Thyroid Cancer Multicenter Study in Adult population of Cordoba: a retrospective 20 ? years study.

ORTIZ, GUSTAVO; GERES, ALEJANDRA; BERGOGLIO, LILIANA; LÓPEZ, MÓNICA; MONTESINOS, MARÍA DEL MAR; ALVAREZ, MARIELA; CASTRO, RICARDO; CUVERTINO, EDUARDO; DAMILANO, ROXANA; FERRARIS, DELVIS; MORENO, PAOLA; RUGGERI, MARCELO

Córdoba - Virtual

Jornada; XIII Jornada Anual de la Sociedad de Endocrinología y Metabolismo de Córdoba; 2021

Sociedad de Endocrinología y Metabolismo de Córdoba (SEMCO)

INTRODUCTION: Differentiated thyroid carcinoma (DTC) has increased exponentially in recent decades. The causes of this increase may be true incidence or attributed to progress in diagnostic methods. GOAL: to evaluate the prevalence and variables of DTC associated with response to treatment in Province of Cordoba. STUDY DESIGN: Retrospective (1999-2019) analysis. DATA EXTRACTION: Data of contributing Centers in public and private settings. Outcomes of interest were sex, prevalence, trend in rural areas with environmental toxics, TSH levels at diagnosis, diabetes, 131I dose, and Hashimoto?s Thyroiditis (HT) as risk factors. STATISTICS: mean and SD for quantitative variables, percentages for qualitative variables and Chi square test and Odss ratio (OR) for association between qualitative variables. RESULTS: Total patients were 369: 27% from Public and 73% from Private Centers, 58% from urban and 42% from rural areas. Female (F)/Male (M) ratio: 4.5. Mean±SD age at diagnosis (AD): 46±13 years. Predominant histological type: Papillary (96.2%). The prevalence (P) was 10.45 and 34.5 cases per year between 1999-2012 and 2013-2019, respectively; with an increase in microcarcinomas in the last years. Moreover, 92% of patients received at least 30 mCi or more of 131I, and the 30 mCi dose was associated with a P of 21%, while with a higher dose of 131I, the P was of 33% (p:0.11). A higher percentage of cases was observed in M, both in fumigated areas (FA) and no fumigated areas (NFA): (FA: M 8% vs F 6%; NFA: M 13% vs F 3%, p:0.006 and a higher percentage of broad capsular invasion (FA: M 23% vs. F11%; NFA: M 5% vs F 3%, p=:0.040). Recurrence risk (RR) was higher in both men and women in FA vs NFA (FA: M 23% vs F 6%; NFA: M 11% vs F 5%). The AD was 35-39 years in FA vs 50-54 years in NFA (p:=0.0001). Diabetics patients showed a higher P compared to non-diabetics (39% vs 29%, p:=0.001). Regarding TSH levels at the time of diagnosis, we found no significant difference in tumor aggressiveness (broad-extension capsular invasion in >4 cm tumors), P and RR between patients in the lower end (0.5-2.0 mU/L) vs in the upper end (2.0-4.0 mU/L), p=: 0.05). The influence of autoimmunity on tumor aggressiveness and response to treatment, showed that positive TgAb patients (+TgAb) had more extensive lymphovascular invasion compared to negative TgAb patients (-TgAb) [OR: 14.83 (95% CI:3.21-68.41)]. Also, +TgAb had a higher RR [OR :3.01 (95% CI:1.10-8.23) and P [OR:2.62 (95% CI:1.36-5.04)] in comparison with (-TgAb). The 70% of +TPOAb patients presented an excellent response (protective effect) compared with the 30% of -TPOAb patients (p=:0.0008). CONCLUSION: Local, national and international registry data should be established to identify populations at increased risk for thyroid cancer. Our study contributes to evaluate the trend in Province of Cordoba, where there may be a real occurrence of DTC in areas with environmental toxics. We found that in FA there was a significantly higher prevalence of recurrence (R), both in men and women, at earlier age in rural areas with environmental toxics. Size and tumor aggressiveness were higher in males than in women. Dose of 131I treatment was associated with a 21% of P at 30 mCi and 33% at higher doses, probably related to more advanced tumor stages. +TgAb should be regarded as a risk condition for an active search for R or P disease. Until the association HT and DTC is fully clarified, patients with HT should monitored periodically for underlying thyroid malignancy.