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Original Article
Clinical Study Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma
Hyemi Kwon1, Mijin Kim1, Yun Mi Choi1, Eun Kyung Jang1, Min Ji Jeon1, Won Gu Kim1, Tae Yong Kim1, Young Kee Shong1, Dong Eun Song2, Jung Hwan Baek3, Suck Joon Hong4, Won Bae Kim1
Endocrinology and Metabolism 2014;30(3):305-311.
DOI: https://doi.org/10.3803/EnM.2015.30.3.305
Published online: November 26, 2014

1Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

3Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

4Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Corresponding author: Won Bae Kim. Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3913, Fax: +82-2-3010-6962, kimwb@amc.seoul.kr
• Received: August 22, 2014   • Revised: September 19, 2014   • Accepted: October 6, 2014

Copyright © 2015 Korean Endocrine Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Background
    Obesity is associated with aggressive pathological features and poor clinical outcomes in breast and prostate cancers. In papillary thyroid carcinoma (PTC), these relationships remain still controversial. This study aimed to evaluate the associations between body mass index (BMI) and the clinical outcomes of patients with PTC.
  • Methods
    This retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size. Clinical outcomes were evaluated and compared based on the BMI quartiles.
  • Results
    There were no significant associations between BMI quartiles and primary tumor size, extrathyroidal invasion, cervical lymph node metastasis, or distant metastasis. However, an increase in mean age was associated with an increased BMI (P for trend <0.001). Multifocality and advanced tumor-node-metastasis (TNM) stage (stage III or IV) were significantly associated with increases of BMI (P for trend 0.02 and <0.001, respectively). However, these associations of multifocality and advanced TNM stage with BMI were not significant in multivariate analyses adjusted for age and gender. Moreover, there were no differences in recurrence-free survivals according to BMI quartiles (P=0.26).
  • Conclusion
    In the present study, BMI was not associated with the aggressive clinicopathological features or recurrence-free survivals in patients with PTC.
  • Keywords: Obesity; Thyroid neoplasms; Prognosis
Obesity is associated with the development and progression of various cancers such as breast cancer, endometrial cancer, colon cancer, esophageal adenocarcinoma, prostate cancer, liver cell carcinoma, leukemia, non-Hodgkin lymphoma, and melanoma [1234]. Recently, several epidemiologic studies have suggested a positive association between obesity and the prevalence of thyroid cancer [5678910].
In addition to the increased prevalence of cancers, obesity is associated with aggressive pathological features and poor clinical outcomes such as increased risk of recurrence and progression in breast and prostate cancers [11121314]. The relationships between obesity and clinical outcomes of thyroid cancer remain still controversial. Three studies showed a correlation between obesity and more advanced tumor stages [51516]. A report suggested that overweight or obese patients with papillary thyroid carcinomas (PTC) larger than 1 cm in size had the increased risk of developing loco-regional persistent or recurrent disease [5]. However, other studies reported that a higher body mass index (BMI) was not associated with more aggressive pathological features, or the recurrence or persistence of disease [1718]. In fact, one study suggested that obesity might be correlated with less aggressive tumor invasion, although this finding was not statistically significant [17].
In the present study, we evaluated the associations of an increased BMI with clinicopathological features and the recurrence-free survivals in patients with PTCs equal to or larger than 1 cm in size.
Study subjects and design
This retrospective study included 1,189 patients who underwent total thyroidectomy for PTCs equal to or larger than 1 cm in size at Asan Medical Center in Seoul, Korea between 2000 and 2005. We reviewed medical records of the patients including preoperative body weights, heights, surgical records, pathology reports, and the results of therapeutic whole body scans to assess the initial clinicopathological status for each patient. The tumor node metastasis (TNM) stage was based on the seventh edition of the American Joint Committee on Cancer (AJCC) staging manual [19].
