{"paper_id":"0bf99cee-4c40-48e3-9a3a-6405d893f230","body_text":"Potential impact of obesity on the aggressiveness of low-to intermediate-risk papillary thyroid carcinoma: results from a MASTER cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Potential impact of obesity on the aggressiveness of low-to intermediate-risk papillary thyroid carcinoma: results from a MASTER cohort study Mijin Kim, Yae Eun Kang, Young Joo Park, Bon Seok Koo, Eu Jeong Ku, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2584761/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Jul, 2023 Read the published version in Endocrine → Version 1 posted 3 You are reading this latest preprint version Abstract Purpose: Obesity is associated with an increased risk of papillary thyroid carcinoma (PTC). Evidence of the impact of obesity on PTC aggressiveness is scarce. We aimed to evaluate the association between the body mass index (BMI) and the presence of aggressive features of low- to intermediate-risk PTC in a prospective cohort. Methods: A total of 1,088 patients with low- to intermediate-risk PTC who underwent lobectomy at 22 hospitals in Korea were prospectively enrolled and divided into three groups according to BMI, as follows: normal/underweight (<23 kg/m 2 ), overweight (23–24.9 kg/m 2 ), and obese (≥25 kg/m 2 ). Clinicopathological features of PTC at diagnosis were evaluated. Results: Obese patients had a larger primary tumor size, higher rate of macro-PTC (>1 cm), and greater incidence of extra-thyroidal extension (ETE) and vascular invasion than those who were not classified as obese. Increased BMI was positively associated with the incidence of macro-PTC ( p for trend = 0.019), ETE ( p for trend = 0.013), and vascular invasion ( p for trend = 0.021). After adjusting for age, sex, pathological features, metabolic syndrome, and thyroid function test, obesity was a risk factor for ETE (odds ratio = 1.6, 95% confidence interval: 1.1–2.3, p = 0.007) in women. This association was significant regardless of whether or not the women had metabolic syndrome. There was no significant association between obesity and aggressive PTC features in men. Conclusion: These results suggest that BMI at the time of thyroid cancer diagnosis may affect the aggressiveness of low- to intermediate-risk PTC, especially in women. Obesity Papillary thyroid carcinoma Aggressiveness Body mass index Metabolic syndrome Figures Figure 1 Introduction Parallel increases in both obesity prevalence and incidence of papillary thyroid carcinoma (PTC) worldwide have encouraged basic and clinical research efforts to understand the potential relationship between obesity and PTC development [1, 2]. Epidemiological evidence has indicated a linear correlation between obesity and PTC risk [3-5]. In a large population study of more than two million Norwegians, body mass index (BMI) was positively associated with the incidence of PTC [3]. In a pooled analysis of 22 prospective studies, greater BMI at baseline and young adulthood and adulthood BMI gains were positively associated with an increased risk of PTC [4]. Based on published evidence, a working group from the International Agency for Research on Cancer added thyroid carcinoma to the growing list of cancers with sufficient evidence of a causal relationship with obesity [5]. The association between obesity and aggressive features of PTC has also been investigated in retrospective cohort studies; however, data gathered thus far are conflicting [4, 6, 7]. A retrospective analysis of 2,057 PTC patients showed that a higher BMI at thyroid cancer diagnosis was strongly associated with an increased primary tumor size, extrathyroidal extension (ETE), and advanced tumor-node-metastasis (TNM) stage [6]. In another retrospective review of 1,216 patients with PTC, among macro-PTC (tumor diameter >1 cm), obese patients were at increased risk of postoperative locoregional persistent or recurrent disease during follow-up [7]. However, several other studies have shown that thyroid cancer aggressiveness and clinical outcomes of obese and non-obese patients do not significantly differ [8-10]. The incidence of PTC has been increasing continuously, with the majority of patients with PTC having low- or intermediate-risk diseases [1, 11]. Recent guidelines recommend less surgery for the treatment of small PTCs and even suggest active surveillance instead of immediate surgery as an alternative management approach for low-risk PTCs [12]. Owing to the recent trend of a more conservative approach towards the management of PTC, the effect of modifiable factors such as changes in lifestyle and environmental influences has become more relevant [13, 14]. A Multicenter Randomized Controlled Study for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER) study is a randomized control trial aimed to established optimal TSH level in patients with low- to intermediate-risk thyroid cancer [15]. Based on these considerations, we aimed to evaluate the association between obesity and tumor aggressiveness in patients with a low to intermediate risk of PTC via an assessment of a MASTER cohort in Korea [15]. Materials and Methods Patients This multicenter prospective cohort study included 1,088 patients with PTC who underwent lobectomy between May 2020 and February 2022 at one of 22 tertiary hospitals in Korea [15]. Eligible patients were aged 18–80 years, had primary tumors ≤ 4 cm, and had clinical N0 or N1a disease according to the 8 th edition of the American Joint Committee on Cancer (AJCC) TNM staging system [16]. Patients were excluded if they had any of the following: advanced pT4, pN1b, or M1 disease; diffuse sclerosing variants of PTC; poorly differentiated thyroid carcinoma; histological types other than PTC (follicular, medullary, or anaplastic thyroid carcinoma), incomplete tumor resection (R1/R2), or candidates for completion thyroidectomy; nodules with Bethesda category IV–VI in the remaining lobes; active hyperthyroidism; pregnancy; or other clinical conditions that, in the opinion of the investigator, would make the subject unsuitable for the study. Patients who lacked data on pathology reports, anthropometric measurements, and laboratory findings were also excluded. The study protocol was reviewed and approved by the Institutional Review Board of each participating institution (trial registration number: KCT0004989). Data Collection and Definitions Data were collected after obtaining informed consent from each patient. BMI, systolic and diastolic blood pressure (BP), and laboratory findings including lipid profile, fasting glucose, and thyroid function tests were measured within a three month period prior to thyroidectomy. Biochemical measurements including plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride, and high-density lipoprotein cholesterol (HDL-C) levels were measured using blood samples taken after fasting for at least eight hours. Data on underlying diseases and medication use were collected during enrollment. After thyroidectomy, the following clinicopathological data were collected from electronic medical records: age at diagnosis, sex, histologic subtype, primary tumor size, presence and extent of ETE, tumor multifocality, presence of vascular invasion, pathologic lymph node (LN) involvement status, and presence of distant metastases. BMI was calculated as weight in kilograms divided by height in meters squared and was categorized according to Asian-specific criteria [17]. Based on BMI, patients were initially classified into two groups, as follows: non-obese group, BMI < 25 kg/m 2 ; and obese group, BMI ≥25 kg/m 2 . Patients in the non-obese group were further placed in normal/underweight (<23 kg/m 2 ) and overweight (23–24.9 kg/m 2 ) subgroups. Metabolic syndrome was defined as the presence of at least two of the following metabolic abnormalities: (i) fasting glucose ≥100 mg/dL or current use of a glucose-lowering agent; (ii) serum triglyceride level ≥150 mg/dL or current use of lipid-lowering agents; (iii) HDL-C level <40 mg/dL in men or <50 mg/dL in women; or (iv) BP ≥130/85 mmHg or taking antihypertensive drugs. Statistical analysis Continuous variables are presented as means with standard deviations, and categorical variables are presented as numbers with percentages. We used a t -test to compare continuous variables and the chi-squared test to compare categorical variables. Odds ratios (ORs) with 95% confidence intervals (CIs) calculated via logistic regression were used to measure risk of aggressiveness according to BMI categories. In the multivariate analysis, adjustment for the following factors was performed: age, sex, primary tumor size, ETE, multifocality, vascular invasion, cervical LN metastasis, AJCC staging, metabolic syndrome, and thyrotropin. Data were analyzed using R software (version 3.6.2, R Foundation for Statistical Computing, Vienna, Austria; http://www.R-project.org). Figures were constructed using GraphPad Prism version 5.0 (GraphPad Software, San Diego, CA, USA; http://www.graphpad.com). Statistical significance was set at p < 0.05. Results Baseline Characteristics of Included Patients The baseline characteristics of the 1,088 patients with low- to intermediate-risk PTC included in this study are shown in Table 1. The mean age at diagnosis of PTC was 46.9 ± 11.6 years, and 274 (25.2%) patients were male. The mean primary tumor size was 0.8 ± 0.5 cm, with 24% of patients having macro-tumors (>1 cm). Microscopic and gross ETE were found in 455 (41.8%) and 13 (1.2%) patients, respectively. Multifocal disease and vascular invasion were observed in 216 (19.9%) and 144 (13.2%) patients, respectively. Cervical LN metastasis was identified in 359 (32.7%) patients;351 (32.3%) and 4 (0.4%) with N1a and N1b disease, respectively. Most patients had AJCC TNM stage I disease ( n = 1002, 92.1%) and classical PTC ( n = 882, 81.1%). The mean