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Nabhan F, Ringel MD. Thyroid nodules and cancer management guidelines: comparisons and controversies. Endocr Relat Cancer 2017; 24:R13-R26. [PMID: 27965276 PMCID: PMC5241202 DOI: 10.1530/erc-16-0432] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 12/23/2022]
Abstract
Thyroid cancer is an increasingly prevalent malignancy throughout the world. Management guidelines for both thyroid nodules and thyroid cancer have been published and updated by a number of societies internationally. All of these guidelines recognize this increasing incidence, particularly of small papillary thyroid cancers, due in part to improved technology enabling early or even 'over' diagnosis. Recent advances in molecular imaging and molecular methods have been developed to better characterize thyroid nodules, and a number of studies that have clarified risk stratification systems that can be modified over time allow for individualization of diagnosis, initial treatment, and subsequent follow-up strategies. Advances in surgical approaches and new treatments for patients with the most aggressive forms of thyroid cancer have all influenced management guidelines. Despite substantial similarities, there also are important differences between recent guidelines for some of the common clinical scenarios encountered by physicians in clinical practice. In the present manuscript, we will highlight similarities and differences between several of the most recently published guidelines focused on key areas of importance to clinical care and controversy. These are key areas for future research to strengthen the data to support future guideline recommendations.
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Affiliation(s)
- Fadi Nabhan
- Division of EndocrinologyDiabetes and Metabolism, The Ohio State University College of Medicine, Wexner Medical Center, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Matthew D Ringel
- Division of EndocrinologyDiabetes and Metabolism, The Ohio State University College of Medicine, Wexner Medical Center, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio, USA
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Alzahrani AS, Murugan AK, Qasem E, Alswailem M, Al-Hindi H, Shi Y. Single Point Mutations in Pediatric Differentiated Thyroid Cancer. Thyroid 2017; 27:189-196. [PMID: 27824297 DOI: 10.1089/thy.2016.0339] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE Differentiated thyroid cancer (DTC) is rare in children. Previous studies have suggested that it has different clinicopathologic features and mutation profiles compared with adult DTC. However, those studies focused on a single or limited number of gene mutations. This study comprehensively investigated a large series of pediatric DTC for single point mutations in BRAF, HRAS, KRAS, NRAS, PIK3CA, PTEN, and TERT. It also analyzed associations between clinicopathologic features and the BRAFV600E mutation. PATIENTS AND METHODS Eighty-nine consecutive cases seen in children and adolescents (≤18 years) during 1998-2015 were identified. Rare variants of DTC were excluded, and the study focused on 72 (91.1%) classical papillary thyroid carcinoma (PTC) and seven (8.9%) follicular variant PTC. These included 68 (86.1%) females and 11 (13.9%) males, with a median age of 15.5 years (range 8-18 years). The clinical and histopathological data were obtained from medical records. DNA was extracted from paraffin-embedded tumor tissue, and was PCR-amplified and directly sequenced. RESULTS Mutations detected included BRAFV600E in 19/72 (26.4%) classical PTC samples, and in none of seven follicular variant PTC. Other mutations included: 1/78 (1.3%) successfully amplified tumor samples with TERT C228T; 2/79 (2.5%) NRAS 61 (c.181C>A and c.182A>G); 1/73 (1.4%) PIK3CA exon 9 (c.1589A>G and c.1598C>T in one tumor); 1/79 (1.3%) PIK3CA exon 20 (c.2951G>A); and 1/74 (1.4%) PTEN exon 5 (c.295G>A). No mutation was found in HRAS, KRAS, NRAS12, PTEN exons 6, 7, and 8, and TERT C250T. No significant association was found between BRAFV600E mutation and sex, extrathyroidal invasion, tumor multifocality, vascular invasion, lymph node or distant metastases, and persistent/recurrent disease. CONCLUSIONS In pediatric DTC, the prevalence of the BRAFV600E mutation is significantly less common compared with adult DTC, and there is no association between this mutation and the histopathological features and outcome of PTC. PIK3CA, PTEN, NRAS 61, and TERT C228T mutations are rare.
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Affiliation(s)
- Ali S Alzahrani
- 1 Department of Medicine, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
- 2 Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
| | - Avaniyapuram Kannan Murugan
- 2 Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
| | - Ebtesam Qasem
- 2 Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
| | - Meshael Alswailem
- 2 Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
| | - Hindi Al-Hindi
- 3 Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
| | - Yufei Shi
- 4 Department of Genetics, King Faisal Specialist Hospital and Research Centre , Riyadh, Saudi Arabia
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Pestana A, Vinagre J, Sobrinho-Simões M, Soares P. TERT biology and function in cancer: beyond immortalisation. J Mol Endocrinol 2017; 58:R129-R146. [PMID: 28057768 DOI: 10.1530/jme-16-0195] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/05/2017] [Indexed: 12/23/2022]
Abstract
Evasion of replicative senescence and proliferation without restriction, sometimes designated as immortalisation, is one of the hallmarks of cancer that may be attained through reactivation of telomerase in somatic cells. In contrast to most normal cells in which there is lack of telomerase activity, upregulation of TERT transcription/activity is detected in 80-90% of malignant tumours. In several types of cancer, there is a relationship between the presence of TERT promoter mutations, TERT mRNA expression and clinicopathological features, but the biological bridge between the occurrence of TERT promoter mutations and the aggressive/invasive features displayed by the tumours remains unidentified. We and others have associated the presence of TERT promoter mutations with metastisation/survival in several types of cancer. In follicular cell-derived thyroid cancer, such mutations are associated with worse prognostic features (age of patients, tumour size and tumour stage) as well as with distant metastases, worse response to treatment and poorer survival. In this review, we analyse the data reported in several studies that imply TERT transcription reactivation/activity with cell proliferation, tumour invasion and metastisation. A particular attention is given to the putative connections between TERT transcriptional reactivation and signalling pathways frequently altered in cancer, such as c-MYC, NF-κB and B-Catenin.
