedGoogle Scholar
  9. 9.
    Rotondi M, Castagna MG, Cappelli C et al (2016) Obesity does not modify the risk of differentiated thyroid cancer in a cytological series of thyroid nodules. Eur Thyroid J 5:125–131.  https://doi.org/10.1159/000445054 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Lamartina L, Grani G, Durante C, Filetti S (2018) Recent advances in managing differentiated thyroid cancer [version 1; referees: 2 approved]. F1000Res 7:86.  https://doi.org/10.12688/f1000research.12811.1 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Lamartina L, Cooper DS (2015) Radioiodine remnant ablation in low-risk differentiated thyroid cancer: the “con” point of view. Endocrine 50:67–71.  https://doi.org/10.1007/s12020-014-0523-4 CrossRefPubMedGoogle Scholar
  12. 12.
    Grani G, Carbotta G, Nesca A et al (2015) A comprehensive score to diagnose Hashimoto’s thyroiditis: a proposal. Endocrine 49:361–365.  https://doi.org/10.1007/s12020-014-0441-5 CrossRefPubMedGoogle Scholar
  13. 13.
    Haugen BR, Alexander EK, Bible KC et al (2016) 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133.  https://doi.org/10.1089/thy.2015.0020 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bulotta S, Celano M, Costante G, Russo D (2016) Emerging strategies for managing differentiated thyroid cancers refractory to radioiodine. Endocrine 52:214–221.  https://doi.org/10.1007/s12020-015-0830-4 CrossRefPubMedGoogle Scholar
  15. 15.
    Cabanillas ME, McFadden DG, Durante C (2016) Thyroid cancer. Lancet 388:2783–2795.  https://doi.org/10.1016/s0140-6736(16)30172-6 CrossRefPubMedGoogle Scholar
  16. 16.
    Kitahara CM, Platz EA, Freeman LE et al (2011) Obesity and thyroid cancer risk among U.S. men and women: a pooled analysis of five prospective studies. Cancer Epidemiol Biomark Prev 20:464–472.  https://doi.org/10.1158/1055-9965.epi-10-1220 CrossRefGoogle Scholar
  17. 17.
    Shin HY, Jee YH, Cho ER (2017) Body mass index and incidence of thyroid cancer in Korea: the Korean Cancer prevention study-II. J Cancer Res Clin Oncol 143:143–149.  https://doi.org/10.1007/s00432-016-2261-x CrossRefPubMedGoogle Scholar
  18. 18.
    Kwon H, Kim M, Choi YM et al (2015) Lack of associations between body mass index and clinical outcomes in patients with papillary thyroid carcinoma. Endocrinol Metab (Seoul) 30:305–311.  https://doi.org/10.3803/EnM.2015.30.3.305 CrossRefGoogle Scholar
  19. 19.
    Paes JE, Hua K, Nagy R et al (2010) The relationship between body mass index and thyroid cancer pathology features and outcomes: a clinicopathological cohort study. J Clin Endocrinol Metab 95:4244–4250.  https://doi.org/10.1210/jc.2010-0440 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chung YS, Lee JH, Lee YD (2017) Is body mass index relevant to prognosis of papillary thyroid carcinoma? A clinicopathological cohort study. Surg Today 47:506–512.  https://doi.org/10.1007/s00595-016-1417-2 CrossRefPubMedGoogle Scholar
  21. 21.
    Kim HJ, Kim NK, Choi JH et al (2013) Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer. Clin Endocrinol (Oxf) 78:134–140.  https://doi.org/10.1111/j.1365-2265.2012.04506.x CrossRefGoogle Scholar
  22. 22.
    Dieringer P, Klass EM, Caine B, Smith-Gagen J (2015) Associations between body mass and papillary thyroid cancer stage and tumor size: a population-based study. J Cancer Res Clin Oncol 141:93–98.  https://doi.org/10.1007/s00432-014-1792-2 CrossRefPubMedGoogle Scholar
