title: Secular trends in the prognostic factors for papillary thyroid cancer.
abstract: OBJECTIVE
  With the recent increasing rates of screening for thyroid cancer, the cancers now tend to be smaller and less aggressive than those that are diagnosed when presented with symptoms, suggesting changes in the clinical validity of conventional prognostic factors for outcomes. We performed the retrospective study to identify the secular trends in the prognostic factors of thyroid cancer.
  
  
  METHODS
  We used medical records of 3147 patients diagnosed with papillary thyroid cancer (PTC) at the Seoul National University Hospital Thyroid Cancer Clinic between 1962 and 2009.
  
  
  RESULTS
  During the median 5.1-year follow-up, the overall recurrence rate was 13.3%, and male sex, tumor size, lymph node (LN) involvement, and extrathyroidal extension (ETE) were the significant prognostic factors for recurrence. Thyroid cancer-specific mortality was 1.4%, and the associated prognostic factors were older age, male sex, and LN involvement. For tumor recurrence, the hazard ratio (HR) for male sex decreased from 2.809 (95% CI, 1.497-5.269) in the pre-1989 period to 1.142 (95% CI, 0.736-1.772) in the post-1999 period. The pathologic characteristics, such as tumor size, LN involvement, and ETE, showed similar or increasing HRs over the time periods. For cancer-specific mortality, the HR for male sex decreased from 6.460 (95% CI, 1.714-24.348) in the pre-1990 period to 0.781 (95% CI, 0.083-7.379) in the post-1999 period.
  
  
  CONCLUSIONS
  The risk for poor outcomes in PTC associated with male sex decreased over time; in contrast, the risk associated with pathologic characteristics remained the same or increased over time. These trends might be associated with recent changes in the characteristics of patients with thyroid cancer.
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Hoonsung
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Jung Ah
authors.initials: JA
authors.lastname: Lim
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Hwa Young
authors.initials: HY
authors.lastname: Ahn
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Sun Wook
authors.initials: SW
authors.lastname: Cho
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyu Eun
authors.initials: KE
authors.lastname: Lee
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyung Won
authors.initials: KW
authors.lastname: Kim
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Ka Hee
authors.initials: KH
authors.lastname: Yi
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Myung-Whun
authors.initials: MW
authors.lastname: Sung
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Yeo-Kyu
authors.initials: YK
authors.lastname: Youn
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: June-Key
authors.initials: JK
authors.lastname: Chung
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea yjparkmd@snu.ac.kr djpark@snu.ac.kr.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea yjparkmd@snu.ac.kr djpark@snu.ac.kr.
authors.forename: Do Joon
authors.initials: DJ
authors.lastname: Park
authors.affiliation: Department of Internal MedicineSeoul National University College of Medicine, Seoul, KoreaDepartment of Internal MedicineChung-Ang University College of Medicine, Seoul, KoreaDepartment of Internal MedicineNational Medical Center, Seoul, KoreaDepartment of Surgery and Cancer Research InstituteSeoul National University College of Medicine, Seoul, KoreaDepartment of Otorhinolaryngology and Head and Neck SurgerySeoul National University College of Medicine, Seoul, KoreaDepartment of SurgeryNational Medical Center, Seoul, KoreaDepartment of Nuclear MedicineSeoul National University College of Medicine, Seoul, Korea.
authors.forename: Bo Youn
authors.initials: BY
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D002291:Carcinoma, Papillary; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D066106:Seoul / Q000453:epidemiology; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D013997:Time Factors