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Affiliation(s)
- Ana Pestana
- Institute of Molecular Pathology and ImmunologyUniversity of Porto (IPATIMUP), Porto, Portugal
- Institute for Research and Innovation in Health (I3S)University of Porto, Porto, Portugal
| | - João Vinagre
- Institute of Molecular Pathology and ImmunologyUniversity of Porto (IPATIMUP), Porto, Portugal
- Institute for Research and Innovation in Health (I3S)University of Porto, Porto, Portugal
| | - Manuel Sobrinho-Simões
- Institute of Molecular Pathology and ImmunologyUniversity of Porto (IPATIMUP), Porto, Portugal
- Institute for Research and Innovation in Health (I3S)University of Porto, Porto, Portugal
- Medical FacultyUniversity of Porto, Porto, Portugal
- Department of PathologyCentro Hospitalar S. João, Porto, Portugal
- Department of PathologyMedical Faculty, University of Porto, Porto, Portugal
| | - Paula Soares
- Institute of Molecular Pathology and ImmunologyUniversity of Porto (IPATIMUP), Porto, Portugal
- Institute for Research and Innovation in Health (I3S)University of Porto, Porto, Portugal
- Medical FacultyUniversity of Porto, Porto, Portugal
- Department of PathologyMedical Faculty, University of Porto, Porto, Portugal
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Su X, Jiang X, Wang W, Wang H, Xu X, Lin A, Teng X, Wu H, Teng L. Association of telomerase reverse transcriptase promoter mutations with clinicopathological features and prognosis of thyroid cancer: a meta-analysis. Onco Targets Ther 2016; 9:6965-6976. [PMID: 27956840 PMCID: PMC5113912 DOI: 10.2147/ott.s116594] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The clinicopathological and prognostic significance of telomerase reverse transcriptase (TERT) promoter mutations have been widely investigated in thyroid cancer; however, the results are still discrepant. Systematic searches were performed in PubMed, Web of Science, Scopus, Ovid, and the Cochran Library databases for relevant articles prior to April 2016. Mutation rates were synthesized by R statistical software. The odds ratio or standardized mean difference with 95% confidence interval was pooled by Stata. A total of 22 studies with 4,907 cases were included in this meta-analysis. TERT promoter mutations tended to present in aggressive histological types including poorly differentiated thyroid cancer (33.37%), anaplastic thyroid cancer (38.69%), and tall-cell variant papillary thyroid cancer (30.23%). These promoter mutations were likely to exist in older patients and males and were well associated with larger tumor size, extrathyroidal extension, vascular invasion, lymph node metastasis, distant metastasis, advanced tumor stage, disease recurrence/persistence, and mortality. In addition, TERT promoter mutations (especially C228T) tended to coexist with BRAFV600E mutation, which indicated more aggressive tumor behavior. Therefore, TERT promoter mutations may be promising biomarkers for early diagnosis, risk stratification, prognostic prediction, and management of thyroid cancer.
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Affiliation(s)
| | | | | | | | - Xin Xu
- Department of Medical Oncology
| | | | | | - Huiling Wu
- Department of Plastic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Transcription Regulation of the Human Telomerase Reverse Transcriptase (hTERT) Gene. Genes (Basel) 2016; 7:genes7080050. [PMID: 27548225 PMCID: PMC4999838 DOI: 10.3390/genes7080050] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/23/2016] [Accepted: 08/01/2016] [Indexed: 12/11/2022] Open
Abstract
Embryonic stem cells and induced pluripotent stem cells have the ability to maintain their telomere length via expression of an enzymatic complex called telomerase. Similarly, more than 85%–90% of cancer cells are found to upregulate the expression of telomerase, conferring them with the potential to proliferate indefinitely. Telomerase Reverse Transcriptase (TERT), the catalytic subunit of telomerase holoenzyme, is the rate-limiting factor in reconstituting telomerase activity in vivo. To date, the expression and function of the human Telomerase Reverse Transcriptase (hTERT) gene are known to be regulated at various molecular levels (including genetic, mRNA, protein and subcellular localization) by a number of diverse factors. Among these means of regulation, transcription modulation is the most important, as evident in its tight regulation in cancer cell survival as well as pluripotent stem cell maintenance and differentiation. Here, we discuss how hTERT gene transcription is regulated, mainly focusing on the contribution of trans-acting factors such as transcription factors and epigenetic modifiers, as well as genetic alterations in hTERT proximal promoter.