Anthropometric measurements
On the day of admission for thyroid surgery, the heights and weights were measured in patients wearing light clothing without shoes. BMI was calculated using the following formula; the weight in kilograms stratified by square of the height in meters (kg/m2). For comparisons, patients were stratified into four groups according to gender-specific quartiles for BMI (kg/m2): Q1 19.4 to 23.0, Q2 23.1 to 24.9, Q3 25.0 to 26.9, and Q4 27.0 to 38.2 for males; Q1 15.8 to 21.7, Q2 21.8 to 23.5, Q3 23.6 to 25.9, and Q4 26.0 to 37.1 for females.
Follow-up protocol for the detection of clinical recurrence
As we previously described, all patients were subjected to regular physical examinations and assessments of serum thyroglobulin (TG) levels in every 6 to 12 months interval [20]. Neck ultrasonography examinations were performed at least once during the follow-up period. Stimulated TG levels were evaluated in patients with thyroid-stimulating hormone withdrawal approximately 12 months after total thyroidectomy. Additional diagnostic imaging studies including fluorodeoxyglucose positron emission tomography and chest computed tomography scans, were performed in patients whose distant metastases were clinically under suspicions [20]. Clinical recurrence was defined as the reappearance of pathologically proven malignant tissues and/or the appearance of metastatic lesions in the lung, bone, and/or brain in patients initially confirmed to be in remission [20].
Statistical analysis
Categorical variables are presented as numbers and percentages. Continuous variables are expressed as mean±standard deviation. The BMI quartiles were calculated separately for males and females. All data analyses were performed using R version 3.0 and R libraries survival (R Foundation for Statistical Computing, Vienna, Austria; http://www.R-project.org). The comparisons of continuous variables, such as age and maximal tumor diameter, according to BMI quartiles were conducted using analysis of variance or Student t test. Trends across the increases in BMI quartiles were performed using a Cochran-Armitage trend test, except for the nodal metastasis variable. Categorical variables were analyzed using chi-square tests. In the multivariate analyses, the relative associations between BMI quartiles and advanced TNM stage or multifocality were presented as odds ratios (ORs) with 95% confidence intervals (CIs) which were calculated using binominal logistic regression analyses. A log-rank test was used to compare recurrence-free survivals among the BMI quartiles. Hazard ratios (HRs) and 95% CIs were derived from the Cox proportional hazards model. All of P values were two-sided. P<0.05 was considered statistically significant.
Baseline characteristics
Total 1,189 patients (157 males and 1,032 females) were included in the present study. The baseline characteristics of patients are shown in Table 1. The mean age was 45.3±11.9 years and 640 patients (53.8%) were older than 45 years of age. The mean maximal tumor diameter was 2.1±1.2 cm. Extrathyroidal invasion and multifocality of the primary tumors were present in 789 patients (66.4%) and 466 (39.2%), respectively. Of the 1,189 patients, 762 patients (64.1%) had cervical lymph node (LN) metastases, 181 (15.2%) had lateral neck LN metastases (N1b), and 25 (2.1%) had distant metastases at the initial diagnosis.
The mean BMI was 24.1±3.2 kg/m2 for all patients, 24.9±3.0 kg/m2 for the males, and 23.5±3.3 kg/m2 for the females. Of the 1,189 patients, 384 (32.3%) were overweight (BMI, 25.0 to 29.9 kg/m2), and 55 (4.6%) were obese (BMI ≥30.0 kg/m2). The proportion of overweight and obese patients (BMI ≥25 kg/m2) was markedly higher in males than females (48.4% vs. 35.2%, P=0.001).
Associations of BMI quartile groups with clinicopathological features of PTC
The clinicopathological features of the PTCs were evaluated according to BMI quartile categories (Table 1). There were no significant associations for primary tumor size, extrathyroidal invasion, LN metastasis, or distant metastasis according to BMI quartiles. However, the mean age showed a significant increase across BMI quartiles (P<0.001). Multifocality and advanced TNM stage (stage III or IV) showed significantly increasing trends with the increases in BMI quartiles (P for trend=0.015 and <0.001, respectively).
