Impact of body mass index on survival outcome in patients with differentiated thyroid cancer

Al-Ammar, Yousif; Al-Mansour, Bader; Al-Rashood, Omar; Tunio, Mutahir A.; Islam, Tahera; Al-Asiri, Mushabbab; Al-Qahtani, Khalid Hussain

doi:10.1016/j.bjorl.2017.02.002

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz. j. otorhinolaryngol. 84 (2) • Mar-Apr 2018 • https://doi.org/10.1016/j.bjorl.2017.02.002 copy

Impact of body mass index on survival outcome in patients with differentiated thyroid cancer^☆ ☆ Please cite this article as: Al-Ammar Y, Al-Mansour B, Al-Rashood O, Tunio MA, Islam T, Al-Asiri M, et al. Impact of body mass index on survival outcome in patients with differentiated thyroid cancer. Braz J Otorhinolaryngol. 2018;84:220-6.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty.

Objective

We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers.

Methods

Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5 kg/m² (underweight); (b) 18.5-25 kg/m² (normal weight); (c) 26-30 kg/m² (overweight); (d) 31-40 kg/m² (obese) and (e) >40 kg/m² (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared.

Results

Median follow up period was 5.2 years (0.6-10). Mean body mass index was 31.3 kg/m² (17-72); body mass index 31-40 kg/m² was predominant (89 patients, 42.6%) followed by 26-30 kg/m² seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p = 0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival.

Conclusion

Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

KEYWORDS
Differentiated thyroid cancers; Body mass index; Overall survival; Disease free survival

Variable	Whole cohort - n (%)
Total patients	209
Age (years)	41.1 (16-78) SD ±11.6
≤45 years	127 (60.7)
≥45 years	82 (39.3)
Gender
Female	165 (79.0)
Male	44 (21.0)
Female to male ratio	3.8
Type of surgery
Near or total thyroidectomy	189 (90.4)
Lobectomy	20 (9.6)
Lymph node surgery
Central neck dissection	58 (27.7)
Lateral neck dissection	28 (13.4)
Sampling	19 (9.1)
None	104 (49.7)
Mean size (cm)	2.3 (0.1-10.0) ± 12.4
Histopathologic variants
Classic	162 (77.5)
Follicular	19 (9.1)
Hurthle cell	6 (2.8)
Tall cell	21 (10.1)
Sclerosing	1 (0.5)
Multifocal
Yes	80 (38.3)
No	129 (61.7)
ETE
Yes	41 (19.6)
No	168 (80.4)
LVSI
Yes	39 (18.6)
No	170 (81.4)
Surgical margins
Positive	21 (10.1)
Negative	188 (89.9)
Lymph node metastasis
Yes	54 (25.8)
No	183 (87.6)
Background thyroid tissue
Normal	64 (30.6)
Multi-nodular goiter	68 (32.6)
Lymphocytic thyroiditis	45 (21.5)
Hashimotos' thyroiditis	32 (15.3)
Distant Metastasis at presentation	5 (2.4)
AJCC staging
I	107 (51.2)
II	36 (17.2)
III	53 (25.4)
IV A	10 (4.8)
IV B	-
IVC	3 (1.4)
Mean postoperative TG (ng/mL)	1.39 (0.1-42,890)
BMI (kg/m ² ) mean	31.2 (17-72)
BMI groups
<18.6	3 (1.4)
18.6-25	43 (20.6)
26-30	58 (27.8)
31-40	89 (42.6)
>40	16 (7.7)
RAI dose
No	53 (25.4)
30 mCi	64 (30.6)
100 mCi	45 (21.5)
150-200 mCi	47 (22.5)
RT to neck	12 (5.7)

Variable	Disease free survival		Overall survival
	p-Value	OR (95% CI)	p-Value	OR (95% CI)
Age (<45 vs. 45 years)	0.033	0.83 (0.90-2.50)	0.041	0.50 (0.10-2.41)
Cormorbids (yes vs. no)	0.091	1.28 (1.07-1.97)	1.00	1.80 (0.79-2.10)
AJCC stage (<II vs. >II)	0.041	0.67 (0.60-1.34)	0.01	0.85 (0.80-1.90)
N stage (N0 vs. N1)	0.033	0.81 (0.79-2.00)	0.051	1.21 (1.10-2.10)
BMI kg/m² (>30 vs. <30)	0.052	1.15 (1.0-2.45)	0.061	1.15 (1.01-1.65)
LVI (no vs. yes)	0.031	0.91 (0.76-1.45)	0.60	1.10 (0.89-2.00)
Adjuvant RAI (yes vs. no)	0.031	0.50 (0.10-2.41)	0.041	0.50 (0.67-2.81)

Authors, Years	BMI categories	Treatment modality	Effect of BMI
Takenaka et al.,¹⁵15 Takenaka Y, Takemoto N, Nakahara S, Yamamoto Y, Yasui T, Hanamoto A, et al. Prognostic significance of body mass index before treatment for head and neck cancer. Head Neck. 2015;37:1518-23. 2015	Obese or overweight (25 kg/m²), normal (18.5 kg/m² and <25 kg/m²), and underweight (<18.5 kg/m²).	Surgery, CRT, RT	192 surgically treated patients no statistically significant the effect of BMI on overall survival.
			In other treatment modalities high BMI was associated with a better prognosis.
Huang PY et al.,¹⁷17 Huang PY, Wang CT, Cao KJ, Guo X, Guo L, Mo HY, et al. Pretreatment body mass index as an independent prognostic factor in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy: findings from a randomised trial. Eur J Cancer. 2013;49:1923-31. 2013	Obese (27.5 kg/m²), overweight (23.0-27.4 kg/m²), normal weight (18.5-22.9 kg/m²), underweight (<18.5 kg/m²).	IC + CCRT	Higher BMI was associated with increased failure free survival and overall survival.
		IC + RT	No influence on the risk of locoregional recurrences.
Lin YH et al.,¹⁸18 Lin YH, Chang KP, Lin YS, Chang TS. Evaluation of effect of body mass index and weight loss on survival of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy. Radiat Oncol. 2015;10:136. 2015	Two groups (<23 kg/m² vs. ≥23 kg/m²)	IMRT, CCRT, RT/CCRT + IC	BMI was not significantly associated with overall survival, disease specific survival, distant metastasis free survival, or locoregional free survival.
van Bokhorst-de van der Schuer B. et al.,²¹21 van Bokhorst-de van der Schuer B, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, et al. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer. 1999;86:519-27. 1999	BMI not calculated, Percentage of weight loss during the 6 months before treatment, the percentage of ideal body weight, serum albumin, total lymphocyte count, nutritional index, and bioelectrical impedance analysis.	Surgery	None of the studied nutritional parameters were associated with survival.
Present study	Morbid obese (>40 kg/m²), obese (31-40 kg/m²), overweight (26-30 kg/m²), normal weight (18.5-25 kg/m²), underweight (<18.5 kg/m²).	Surgery	BMI was not significantly associated with overall survival, disease free survival

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[1] * Corresponding author. E-mail:kqresearch@hotmail.com (K.H. Al-Qahtani).