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Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract 2016; 22:622-39. [PMID: 27167915 DOI: 10.4158/ep161208.gl] [Citation(s) in RCA: 708] [Impact Index Per Article: 88.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
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Yin DT, Yu K, Lu RQ, Li X, Xu J, Lei M, Li H, Wang Y, Liu Z. Clinicopathological significance of TERT promoter mutation in papillary thyroid carcinomas: a systematic review and meta-analysis. Clin Endocrinol (Oxf) 2016; 85:299-305. [PMID: 26732020 DOI: 10.1111/cen.13017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/20/2015] [Accepted: 01/04/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The prognostic value of the telomerase reverse transcriptase (TERT) promoter mutation, resulting in poor clinical outcomes of papillary thyroid carcinoma (PTC), has been generally confirmed. To data, there is no high-level evidence approving the association of TERT promoter mutation and aggressive clinical behaviours in PTC. To systematically evaluate it, a systematic review and meta-analysis of the published literatures were carried out. METHODS We conducted a systematic search in PubMed, EMBASE, OVID and Web of Science databases for relevant studies. We selected all the studies that reported clinicopathological features of PTC patients with information available on TERT promoter mutation status. Individual study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, as were Mantel-Haenszel pooled odds ratios for the combined studies. RESULTS Eight eligible trials involved 2035 patients were included in the analysis. The average prevalence of the TERT promoter mutation was 10·32%. Compared with the wild-type TERT promoter gene, the TERT promoter mutation was associated with male gender, lymph node metastasis, extrathyroidal extension, distant metastasis, advanced TNM stage III/IV, poor clinical outcome (persistence or recurrence) and mortality. The associations were generally consistent across the different study populations. CONCLUSIONS Thus, our findings from this large meta-analysis definitively demonstrate that TERT promoter mutation-positive PTC is more likely to manifest with aggressive clinicopathological characteristics. In appropriate clinical settings, testing for the TERT promoter mutation is likely to be useful in assisting the risk stratification and management of PTC.
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Affiliation(s)
- De-Tao Yin
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
| | - Kun Yu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
| | - Run-Qing Lu
- Department of Hematology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianghua Li
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
| | - Jianhui Xu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
| | - Mengyuan Lei
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
| | - Hongqiang Li
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
| | - Yongfei Wang
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
| | - Zhen Liu
- Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Discipline Laboratory of Clinical Medicine Henan, Zhengzhou, China
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Bullock M, Ren Y, O'Neill C, Gill A, Aniss A, Sywak M, Sidhu S, Delbridge L, Learoyd D, de Vathaire F, Robinson BG, Clifton-Bligh RJ. TERT promoter mutations are a major indicator of recurrence and death due to papillary thyroid carcinomas. Clin Endocrinol (Oxf) 2016; 85:283-90. [PMID: 26667986 PMCID: PMC5683578 DOI: 10.1111/cen.12999] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/30/2015] [Accepted: 12/07/2015] [Indexed: 12/14/2022]
Abstract
CONTEXT TERT promoter mutations have been associated with adverse prognosis in papillary thyroid carcinomas (PTCs). OBJECTIVE We investigated the association between TERT promoter mutations and survival from PTC. DESIGN Retrospective observational cohort study. PATIENTS Eighty consecutive patients with PTC who underwent surgery between 1990 and 2003. MEASUREMENTS TERT promoter was genotyped in DNA from 80 archival PTCs by Sanger sequencing. Median follow-up was 106 months (range 1-270). Outcomes analysis was stratified according to disease and overall survival status. For each parameter, relative risk (RR) adjusted for age at first surgery and gender was estimated. Both univariate and multivariate analyses were performed using logistic regression, Kaplan-Meier survival analysis and Cox regression models. RESULTS PTCs from 11 patients (14%) contained either C228T or C250T TERT promoter mutation. TERT mutations were significantly associated with adverse prognostic features such as older age (P = 0·002), male gender (P = 0·01) and Stage IV disease (P = 0·03). Four patients died from PTC during follow-up: 3 patients with TERT mutations (27%) and one without (1·5%). Disease-related mortality rate with or without TERT mutations was 33·7 vs 1·6 per 1000 patient-years respectively, that is 10 (95% CI = 1·0-104·1, P = 0·05) fold higher, after adjustment for age at first surgery and gender. The combination of TERT promoter mutation and BRAF(V) (600E) significantly increased disease-related death risk (P = 0·002). TERT mutations increased expression of a reporter gene in thyroid cells containing BRAF(V) (600E) . CONCLUSIONS TERT promoter mutations are a major indicator of death due to PTCs. Conversely, absence of TERT mutations portends better survival.