BMI was 25.0 ± 4.1 kg/m 2 , and 486 (44.7%) patients were obese. Clinicopathologic Characteristics of Patients with Low- to Intermediate-Risk PTC According to BMI Clinicopathological features of PTC according to BMI are shown in Table 1. In total, 602 (55.3%) and 486 (44.7%) patients were included in non-obese and obese groups, respectively (Table 2). The mean primary tumor size was larger ( p = 0.036) and the proportion of macro-PTC was higher ( p = 0.033) in the obese group than in the non-obese group. ETE (46.5% vs. 40.2%, p = 0.043) and vascular invasion (15.8% vs. 11.1%, p = 0.028) occurred significantly more frequently in the obese versus non-obese group. When patients in the non-obese group were subdivided based on a cut-off BMI value of 23 kg/m 2 , 379 (35%) and 223 (20%) individuals were classified as normal/underweight and overweight, respectively (Table 2). An increased BMI value was positively associated with a higher proportion of macro-PTC ( p for trend = 0.019), ETE ( p for trend = 0.013), and vascular invasion ( p for trend = 0.021). Odds Ratios for Tumor Aggressiveness in Obese Patients with Low-to Intermediate-Risk PTC Figure 1 shows adjusted ORs for aggressive tumor phenotypes in the obese group compared with the non-obese group separately by sex. After adjustment for age, sex, pathological features, coexisting metabolic abnormalities, and thyroid function, obesity was a risk factor for ETE (adjusted OR = 1.4, 95% CI 1.0–1.8, p = 0.030). Among women, the adjusted OR for ETE in obese patients compared to non-obese patients was 1.4 (95% CI 1.1–2.0, p = 0.026). However, this association was not observed in men. Combined Effects of Obesity and Metabolic Syndrome Status on Tumor Aggressiveness The association between the tumor aggressiveness of low-to intermediate-risk PTC and a combination of obesity and metabolic syndrome, after adjusting for confounding factors, is reported in Table 3. In the non-obese group, both men and women with metabolic syndrome did not have significantly increased risk of tumor aggressiveness compared to those without metabolic syndrome. In the obese group, the effect of metabolic syndrome on tumor aggressiveness differed between men and women. Obese women were at significantly increased risk of ETE regardless of the presence of metabolic syndrome (adjusted OR = 1.6, 95% CI 1.1-2.4, p = 0.027 in obese women without metabolic syndrome; adjusted OR = 1.5, 95% CI 1.0-2.2, p = 0.040 in obese women with metabolic syndrome). In addition, the combined effect of obesity and metabolic syndrome on vascular invasion risk was significant in women (adjusted OR = 2.4, 95% CI 1.4-4.1, p = 0.001). In contrast, obese men with metabolic syndrome were not at increased risk of aggressive PTC versus those without metabolic syndrome. Discussion In this multicenter prospective cohort study, most patients had a small-PTC. Obesity and metabolic abnormalities are more common in men than in women. Increased BMI categories were positively associated with risk of macro-PTC, ETE, and vascular invasion in patients with low- to intermediate-risk PTC. After adjusting for major confounding parameters, obesity was found to be an independent risk factor for ETE in women. This association was significant regardless of whether or not women had metabolic syndrome. There was no significant association between obesity and an aggressive PTC phenotype in men. Although substantial evidence indicating a relationship between obesity and the incidence of PTC has been reported, data indicating a possible association between obesity and tumor aggressiveness in patients with PTC is scarce [3-10]. Some studies have shown a marked aggressiveness of PTC at diagnosis among obese patients, with heterogeneous findings reported regarding aggressive features in these individuals [4, 6-10, 18, 19]. In a retrospective analysis of 13,995 Chinese patients with PTC, obesity was a relevant risk factor for large tumor size, multifocality, ETE, and advanced tumor stage, with gender differences reported [19]. Another retrospective analysis of 716 patients with PTC in Korea showed that increased BMI was correlated with lymphatic invasion and multifocality in older (≥45 years) but not younger (<45 years) patients [18]. In a retrospective analysis of 1,216 patients with PTC in France, after excluding PTC <1 cm, obesity was associated with locoregional disease during a median follow-up of 6.2 years [7]. Differences in ethnicity, epidemiological and pathological features of study populations, study type, and self-reported body measures may have contributed to differences in study conclusions [4, 6-10, 18, 19]. Therefore, there is a need for cautious interpretation of prior findings. Importantly, our study analyzed a well-designed, prospective cohort of patients with low- to intermediate-risk PTC. In our multicenter, prospective cohort, obese patients with low- to intermediate-risk PTC had significantly larger tumors and higher proportions of ETE and vascular invasion than non-obese patients. In the multivariate analysis, obesity was an independent risk factor for ETE, regardless of the presence of metabolic syndrome. Although there is a recent debate about the clinical significance of microscopic ETE observed via histopathology, ETE is a well-known prognostic factor associated with recurrence and mortality [20, 21]. In a population-based cohort study of 107,114 patients with differentiated thyroid carcinoma in Surveillance, Epidemiology, and End Results data, Liu et al reported significantly poorer overall and cancer-specific survival among patients with microscopic ETE compared with those with no ETE [21]. In this study, some aggressive histopathological features of PTC, including nodal and TNM stages, were not significantly correlated with obesity. The characteristics of the cohort may explain significant differences observed between aggressive features. Our study cohort mainly included patients with low-risk PTC whose tumors were treated via thyroid lobectomy alone. Therefore, most patients had N0 and AJCC TNM stage I disease. Since the prevalence of low-risk PTC is increasing, more population-based studies will be needed to validate these findings. Another possible explanation for the lack of an association between BMI and nodal stages is that LN metastasis may not be related to obesity in PTC patients. Prior studies have also shown that obesity is not related to LN metastasis in PTC [6, 18, 19, 22]. Biological mechanisms linking obesity with ETE and LN metastasis may differ [23]. Additional research is needed to improve our understanding of biological mechanisms underlying the relationship between obesity and tumor aggressiveness in PTC. In our study, there was no association between obesity and aggressive features of PTC in men, despite the fact that men had higher prevalence rates of obesity and metabolic component abnormalities. Whereas, in women, combined effects of obesity and metabolic syndrome on vascular invasion risk was significant. Previous studies have also reported sex-based differences [19, 24]. Although the underlying biological mechanisms are not completely understood, some researchers suggest that obesity-related metabolic abnormalities such as chronic inflammation, insulin resistance, and the presence of some adipokines may contribute to the positive correlation between thyroid cancer risk and obesity [24, 25]. Our results support the finding that metabolic dysregulation might affect tumor aggressiveness in patients with PTC in addition to excessive adiposity. The relatively small number of men included in the study may have contributed to this lack of association. One of the strengths of this study is that we evaluated the impact of obesity on tumor aggressiveness in a well-designed large, multicenter, prospective cohort of patients with low- to intermediate-risk PTC. The incidence of PTC has increased worldwide, and most newly diagnosed cancers are micro-PTCs, defined as tumors ≤1 cm in size [11]. Reflecting on recent guidelines, rates of lobectomy and active surveillance are increasing [13, 14]. Therefore, at the time of diagnosis, the identification of PTC with aggressive features has become one of the most important challenges in the management of affected patients. The identification of modifiable factors affecting prognosis has the potential to improve treatment and outcomes. Another strength is that anthropometric and laboratory data were measured using a standardized protocol. Weight, height, and BP were assessed by trained nurses, with laboratory data including fasting glucose, total cholesterol, LDL-C, triglycerides, and HDL-C measured in blood samples after fasting for at least eight hours. Nonetheless, this study had several limitations. This study cohort included only patients with confirmed PTC; therefore, we were unable to evaluate the association between obesity and the development of thyroid cancer. In addition, this study had a cross-sectional design; it is unclear whether differences in aggressive phenotypes of obese and non-obese groups will directly affect long-term outcomes, including recurrence and mortality. Subsequent analysis of this study cohort will help answer this question. In summary, we have evaluated the association between the obesity and metabolic syndrome and PTC aggressiveness. This multicenter, prospective cohort study indicates that BMI at the time of diagnosis may affect the tumor aggressiveness in patients, particularly women, with a low- to intermediate-risk PTC. This analysis might have a clinical importance on answering the question whether obese patients with low-to intermediate-risk thyroid cancer might be managed differently than non-obese patients. Future studies are required to determine whether PTC becomes less aggressive after weight reduction or obesity at PTC diagnosis influences long-term clinical outcomes in patients with low- to intermediate-risk PTC. Declarations The authors have no conflicts of interest to desclose . Funding This study was supported by a grant from the Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health & Welfare, Republic of Korea (grant numbers: HI19C0481, HC19C0103). Ethical approval The study protocol was reviewed and approved by the Institutional Review Board of each participating institution (trial registration number: KCT0004989). References Davies, L., Welch, H.G.: Current thyroid cancer trends in the United States. 