Advanced age and differentiated thyroid carcinoma: a retrospective cohort study investigating surgical outcomes and recurrence risk

Abstract

Background: The increase in the older population globally presents unique challenges in thyroid cancer management. Age is a crucial prognostic factor in differentiated thyroid carcinoma (DTC); however, its effect on surgical outcomes in older patients is unclear. Therefore, we aimed to evaluate the clinical characteristics, postoperative complications, and long-term outcomes of DTC in older patients and determine the effect of advanced age on recurrence risk and surgical morbidity. Methods: A retrospective cohort study including 27,427 patients who underwent thyroidectomy for DTC between 2003 and 2019 was conducted. Patients were stratified into three age groups: Group A (16-64 years), Group B (65-74 years), and Group C (>= 75 years). Clinicopathological characteristics, postoperative complications, and recurrence rates were analyzed. Multivariate Cox regression was performed to identify predictors of recurrence. Results: Older patients had more aggressive tumor features, including higher rates of extrathyroidal extension (Group C: 70.6% vs. Group A: 51.6%, p<0.0001) and distant metastasis (p=0.0006). Postoperative complications, including seroma (Group C: 15.58% vs. Group A: 2.85%, p<0.0001) and recurrent laryngeal nerve injury (Group C: 2.16% vs. Group A: 0.45%, p=0.0001), were more common in older patients. Recurrence risk increased with age (Group C: hazard ratio 1.894, 95% confidence interval: 1.156-3.104, p=0.0113). Despite higher risks, more extensive surgery was associated with improved survival in older patients. Conclusions: Advanced age is associated with more aggressive DTC and increased recurrence risk, yet thyroidectomy remains a viable treatment option. Close surveillance is essential to optimize outcomes in older patients.