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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%, p0.0001) and distant metastasis (p=0.0006). Postoperative complications, including seroma (Group C: 15.58% vs. Group A: 2.85%, p0.0001) 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.
Kim et al. (Fri,) studied this question.