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Baseline characteristics of patient with low- to intermediate-risk PTC according to obesity Characteristics Total (n=1088) Non-obese (n=602) Obese (n=486) P -value Age (years) 46.9 ± 11.6 46.5 ± 11.7 47.4 ± 11.4 0.207 Sex, male 274 (25.2) 82 (13.6) 192 (39.5) <0.001 Primary t umor size (cm) 0.8 ± 0.5 0.8 ± 0.5 0.9 ± 0.5 0.036 ≤1cm 827 (76.0) 473 (78.6) 354 (72.8) 0.033 >1cm 261 (24.0) 129 (21.4) 132 (27.2) Extra-thyroidal extension 468 (43.0) 242 (40.2) 226 (46.5) 0.043 Microscopic 455 (41.8) 234 (38.9) 221 (45.5) 0.087 Gross 13 (1.2) 8 (1.3) 5 (1.0) Multifocal disease 216 (19.9) 113 (18.8) 103 (21.2) 0.358 Vascular invasion 144 (13.2) 67 (11.1) 77 (15.8) 0.028 Cervical LN metastasis N0/Nx 733 (67.4) 415 (68.9) 318 (65.4) 0.075 N1a 351 (32.3) 183 (30.4 168 (34.6) N1b 4 (0.4) 4 (0.7) 0 TNM stage (8 th ) Stage I 1002 (92.1) 550 (91.4) 452 (93.0) 0.376 Stage II 86 (7.9) 52 (8.6) 34 (7.0) PTC subtype Classic 882 (81.1) 488 (81.1) 394 (81.1) 0.999 Follicular 18 (1.7) 10 (1.7) 8 (1.6) Others 188 (17.3) 104 (17.3) 84 (17.3) BMI (kg/m 2 ) 25.0 ± 4.1 22.2 ± 1.8 28.6 ± 3.2 <0.001 Systolic BP (mmHg) 126.5 ± 15.1 122.2 ± 13.6 131.7 ± 15.2 <0.001 Diastolic BP (mmHg) 78.3 ± 10.9 75.7 ± 10.3 81.4 ± 10.8 <0.001 Triglycerides (mg/dL) 126.7 ± 89.4 103.0 ± 67.6 157.0 ± 103.6 <0.001 LDL-C (mg/dL) 106.4 ± 35.2 104.9 ± 34.3 108.4 ± 36.3 0.175 HDL-C (mg/dL) 55.9 ± 14.7 60.7 ± 14.8 49.8 ± 12.1 <0.001 Fasting glucose (mg/dL) 102.7 ± 23.6 99.4 ± 18.7 106.6 ± 27.9 <0.001 TSH (IU/mL) 2.0 ± 1.4 2.0 ± 1.6 2.0 ± 1.1 0.747 fT4 (ng/dL) 1.2 ± 0.2 1.2 ± 0.2 1.2 ± 0.2 0.310 Values are expressed as mean ± standard deviation or number (%). Abbreviations: LN, Lymph Node; TNM, tumor-node-metastasis; PTC, papillary thyroid carcinoma; BMI, body mass index; BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TSH, thyrotropin; fT4, free thyroxine thyroxine Table 2. Clinicopathologic characteristics of PTC patients with normal/under-weight, overweight, and obese Characteristics Normal/under-weight Overweight Obese P -value Number of patients 379 223 486 Age (years) 44.6 ± 11.6 49.6 ± 11.3 47.4 ± 11.4 <0.001 a Sex, male 33 (8.7) 49 (22.0) 192 (39.5) <0.001 b Primary t umor size (cm) 0.8 ± 0.5 0.8 ± 0.4 0.9 ± 0.5 0.109 ≤1cm 302 (79.7) 171 (76.7) 354 (72.8) 0.019 c >1cm 77 (20.3) 52 (23.3) 132 (27.2) Extra-thyroidal extension 144 (38.0) 98 (43.9) 226 (46.5) 0.013 c Multifocal disease 68 (17.9) 45 (20.2) 103 (21.2) 0.238 c Vascular invasion 40 (10.6) 27 (12.1) 77 (15.8) 0.021 c Cervical LN metastasis N0/Nx 259 (68.3) 156 (70.0) 318 (65.4) 0.206 b N1a 118 (31.1) 65 (29.1) 168 (34.6) N1b 2 (0.5) 2 (0.9) 0 TNM stage (8 th ) Stage I 352 (92.9) 198 (88.8) 452 (93.0) 0.121 b Stage II 27 (7.1) 25 (11.2) 34 (7.0) PTC subtype Classic 307 (81.0) 181 (81.2) 394 (81.1) 0.999 b Follicular 6 (1.6) 4 (1.8) 8 (1.6) Others 66 (17.4) 38 (17.0) 84 (17.3) BMI (kg/m 2 ) 21.1 ± 1.4 24.0 ± 0.6 28.6 ± 3.2 <0.001 a Systolic BP (mmHg) 120.7 ± 13.6 124.9 ± 13.0 131.7 ± 15.2 <0.001 a Diastolic BP (mmHg) 74.5 ± 10.3 77.8 ± 10.0 81.4 ± 10.8 <0.001 a Triglycerides (mg/dL) 93.4 ± 50.6 120.0 ± 88.0 157.0 ± 103.6 <0.001 a LDL-C (mg/dL) 101.0 ± 34.7 111.8 ± 32.6 108.4 ± 36.3 0.003 a HDL-C (mg/dL) 62.4 ± 13.9 57.6 ± 15.8 49.8 ± 12.1 <0.001 a Fasting glucose (mg/dL) 98.5 ± 21.2 100.9 ± 13.4 106.6 ± 27.9 <0.001 a TSH (IU/mL) 2.1 ± 1.8 1.9 ± 1.1 2.0 ± 1.1 0.271 a fT4 (ng/dL) 1.2 ± 0.2 1.2 ± 0.2 1.2 ± 0.2 0.425 a a Kruskal-wallis rank sum test, b Chi-square test, c p for trend Values are expressed as mean ± standard deviation or number (%). Abbreviations: LN, Lymph Node; TNM, tumor-node-metastasis; PTC, papillary thyroid carcinoma; BMI, body mass index; BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TSH, thyrotropin; fT4, free thyroxine Table 3. Risk for tumor aggressiveness in patients with low- to intermediate-risk PTC according to the obesity and metabolic syndrome Non-obese + non-MetS (component 0-1) Non-obese + MetS (component ≥2) Obese + non-MetS (component 0-1) Obese + MetS (component ≥2) *OR *OR (95% CI) p *OR (95% CI) p *OR (95% CI) p Male Larger tumor (>1 cm) 1 1.2 (0.4-3.5) 0.731 1.6 (0.7-4.2) 0.282 1.1 (0.4-2.5) 0.968 ETE (ref. no ETE) 1 1.5 (0.6-3.8) 0.435 1.2 (0.5-2.9) 0.601 1.4 (0.7-3.1) 0.397 Multifocal disease 1 2.3 (0.6-12.0) 0.266 3.9 (1.2-18.0) 0.041 3.1 (1.0-13.8) 0.083 Vascular invasion 1 0.9 (0.2-3.3) 0.840 0.9 (0.3-3.0) 0.873 1.2 (0.4-3.6) 0.759 Cervical LN metastasis 1 1.0 (0.3-3.0) 0.973 0.7 (0.3-1.7) 0.397 0.9 (0.4-2.2) 0.885 Advanced AJCC stage 1 47.7 (0-INF) 0.999 1.1 (0-INF) 0.999 2.3e-33 (0-INF) 0.999 Female Larger tumor (>1 cm) 1 1.5 (0.9-2.4) 0.107 1.3 (0.8-2.2) 0.231 1.5 (0.9-2.3) 0.101 ETE (ref. no ETE) 1 1.3 (0.9-2.0) 0.181 1.6 (1.1-2.4) 0.027 1.5 (1.0-2.2) 0.040 Multifocal disease 1 1.0 (0.6-1.6) 0.981 1.5 (0.9-2.4) 0.098 0.9 (0.5-1.4) 0.553 Vascular invasion 1 1.5 (0.8-2.8) 0.163 1.3 (0.7-2.5) 0.374 2.4 (1.4-4.1) 0.001 Cervical LN metastasis 1 0.5 (0.3-1.0) 0.129 1.1 (0.7-1.8) 0.621 0.8 (0.5-1.3) 0.336 Advanced AJCC stage 1 1.5 (0.3-9.0) 0.658 0.5 (0.1-4.7) 0.580 0.9 (0.1-5.7) 0.885 * Adjusted for age, tumor size, extrathyroidal extension, multifocality, vascular invasion, cervical lymph node metastasis, AJCC staging, and thyrotropin Abbreviations: MetS, metabolic syndrome; ETE, extrathyroidal extension; LN, Lymph Node; AJCC, American Joint Committee on Cancer; INF, infinitive Cite Share Download PDF Status: Published Journal Publication published 29 Jul, 2023 Read the published version in Endocrine → Version 1 posted Reviewers agreed at journal 15 Feb, 2023 Editor assigned by journal 14 Feb, 2023 First submitted to journal 13 Feb, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-2584761\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":176434403,\"identity\":\"296728ba-c9a7-4230-ae95-9d0afdaa6766\",\"order_by\":0,\"name\":\"Mijin 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06:06:35\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-2584761/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-2584761/v1\",\"draftVersion\":[],\"editorialEvents\":[{\"content\":\"https://doi.org/10.1007/s12020-023-03416-5\",\"type\":\"published\",\"date\":\"2023-07-29T21:47:03+00:00\"}],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":33107487,\"identity\":\"2730cc71-e1e0-486d-bfe8-8b548f6d1091\",\"added_by\":\"auto\",\"created_at\":\"2023-02-17 22:26:38\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1608647,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eRisk of aggressive disease among obese patients with low- to intermediate-risk papillary thyroid carcinoma\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"FIg1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2584761/v1/0cb285b723c55c7ab3aa0202.png\"},{\"id\":44734914,\"identity\":\"7793fa46-48b4-4cab-8019-4f97bb5b07a8\",\"added_by\":\"auto\",\"created_at\":\"2023-10-16 22:22:25\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":846428,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2584761/v1/2e4e2773-38c6-4aab-8a75-8cc590b59f0a.pdf\"}],\"financialInterests\":\"\",\"formattedTitle\":\"Potential impact of obesity on the aggressiveness of low-to intermediate-risk papillary thyroid carcinoma: results from a MASTER cohort study\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eParallel increases in both obesity prevalence and incidence of papillary thyroid carcinoma (PTC) worldwide have encouraged basic and clinical research efforts to understand the potential relationship between obesity and PTC development [1, 2]. Epidemiological evidence has indicated a linear correlation between obesity and PTC risk [3-5]. In a large population study of more than two million Norwegians, body mass index (BMI) was positively associated with the incidence of PTC [3]. In a pooled analysis of 22 prospective studies, greater BMI at baseline and young adulthood and adulthood BMI gains were positively associated with an increased risk of PTC [4]. Based on published evidence, a working group from the International Agency for Research on Cancer added thyroid carcinoma to the growing list of cancers with sufficient evidence of a causal relationship with obesity [5].\\u003c/p\\u003e\\n\\u003cp\\u003eThe association between obesity and aggressive features of PTC has also been investigated in retrospective cohort studies; however, data gathered thus far are conflicting [4, 6, 7]. A retrospective analysis of 2,057 PTC patients showed that a higher BMI at thyroid cancer diagnosis was strongly associated with an increased primary tumor size, extrathyroidal extension (ETE), and advanced tumor-node-metastasis (TNM) stage [6]. In another retrospective review of 1,216 patients with PTC, among macro-PTC (tumor diameter \\u0026gt;1 cm), obese patients were at increased risk of postoperative locoregional persistent or recurrent disease during follow-up [7]. However, several other studies have shown that thyroid cancer aggressiveness and clinical outcomes of obese and non-obese patients do not significantly differ [8-10].