Objective. This study aims to determine the association between body mass index and the pathologic features of papillary thyroid cancer among adult Filipinos who underwent thyroid surgery.

Methodology. This is a retrospective cohort study including all patients admitted from January 2014 to December 2020 in a tertiary hospital in Cebu City. Adult Filipino patients who underwent thyroid surgery with a final histopathologic diagnosis of papillary thyroid carcinoma we included in the study and were categorized based on their BMI using the Asian classification. Primary outcome is to identify the association of any BMI category with the clinical features of papillary thyroid cancer using multivariate ordinal logistic regression and Pearson product-moment correlation.

Results. There are 234 patients included in the study. Majority of the participants are middle-aged (mean 42.71), and most are female (82%). The mean anthropometric measurement values include weight of 61kg, height of 155.47cm, and BMI of 25.26kg/m2. Majority of the patients are obese. Among the participants more than half showed positive for nodal metastasis, with 1.2% having extrathyroidal invasion. Average tumor size is 2.5cm and about a third having multifocal features. Among the pathologic features, only the primary tumor size is significantly associated with BMI, the obese or overweight being more likely to have larger tumor size.

Conclusion. Increased BMI may be associated with increased primary nodule size in patients with papillary thyroid carcinoma. It did not show a significant correlation with other pathological features such as lymph node metastasis, extrathyroidal extension and multifocality.

Keywords. Body Mass Index, papillary thyroid cancer, obesity

1. Limaiem F, Rehman A, Mazzoni T. Papillary Thyroid Carcinoma. [Updated 2020 Oct 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.
2. Hruby A, Hu FB. The Epidemiology of Obesity: A Big Picture. Pharmacoeconomics. 2015;33(7):673-689.
3. Department of Science and Technology, Food and Nutrition Research Institute: Overweight and obesity is top nutrition concern in 8 Metro Manila cities-FNRI Survey, (Set 20, 2019). https://www.fnri.dost.gov.ph/index.php/programs-and-projects/news-and-announcement/769-overweight-and-obesity-is-top-nutrition-concern-in-8-metro-manila-cities-fnri-survey
4. National Cancer Institute: Obesity and Cancer (January 17, 2017). https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#r6
5. Kim BH. Differentiated Thyroid Cancer in Asians. Endocrinol Metab (Seoul). 2016;31(1):62-63.
6. Kus LH, Shah M, Eski S, Walfish PG, Freeman JL. Thyroid cancer outcomes in Filipino patients. Arch Otolaryngol Head Neck Surg. 2010 Feb;136(2):138-42.
7. Lo TE, Canto AU, Maningat PD. Risk Factors for Recurrence in Filipinos with Well-Differentiated Thyroid Cancer. Endocrinol Metab (Seoul). 2015;30(4):543-550.
8. Deng Y, Li H, Wang M, et al. Global Burden of Thyroid Cancer From 1990 to 2017. JAMA Netw Open. 2020;3(6):e208759.
9. Rossi, E. D., Pantanowitz, L., & Hornick, J. L. (2021). A worldwide journey of thyroid cancer incidence centred on tumour histology. The Lancet Diabetes & Endocrinology, 9(4), 193–194.
10. Zhao ZG, Guo XG, Ba CX, Wang W, Yang YY, Wang J, Cao HY. Overweight, obesity and thyroid cancer risk: a meta-analysis of cohort studies. J Int Med Res. 2012;40(6):2041-50.
11. Harari A, Endo B, Nishimoto S, Ituarte PHG, Yeh MW. Risk of Advanced Papillary Thyroid Cancer in Obese Patients. Arch Surg. 2012;147(9):805–8
12. Shin A, Cho S, Jang D, Abe SK, Saito E, Rahman MS, Islam MR, Sawada N, Shu XO, Koh WP, Sadakane A, Tsuji I, Sugawara Y, Ito H, Nagata C, Park SK, Yuan JM, Kim J, Tsugane S, Cai H, Wen W, Ozasa K, Matsuyama S, Kanemura S, Oze I, Wada K, Wang R, Yoo KY, Potter JD, Ahsan H, Boffetta P, Chia KS, Matsuo K, Qiao YL, Rothman N, Zheng W, Inoue M, Kang D. Body Mass Index and Thyroid Cancer Risk: A Pooled Analysis of Half a Million Men and Women in the Asia Cohort Consortium. Thyroid. 2022 Jan 11
13. Yu, S., Chen, W., Cai, Q., Liang, F., Xu, D., Han, P., … Huang, X. (2017). Pretreatment BMI Is Associated with Aggressive Clinicopathological Features of Papillary Thyroid Carcinoma: A Multicenter Study. International Journal of Endocrinology, 2017, 1–7.
14. Kim HJ, Kim NK, Choi JH, Sohn SY, Kim SW, Jin SM, Jang HW, Suh S, Min YK, Chung JH, Kim SW. Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer. Clin Endocrinol (Oxf). 2013 Jan;78(1):134-40.
15. Lohmann, A. E., Goodwin, P. J., Chlebowski, R. T., Pan, K., Stambolic, V., & Dowling, R. J. O. (2016). Association of Obesity-Related Metabolic Disruptions With Cancer Risk and Outcome. Journal of Clinical Oncology, 34(35), 4249–4255.
16. Cheng SP, Chi CW, Tzen CY, Yang TL, Lee JJ, Liu TP, Liu CL. Clinicopathologic significance of leptin and leptin receptor expressions in papillary thyroid carcinoma. Surgery. 2010 Jun;147(6):847-53
17. Harikrishna, A., Ishak, A., Ellinides, A., Saad, R., Christodoulou, H., Spartalis, E., & Paschou, S. A. (2019). The impact of obesity and insulin resistance on thyroid cancer: a systematic review. Maturitas.
18. Marcello, M. A., Cunha, L. L., Batista, F. A., and Ward, L. S. (2014). Obesity and thyroid cancer. Endocrine-Related Cancer 21, 5, T255-T271
19. Economides Aliki, Giannakou Konstantinos, Mamais Ioannis, Economides Panayiotis A., Papageorgis Panagiotis. Association Between Aggressive Clinicopathologic Features of Papillary Thyroid Carcinoma and Body Mass Index: A Systematic Review and Meta-Analysis.Frontiers in Endocrinology VOLUME 12 YEAR 2021
20. Zhao, Sitong MDa; Jia, Xiaomeng PhDa; Fan, Xiaojing MDa; Zhao, Ling PhDa; Pang, Ping MDb; Wang, Yajing MDa; Luo, Yukun PhDc; Wang, Fulin PhDd; Yang, Guoqing PhDa; Wang, Xianling PhDa; Gu, Weijun PhDa; Zang, Li PhDa; Pei, Yu PhDa; Du, Jin PhDa; Ba, Jianming PhDa; Dou, Jingtao PhDa; Mu, Yiming PhDa; Lyu, Zhaohui MD, PhDa,∗ Association of obesity with the clinicopathological features of thyroid cancer in a large, operative population, Medicine: December 2019 - Volume 98 - Issue 50 - p e18213
21. Zaman SU, Awan MS, Sulaiman MA. Obesity and High Risk Pathological Features of Papillary Thyroid Carcinoma: A Retrospective Analysis of a University Hospital in Pakistan. Gulf J Oncolog. 2018 May;1(27):6-10.