Abdominal obesity and insulin resistance as independent risk factors for recurrence of papillary thyroid cancer

   Relevance. Papillary thyroid cancer (PTC) is the most common form of differentiated thyroid cancer. The increasing incidence of thyroid cancer coincides with the growing prevalence of obesity and metabolic disorders; however, their impact on the risk of recurrence remains in-sufficiently studied.

   Objective. To evaluate the role of obesity and associated metabolic disorders in determining the risk of PTC recurrence.

   Materials and Methods. The study included 145 patients with verified prostate cancer who underwent surgery until 2023. A retrospective analysis of clinical, anthropometric, and metabolic parameters was performed. The patients were divided into 2 groups: Group 1 – the patients with absence of recurrence of the disease for 5 years or more, Group 2 – the patients with a recurrence of prostate cancer. Body mass index (BMI), waist circumference (WC), duration of obesity, indicators of carbohydrate and lipid metabolism, and the HOMA-IR index were evaluated. ROC analysis and logistic regression were performed.

   Results. Disease recurrence was observed in 16 (11 %) patients, on average 8.9 (4.3–11.2) years after the primary surgical intervention. Patients with recurrence had higher values of BMI (32.23 vs. 26.88 kg/m²; p < 0.001), WC (99.03 vs. 86.02 cm; p< 0.001), HOMA-IR (5.57 vs. 3.25; p < 0.001), and a longer history of obesity (19.02 vs. 10 years; p < 0.001). Threshold values associated with an increased risk of recurrence were: BMI ≥ 28.13 kg/m², obesity duration ≥ 12 years, HOMA-IR ≥ 3.90, WC ≥ 90 cm. Logistic regression showed an independent contribution of all metabolic factors to the risk of recurrence.

   Conclusion. Obesity, its duration, and the severity of metabolic disorders, primarily insulin resistance, are significant predictors of PTC recurrence. The identified threshold values can be used for risk stratification and optimization of patient follow-up. Moreover, all patients had abdominal obesity before and after surgery, suggesting that persistent obesity acts not only as a risk factor for development but also as a powerful driver sustaining the risk of recurrence for many years after treatment.

1. Clinical guidelines. Differentiated thyroid cancer. Russian Association of Endocrinologists, Russian Association of Oncologists, Russian Society of Head and Neck Tumor Specialists, Association of Endocrine Surgeons, Russian Society of Clinical Oncology, Federation of Head and Neck Disease Specialists, Association of Oncology Organizations of Siberia and the Far East. Rubricator of clinical guidelines of the Ministry of Health of the Russian Federation. 2024. ID: 329_2. URL: https://cr.minzdrav.gov.ru/view-cr/329_2 (date of access – 10. 04. 2025) (In Russ.)

2. Hu J, Yuan IJ, Mirshahidi S, Simental A, Lee SC, Yuan X. Thyroid carcinoma: Phenotypic features, underlying biology and potential relevance for targeting therapy. Int J Mol Sci. 2021;22(4):1950. doi: 10.3390/ijms22041950

3. Lazarev AF, Zakharova IM, Petrova VD. Risk factors for the development of thyroid cancer. Rossiyskiy onkologicheskiy zhurnal = Russian Journal of Oncology. 2021;26(4):129–144 (In Russ.) doi: 10.17816/onco105514

4. Wang X, Yu Y, Ji Y, Ma Z, Tan J, Jia Q, et al. Clinical characteristics and therapeutic response of differentiated thyroid carcinoma with obesity and diabetes. BMC Cancer. 2023;23(1):1077. doi: 10.1186/s12885-023-11591-x

5. International Agency for Research on Cancer. Global cancer observatory: Cancer today. World Health Organization. 2020. URL: https://gco.iarc.fr/today/home (date of access – 01. 10. 2025).

6. Pasqual E, O’Brien K, Rinaldi S, Sandler DP, Kitahara CM. Obesity, obesity-related metabolic conditions, and risk of thyroid cancer in women: Results from a prospective cohort study (Sister Study). Lancet Reg Health Am. 2023;23:100537. doi: 10.1016/j.lana.2023.100537

7. Grogan RH, Kaplan SP, Cao H, Weiss RE, Degroot LJ, Simon CA, et al. A study of recurrence and death from papillary thyroid cancer with 27 years of median follow-up. Surgery. 2013;154(6):1436–47. doi: 10.1016/j.surg.2013.07.008

8. Ringel MD, Sosa JA, Baloch Z, Bischoff L, Bloom G, Brent GA, et al. 2025 American Thyroid Association management guidelines for adult patients with differentiated thyroid cancer. Thyroid. 2025;35(8):841–985. doi: 10.1177/10507256251363120

9. Zhang X, Ha S, Lau HC, Yu J. Excess body weight: Novel insights into its roles in obesity comorbidities. Semin Cancer Biol. 2023;92:16–27. doi: 10.1016/j.semcancer.2023.03.008

10. Li LR, Song JL, Liu HQ, Chen C. Metabolic syndrome and thyroid cancer: risk, prognosis, and mechanism. Discov Oncol. 2023;14(1):23. doi: 10.1007/s12672-022-00599-7

11. Koliaki C, Dalamaga M, Liatis S. Update on the obesity epidemic: After the sudden rise, is the upward trajectory beginning to flatten? Curr Obes Rep. 2023;12(4):514–27. doi: 10.1007/s13679-023-00527-y

12. da Cunha Junior AD, Carrilho LAO, Nunes Filho PRS, Cantini L, Vidal L, Mendes MCS, et al. The role of metabolic inflammation and insulin resistance in obesity-associated carcinogenesis – a narrative review. Onco. 2025;5(4):47. doi: 10.3390/onco5040047

13. Kounatidis D, Vallianou NG, Karampela I, Grivakou E, Dalamaga M. The intricate role of adipokines in cancer-related signaling and the tumor microenvironment: Insights for future research. Semin Cancer Biol. 2025;113:130–50. doi: 10.1016/j.semcancer.2025.05.013

14. Furuya-Kanamori L, Bell KJL, Clark J, Glasziou P, Dоi SAR. Prevalence of differentiated thyroid cancer in autopsy studies over six decades: A meta-analysis. J Clin Oncol. 2016;34(30):3672–79. doi: 10.1200/JCO.2016.67.7419

15. Kim JM. The clinical importance of overweight or obesity on tumor recurrence in papillary thyroid carcinoma. Gland Surg. 2022;11(1):35–41. doi: 10.21037/gs-21-695