\\u003c/p\\u003e\\n\\u003cp\\u003eThe incidence of PTC has been increasing continuously, with the majority of patients with PTC having low- or intermediate-risk diseases [1, 11]. Recent guidelines recommend less surgery for the treatment of small PTCs and even suggest active surveillance instead of immediate surgery as an alternative management approach for low-risk PTCs [12]. Owing to the recent trend of a more conservative approach towards the management of PTC, the effect of modifiable factors such as changes in lifestyle and environmental influences has become more relevant [13, 14]. A Multicenter Randomized Controlled Study for Assessing the Usefulness of Suppressing Thyroid Stimulating Hormone Target Levels after Thyroid lobectomy in Low to Intermediate Risk Thyroid Cancer Patients (MASTER) study is a randomized control trial aimed to established optimal TSH level in patients with low- to intermediate-risk thyroid cancer [15]. Based on these considerations, we aimed to evaluate the association between obesity and tumor aggressiveness in patients with a low to intermediate risk of PTC via an assessment of a MASTER cohort in Korea [15].\\u003c/p\\u003e\"},{\"header\":\"Materials and Methods\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ePatients\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis multicenter prospective cohort study included 1,088 patients with PTC who underwent lobectomy between May 2020 and February 2022 at one of 22 tertiary hospitals in Korea [15]. Eligible patients were aged 18\\u0026ndash;80 years, had primary tumors \\u0026le; 4 cm, and had clinical N0 or N1a disease according to the 8\\u003csup\\u003eth\\u003c/sup\\u003e edition of the American Joint Committee on Cancer (AJCC) TNM staging system [16]. Patients were excluded if they had any of the following: advanced pT4, pN1b, or M1 disease; diffuse sclerosing variants of PTC; poorly differentiated thyroid carcinoma; histological types other than PTC (follicular, medullary, or anaplastic thyroid carcinoma), incomplete tumor resection (R1/R2), or candidates for completion thyroidectomy; nodules with Bethesda category IV\\u0026ndash;VI in the remaining lobes; active hyperthyroidism; pregnancy; or other clinical conditions that, in the opinion of the investigator, would make the subject unsuitable for the study. Patients who lacked data on pathology reports, anthropometric measurements, and laboratory findings were also excluded. The study protocol was reviewed and approved by the Institutional Review Board of each participating institution (trial registration number: KCT0004989).\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eData Collection and Definitions\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eData were collected after obtaining informed consent from each patient. BMI, systolic and diastolic blood pressure (BP), and laboratory findings including lipid profile, fasting glucose, and thyroid function tests were measured within a three month period prior to thyroidectomy. Biochemical measurements including plasma glucose, total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglyceride, and high-density lipoprotein cholesterol (HDL-C) levels were measured using blood samples taken after fasting for at least eight hours. Data on underlying diseases and medication use were collected during enrollment. After thyroidectomy, the following clinicopathological data were collected from electronic medical records: age at diagnosis, sex, histologic subtype, primary tumor size, presence and extent of ETE, tumor multifocality, presence of vascular invasion, pathologic lymph node (LN) involvement status, and presence of distant metastases.\\u003c/p\\u003e\\n\\u003cp\\u003eBMI was calculated as weight in kilograms divided by height in meters squared and was categorized according to Asian-specific criteria [17]. Based on BMI, patients were initially classified into two groups, as follows: non-obese group, BMI \\u0026lt; 25 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e; and obese group, BMI \\u0026ge;25 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e. Patients in the non-obese group were further placed in normal/underweight (\\u0026lt;23 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e) and overweight (23\\u0026ndash;24.9 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e) subgroups. Metabolic syndrome was defined as the presence of at least two of the following metabolic abnormalities: (i) fasting glucose \\u0026ge;100 mg/dL or current use of a glucose-lowering agent; (ii) serum triglyceride level \\u0026ge;150 mg/dL or current use of lipid-lowering agents; (iii) HDL-C level \\u0026lt;40 mg/dL in men or \\u0026lt;50 mg/dL in women; or (iv) BP \\u0026ge;130/85 mmHg or taking antihypertensive drugs.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eStatistical analysis\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eContinuous variables are presented as means with standard deviations, and categorical variables are presented as numbers with percentages. We used a \\u003cem\\u003et\\u003c/em\\u003e-test to compare continuous variables and the chi-squared test to compare categorical variables. Odds ratios (ORs) with 95% confidence intervals (CIs) calculated via logistic regression were used to measure risk of aggressiveness according to BMI categories. In the multivariate analysis, adjustment for the following factors was performed: age, sex, primary tumor size, ETE, multifocality, vascular invasion, cervical LN metastasis, AJCC staging, metabolic syndrome, and thyrotropin. Data were analyzed using R software (version 3.6.2, R Foundation for Statistical Computing, Vienna, Austria; http://www.R-project.org). Figures were constructed using GraphPad Prism version 5.0 (GraphPad Software, San Diego, CA, USA; http://www.graphpad.com). Statistical significance was set at \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.05. \\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eBaseline Characteristics of Included Patients\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe baseline characteristics of the 1,088 patients with low- to intermediate-risk PTC included in this study are shown in Table 1. The mean age at diagnosis of PTC was 46.9 \\u0026plusmn; 11.6 years, and 274 (25.2%) patients were male. The mean primary tumor size was 0.8 \\u0026plusmn; 0.5 cm, with 24% of patients having macro-tumors (\\u0026gt;1 cm). Microscopic and gross ETE were found in 455 (41.8%) and 13 (1.2%) patients, respectively. Multifocal disease and vascular invasion were observed in 216 (19.9%) and 144 (13.2%) patients, respectively. Cervical LN metastasis was identified in 359 (32.7%) patients;351 (32.3%) and 4 (0.4%) with N1a and N1b disease, respectively. Most patients had AJCC TNM stage I disease (\\u003cem\\u003en\\u003c/em\\u003e = 1002, 92.1%) and classical PTC (\\u003cem\\u003en\\u003c/em\\u003e = 882, 81.1%). The mean BMI was 25.0 \\u0026plusmn; 4.1 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e, and 486 (44.7%) patients were obese.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eClinicopathologic Characteristics of Patients with Low- to Intermediate-Risk PTC According to BMI\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eClinicopathological features of PTC according to BMI are shown in Table 1. In total, 602 (55.3%) and 486 (44.7%) patients were included in non-obese and obese groups, respectively (Table 2). The mean primary tumor size was larger (\\u003cem\\u003ep\\u003c/em\\u003e = 0.036) and the proportion of macro-PTC was higher (\\u003cem\\u003ep\\u003c/em\\u003e = 0.033) in the obese group than in the non-obese group. ETE (46.5% vs. 40.2%, \\u003cem\\u003ep\\u003c/em\\u003e = 0.043) and vascular invasion (15.8% vs. 11.1%, \\u003cem\\u003ep\\u003c/em\\u003e = 0.028) occurred significantly more frequently in the obese versus non-obese group.\\u003c/p\\u003e\\n\\u003cp\\u003eWhen patients in the non-obese group were subdivided based on a cut-off BMI value of 23 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e, 379 (35%) and 223 (20%) individuals were classified as normal/underweight and overweight, respectively (Table 2). An increased BMI value was positively associated with a higher proportion of macro-PTC (\\u003cem\\u003ep\\u003c/em\\u003e for trend = 0.019), ETE (\\u003cem\\u003ep\\u003c/em\\u003e for trend = 0.013), and vascular invasion (\\u003cem\\u003ep\\u003c/em\\u003e for trend = 0.021).\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eOdds Ratios for Tumor Aggressiveness in Obese Patients with Low-to Intermediate-Risk PTC\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFigure 1 shows adjusted ORs for aggressive tumor phenotypes in the obese group compared with the non-obese group separately by sex. After adjustment for age, sex, pathological features, coexisting metabolic abnormalities, and thyroid function, obesity was a risk factor for ETE (adjusted OR = 1.4, 95% CI 1.0\\u0026ndash;1.8, \\u003cem\\u003ep\\u003c/em\\u003e = 0.030). Among women, the adjusted OR for ETE in obese patients compared to non-obese patients was 1.4 (95% CI 1.1\\u0026ndash;2.0, \\u003cem\\u003ep\\u003c/em\\u003e = 0.026). However, this association was not observed in men.