In multivariate analyses, these associations of increased BMI with multifocality (OR, 1.11; 95% CI, 0.99 to 1.23; P=0.067) and advanced TNM stage (OR, 1.11; 95% CI, 0.99 to 1.23; P=0.769) were disappeared after adjusting for age and gender. The associations between clinico-pathological features of PTC and BMI quartiles were also evaluated according to gender (Tables 2, 3). The females showed the same patterns as overall subjects, while the proportion of the males with maximal tumor diameters larger than 2 cm was associated with higher BMI quartile (P for trend=0.043). However, its association disappeared after adjusting for age (The data was not shown).
Recurrence-free survivals according to BMI quartiles
After the exclusion of patients with distant metastases at initial diagnosis (n=25), the recurrence-free survivals of the PTC patients were evaluated during median 8.4 years of the follow-up period. Total 160 of 1,164 patients (13.7%) experienced PTC recurrence during the follow-up. There were no significant differences in recurrence-free survivals across the BMI quartiles (log rank statistics=4.0, df=3, P=0.26) (Fig. 1).
The present study evaluated associations of the increases in BMI with clinicopathological features and recurrence free survivals in patients who underwent total thyroidectomy for PTCs. There were no significant relationships between increased BMI and clinicopathological features of PTC. Patients with PTCs that were less than 1 cm in size were excluded because papillary thyroid microcarcinoma has favorable prognoses which included a low rate of distant metastasis and a low risk of disease recurrence [212223].
In this study, we applied gender-specific BMI quartiles to the data to evaluate possible associations between increased BMI and clinicopathological features of PTC. Gender is an important contributing factor to obesity, and a significant difference in the proportion of obese patients according to gender was observed in our study (males vs. females, 48.4% vs. 35.2%; P=0.001). Therefore, gender-specific BMI quartiles were calculated to adjust for the differences in BMI distribution between males and females.
In univariate analyses, an advanced TNM stage was significantly associated with increased BMI. However, this increase was also associated with older age. Age at the time of diagnosis was a major variable when assessing tumor staging based on the AJCC TNM staging system [19]. Therefore, age might be a confounding factor when assessing the impact of obesity in the TNM stage of PTC. In our multivariate analysis, the positive association between BMI and advanced TNM stage disappeared after adjusting for age and gender.
The World Health Organization defined obesity as BMI ≥30.0 kg/m2 [24]. Tresallet et al. [5] suggested that overweight or obese patients with PTC larger than 1 cm in size had an increased risk of developing loco-regional persistent or recurrent disease (OR, 3.8; P=0.03). Using Western standards, these authors categorized 14.5% of patients as obese (BMI ≥30.0 kg/m2) and 29.3% of patients as overweight (BMI, 25.0 to 29.9 kg/m2). However, only 55 of 1,189 patients (4.6%) in the present study had BMI ≥30.0 kg/m2. The Korean Endocrine Society defined obesity as BMI ≥25.0 kg/m2 [25]. Using this definition, approximately 36% of patients in the present study were categorized as the obese group. This difference in the prevalence of obesity between Western countries and Korea may explain the lack of associations between obesity and clinico-pathological features of PTC. Therefore, BMI quartiles were used for analyses in this study.
This retrospective study has several limitations. First, information such as waist to hip ratio, percentage of body fat, skin-fold thickness, and assessments of intra-abdominal fat were unavailable. Thus, the present study defined obesity based only on BMI. Similarly, other potential contributing factors including the history of diabetes mellitus, dyslipidemia, smoking, and physical activity could not be obtained. However, this study did include a large, homogenous, and well-defined population of subjects (n=1,189) with PTC equal to or greater than 1 cm in size. Moreover, the study subjects underwent total thyroidectomy and followed by same strategy at one institution for long term period. And, we applied gender-specific BMI quartiles.
In conclusion, the present study found that increased BMI was not associated with the clinical outcomes of patients with PTC, including their clinicopathological features and recurrence-free survivals.
Acknowledgements
This study was supported by the 2013 Korean Endocrine Society Research Grant Award in year 2013.