  23. 23.
    Harari A, Endo B, Nishimoto S et al (2012) Risk of advanced papillary thyroid cancer in obese patients. Arch Surg 147:805–811.  https://doi.org/10.1001/archsurg.2012.713 CrossRefPubMedGoogle Scholar
  24. 24.
    Yu ST, Chen W, Cai Q et al (2017) Pretreatment BMI is associated with aggressive clinicopathological features of papillary thyroid carcinoma: a multicenter study. Int J Endocrinol 2017:5841942.  https://doi.org/10.1155/2017/5841942 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Liu Z, Maimaiti Y, Yu P et al (2015) Correlation between body mass index and clinicopathological features of papillary thyroid microcarcinoma. Int J Clin Exp Med 8:16472–16479PubMedPubMedCentralGoogle Scholar
  26. 26.
    Wu C, Wang L, Chen W et al (2017) Associations between body mass index and lymph node metastases of patients with papillary thyroid cancer: a retrospective study. Medicine (Baltim) 96:e6202.  https://doi.org/10.1097/md.0000000000006202 CrossRefGoogle Scholar
  27. 27.
    Choi JS, Kim EK, Moon HJ, Kwak JY (2015) Higher body mass index may be a predictor of extrathyroidal extension in patients with papillary thyroid microcarcinoma. Endocrine 48:264–271.  https://doi.org/10.1007/s12020-014-0293-z CrossRefPubMedGoogle Scholar
  28. 28.
    Diker-Cohen T, Hirsch D, Shimon I et al (2018) Impact of minimal extra-thyroid extension in differentiated thyroid cancer: systematic review and meta-analysis. J Clin Endocrinol Metab.  https://doi.org/10.1210/jc.2018-00081 Google Scholar
  29. 29.
    Castagna MG, Forleo R, Maino F et al (2018) Small papillary thyroid carcinoma with minimal extrathyroidal extension should be managed as ATA low-risk tumor. J Endocrinol Invest.  https://doi.org/10.1007/s40618-018-0854-8 Google Scholar
  30. 30.
    Lamartina L, Grani G, Arvat E et al (2017) 8th edition of AJCC/TNM staging system of thyroid cancer: what to expect. Endocr Relat Cancer 25:L7–L11.  https://doi.org/10.1530/ERC-17-0453 CrossRefPubMedGoogle Scholar
  31. 31.
    Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid 27:751–756.  https://doi.org/10.1089/thy.2017.0102 CrossRefPubMedGoogle Scholar
  32. 32.
    Lamartina L, Durante C, Lucisano G et al (2017) Are evidence-based guidelines reflected in clinical practice? an analysis of prospectively collected data of the italian thyroid cancer observatory. Thyroid 27:1490–1497.  https://doi.org/10.1089/thy.2017.0299 CrossRefPubMedGoogle Scholar
  33. 33.
    Dal Maso L, Panato C, Franceschi S et al (2018) The impact of overdiagnosis on thyroid cancer epidemic in Italy, 1998–2012. Eur J Cancer 94:6–15.  https://doi.org/10.1016/j.ejca.2018.01.083 CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2018

Authors and Affiliations

  • G. Grani
    • 1
  • L. Lamartina
    • 1
  • T. Montesano
    • 2
  • G. Ronga
    • 2
  • V. Maggisano
    • 3
  • R. Falcone
    • 1
  • V. Ramundo
    • 1
  • L. Giacomelli
    • 4
  • C. Durante
    • 1
  • D. Russo
    • 3
  • M. Maranghi
    • 1
  1. 1.Dipartimento di Medicina Interna e Specialità MedicheSapienza Università di RomaRomeItaly
  2. 2.Unità di Medicina NucleareSapienza Università di RomaRomeItaly
  3. 3.Dipartimento di Scienze della SaluteUniversità di Catanzaro “Magna Graecia”CatanzaroItaly
  4. 4.Dipartimento di Scienze ChirurgicheSapienza Università di RomaRomeItaly

Personalised recommendations