\\u003c/p\\u003e\\n\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eCombined Effects of Obesity and Metabolic Syndrome Status on Tumor Aggressiveness\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe association between the tumor aggressiveness of low-to intermediate-risk PTC and a combination of obesity and metabolic syndrome, after adjusting for confounding factors, is reported in Table 3. In the non-obese group, both men and women with metabolic syndrome did not have significantly increased risk of tumor aggressiveness compared to those without metabolic syndrome. In the obese group, the effect of metabolic syndrome on tumor aggressiveness differed between men and women. Obese women were at significantly increased risk of ETE regardless of the presence of metabolic syndrome (adjusted OR = 1.6, 95% CI 1.1-2.4, \\u003cem\\u003ep\\u003c/em\\u003e = 0.027 in obese women without metabolic syndrome; adjusted OR = 1.5, 95% CI 1.0-2.2, \\u003cem\\u003ep\\u003c/em\\u003e = 0.040 in obese women with metabolic syndrome). In addition, the combined effect of obesity and metabolic syndrome on vascular invasion risk was significant in women (adjusted OR = 2.4, 95% CI 1.4-4.1, \\u003cem\\u003ep\\u003c/em\\u003e = 0.001). In contrast, obese men with metabolic syndrome were not at increased risk of aggressive PTC versus those without metabolic syndrome. \\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this multicenter prospective cohort study, most patients had a small-PTC. Obesity and metabolic abnormalities are more common in men than in women. Increased BMI categories were positively associated with risk of macro-PTC, ETE, and vascular invasion in patients with low- to intermediate-risk PTC. After adjusting for major confounding parameters, obesity was found to be an independent risk factor for ETE in women. This association was significant regardless of whether or not women had metabolic syndrome. There was no significant association between obesity and an aggressive PTC phenotype in men.\\u003c/p\\u003e\\n\\u003cp\\u003eAlthough substantial evidence indicating a relationship between obesity and the incidence of PTC has been reported, data indicating a possible association between obesity and tumor aggressiveness in patients with PTC is scarce\\u0026nbsp;[3-10]. Some studies have shown a marked aggressiveness of PTC at diagnosis among obese patients, with heterogeneous findings reported regarding aggressive features in these individuals\\u0026nbsp;[4, 6-10, 18, 19]. In a retrospective analysis of 13,995 Chinese patients with PTC, obesity was a relevant risk factor for large tumor size, multifocality, ETE, and advanced tumor stage, with gender differences reported\\u0026nbsp;[19]. Another retrospective analysis of 716 patients with PTC in Korea showed that increased BMI was correlated with lymphatic invasion and multifocality in older (\\u0026ge;45 years) but not younger (\\u0026lt;45 years) patients\\u0026nbsp;[18]. In a retrospective analysis of 1,216 patients with PTC in France, after excluding PTC \\u0026lt;1 cm, obesity was associated with locoregional disease during a median follow-up of 6.2 years\\u0026nbsp;[7]. Differences in ethnicity, epidemiological and pathological features of study populations, study type, and self-reported body measures may have contributed to differences in study conclusions\\u0026nbsp;[4, 6-10, 18, 19]. Therefore, there is a need for cautious interpretation of prior findings. Importantly, our study analyzed a well-designed, prospective cohort of patients with low- to intermediate-risk PTC.\\u003c/p\\u003e\\n\\u003cp\\u003eIn our multicenter, prospective cohort, obese patients with low- to intermediate-risk PTC had significantly larger tumors and higher proportions of ETE and vascular invasion than non-obese patients. In the multivariate analysis, obesity was an independent risk factor for ETE, regardless of the presence of metabolic syndrome. Although there is a recent debate about the clinical significance of microscopic ETE observed via histopathology, ETE is a well-known prognostic factor associated with recurrence and mortality\\u0026nbsp;[20, 21]. In a population-based cohort study of 107,114 patients with differentiated thyroid carcinoma in Surveillance, Epidemiology, and End Results data, Liu \\u003cem\\u003eet al\\u003c/em\\u003e reported significantly poorer overall and cancer-specific survival among patients with microscopic ETE compared with those with no ETE\\u0026nbsp;[21]. In this study, some aggressive histopathological features of PTC, including nodal and TNM stages, were not significantly correlated with obesity. The characteristics of the cohort may explain significant differences observed between aggressive features. Our study cohort mainly included patients with low-risk PTC whose tumors were treated via thyroid lobectomy alone. Therefore, most patients had N0 and AJCC TNM stage I disease. Since the prevalence of low-risk PTC is increasing, more population-based studies will be needed to validate these findings. Another possible explanation for the lack of an association between BMI and nodal stages is that LN metastasis may not be related to obesity in PTC patients. Prior studies have also shown that obesity is not related to LN metastasis in PTC\\u0026nbsp;[6, 18, 19, 22]. Biological mechanisms linking obesity with ETE and LN metastasis may differ\\u0026nbsp;[23]. Additional research is needed to improve our understanding of biological mechanisms underlying the relationship between obesity and tumor aggressiveness in PTC.\\u003c/p\\u003e\\n\\u003cp\\u003eIn our study, there was no association between obesity and aggressive features of PTC in men, despite the fact that men had higher prevalence rates of obesity and metabolic component abnormalities. Whereas, in women, combined effects of obesity and metabolic syndrome on vascular invasion risk was significant. Previous studies have also reported sex-based differences\\u0026nbsp;[19, 24]. Although the underlying biological mechanisms are not completely understood, some researchers suggest that obesity-related metabolic abnormalities such as chronic inflammation, insulin resistance, and the presence of some adipokines may contribute to the positive correlation between thyroid cancer risk and obesity\\u0026nbsp;[24, 25]. Our results support the finding that metabolic dysregulation might affect tumor aggressiveness in patients with PTC in addition to excessive adiposity. The relatively small number of men included in the study may have contributed to this lack of association.\\u003c/p\\u003e\\n\\u003cp\\u003eOne of the strengths of this study is that we evaluated the impact of obesity on tumor aggressiveness in a well-designed large, multicenter, prospective cohort of patients with low- to intermediate-risk PTC. The incidence of PTC has increased worldwide, and most newly diagnosed cancers are micro-PTCs, defined as tumors \\u0026le;1 cm in size\\u0026nbsp;[11]. Reflecting on recent guidelines, rates of lobectomy and active surveillance are increasing\\u0026nbsp;[13, 14]. Therefore, at the time of diagnosis, the identification of PTC with aggressive features has become one of the most important challenges in the management of affected patients. The identification of modifiable factors affecting prognosis has the potential to improve treatment and outcomes. Another strength is that anthropometric and laboratory data were measured using a standardized protocol. Weight, height, and BP were assessed by trained nurses, with laboratory data including fasting glucose, total cholesterol, LDL-C, triglycerides, and HDL-C measured in blood samples after fasting for at least eight hours. Nonetheless, this study had several limitations. This study cohort included only patients with confirmed PTC; therefore, we were unable to evaluate the association between obesity and the development of thyroid cancer. In addition, this study had a cross-sectional design; it is unclear whether differences in aggressive phenotypes of obese and non-obese groups will directly affect long-term outcomes, including recurrence and mortality. Subsequent analysis of this study cohort will help answer this question.\\u003c/p\\u003e\\n\\u003cp\\u003eIn summary, we have evaluated the association between the obesity and metabolic syndrome and PTC aggressiveness. This multicenter, prospective cohort study indicates that BMI at the time of diagnosis may affect the tumor aggressiveness in patients, particularly women, with a low- to intermediate-risk PTC. This analysis might have a clinical importance on answering the question whether obese patients with low-to intermediate-risk thyroid cancer might be managed differently than non-obese patients. Future studies are required to determine whether PTC becomes less aggressive after weight reduction or obesity at PTC diagnosis influences long-term clinical outcomes in patients with low- to intermediate-risk PTC.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eThe authors have no conflicts of interest to desclose\\u003cstrong\\u003e.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was supported by a grant from the Patient-Centered Clinical Research Coordinating Center funded by the Ministry of Health \\u0026amp; Welfare, Republic of Korea (grant numbers: HI19C0481, HC19C0103).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical approval\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study protocol was reviewed and approved by the Institutional Review Board of each participating institution (trial registration number: KCT0004989).\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eDavies, L., Welch, H.G.: Current thyroid cancer trends in the United States. 