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

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Fig. 1

Recurrence-free survivals across the body mass index (BMI) quartiles. There were no significant differences in recurrence-free survivals of papillary thyroid carcinoma patients across the BMI quartiles. The numbers of patients who remained no evidence of disease at each time point were described at the bottom.

enm-30-305-g001.jpg
Table 1

Baseline Characteristics of Study Subjects and Associations between Body Mass Index Quartiles and Clinicopathological Features of Papillary Thyroid Carcinoma

enm-30-305-i001.jpg
Characteristic Total (n=1,189) Quartile according to body mass index P valueb
Q1a (n=290) Q2a (n=293) Q3a (n=301) Q4a (n=305)
Age, yr 45.3±11.9 44.7±11.3 38.4±11.8 48.2±10.1 49.7±11.2 <0.001c,d
 <45 549 (46.2) 146 (50.3) 205 (70.0) 96 (31.9) 102 (33.4) <0.001d
 ≥45 640 (53.8) 144 (49.7) 88 (30.0) 205 (68.1) 203 (66.6)
Gender
 Male 157 (13.2) 39 (13.4) 39 (13.3) 38 (12.6) 41 (13.4) 0.939
 Female 1,032 (86.8) 251 (86.6) 254 (86.7) 263 (87.4) 264 (86.6)
Maximal tumor diameter, cm 2.1±1.2 2.0±1.1 2.2±1.2 2.0±1.0 2.1±1.2 0.209c
 ≤2 775 (65.2) 199 (68.6) 178 (60.8) 201 (66.8) 197 (64.6) 0.633
 >2 414 (34.8) 91 (31.4) 115 (39.2) 100 (33.2) 108 (35.4)
Extrathyroidal invasion
 Absent 400 (33.6) 92 (31.7) 112 (38.2) 101 (33.6) 95 (31.1) 0.586
 Present 789 (66.4) 198 (68.3) 181 (61.8) 200 (66.4) 210 (68.9)
Mutifocal 466 (39.2) 115 (39.7) 85 (29.0) 128 (42.5) 138 (45.2) 0.015d
Lymph node metastasis
 pN0/Nx 427 (35.9) 100 (34.5) 92 (31.4) 121 (40.2) 114 (37.4) 0.330e
 pN1a 581 (48.9) 145 (50.0) 148 (50.5) 138 (45.8) 150 (49.2)
 pN1b 181 (15.2) 45 (15.5) 53 (18.1) 42 (14.0) 41 (13.4)
Distant metastasis, present 25 (2.1) 6 (2.1) 11 (3.8) 5 (1.7) 3 (1.0) 0.145
Staging according to TNM
 I/II 638 (53.7) 165 (56.9) 217 (74.1) 129 (42.9) 127 (41.6) <0.001d
 III/IV 551 (46.3) 125 (43.1) 76 (25.9) 172 (57.1) 178 (58.4)

Values are expressed as mean±SD or number (%).

TNM, tumor node metastasis.

aQuartiles for body mass index (kg/m2): Q1 19.4-23.0, Q2 23.1-24.9 , Q3 25.0-26.9, and Q4 27.0-38.2 for males and Q1 15.8-21.7, Q2 21.8-23.5, Q3 23.6-25.9, and Q4 26.0-37.1 for females; bP values for trends across the body mass index quartiles were conducted using a Cochran-Armitage trend test, except nodal metastasis variable; cP values by analysis of variance; dStatistically significant; eNodal metastasis variable was analyzed by a chi-square test.

Table 2

Associations between Body Mass Index Quartile and Clinicopathological Features for Females

enm-30-305-i002.jpg
Variable Total (n=1,032) Quartile according to body mass index P valueb
Q1a (n=251) Q2a (n=254) Q3a (n=263) Q4a (n=264)
Age, yr 45.3±11.9 44.3±11.2 37.6±11.3 48.3±10.0 50.7±10.7 <0.001c,d
 <45 476 (46.1) 129 (51.4) 187 (73.6) 79 (30.0) 81 (30.7) <0.001d
 ≥45 556 (53.9) 122 (48.6) 67 (26.4) 184 (70.0) 183 (69.3)
Maximal tumor diameter, cm 2.0±1.1 2.0±1.0 2.1±1.1 1.9±1.0 2.0±1.1 0.441c
 ≤2 695 (67.3) 172 (68.5) 160 (63.0) 185 (70.3) 178 (67.4) 0.751
 >2 337 (32.7) 79 (31.5) 94 (37.0) 78 (29.7) 86 (32.6)
Extrathyroidal invasion
 Absent 345 (33.4) 78 (31.1) 93 (36.6) 91 (34.6) 83 (31.4) 0.928
 Present 687 (66.6) 173 (68.9) 161 (63.4) 172 (65.4) 181 (68.6)
Mutifocal 411 (39.8) 99 (39.4) 75 (29.5) 113 (43.0) 124 (47.0) 0.008d
Lymph node metastasis
 pN0/Nx 393 (38.1) 93 (37.1) 83 (32.7) 113 (43.0) 104 (39.4) 0.210e
 pN1a 502 (48.6) 126 (50.2) 128 (50.4) 122 (46.4) 126 (47.7)
 pN1b 137 (13.3) 32 (12.7) 43 (16.9) 28 (10.6) 34 (12.9)
Distant metastasis, present 20 (1.9) 5 (2.0) 9 (3.5) 4 (1.5) 2 (0.8) 0.131
Staging according to TNM
 I/II 559 (54.2) 146 (58.2) 196 (77.2) 111 (42.2) 106 (40.2) <0.001d
 III/IV 473 (45.8) 105 (41.8) 58 (22.8) 152 (57.8) 158 (59.8)

