title: The impact of age and gender on papillary thyroid cancer survival.
abstract: BACKGROUND
  Thyroid cancer predominately affects women, carries a worse prognosis in older age, and may have higher mortality in men. Superimposed on these observations is the fact that most women have attained menopause by age 55 yr.
  
  
  OBJECTIVE
  The objective of the study was to determine whether men contribute disproportionately to papillary thyroid cancer (PTC) mortality or whether menopause affects PTC prognosis.
  
  
  METHODS
  Gender-specific mortality was normalized using age-matched subjects from the U.S. population. Multivariate Cox proportional hazard regression models incorporating gender, age, and National Thyroid Cancer Treatment Cooperative Study Group stage were used to model disease-specific survival (DSS).
  
  
  METHODS
  Patients were followed in a prospective registry.
  
  
  METHODS
  The relationships between gender, age, and PTC outcomes were analyzed.
  
  
  RESULTS
  The unadjusted hazard ratio (HR) for DSS for women was 0.40 [confidence interval (CI) 0.24-0.65]. This female advantage diminished when DSS was adjusted for age at diagnosis and stage with a HR encompassing unity (HR 0.72, CI 0.44-1.19). Additional multivariate models of DSS considering gender, disease stage, and various age groupings showed that the DSS for women diagnosed at under 55 yr was improved over men (HR 0.33, CI 0.13-0.81). However, the HR for DSS increased to become similar to men for women diagnosed at 55-69 yr (HR 1.01, CI 0.42-2.37) and at 70 yr or greater (HR 1.17, CI 0.48-2.85).
  
  
  CONCLUSIONS
  Although the overall outcome of women with PTC is similar to men, subgroup analysis showed that this composite outcome is composed of two periods with different outcomes. The first period is a period with better outcomes for women than men when the diagnosis occurs at younger than 55 yr; the second is a period with similar outcomes for both women and men diagnosed at ages greater than 55 yr. These data raise the question of whether an older age cutoff would improve current staging systems. We hypothesize that older age modifies the effect of gender on outcomes due to menopause-associated hormonal alterations.
authors.affiliation: Division of Endocrinology and Metabolism, Georgetown University Medical Center, Washington, DC 20007, USA. jonklaaj@georgetown.edu
authors.forename: J
authors.initials: J
authors.lastname: Jonklaas
authors.forename: G
authors.initials: G
authors.lastname: Nogueras-Gonzalez
authors.forename: M
authors.initials: M
authors.lastname: Munsell
authors.forename: D
authors.initials: D
authors.lastname: Litofsky
authors.forename: K B
authors.initials: KB
authors.lastname: Ain
authors.forename: S T
authors.initials: ST
authors.lastname: Bigos
authors.forename: J D
authors.initials: JD
authors.lastname: Brierley
authors.forename: D S
authors.initials: DS
authors.lastname: Cooper
authors.forename: B R
authors.initials: BR
authors.lastname: Haugen
authors.forename: P W
authors.initials: PW
authors.lastname: Ladenson
authors.forename: J
authors.initials: J
authors.lastname: Magner
authors.forename: J
authors.initials: J
authors.lastname: Robbins
authors.forename: D S
authors.initials: DS
authors.lastname: Ross
authors.forename: M C
authors.initials: MC
authors.lastname: Skarulis
authors.forename: D L
authors.initials: DL
authors.lastname: Steward
authors.forename: H R
authors.initials: HR
authors.lastname: Maxon
authors.forename: S I
authors.initials: SI
authors.lastname: Sherman
mesh_terms: D017677:Age Distribution; D000368:Aged; D002291:Carcinoma, Papillary / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008136:Longevity; D008297:Male; D008593:Menopause; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013964:Thyroid Neoplasms / Q000401:mortality*; D014481:United States / Q000453:epidemiology