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Surg Today \\u003cstrong\\u003e45\\u003c/strong\\u003e(6), 723-729 (2015)\\u003c/li\\u003e\\n\\u003cli\\u003eLi, C.L., Dionigi, G., Zhao, Y.S., Liang, N., Sun, H.: Influence of body mass index on the clinicopathological features of 13,995 papillary thyroid tumors. J Endocrinol Invest \\u003cstrong\\u003e43\\u003c/strong\\u003e(9), 1283-1299 (2020)\\u003c/li\\u003e\\n\\u003cli\\u003eBortz, M.D., Kuchta, K., Winchester, D.J., Prinz, R.A., Moo-Young, T.A.: Extrathyroidal extension predicts negative clinical outcomes in papillary thyroid cancer. Surgery \\u003cstrong\\u003e169\\u003c/strong\\u003e(1), 2-6 (2021)\\u003c/li\\u003e\\n\\u003cli\\u003eLiu, Z., Huang, Y., Chen, S., Hu, D., Wang, M., Zhou, L., Zhou, W., Chen, D., Feng, H., Wei, W., Zhang, C., Zeng, W., Guo, L.: Minimal extrathyroidal extension affects the prognosis of differentiated thyroid cancer: Is there a need for change in the AJCC classification system? PLoS One \\u003cstrong\\u003e14\\u003c/strong\\u003e(6), e0218171 (2019)\\u003c/li\\u003e\\n\\u003cli\\u003eChoi, J.S., Kim, E.K., Moon, H.J., Kwak, J.Y.: Higher body mass index may be a predictor of extrathyroidal extension in patients with papillary thyroid microcarcinoma. Endocrine \\u003cstrong\\u003e48\\u003c/strong\\u003e(1), 264-271 (2015)\\u003c/li\\u003e\\n\\u003cli\\u003eFeng, C., Gao, Y., Wang, C., Yu, X., Zhang, W., Guan, H., Shan, Z., Teng, W.: Aberrant overexpression of pyruvate kinase M2 is associated with aggressive tumor features and the BRAF mutation in papillary thyroid cancer. J Clin Endocrinol Metab \\u003cstrong\\u003e98\\u003c/strong\\u003e(9), E1524-1533 (2013)\\u003c/li\\u003e\\n\\u003cli\\u003eKwon, H., Chang, Y., Cho, A., Ahn, J., Park, S.E., Park, C.Y., Lee, W.Y., Oh, K.W., Park, S.W., Shin, H., Ryu, S., Rhee, E.J.: Metabolic Obesity Phenotypes and Thyroid Cancer Risk: A Cohort Study. Thyroid \\u003cstrong\\u003e29\\u003c/strong\\u003e(3), 349-358 (2019)\\u003c/li\\u003e\\n\\u003cli\\u003eMatrone, A., Ferrari, F., Santini, F., Elisei, R.: Obesity as a risk factor for thyroid cancer. Curr Opin Endocrinol Diabetes Obes \\u003cstrong\\u003e27\\u003c/strong\\u003e(5), 358-363 (2020)\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eTable 1. Baseline characteristics of patient with low- to intermediate-risk PTC according to obesity\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n=1088)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-obese\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n=602)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eObese\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e(n=486)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge (years)\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e46.9\\u0026nbsp;\\u0026plusmn; 11.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e46.5\\u0026nbsp;\\u0026plusmn; 11.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e47.4\\u0026nbsp;\\u0026plusmn; 11.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.207\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSex, male\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e274 (25.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e82 (13.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e192 (39.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePrimary t\\u003c/strong\\u003e\\u003cstrong\\u003eumor size (cm)\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e0.8\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e0.8\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e0.9\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.036\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; \\u0026le;1cm\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e827 (76.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e473 (78.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e354 (72.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.033\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026gt;1cm\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e261 (24.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e129 (21.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e132 (27.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eExtra-thyroidal extension\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e468 (43.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e242 (40.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e226 (46.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.043\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMicroscopic\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e455 (41.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e234 (38.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e221 (45.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.087\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eGross\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e13 (1.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e8 (1.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e5 (1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMultifocal disease\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e216 (19.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e113 (18.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e103 (21.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.358\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVascular invasion\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e144 (13.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e67 (11.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e77 (15.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.028\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCervical LN metastasis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd 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width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e4 (0.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e4 (0.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTNM stage (8\\u003csup\\u003eth\\u003c/sup\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Stage I\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e1002 (92.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e550 (91.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e452 (93.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.376\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Stage II\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e86 (7.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e52 (8.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e34 (7.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePTC subtype\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Classic\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e882 (81.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e488 (81.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e394 (81.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.999\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Follicular\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e18 (1.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e10 (1.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e8 (1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Others\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e188 (17.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e104 (17.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e84 (17.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e25.0\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;4.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e22.2\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;1.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e28.6\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;3.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSystolic BP (mmHg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e126.5\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;15.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e122.2\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;13.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e131.7\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;15.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDiastolic BP (mmHg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e78.3\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;10.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e75.7\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;10.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e81.4\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;10.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTriglycerides (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e126.7\\u0026nbsp;\\u0026plusmn; 89.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e103.0\\u0026nbsp;\\u0026plusmn; 67.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e157.0\\u0026nbsp;\\u0026plusmn; 103.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLDL-C (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e106.4\\u0026nbsp;\\u0026plusmn; 35.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e104.9\\u0026nbsp;\\u0026plusmn; 34.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e108.4\\u0026nbsp;\\u0026plusmn; 36.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.175\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHDL-C (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e55.9\\u0026nbsp;\\u0026plusmn; 14.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e60.7\\u0026nbsp;\\u0026plusmn; 14.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e49.8\\u0026nbsp;\\u0026plusmn; 12.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFasting glucose (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e102.7\\u0026nbsp;\\u0026plusmn; 23.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e99.4\\u0026nbsp;\\u0026plusmn; 18.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e106.6\\u0026nbsp;\\u0026plusmn; 27.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTSH (IU/mL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e2.0\\u0026nbsp;\\u0026plusmn; 1.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e2.0\\u0026nbsp;\\u0026plusmn; 1.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e2.0\\u0026nbsp;\\u0026plusmn; 1.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.747\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"33.84615384615385%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003efT4 (ng/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e1.2\\u0026nbsp;\\u0026plusmn; 0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.77777777777778%\\\"\\u003e\\n \\u003cp\\u003e1.2\\u0026nbsp;\\u0026plusmn; 0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.316239316239315%\\\"\\u003e\\n \\u003cp\\u003e1.2\\u0026nbsp;\\u0026plusmn; 0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.282051282051283%\\\"\\u003e\\n \\u003cp\\u003e0.310\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eValues are expressed as mean \\u0026plusmn; standard deviation or number (%).