Values are expressed as mean±SD or number (%).

TNM, tumor node metastasis.

aQuartiles for body mass index (kg/m2): Q1 15.8-21.7, Q2 21.8-23.5, Q3 23.6-25.9, and Q4 26.0-37.1 for females; bP values for trends across the body mass index quartiles were conducted using a Cochran-Armitage trend test, except nodal metastasis variable; cP values by analysis of variance; dStatistically significant; eNodal metastasis variable was analyzed by a chi-square test.

Table 3

Associations between Body Mass Index Quartiles and Clinicopathological Features for Males

enm-30-305-i003.jpg
Variable Total (n=157) Quartile according to body mass index P valueb
Q1a (n=39) Q2a (n=39) Q3a (n=38) Q4a (n=41)
Age, yr 45.2±12.5 47.1±12.1 43.0±14.1 47.6±11.1 43.5±12.1 0.234c
 <45 73 (46.5) 17 (43.6) 18 (46.2) 17 (44.7) 21 (51.2) 0.538
 ≥45 84 (53.5) 22 (56.4) 21 (53.8) 21 (55.3) 20 (48.8)
Maximal tumor diameter, cm 2.5±1.5 2.1±1.6 2.7±1.8 2.6±1.1 2.8±1.6 0.200c
 ≤2 80 (51.0) 27 (69.2) 18 (46.2) 16 (42.1) 19 (46.3) 0.043d
 >2 77 (49.0) 12 (30.8) 21 (53.8) 22 (57.9) 22 (53.7)
Extrathyroidal invasion
 Absent 55 (35.0) 14 (35.9) 19 (48.7) 10 (26.3) 12 (29.3) 0.214
 Present 102 (65.0) 25 (64.1) 20 (51.3) 28 (73.7) 29 (70.7)
Mutifocal 55 (35.0) 116 (41.0) 10 (25.6) 15 (39.5) 14 (34.1) 0.838
Lymph node metastasis
 pN0/Nx 34 (21.7) 7 (17.9) 9 (23.1) 8 (21.1) 10 (24.4) 0.570e
 pN1a 79 (50.3) 19 (48.7) 20 (51.3) 16 (42.1) 24 (58.5)
 pN1b 44 (28.0) 13 (33.3) 10 (25.6) 14 (36.8) 7 (17.1)
Distant metastasis, present 5 (3.2) 1 (2.6) 2 (5.1) 1 (2.6) 1 (2.4) 0.815
Staging according to TNM
 I/II 79 (50.3) 19 (48.7) 21 (53.8) 18 (47.4) 21 (51.2) 0.973
 III/IV 78 (49.7) 20 (51.3) 18 (46.2) 20 (52.6) 20 (48.8)

Values are expressed as mean±SD or number (%).

TNM, tumor node metastasis.

aQuartiles for body mass index (kg/m2); Q1 19.4-23.0, Q2 23.1-24.9, Q3 25.0-26.9, and Q4 27.0-38.2 for males; bP values for trends across the body mass index quartiles were conducted using a Cochran-Armitage trend test, except nodal metastasis variable; cP values by analysis of variance; dStatistically significant; eNodal metastasis variable was analyzed by a chi-square test.

