Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion
Background Laryngotracheal invasion occurs in a subset of patients with well-differentiated thyroid cancer (WDTC) and is associated with a poor prognosis. We aimed to analyze patterns and predictors/outcomes related to this high-risk manifestation. Methods This population-based analysis utilized the...
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Korean Endocrine Society
2025-04-01
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| Series: | Endocrinology and Metabolism |
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| Online Access: | http://e-enm.org/upload/pdf/enm-2024-2033.pdf |
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| author | Eman A. Toraih Jessan A. Jishu Mohammad H. Hussein Aly A. M. Shaalan Manal S. Fawzy Emad Kandil |
| author_facet | Eman A. Toraih Jessan A. Jishu Mohammad H. Hussein Aly A. M. Shaalan Manal S. Fawzy Emad Kandil |
| author_sort | Eman A. Toraih |
| collection | DOAJ |
| description | Background Laryngotracheal invasion occurs in a subset of patients with well-differentiated thyroid cancer (WDTC) and is associated with a poor prognosis. We aimed to analyze patterns and predictors/outcomes related to this high-risk manifestation. Methods This population-based analysis utilized the Surveillance, Epidemiology, and End Results (SEER) registry (2000 to 2015) to identify WDTC patients. Temporal trends and geographic variation in invasion rates were assessed. Logistic regression and propensity score matching were employed to identify predictors of secondary malignancy, mortality, and treatment impact on overall and thyroid cancer (TC)-specific survival. Results Of 131,721 WDTC patients, 1,662 (1.3%) had tracheal invasion and 976 (0.7%) had laryngeal invasion at diagnosis. Tracheal and laryngeal invasion rates declined from 3.7%–0.7% and 1.5%–0.6%, respectively, from 2000 to 2015. Compared to 98,835 noninvasive cases, patients with laryngotracheal invasion were older and more often male, Asian, and Hispanic (all P<0.001). This group had larger tumors with higher rates of nodal (N1: 61.8% vs. 15.1%) and distant metastases (M1: 9.3% vs. 0.4%). Age ≥55 years (hazard ratio [HR], 1.19; P=0.004) and metastases (HR, 1.75; P<0.001) increased TC-specific mortality, whereas the converse pattern was found for Asian race (HR, 0.63; P=0.002) and surgery (HR, 0.35; P<0.001). In rigorously matched groups to control confounding, adding radioactive iodine to surgery reduced mortality by 30% (P<0.001). However, external beam radiation and systemic therapy did not improve survival over surgery alone. Conclusion Laryngotracheal invasion is present in 0.7% to 1.3% of cases, conferring over double the mortality risk. Radioactive iodine with surgery improves outcomes in this aggressive WDTC subset. |
| format | Article |
| id | doaj-art-e92abe2755754e0785c3750da1c9b01a |
| institution | Kabale University |
| issn | 2093-596X 2093-5978 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Korean Endocrine Society |
| record_format | Article |
| series | Endocrinology and Metabolism |
| spelling | doaj-art-e92abe2755754e0785c3750da1c9b01a2025-08-20T03:49:16ZengKorean Endocrine SocietyEndocrinology and Metabolism2093-596X2093-59782025-04-0140220121510.3803/EnM.2024.20332574Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal InvasionEman A. Toraih0Jessan A. Jishu1Mohammad H. Hussein2Aly A. M. Shaalan3Manal S. Fawzy4Emad Kandil5 Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA School of Medicine, Tulane University, New Orleans, LA, USA Ochsner Clinic Foundation, New Orleans, LA, USA Department of Anatomy, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia Center for Health Research, Northern Border University, Arar, Saudi Arabia Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USABackground Laryngotracheal invasion occurs in a subset of patients with well-differentiated thyroid cancer (WDTC) and is associated with a poor prognosis. We aimed to analyze patterns and predictors/outcomes related to this high-risk manifestation. Methods This population-based analysis utilized the Surveillance, Epidemiology, and End Results (SEER) registry (2000 to 2015) to identify WDTC patients. Temporal trends and geographic variation in invasion rates were assessed. Logistic regression and propensity score matching were employed to identify predictors of secondary malignancy, mortality, and treatment impact on overall and thyroid cancer (TC)-specific survival. Results Of 131,721 WDTC patients, 1,662 (1.3%) had tracheal invasion and 976 (0.7%) had laryngeal invasion at diagnosis. Tracheal and laryngeal invasion rates declined from 3.7%–0.7% and 1.5%–0.6%, respectively, from 2000 to 2015. Compared to 98,835 noninvasive cases, patients with laryngotracheal invasion were older and more often male, Asian, and Hispanic (all P<0.001). This group had larger tumors with higher rates of nodal (N1: 61.8% vs. 15.1%) and distant metastases (M1: 9.3% vs. 0.4%). Age ≥55 years (hazard ratio [HR], 1.19; P=0.004) and metastases (HR, 1.75; P<0.001) increased TC-specific mortality, whereas the converse pattern was found for Asian race (HR, 0.63; P=0.002) and surgery (HR, 0.35; P<0.001). In rigorously matched groups to control confounding, adding radioactive iodine to surgery reduced mortality by 30% (P<0.001). However, external beam radiation and systemic therapy did not improve survival over surgery alone. Conclusion Laryngotracheal invasion is present in 0.7% to 1.3% of cases, conferring over double the mortality risk. Radioactive iodine with surgery improves outcomes in this aggressive WDTC subset.http://e-enm.org/upload/pdf/enm-2024-2033.pdfprognosticationthyroid neoplasmsprecision medicineextrathyroidal extensionmortality predictorsrisk stratification |
| spellingShingle | Eman A. Toraih Jessan A. Jishu Mohammad H. Hussein Aly A. M. Shaalan Manal S. Fawzy Emad Kandil Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion Endocrinology and Metabolism prognostication thyroid neoplasms precision medicine extrathyroidal extension mortality predictors risk stratification |
| title | Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion |
| title_full | Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion |
| title_fullStr | Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion |
| title_full_unstemmed | Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion |
| title_short | Prognostic Indicators and Comparative Treatment Outcomes in High-Risk Thyroid Cancer with Laryngotracheal Invasion |
| title_sort | prognostic indicators and comparative treatment outcomes in high risk thyroid cancer with laryngotracheal invasion |
| topic | prognostication thyroid neoplasms precision medicine extrathyroidal extension mortality predictors risk stratification |
| url | http://e-enm.org/upload/pdf/enm-2024-2033.pdf |
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