Predictors of Recurrence in Patients with Papillary Thyroid Carcinoma: Does Male Sex Matter?

SIMPLE SUMMARY: Men with papillary thyroid carcinoma tend to have more high-risk features for recurrence than women. However, the prognostic impact of sex remains controversial and unestablished. Our study of 1252 patients indicated that men had risk of recurrence comparable to that of women, although male sex was associated with more aggressive disease. Furthermore, we also confirmed that the impact of sex for recurrence was not associated with tumor size or patient age. In conclusion, male sex did not increase the risk of recurrence in patients with papillary thyroid carcinoma. Male patients do not always require aggressive treatment and follow-up approaches. ABSTRACT: Male patients with papillary thyroid carcinoma (PTC) usually have aggressive clinicopathological features, including large tumor size and lymph node metastasis; however, it is unclear whether male sex increases the risk of recurrence. Here, we evaluated the effect of sex on disease-free survival (DFS) of patients with PTC. Between 2009 and 2016, 1252 patients who underwent total thyroidectomy for PTC were enrolled; 157 (12.5%) were male and 1095 (87.5%) were female. With a mean follow-up of 6.6 years, five-year DFS rates were comparable between male and female patients (94.9% vs. 96.9%; p = 0.616) after adjusting for potential confounders. Multivariate Cox regression analysis also demonstrated that male sex was not an independent risk factor for recurrence (HR 1.982, 95% CI 0.831–4.726). Subgroup analyses further indicated that both male and female sex—in terms of their associations with five-year DFS—were comparable with other variables, including age < 55 years (94.5% vs. 97.3%; p = 0.520) and tumor size > 1 cm (91.9% vs. 97.0%; p = 0.243). In conclusion, male sex was not associated with the risk of recurrence in patients with PTC. Male patients do not always require aggressive treatment and follow-up approaches.