Figure & Data

References

    Citations

    Citations to this article as recorded by  
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    Figure
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    Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma
    Image
    Fig. 1 Recurrence-free survivals across the body mass index (BMI) quartiles. There were no significant differences in recurrence-free survivals of papillary thyroid carcinoma patients across the BMI quartiles. The numbers of patients who remained no evidence of disease at each time point were described at the bottom.

    Fig. 1

    Lack of Associations between Body Mass Index and Clinical Outcomes in Patients with Papillary Thyroid Carcinoma
    CharacteristicTotal (n=1,189)Quartile according to body mass indexP valueb
    Q1a (n=290)Q2a (n=293)Q3a (n=301)Q4a (n=305)
    Age, yr45.3±11.944.7±11.338.4±11.848.2±10.149.7±11.2<0.001c,d
     <45549 (46.2)146 (50.3)205 (70.0)96 (31.9)102 (33.4)<0.001d
     ≥45640 (53.8)144 (49.7)88 (30.0)205 (68.1)203 (66.6)
    Gender
     Male157 (13.2)39 (13.4)39 (13.3)38 (12.6)41 (13.4)0.939
     Female1,032 (86.8)251 (86.6)254 (86.7)263 (87.4)264 (86.6)
    Maximal tumor diameter, cm2.1±1.22.0±1.12.2±1.22.0±1.02.1±1.20.209c
     ≤2775 (65.2)199 (68.6)178 (60.8)201 (66.8)197 (64.6)0.633
     >2414 (34.8)91 (31.4)115 (39.2)100 (33.2)108 (35.4)
    Extrathyroidal invasion
     Absent400 (33.6)92 (31.7)112 (38.2)101 (33.6)95 (31.1)0.586
     Present789 (66.4)198 (68.3)181 (61.8)200 (66.4)210 (68.9)
    Mutifocal466 (39.2)115 (39.7)85 (29.0)128 (42.5)138 (45.2)0.015d
    Lymph node metastasis
     pN0/Nx427 (35.9)100 (34.5)92 (31.4)121 (40.2)114 (37.4)0.330e
     pN1a581 (48.9)145 (50.0)148 (50.5)138 (45.8)150 (49.2)
     pN1b181 (15.2)45 (15.5)53 (18.1)42 (14.0)41 (13.4)
    Distant metastasis, present25 (2.1)6 (2.1)11 (3.8)5 (1.7)3 (1.0)0.145
    Staging according to TNM
     I/II638 (53.7)165 (56.9)217 (74.1)129 (42.9)127 (41.6)<0.001d
     III/IV551 (46.3)125 (43.1)76 (25.9)172 (57.1)178 (58.4)
    VariableTotal (n=1,032)Quartile according to body mass indexP valueb
    Q1a (n=251)Q2a (n=254)Q3a (n=263)Q4a (n=264)
    Age, yr45.3±11.944.3±11.237.6±11.348.3±10.050.7±10.7<0.001c,d
     <45476 (46.1)129 (51.4)187 (73.6)79 (30.0)81 (30.7)<0.001d
     ≥45556 (53.9)122 (48.6)67 (26.4)184 (70.0)183 (69.3)
    Maximal tumor diameter, cm2.0±1.12.0±1.02.1±1.11.9±1.02.0±1.10.441c
     ≤2695 (67.3)172 (68.5)160 (63.0)185 (70.3)178 (67.4)0.751
     >2337 (32.7)79 (31.5)94 (37.0)78 (29.7)86 (32.6)
    Extrathyroidal invasion
     Absent345 (33.4)78 (31.1)93 (36.6)91 (34.6)83 (31.4)0.928
     Present687 (66.6)173 (68.9)161 (63.4)172 (65.4)181 (68.6)
    Mutifocal411 (39.8)99 (39.4)75 (29.5)113 (43.0)124 (47.0)0.008d
    Lymph node metastasis
     pN0/Nx393 (38.1)93 (37.1)83 (32.7)113 (43.0)104 (39.4)0.210e
     pN1a502 (48.6)126 (50.2)128 (50.4)122 (46.4)126 (47.7)
     pN1b137 (13.3)32 (12.7)43 (16.9)28 (10.6)34 (12.9)
    Distant metastasis, present20 (1.9)5 (2.0)9 (3.5)4 (1.5)2 (0.8)0.131
    Staging according to TNM
     I/II559 (54.2)146 (58.2)196 (77.2)111 (42.2)106 (40.2)<0.001d
     III/IV473 (45.8)105 (41.8)58 (22.8)152 (57.8)158 (59.8)
    VariableTotal (n=157)Quartile according to body mass indexP valueb
    Q1a (n=39)Q2a (n=39)Q3a (n=38)Q4a (n=41)
    Age, yr45.2±12.547.1±12.143.0±14.147.6±11.143.5±12.10.234c
     <4573 (46.5)17 (43.6)18 (46.2)17 (44.7)21 (51.2)0.538
     ≥4584 (53.5)22 (56.4)21 (53.8)21 (55.3)20 (48.8)
    Maximal tumor diameter, cm2.5±1.52.1±1.62.7±1.82.6±1.12.8±1.60.200c
     ≤280 (51.0)27 (69.2)18 (46.2)16 (42.1)19 (46.3)0.043d
     >277 (49.0)12 (30.8)21 (53.8)22 (57.9)22 (53.7)
    Extrathyroidal invasion
     Absent55 (35.0)14 (35.9)19 (48.7)10 (26.3)12 (29.3)0.214
     Present102 (65.0)25 (64.1)20 (51.3)28 (73.7)29 (70.7)
    Mutifocal55 (35.0)116 (41.0)10 (25.6)15 (39.5)14 (34.1)0.838
    Lymph node metastasis
     pN0/Nx34 (21.7)7 (17.9)9 (23.1)8 (21.1)10 (24.4)0.570e
     pN1a79 (50.3)19 (48.7)20 (51.3)16 (42.1)24 (58.5)
     pN1b44 (28.0)13 (33.3)10 (25.6)14 (36.8)7 (17.1)
    Distant metastasis, present5 (3.2)1 (2.6)2 (5.1)1 (2.6)1 (2.4)0.815
    Staging according to TNM
     I/II79 (50.3)19 (48.7)21 (53.8)18 (47.4)21 (51.2)0.973
     III/IV78 (49.7)20 (51.3)18 (46.2)20 (52.6)20 (48.8)
    Table 1 Baseline Characteristics of Study Subjects and Associations between Body Mass Index Quartiles and Clinicopathological Features of Papillary Thyroid Carcinoma

