Differentiated thyroid cancer in patients over 60 years of age at presentation: A retrospective study of 438 patients Aayushi Garg, Saurav Chopra, Sanjana Ballal, Ramya Soundararajan, C.S. Bal ⁎ Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India ARTICLE INFO ABSTRACT Article history: Received 7 May 2014 Received in revised form 22 August 2014 Accepted 18 September 2014 Available online 3 October 2014 Objectives: The aim of this study is to identify the prognostic factors predicting remission and subsequent disease relapse in patients with differentiated thyroid cancer (DTC) greater than 60 years of age. Materials and Methods: The institute thyroid cancer database had 4370 patients with DTC, of which 447 (10%) were aged > 60. However, 9 patients were excluded due to follow-up less than 1 year. The prognostic factors in the remaining 438 patients were studied. Results: Among the 438 patients, 311 (71%) had only loco-regional disease (M 0 ) and 127 (29%) had distant metastases (M 1 ) at the time of initial presentation. The host factors predictive of distant metastases at presentation were female gender, primary tumor size (> 4 cm), follicular histology, and extra-thyroidal extension. Among M o patients, 195 (63%) achieved complete remission while only 12 (9%) M 1 patients did so. Average number of radioactive iodine ( 131 I) doses administered to achieve complete remission was 2.3 (range, 1–6) and the mean cumulative dose was 3404 MBq (range, 925–46,250 MBq). In multivariate logistic regression among M 0 patients, follicular histology, nodal metastases, and surgical treatment lesser than total/near-total thyroidectomy and among M 1 patients, site of distant metastases (skeletal and multiple sites) were independent factors predicting non-remission. Among the patients (both M 0 and M 1 ) who achieved remission, factors associated with disease recurrence were primary tumor size (>4 cm), nodal metastases, pulmonary metastases, and non-remission after first dose of radioactive iodine and were associated with greater chances of disease relapse. Conclusion: This study highlights that DTC in older patients behaves more aggressively than in adults age < 60 years, and identifies several prognostic factors for remission and subsequent relapse. © 2014 Elsevier Ltd. All rights reserved. Keywords: Differentiated thyroid cancer Elderly Prognostic factors Remission Recurrence 1. Introduction Thyroid cancer accounts for only 1% of all human cancers, but it is the most common endocrine malignancy 1 . Differentiated thyroid cancer (DTC) comprising of papillary and follicular histology, makes up 90% of all thyroid cancers 2 . Unlike other cancers, DTC has been shown to have favourable overall prognosis with 10-year survival rates as high as 93% in papillary thyroid cancer (PTC) and 85% in follicular thyroid cancer (FTC) 3 . Maximum disease-related mortality has been attributed to distant metastases 4 . American Joint Commis- sion on Cancer (AJCC) staging system stratifies the risk in JOURNAL OF GERIATRIC ONCOLOGY 6 (2015) 29 – 37 ⁎ Corresponding author. Tel.: +91 11 26593530; fax: +91 11 2658864. E-mail addresses: aayushigarg18@gmail.com (A. Garg), saurav.quasar@gmail.com (S. Chopra), mail.sanjanaballal87@gmail.com (S. Ballal), ramyasoundar@yahoo.co.in (R. Soundararajan), csbal@hotmail.com (C.S. Bal). http://dx.doi.org/10.1016/j.jgo.2014.09.182 1879-4068/© 2014 Elsevier Ltd. All rights reserved. Available online at www.sciencedirect.com ScienceDirect