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Nguyen MLT, Hu J, Hastings KG, Daza EJ, Cullen MR, Orloff LA, Palaniappan LP. Thyroid cancer mortality is higher in Filipinos in the United States: An analysis using national mortality records from 2003 through 2012. Cancer 2017; 123:4860-4867. [PMID: 28881423 DOI: 10.1002/cncr.30958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/06/2017] [Accepted: 08/01/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Well-differentiated thyroid carcinoma has a favorable prognosis, but patients with multiple recurrences have drastically lower survival. Filipinos in the United States are known to have high rates of thyroid cancer incidence and disease recurrence. To the authors' knowledge, it is unknown whether Filipinos also have higher thyroid cancer mortality rates. METHODS The authors studied thyroid cancer mortality in Filipino, non-Filipino Asian (NFA), and non-Hispanic white (NHW) adults using US death records (2003-2012) and US Census data. Age-adjusted mortality rates and proportional mortality ratios (PMRs) were calculated. Sex, nativity status, age at death, and educational attainment also were examined. RESULTS The authors examined 19,940,952 deaths. The age-adjusted mortality rates due to thyroid cancer were highest in Filipinos (1.72 deaths per 100,000 population; 95% confidence interval [95% CI], 1.51-1.95) compared with NFAs (1.03 per 100,000 population; 95% CI, 0.95-1.12) and NHWs (1.17 per 100,000 population; 95% CI, 1.16-1.18). Compared with NHWs, higher proportionate mortality was observed in Filipino women (3-5 times higher) across all age groups, and among Filipino men, the PMR was 2 to 3 times higher in the subgroup aged >55 years. Filipinos who completed a higher educational level had a notably higher PMR (5.0) compared with their counterparts who had not (3.5). CONCLUSIONS Negative prognostic factors for thyroid cancer traditionally include age >45 years and male sex. The results of the current study demonstrate that Filipinos die of thyroid cancer at higher rates than NFA and NHW individuals of similar ages. Highly educated Filipinos and Filipino women may be especially at risk of poor thyroid cancer outcomes. Filipino ethnicity should be factored into clinical decision making in the management of patients with thyroid cancer. Cancer 2017;123:4860-7. © 2017 American Cancer Society.
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Affiliation(s)
- Michelle-Linh T Nguyen
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jiaqi Hu
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
| | - Eric J Daza
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Latha P Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
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102
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Jo K, Kim MH, Ha J, Lim Y, Lee S, Bae JS, Jung CK, Kang MI, Cha BY, Lim DJ. Prognostic value of preoperative anti-thyroglobulin antibody in differentiated thyroid cancer. Clin Endocrinol (Oxf) 2017; 87:292-299. [PMID: 28493284 DOI: 10.1111/cen.13367] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/13/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022]
Abstract
CONTEXT The coexistence of differentiated thyroid cancer (DTC) and thyroid autoimmune disease could represent a better or worse prognosis. This study investigated the prognostic importance of preoperative anti-thyroglobulin antibody (TgAb) in DTC patients. DESIGN AND PATIENTS This retrospective hospital-cohort study enrolled 1171 consecutive DTC patients with preoperative TgAb data, who underwent total thyroidectomy between January 2006 and December 2011. Clinical parameters studied included demographics, primary tumour characteristics, radioiodine therapy, thyroid function tests, preoperative thyroglobulin (Tg) and TgAb levels, and cancer persistence/recurrence. RESULTS A total of 254 (21.7%) patients were preoperatively TgAb positive. The percentage positive for thyroid peroxidase (TPO) antibody and lymphocytic thyroiditis was significantly higher in the TgAb-positive group. The TgAb-positive group had a significantly higher rate of lymphatic invasion and lymph node metastasis both overall and in patients without TPOAb and lymphocytic thyroiditis (non-HT group). The mean number of total and central lymph nodes dissected and rate of lateral lymph node dissection were significantly higher in the TgAb-positive group, both overall and in non-HT patients. In regression analysis, preoperative TgAb was an independent risk factor for lateral lymph node metastasis. Over 50.2±14.5 months of follow-up, disease persistence/recurrence was not significantly different between patients with and without TgAb, both overall and in non-HT patients. Preoperative TgAb showed no significant correlation with final disease status. CONCLUSION Positive preoperative serum TgAb is associated with worse primary tumour characteristics but rarely showed poor prognosis, probably due to more aggressive treatment of these subjects.