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Affiliation(s)
- Martyn Bullock
- Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Yan Ren
- National Institute of Health and Medical Research (Inserm), Center for research in Epidemiology and Population Health (CESP), U1018, Radiation Epidemiology Group, Villejuif, France
- Gustave Roussy Institute, Villejuif, France
- Faculty of Medicine, University of ParisXI, Le Kremlin-Bicêtre, France
| | | | - Anthony Gill
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Adam Aniss
- University of Sydney Endocrine Surgical Unit, Sydney, NSW, Australia
| | - Mark Sywak
- University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgical Unit, Sydney, NSW, Australia
| | - Stan Sidhu
- Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgical Unit, Sydney, NSW, Australia
| | - Leigh Delbridge
- University of Sydney, Sydney, NSW, Australia
- University of Sydney Endocrine Surgical Unit, Sydney, NSW, Australia
| | - Diana Learoyd
- University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Florent de Vathaire
- National Institute of Health and Medical Research (Inserm), Center for research in Epidemiology and Population Health (CESP), U1018, Radiation Epidemiology Group, Villejuif, France
- Gustave Roussy Institute, Villejuif, France
- Faculty of Medicine, University of ParisXI, Le Kremlin-Bicêtre, France
| | - Bruce G Robinson
- Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Roderick J Clifton-Bligh
- Cancer Genetics Unit, Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
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Cancer-Specific Telomerase Reverse Transcriptase (TERT) Promoter Mutations: Biological and Clinical Implications. Genes (Basel) 2016; 7:genes7070038. [PMID: 27438857 PMCID: PMC4962008 DOI: 10.3390/genes7070038] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 12/11/2022] Open
Abstract
The accumulated evidence has pointed to a key role of telomerase in carcinogenesis. As a RNA-dependent DNA polymerase, telomerase synthesizes telomeric DNA at the end of linear chromosomes, and attenuates or prevents telomere erosion associated with cell divisions. By lengthening telomeres, telomerase extends cellular life-span or even induces immortalization. Consistent with its functional activity, telomerase is silent in most human normal somatic cells while active only in germ-line, stem and other highly proliferative cells. In contrast, telomerase activation widely occurs in human cancer and the enzymatic activity is detectable in up to 90% of malignancies. Recently, hotspot point mutations in the regulatory region of the telomerase reverse transcriptase (TERT) gene, encoding the core catalytic component of telomerase, was identified as a novel mechanism to activate telomerase in cancer. This review discusses the cancer-specific TERT promoter mutations and potential biological and clinical significances.
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60
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Lee SE, Hwang TS, Choi YL, Han HS, Kim WS, Jang MH, Kim SK, Yang JH. Prognostic Significance of TERT Promoter Mutations in Papillary Thyroid Carcinomas in a BRAF(V600E) Mutation-Prevalent Population. Thyroid 2016; 26:901-10. [PMID: 27184112 DOI: 10.1089/thy.2015.0488] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of telomerase reverse transcriptase (TERT) promoter mutations in differentiated thyroid cancer has been well established. These mutations have a significantly higher prevalence in aggressive thyroid tumors, including widely invasive oncocytic carcinomas, poorly differentiated carcinomas, and anaplastic thyroid carcinomas. Interestingly, in some studies, TERT mutations were found to be more common in tumors with a BRAF(V600E) mutation. However, mutational analysis of TERT promoter mutations in thyroid tumors has not been previously performed for patients in Korea, where the BRAF(V600E) mutation in papillary thyroid carcinoma (PTC) is particularly prevalent. This study analyzed TERT promoter mutations in various thyroid tumors and examined their relationship with clinicopathologic factors and the BRAF(V600E) mutation in PTC cases. METHODS Using 242 preoperative fine-needle aspiration biopsy specimens (including 207 PTCs) with confirmed histopathological diagnosis of the biopsied thyroid nodules, the TERT promoter status (C228T and C250T) was analyzed, and the relationship with clinicopathologic factors and the BRAF(V600E) mutation in PTC cases was examined. RESULTS Of 242 patients, 14.5% (30/207), 26.7% (4/15), 50% (1/2), and 60% (2/5) of PTCs, follicular thyroid carcinomas, poorly differentiated carcinomas, and anaplastic thyroid carcinomas harbored a TERT(C228T) mutation, respectively. The TERT(C228T) mutation was associated with recurrence (p = 0.03). However, no association with other clinicopathologic factors in PTC was found. Coexistence of TERT(C228T) and BRAF(V600E) mutations was found in 13.0% of PTCs and was significantly associated with older age and advanced stage compared with the group negative for either mutation. The TERT(C228T) mutation status was an independent prognostic factor for recurrence-free survival (hazard ratio = 3.08 [confidence interval 1.042-9.079]; p = 0.042) in patients with PTC in multivariate analysis. CONCLUSIONS Identification of TERT promoter mutations in preoperative fine-needle aspiration biopsy specimens may help in better characterizing the prognosis and triaging thyroid cancer patients for appropriate treatment.
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Affiliation(s)
- Seung Eun Lee
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Tae Sook Hwang
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Yoon-La Choi
- 4 Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Korea
| | - Hye Seung Han
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Wan Seop Kim
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Min Hye Jang
- 1 Department of Pathology, Konkuk University School of Medicine , Seoul, Korea
| | - Suk Kyeong Kim
- 2 Department of Internal Medicine, Konkuk University School of Medicine , Seoul, Korea
| | - Jung Hyun Yang
- 3 Department of Surgery, Konkuk University School of Medicine , Seoul, Korea
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61
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Selivanova LS, Volganova KS, Abrosimov AY. [Telomerase reverse transcriptase (TERT) promoter mutations in the tumors of human endocrine organs: Biological and prognostic value]. Arkh Patol 2016; 78:62-69. [PMID: 27077147 DOI: 10.17116/patol201678162-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The analysis of the data available in the literature has shown that telomerase reverse transcriptase TERT promoter may serve as promising markers of malignancy, aggressive disease course, and poor prognosis for malignant tumors of endocrine organs. Considering the established association of mutations with tumors having a poor prognosis (high-grade and anaplastic carcinoma of the thyroid), it is reasonable to perform prognostic-value investigations in a group of low-grade thyroid carcinomas that may occasionally recur and may be resistant to radioactive iodine therapy, i.e. can demonstrate a poor course and prognosis. TERT promoter mutations may be a specific marker of the clinically aggressive forms of adrenocortical carcinoma, but the determination of its diagnostic value calls for additional investigations that will have the larger number cases and establish the association with clinical features and survival rates.