\\u003c/p\\u003e\\n\\u003cp\\u003eAbbreviations:\\u0026nbsp;LN, Lymph Node; TNM, tumor-node-metastasis; PTC, papillary thyroid carcinoma; BMI, body mass index; BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TSH, thyrotropin; fT4, free thyroxine\\u003c/p\\u003e\\n\\u003cp\\u003ethyroxine\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2. Clinicopathologic characteristics of PTC patients with normal/under-weight, overweight, and obese\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCharacteristics\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNormal/under-weight\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOverweight\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eObese\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003eP\\u003c/em\\u003e\\u003c/strong\\u003e\\u003cstrong\\u003e-value\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber of patients\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e379\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e223\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e486\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAge (years)\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e44.6\\u0026nbsp;\\u0026plusmn; 11.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e49.6\\u0026nbsp;\\u0026plusmn; 11.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e47.4\\u0026nbsp;\\u0026plusmn; 11.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSex, male\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e33 (8.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e49 (22.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e192 (39.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePrimary t\\u003c/strong\\u003e\\u003cstrong\\u003eumor size (cm)\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e0.8\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e0.8\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd 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\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Stage I\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e352 (92.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e198 (88.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e452 (93.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e0.121\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Stage II\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e27 (7.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e25 (11.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e34 (7.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePTC subtype\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Classic\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e307 (81.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e181 (81.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e394 (81.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e0.999\\u003csup\\u003eb\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Follicular\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e6 (1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e4 (1.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e8 (1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Others\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e66 (17.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e38 (17.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e84 (17.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBMI (kg/m\\u003csup\\u003e2\\u003c/sup\\u003e)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e21.1\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;1.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e24.0\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e28.6\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;3.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSystolic BP (mmHg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e120.7\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;13.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e124.9\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;13.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e131.7\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;15.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eDiastolic BP (mmHg)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e74.5\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;10.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e77.8\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;10.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e81.4\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;10.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTriglycerides (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e93.4\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;50.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e120.0\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;88.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e157.0\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;103.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLDL-C (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e101.0\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;34.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e111.8\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;32.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e108.4\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;36.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e0.003\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHDL-C (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e62.4\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;13.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e57.6\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;15.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e49.8\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;12.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFasting glucose (mg/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e98.5\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;21.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e100.9\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;13.4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e106.6\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;27.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTSH (IU/mL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e2.1\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;1.8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e1.9\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;1.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e2.0\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;1.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e0.271\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"34.660033167495854%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003efT4 (ng/dL)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.402985074626866%\\\"\\u003e\\n \\u003cp\\u003e1.2\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.58374792703151%\\\"\\u003e\\n \\u003cp\\u003e1.2\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"17.24709784411277%\\\"\\u003e\\n \\u003cp\\u003e1.2\\u0026nbsp;\\u0026plusmn;\\u0026nbsp;0.2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.106135986733001%\\\"\\u003e\\n \\u003cp\\u003e0.425\\u003csup\\u003ea\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003csup\\u003ea\\u003c/sup\\u003eKruskal-wallis rank sum test, \\u003csup\\u003eb\\u003c/sup\\u003eChi-square test, \\u003csup\\u003ec\\u003c/sup\\u003e\\u003cem\\u003ep\\u003c/em\\u003e for trend\\u003c/p\\u003e\\n\\u003cp\\u003eValues are expressed as mean \\u0026plusmn; standard deviation or number (%).\\u003c/p\\u003e\\n\\u003cp\\u003eAbbreviations:\\u0026nbsp;LN, Lymph Node; TNM, tumor-node-metastasis; PTC, papillary thyroid carcinoma; BMI, body mass index; BP, blood pressure; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TSH, thyrotropin; fT4, free thyroxine\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 3.\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003eRisk for tumor aggressiveness\\u0026nbsp;\\u003c/strong\\u003e\\u003cstrong\\u003ein patients with low- to intermediate-risk PTC according to the obesity and metabolic syndrome\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\" width=\\\"917\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-obese + non-MetS (component 0-1)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNon-obese + MetS (component \\u0026ge;2)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eObese + non-MetS (component 0-1)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eObese + MetS (component \\u0026ge;2)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e*OR\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e*OR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e*OR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e*OR (95% CI)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003ep\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMale\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Larger tumor (\\u0026gt;1 cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.2 (0.4-3.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.731\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.6 (0.7-4.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.282\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.1 (0.4-2.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.968\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; ETE (ref. no ETE)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.5 (0.6-3.