    Values are expressed as mean±SD or number (%).

    TNM, tumor node metastasis.

    aQuartiles for body mass index (kg/m2): Q1 19.4-23.0, Q2 23.1-24.9 , Q3 25.0-26.9, and Q4 27.0-38.2 for males and Q1 15.8-21.7, Q2 21.8-23.5, Q3 23.6-25.9, and Q4 26.0-37.1 for females; bP values for trends across the body mass index quartiles were conducted using a Cochran-Armitage trend test, except nodal metastasis variable; cP values by analysis of variance; dStatistically significant; eNodal metastasis variable was analyzed by a chi-square test.

    Table 2 Associations between Body Mass Index Quartile and Clinicopathological Features for Females

    Values are expressed as mean±SD or number (%).

    TNM, tumor node metastasis.

    aQuartiles for body mass index (kg/m2): Q1 15.8-21.7, Q2 21.8-23.5, Q3 23.6-25.9, and Q4 26.0-37.1 for females; bP values for trends across the body mass index quartiles were conducted using a Cochran-Armitage trend test, except nodal metastasis variable; cP values by analysis of variance; dStatistically significant; eNodal metastasis variable was analyzed by a chi-square test.

    Table 3 Associations between Body Mass Index Quartiles and Clinicopathological Features for Males

    Values are expressed as mean±SD or number (%).

    TNM, tumor node metastasis.

    aQuartiles for body mass index (kg/m2); Q1 19.4-23.0, Q2 23.1-24.9, Q3 25.0-26.9, and Q4 27.0-38.2 for males; bP values for trends across the body mass index quartiles were conducted using a Cochran-Armitage trend test, except nodal metastasis variable; cP values by analysis of variance; dStatistically significant; eNodal metastasis variable was analyzed by a chi-square test.

    Table 1

    Table 2

    Table 3

    Endocrinol Metab : Endocrinology and Metabolism
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