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Affiliation(s)
- L S Selivanova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - K S Volganova
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
| | - A Yu Abrosimov
- Endocrinology Research Center, Ministry of Health of Russia, Moscow, Russia
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Bell RJA, Rube HT, Xavier-Magalhães A, Costa BM, Mancini A, Song JS, Costello JF. Understanding TERT Promoter Mutations: A Common Path to Immortality. Mol Cancer Res 2016; 14:315-23. [PMID: 26941407 PMCID: PMC4852159 DOI: 10.1158/1541-7786.mcr-16-0003] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/24/2016] [Indexed: 12/23/2022]
Abstract
Telomerase (TERT) activation is a fundamental step in tumorigenesis. By maintaining telomere length, telomerase relieves a main barrier on cellular lifespan, enabling limitless proliferation driven by oncogenes. The recently discovered, highly recurrent mutations in the promoter of TERT are found in over 50 cancer types, and are the most common mutation in many cancers. Transcriptional activation of TERT, via promoter mutation or other mechanisms, is the rate-limiting step in production of active telomerase. Although TERT is expressed in stem cells, it is naturally silenced upon differentiation. Thus, the presence of TERT promoter mutations may shed light on whether a particular tumor arose from a stem cell or more differentiated cell type. It is becoming clear that TERT mutations occur early during cellular transformation, and activate the TERT promoter by recruiting transcription factors that do not normally regulate TERT gene expression. This review highlights the fundamental and widespread role of TERT promoter mutations in tumorigenesis, including recent progress on their mechanism of transcriptional activation. These somatic promoter mutations, along with germline variation in the TERT locus also appear to have significant value as biomarkers of patient outcome. Understanding the precise molecular mechanism of TERT activation by promoter mutation and germline variation may inspire novel cancer cell-specific targeted therapies for a large number of cancer patients.
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Affiliation(s)
- Robert J A Bell
- Department of Neurological Surgery, University of California, San Francisco, California
| | - H Tomas Rube
- Department of Biological Sciences, Columbia University, New York, New York
| | - Ana Xavier-Magalhães
- Department of Neurological Surgery, University of California, San Francisco, California. Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Braga, Portugal
| | - Bruno M Costa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal. ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Braga, Portugal
| | - Andrew Mancini
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jun S Song
- Departments of Bioengineering and Physics, University of Illinois, Urbana-Champaign, Illinois
| | - Joseph F Costello
- Department of Neurological Surgery, University of California, San Francisco, California.
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Abstract
The 2013 discovery of Telomerase reverse transcriptase (TERT) promoter mutations chr5, 1,295,228 C>T (C228T) and 1,295,250 C>T (C250T) in thyroid cancer represents an important event in the thyroid cancer field and much progress has occurred since then. This article provides a comprehensive review of this exciting new thyroid cancer field. The oncogenic role of TERT promoter mutations involves their creation of consensus binding sites for E-twenty-six transcriptional factors. TERT C228T is far more common than TERT C250T and their collective prevalence is, on average, 0, 11.3, 17.1, 43.2 and 40.1% in benign thyroid tumors, papillary thyroid cancer (PTC), follicular thyroid cancer, poorly differentiated thyroid cancer and anaplastic thyroid cancer, respectively, displaying an association with aggressive types of thyroid cancer. TERT promoter mutations are associated with aggressive thyroid tumor characteristics, tumor recurrence and patient mortality as well as BRAF V600E mutation. Coexisting BRAF V600E and TERT promoter mutations have a robust synergistic impact on the aggressiveness of PTC, including a sharply increased tumor recurrence and patient mortality, while either mutation alone has a modest impact. Thus, TERT with promoter mutations represents a prominent new oncogene in thyroid cancer and the mutations are promising new diagnostic and prognostic genetic markers for thyroid cancer, which, in combination with BRAF V600E mutation or other genetic markers (e.g. RAS mutations), are proving to be clinically useful for the management of thyroid cancer. Future studies will specifically define such clinical utilities, elucidate the biological mechanisms and explore the potential as therapeutic targets of TERT promoter mutations in thyroid cancer.
