In a large-scale retrospective analysis reported in the Journal of Clinical Oncology, Wang et al found that male sex is a predictor of poorer disease-specific survival in BRAF V600E papillary thyroid cancer.
The study involved 2,638 patients (male = 623, female = 2,015) from 11 centers in 6 countries (including the United States), with a median age of 46 years at diagnosis (interquartile range = 35–58 years) and median follow-up of 58 months. The overall prevalence of BRAF V600E mutation was 41.8%, including 41.2% of women and 43.8% of men.
Disease-Specific Mortality by BRAF Status
Distant metastasis rates in men vs women did not differ in wild-type BRAF PTC, but were significantly higher in men vs women with BRAF V600E papillary thyroid cancer (8.9% vs 3.7%, P = .001). Among patients with wild-type BRAF PTC, disease-specific mortality rates were 1.4% for men vs 0.9% for women (hazard ratio [HR] = 1.59, P = .384; HR = 0.70, 95% confidence interval [CI] = 0.23–2.09, after adjustment for clinicopathologic factors in multivariate analysis). Among patients with BRAF V600E papillary thyroid cancer, disease-specific mortality rates were 6.6% for men vs 2.9% for women (HR = 2.43, P = .006; HR = 2.74, 95% CI = 1.38–5.43, after multivariate adjustment).
In conventional-variant papillary thyroid cancer (72% of patients), mortality rates were similar for men vs women with wild-type BRAF (adjusted HR = 0.86, 95% CI =0.15–4.91), but were 7.2% vs 2.9% among those with BRAF V600E disease (HR = 2.86, P = .004; HR = 3.51, 95% CI = 1.62–7.63, after multivariate adjustment).
The investigators concluded, “Male sex is a robust independent risk factor for papillary thyroid cancer–specific mortality in BRAF V600E patients but not in wild-type BRAF patients. The prognostic risk of male sex in [papillary thyroid cancer] can thus be stratified by BRAF status in clinical application.”
The study was supported by the National Institutes of Health and others.
Mingzhao Xing, MD, PhD, of the Johns Hopkins Thyroid Tumor Center, Johns Hopkins University School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.
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