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.435\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.2 (0.5-2.9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.601\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.4 (0.7-3.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.397\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Multifocal disease\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e2.3 (0.6-12.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.266\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e3.9 (1.2-18.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.041\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e3.1 (1.0-13.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.083\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Vascular invasion\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.2-3.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.840\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.3-3.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.873\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.2 (0.4-3.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.759\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Cervical LN metastasis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.0 (0.3-3.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.973\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.7 (0.3-1.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.397\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.4-2.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.885\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Advanced AJCC stage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e47.7 (0-INF)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.999\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.1 (0-INF)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.999\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e2.3e-33 (0-INF)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.999\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFemale\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Larger tumor (\\u0026gt;1 cm)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.5 (0.9-2.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.107\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.3 (0.8-2.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.231\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.5 (0.9-2.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.101\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; ETE (ref. no ETE)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.3 (0.9-2.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.181\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.6 (1.1-2.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.027\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.5 (1.0-2.2)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.040\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Multifocal disease\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.0 (0.6-1.6)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.981\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.5 (0.9-2.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.098\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.5-1.4)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.553\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Vascular invasion\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.5 (0.8-2.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.163\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.3 (0.7-2.5)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.374\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e2.4 (1.4-4.1)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Cervical LN metastasis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.3-1.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.129\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.1 (0.7-1.8)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.621\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.8 (0.5-1.3)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.336\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"21.568627450980394%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp; Advanced AJCC stage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"19.607843137254903%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e1.5 (0.3-9.0)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.658\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.5 (0.1-4.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.580\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.398692810457517%\\\"\\u003e\\n \\u003cp\\u003e0.9 (0.1-5.7)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"6.209150326797386%\\\"\\u003e\\n \\u003cp\\u003e0.885\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e*\\u0026nbsp;Adjusted for age, tumor size, extrathyroidal extension, multifocality, vascular invasion, cervical lymph node metastasis, AJCC staging, and thyrotropin\\u003c/p\\u003e\\n\\u003cp\\u003eAbbreviations: MetS, metabolic syndrome; ETE, extrathyroidal extension;\\u0026nbsp;LN, Lymph Node; AJCC,\\u0026nbsp;American Joint Committee on Cancer; INF, infinitive\\u003c/p\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":true,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"endocrine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"endo\",\"sideBox\":\"Learn more about [Endocrine](https://www.springer.com/journal/12020)\",\"snPcode\":\"12020\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12020/3\",\"title\":\"Endocrine\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"Obesity, Papillary thyroid carcinoma, Aggressiveness, Body mass index, Metabolic syndrome \",\"lastPublishedDoi\":\"10.21203/rs.3.rs-2584761/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-2584761/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003ePurpose: \\u003c/strong\\u003eObesity is associated with an increased risk of papillary thyroid carcinoma (PTC). Evidence of the impact of obesity on PTC aggressiveness is scarce. We aimed to evaluate the association between the body mass index (BMI) and the presence of aggressive features of low- to intermediate-risk PTC in a prospective cohort.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eA total of 1,088 patients with low- to intermediate-risk PTC who underwent lobectomy at 22 hospitals in Korea were prospectively enrolled and divided into three groups according to BMI, as follows: normal/underweight (\\u0026lt;23 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e), overweight (23–24.9 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e), and obese (≥25 kg/m\\u003csup\\u003e2\\u003c/sup\\u003e). Clinicopathological features of PTC at diagnosis were evaluated.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults: \\u003c/strong\\u003eObese patients had a larger primary tumor size, higher rate of macro-PTC (\\u0026gt;1 cm), and greater incidence of extra-thyroidal extension (ETE) and vascular invasion than those who were not classified as obese. Increased BMI was positively associated with the incidence of macro-PTC (\\u003cem\\u003ep\\u003c/em\\u003e for trend = 0.019), ETE (\\u003cem\\u003ep\\u003c/em\\u003e for trend = 0.013), and vascular invasion (\\u003cem\\u003ep\\u003c/em\\u003e for trend = 0.021). After adjusting for age, sex, pathological features, metabolic syndrome, and thyroid function test, obesity was a risk factor for ETE (odds ratio = 1.6, 95% confidence interval: 1.1–2.3, \\u003cem\\u003ep\\u003c/em\\u003e = 0.007) in women. This association was significant regardless of whether or not the women had metabolic syndrome. There was no significant association between obesity and aggressive PTC features in men.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion: \\u003c/strong\\u003eThese results suggest that BMI at the time of thyroid cancer diagnosis may affect the aggressiveness of low- to intermediate-risk PTC, especially in women.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Potential impact of obesity on the aggressiveness of low-to intermediate-risk papillary thyroid carcinoma: results from a MASTER cohort study\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2023-02-17 22:26:33\",\"doi\":\"10.21203/rs.3.rs-2584761/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"reviewerAgreed\",\"content\":\"\",\"date\":\"2023-02-15T20:26:07+00:00\",\"index\":0,\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2023-02-14T14:55:01+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Endocrine\",\"date\":\"2023-02-14T01:06:28+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"endocrine\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"endo\",\"sideBox\":\"Learn more about [Endocrine](https://www.springer.com/journal/12020)\",\"snPcode\":\"12020\",\"submissionUrl\":\"https://submission.nature.com/new-submission/12020/3\",\"title\":\"Endocrine\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"5be9a147-1e63-41c0-baae-fbfa88b64487\",\"owner\":[],\"postedDate\":\"February 17th, 2023\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2023-10-16T22:05:23+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-2584761\",\"link\":\"https://doi.org/10.1007/s12020-023-03416-5\",\"journal\":{\"identity\":\"endocrine\",\"isVorOnly\":false,\"title\":\"Endocrine\"},\"publishedOn\":\"2023-07-29 21:47:03\",\"publishedOnDateReadable\":\"July 29th, 2023\"},\"versionCreatedAt\":\"2023-02-17 22:26:33\",\"video\":\"\",\"vorDoi\":\"10.1007/s12020-023-03416-5\",\"vorDoiUrl\":\"https://doi.org/10.1007/s12020-023-03416-5\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-2584761\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-2584761\",\"identity\":\"rs-2584761\",\"version\":[\"v1\"]},\"buildId\":\"-HB7Z8yhvgn0wM9Nzuekk\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}