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Affiliation(s)
- Rengyun Liu
- Laboratory for Cellular and Molecular Thyroid ResearchDivision of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA
| | - Mingzhao Xing
- Laboratory for Cellular and Molecular Thyroid ResearchDivision of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA
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Alzahrani AS, Alsaadi R, Murugan AK, Sadiq BB. TERT Promoter Mutations in Thyroid Cancer. Discov Oncol 2016; 7:165-77. [PMID: 26902827 DOI: 10.1007/s12672-016-0256-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 02/09/2016] [Indexed: 01/06/2023] Open
Abstract
Two mutations (C228T and C250T) in the promoter region of the telomerase reverse transcriptase (TERT) have recently been described in different types of cancer including follicular cell-derived thyroid cancer (TC). In this paper, we reviewed the rates of these mutations in different types and subtypes of TC, their association with a number of clinical and histopathological features and outcome of TC, and their potential diagnostic and prognostic roles in TC. The overall rate of these mutations in TC is about 14 % with least prevalence in the well-differentiated subtypes of papillary thyroid cancer (10-13 %). Their rates increase significantly with increasing aggressiveness of TC reaching about 40 % in the undifferentiated and anaplastic thyroid cancers. There is also clear association with increasing age of patients at the time of diagnosis of TC. The evidence is compelling but with some conflicting results for associations between TERT promoter mutations and tumor size, extrathyroidal invasion, distant metastases, high tumor TNM stage, BRAF (V600E) mutation, recurrence, and mortality. A couple of studies reported a potential diagnostic role for TERT promoter mutations in thyroid nodules with indeterminate cytology of fine needle aspiration biopsy. These studies showed 100 % specificity but very low sensitivity of 7-10 %. The sensitivity increases significantly when TERT promoter mutation testing is combined with other gene mutations, particularly BRAF (V600E) and RAS mutations. Although TERT promoter mutations seem to play significant roles in the pathogenesis of TC, the mechanisms by which they contribute to carcinogenesis remain elusive and future work is needed to fully assess the roles, interactions, and impact of these mutations on the pathogenesis, diagnosis, prognosis, and therapeutics of TC.
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Affiliation(s)
- Ali S Alzahrani
- Research Centre, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia. .,Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. .,Department of Medicine, King Faisal Specialist Hospital & Research Centre, P. O. Box 3354, Riyadh, 11211, Saudi Arabia.
| | - Rawan Alsaadi
- Research Centre, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | | | - Bakr Bin Sadiq
- Research Centre, King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
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65
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Li D, Gao M, Li X, Xing M. Molecular Aberrance in Papillary Thyroid Microcarcinoma Bearing High Aggressiveness: Identifying a "Tibetan Mastiff Dog" From Puppies. J Cell Biochem 2016; 117:1491-6. [PMID: 26841328 DOI: 10.1002/jcb.25506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 11/11/2022]
Abstract
Today the most common differentiated thyroid cancer in many countries is papillary thyroid microcarcinoma (PTMC). Although the majority of PTMCs exhibit an indolent clinical course, a few possess high risk for aggressiveness with tumor invasion, metastasis, and even patient mortality. This imposes significant confusion and often dilemma in the clinical management of PTMC. The present review summarizes the molecular pathogenesis, particularly the major genetic alterations, of PTMC that may have prognostic values in assisting risk stratification of this cancer and identification of the most aggressive cases from the many well-behaving cases. J. Cell. Biochem. 117: 1491-1496, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Dapeng Li
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Xiaolong Li
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, 77025
| | - Mingzhao Xing
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
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66
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Alzahrani AS, Qasem E, Murugan AK, Al-Hindi HN, AlKhafaji D, Almohanna M, Xing M, Alhomaidah D, AlSwailem M. Uncommon TERT Promoter Mutations in Pediatric Thyroid Cancer. Thyroid 2016; 26:235-41. [PMID: 26711586 DOI: 10.1089/thy.2015.0510] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of this study was to determine the rate and significance of TERT promoter mutations that have been recently described in adult thyroid cancer (TC) but not yet in the uncommonly occurring pediatric TC. Furthermore, the role of the BRAF(V600E) mutation in the clinical outcome of pediatric TC is unknown. METHOD The study included 55 pediatric (median age 16 years, range 9-18 years; 46 females) and 210 adult TC patients (median age 40 years, range 20-75 years; 155 females) seen during the same time period. DNA was isolated from TC tissues and subjected to direct sequencing. Genetic-clinicopathological correlations were analyzed. RESULTS Only one case of pediatric TC was found to harbor the C228T TERT promoter mutation (1.8%). The C250T mutation was not detected in any of the 55 pediatric TC. In contrast, there was a significantly higher rate of TERT promoter mutations in the adult patients (15.7%, 33/210) compared with the pediatric patients (p = 0.003). In addition, persistent/recurrent TC was seen in 8/12 (66.7%) pediatric patients harboring the BRAF(V600E) mutation versus 14/41 (34.1%) patients harboring the wild type BRAF (p = 0.05), and when only conventional papillary TC was examined, in 7/9 (77.8%) cases harboring BRAF(V600E) mutation versus 11/33 (33.3%) cases harboring wild type BRAF (p = 0.025). CONCLUSIONS This is the first study on TERT promoter mutations in pediatric TC, which revealed an exceedingly low prevalence, suggesting a limited role of these mutations in pediatric TC. This study also for the first time demonstrates an association of the BRAF(V600E) mutation with TC recurrence in pediatric patients.
