Cohort study of association of sex with mortality among patients with papillary thyroid cancer

The prognostic value of patient sex in papillary thyroid cancer (PTC) is not clear. A cohort study at 15 centers in 10 countries between 1979 and 2023 examine PTC-specific mortality risk of sex with respect to patient age and tumor genetics – specifically the status of BRAF V600E and TERT promoter (TERTp) mutations. The study included 4746 patients with PTC. The median age was 48 years (IQR 37-59; 76.1% of patients were female; the median follow-up time was 51.0 months (IQR 26.4-109.1) after initial treatment. Male patients, compared to female patients, had a higher overall PTC-specific mortality (3.7% versus 1.7%; p<0.001). This male sex-associated risk was observed only in patients harboring BRAF V600E or TERTp mutations, not wild type genes. The risk was highest in male patients aged 45 years or older with dual BRAF V600E and TERTp mutations, with an adjusted male-to-female hazard ratio of 3.07. The authors conclude that this study supports the integration of patient sex, in conjunction with patient age and tumor genetics, into the risk prognostication of PTC.