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Affiliation(s)
- Ali S Alzahrani
- 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
- 2 Department of Medicine, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
| | - Ebtesam Qasem
- 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
| | - Avaniyapuram Kannan Murugan
- 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
| | - Hindi N Al-Hindi
- 3 Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
| | - Dania AlKhafaji
- 2 Department of Medicine, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
| | - Mai Almohanna
- 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
| | - Mingzhao Xing
- 4 Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Doha Alhomaidah
- 5 Department of Pediatrics, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
| | - Meshael AlSwailem
- 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia
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67
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Xing M. Clinical utility of RAS mutations in thyroid cancer: a blurred picture now emerging clearer. BMC Med 2016; 14:12. [PMID: 26817707 PMCID: PMC4730731 DOI: 10.1186/s12916-016-0559-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 12/21/2022] Open
Abstract
RAS mutations play an important role in thyroid tumorigenesis. Considerable effort has been made in the last decade to apply RAS mutations as molecular markers to the clinical management of thyroid nodules and thyroid cancer. Yet, for the low diagnostic sensitivities and specificities of RAS mutations, when used alone, and for their uncertain role in the clinical outcomes of thyroid cancer, it has been unclear how to appropriately use them to assist the management of thyroid nodules and thyroid cancer. Studies from recent years, now added from the Alexander group, have shed light on this issue, making a blurred clinical picture now emerge clearer-RAS mutations, when combined with other genetic markers, have high diagnostic negative predictive values for thyroid cancer; cytologically benign thyroid nodules, including those positive for RAS mutations, have long-term clinical stability when non-surgically managed; and differentiated thyroid cancers harboring RAS mutations alone have an excellent prognosis. This progress in understanding RAS mutations in thyroid cancer is showing a major impact on molecular-based practice in the management of thyroid cancer.Please see related research articles: http://dx.doi.org/10.1186/s12916-016-0554-1 and http://dx.doi.org/10.1186/s12916-015-0419-z.
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Affiliation(s)
- Mingzhao Xing
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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68
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Qasem E, Murugan AK, Al-Hindi H, Xing M, Almohanna M, Alswailem M, Alzahrani AS. TERT promoter mutations in thyroid cancer: a report from a Middle Eastern population. Endocr Relat Cancer 2015; 22:901-8. [PMID: 26354077 DOI: 10.1530/erc-15-0396] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2015] [Indexed: 01/03/2023]
Abstract
Telomerase reverse transcriptase (TERT) promoter mutations C228T and C250T have recently been described in follicular cell-derived thyroid cancer (TC) in patients from North America and Europe. In this study, we explored whether these findings could be replicated in patients from a different ethnic group. We screened 17 benign thyroid adenomas and 265 TC samples from patients in the Middle East for these mutations by PCR and direct sequencing using DNA isolated from paraffin-embedded tumor tissues. None of the 17 benign adenomas harbored TERT promoter mutations. Of 265 TC, 34 (12.8%) harbored TERT promoter mutations, including 10/153 (6.5%) conventional papillary TC (CPTC), 8/57 (14.0%) follicular variant PTC, 9/30 (30%) tall cell variant PTC, 1/3 (30%) Hurthle cell thyroid cancer (HTC), 1/5 (20%) follicular TC, and 5/13 (38.5%) poorly differentiated TC. C250T mutation was present in only 6/265 (2.3%) cases, while C228T mutation was present in a total of 28/265 (10.6%) cases. These two mutations were mutually exclusive. TERT promoter mutations were significantly more common in older (≥45 years) than younger patients and were associated with larger tumour size, vascular invasion, higher TNM stage (stage III and IV), BRAF(V600E) mutation and persistent/recurrent disease at 6-12 months after initial treatment and at the last follow up. These associations were stronger in non-CPTC. Thus, this study on a large cohort of TC patients from Middle East demonstrates that TERT promoter mutations are relatively common, especially in the non-CPTC, and are associated with more aggressive histopathological features, BRAF(V600E) mutation, and disease persistence/recurrence than the WT TERT.
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MESH Headings
- Adenocarcinoma, Follicular/ethnology
- Adenocarcinoma, Follicular/genetics
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Adenoma/ethnology
- Adenoma/genetics
- Adenoma/pathology
- Adenoma, Oxyphilic/ethnology
- Adenoma, Oxyphilic/genetics
- Adenoma, Oxyphilic/pathology
- Adenoma, Oxyphilic/therapy
- Adolescent
- Adult
- Age Factors
- Aged
- Arabs/genetics
- Carcinoma, Papillary/ethnology
- Carcinoma, Papillary/genetics
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/therapy
- Child
- Combined Modality Therapy
- DNA, Neoplasm/genetics
- Ethnicity/genetics
- Female
- Follow-Up Studies
- Humans
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Mutation, Missense
- Neoplasm Invasiveness
- Neoplasm Proteins/genetics
- Neoplasm Staging
- Point Mutation
- Promoter Regions, Genetic/genetics
- Proto-Oncogene Proteins B-raf/genetics
- Recurrence
- Saudi Arabia/epidemiology
- Telomerase/genetics
- Thyroid Neoplasms/ethnology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Thyroidectomy
- Treatment Outcome
- Tumor Burden
- Young Adult
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Affiliation(s)
- Ebtesam Qasem
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avaniyapuram Kannan Murugan
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hindi Al-Hindi
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mingzhao Xing
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mai Almohanna
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meshael Alswailem
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali S Alzahrani
- Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Molecular OncologyKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of Pathology and Laboratory MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDepartment of MedicineKing Faisal Specialist Hospital and Research Centre, Riyadh, Saudi ArabiaDivision of Endocrinology and MetabolismJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
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69
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Marino M, Monzani ML, Brigante G, Cioni K, Madeo B, Santi D, Maiorana A, Bettelli S, Moriondo V, Pignatti E, Bonacini L, Carani C, Rochira V, Simoni M. High-Resolution Melting Is a Sensitive, Cost-Effective, Time-Saving Technique for BRAF V600E Detection in Thyroid FNAB Washing Liquid: A Prospective Cohort Study. Eur Thyroid J 2015; 4:73-81. [PMID: 26279992 PMCID: PMC4521072 DOI: 10.1159/000430092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/09/2015] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The diagnostic accuracy of thyroid fine needle aspiration biopsy (FNAB) can be improved by the combination of cytological and molecular analysis. In this study, washing liquids of FNAB (wFNAB) were tested for the BRAF V600E mutation, using the sensitive and cost-effective technique called high-resolution melting (HRM). The aim was to demonstrate the feasibility of BRAF analysis in wFNAB and its diagnostic utility, combined with cytology. DESIGN Prospective cohort study. METHODS 481 patients, corresponding to 648 FNAB samples, were subjected to both cytological (on cells smeared onto a glass slide) and molecular analysis (on fluids obtained washing the FNAB needle with 1 ml of saline) of the same aspiration. BRAF V600E analysis was performed by HRM after methodological validation for application to wFNAB (technique sensitivity: 5.4%). RESULTS The cytological results of the FNAB were: 136 (21%) nondiagnostic (THY1); 415 (64%) benign (THY2); 80 (12.4%) indeterminate (THY3); 9 (1.4%) suspicious for malignancy (THY4); 8 (1.2%) diagnostic of malignancy (THY5). The BRAF V600E mutation was found in 5 THY2, 2 THY3, 6 THY4 and 6 THY5 samples. Papillary carcinoma diagnosis was histologically confirmed in all BRAF+ thyroidectomized patients. BRAF combined with cytology improved the diagnostic value compared to cytology alone in a subgroup of 74 operated patients. CONCLUSIONS HRM was demonstrated to be a feasible method for BRAF analysis in wFNAB. Thanks to its sensitivity and cost-effectiveness, it might be routinely used on a large scale in clinical practice. In perspective, standby wFNAB samples could be analyzed a posteriori in case of indeterminate cytology and/or suspicious findings on ultrasound.
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Affiliation(s)
- Marco Marino
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Maria Laura Monzani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Giulia Brigante
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Katia Cioni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Bruno Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Antonino Maiorana
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Italy
| | - Stefania Bettelli
- Department of Diagnostic and Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Italy
| | - Valeria Moriondo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Elisa Pignatti
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
| | - Lara Bonacini
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
| | - Cesare Carani
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Azienda USL of Modena, Modena, Italy
- *Vincenzo Rochira, MD, PhD, Unit of Endocrinology, NOCSAE, Via Giardini 1355, IT-41126 Modena (Italy), E-Mail
| | - Manuela Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, Italy
- Center for Genomic Research, University of Modena and Reggio Emilia, Italy
- Azienda USL of Modena, Modena, Italy
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70
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Smith N, Nucera C. Personalized therapy in patients with anaplastic thyroid cancer: targeting genetic and epigenetic alterations. J Clin Endocrinol Metab 2015; 100:35-42. [PMID: 25347569 PMCID: PMC4283016 DOI: 10.1210/jc.2014-2803] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Anaplastic thyroid cancer (ATC) is the most lethal of all thyroid cancers and one of the most aggressive human carcinomas. In the search for effective treatment options, research toward targeted, personalized therapies is proving to be a path with great potential. As we gain a deeper understanding of the genetic (eg, BRAF(V600E), PIK3CA, TP53, hTERT mutations, etc) and epigenetic (eg, histone methylation, histone de-acetylation, microRNA regulatory circuits, etc) alterations driving ATC, we are able to find targets when developing novel therapies to improve the lives of patients. Beyond development, we can look into the effectiveness of already approved targeted therapies (eg, anti-BRAF(V600E) selective inhibitors, tyrosine kinase inhibitors, histone deacetylase inhibitors, inhibitors of DNA methylation, etc) to potentially test in ATC after learning the molecular mechanisms that aid in tumor progression. DESIGN We performed a literature analysis in Medline through the PubMed web site for studies published between 2003 and 2014 using the following main keywords: anaplastic thyroid cancer, genetic and epigenetic alterations. OBJECTIVE Here, we outlined the common pathways that are altered in ATC, including the BRAF(V600E)/ERK1/2-MEK1/2 and PI3K-AKT pathways. We then examined the current research looking into personalized, potential targeted therapies in ATC, mentioning those that have been tentatively advanced into clinical trials and those with the potential to reach that stage. We also reviewed side effects of the current and potential targeted therapies used in patients with advanced thyroid cancer. CONCLUSIONS DNA and RNA next-generation sequencing analysis will be fundamental to unraveling a precise medicine and therapy in patients with ATC. Indeed, given the deep biological heterogeneity/complexity and high histological grade of this malignancy and its tumor microenvironment, personalized therapeutic approaches possibly based on the use of combinatorial targeted therapy will provide a rational approach when finding the optimal way to improve treatments for patients with ATC.
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Affiliation(s)
- Neal Smith
- Laboratory of Human Thyroid Cancers Preclinical and Translational Research, Division of Cancer Biology and Angiogenesis, Department of Pathology, Center for Vascular Biology Research, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
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