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Affiliation(s)
- Kwanhoon Jo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yejee Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sohee Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moo Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bong Yun Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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103
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Qu Y, Zhang H, Zhang P, Dong W, He L, Sun W, Liu J. Risk factors and the preoperative assessment of right para-oesophageal lymph node metastasis in right lobe papillary thyroid carcinoma: A case series. Int J Surg 2017; 42:123-127. [DOI: 10.1016/j.ijsu.2017.04.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/16/2017] [Accepted: 04/30/2017] [Indexed: 11/29/2022]
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Predictive factors of right paraesophageal lymph node metastasis in papillary thyroid carcinoma: Single center experience and meta-analysis. PLoS One 2017; 12:e0177956. [PMID: 28545107 PMCID: PMC5435339 DOI: 10.1371/journal.pone.0177956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/05/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We performed this retrospective study to identify predictors of right paraesophageal lymph node metastasis, and reviewed previous studies related to this topic. METHODS Between June 2005 and March 2015, 1107 patients were diagnosed with papillary thyroid carcinoma and underwent surgery at Pusan National University Hospital. RESULTS Right paraesophageal lymph node metastasis was observed in 171 (15.4%) patients. Multivariate analyses showed that the risk of right paraesophageal metastasis was significantly associated with tumor size, location, a higher number of metastatic central lymph nodes, and lateral lymph node metastasis. In a meta-analysis of the eligible studies, tumor size, number of metastatic central lymph nodes, and lateral lymph node metastasis showed significant relationships with the risk of right paraesophageal metastasis. CONCLUSIONS In patients with risk factors such as those identified in our study, the possibility of right paraesophageal metastasis should be kept in mind, and careful inspection and dissection are required.
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105
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Al-Qurayshi Z, Shama MA, Randolph GW, Kandil E. Minimal extrathyroidal extension does not affect survival of well-differentiated thyroid cancer. Endocr Relat Cancer 2017; 24:221-226. [PMID: 28249964 DOI: 10.1530/erc-16-0509] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/01/2017] [Indexed: 12/11/2022]
Abstract
Differentiated thyroid cancer (DTC) with minimal extrathyroidal extension (MEE) is classified as stage III regardless of the tumor size. In this study, we aim to examine the effect of MEE on the overall survival and management of this population. A retrospective cohort study was performed, which utilized the National Cancer Database (NCDB), 2004-2012. The study population included patients, aged ≥ 45 years, who underwent surgery for DTC (pT3N0M0) with MEE compared to that in patients with pT2N0M0. A total of 9556 patients were included. These were divided into four groups, 4410 patients with pT2N0M0 (Group 1: T ≤ 4 cm without MEE), 3274 with pT3N0M0 (Group 2: T ≤ 4 cm with MEE), 447 with pT3N0M0 (Group 3: T > 4 cm with MEE) and 1430 patients with pT3N0M0 without MEE (Group 4: T > 4 cm without MEE). Median follow-up time was 46.7 months (interquartile range: 27.8-72.1). Patients in Group 2 (T ≤ 4 cm with MEE) had no significant worse survival compared to patients in Group 1 (T ≤ 4 cm without MEE) (P = 0.85), whereas Groups 3 and 4 (T > 4 cm), both had significantly lower survival (P < 0.001) with no difference between the two groups. Total thyroidectomy was associated with improved overall survival compared to that in lobectomy in Group 4 (T > 4 cm without MEE). Radioiodine utilization was associated with improved survival only with tumors larger than 4 cm with or without MEE. In DTC patients aged older than 45 years of age with tumor size less than 4 cm, MEE has no survival significance. Tumor size is an independent prognostic marker regardless of MEE status. Our data support re-evaluation of the current staging system.
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Affiliation(s)
- Zaid Al-Qurayshi
- Department of Otolaryngology - Head & Neck SurgeryUniversity of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mohamed A Shama
- Department of SurgerySchool of Medicine, Tulane University, New Orleans, Louisiana, USA
- Department of Head and Neck Surgical OncologyNCI, Cairo University, Cairo, Egypt
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid SurgeryDepartment of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Emad Kandil
- Department of SurgerySchool of Medicine, Tulane University, New Orleans, Louisiana, USA
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106
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Kim ES, Lee Y, Seo H, Son GS, Kwon SY, Kim YS, Seo JA, Kim NH, Suh SI, Ryoo I, You SH. Clinical features of recently diagnosed papillary thyroid carcinoma in elderly patients aged 65 and older based on 10 years of sonographic experience at a single institution in Korea. Ultrasonography 2017; 36:355-362. [PMID: 28513128 PMCID: PMC5621799 DOI: 10.14366/usg.17010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/10/2017] [Accepted: 04/13/2017] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to assess the characteristics of papillary thyroid carcinoma (PTC) in patients aged 65 and older in order to predict postoperative recurrence based on the results of ultrasonographic surveillance. Methods Among 1,494 patients (200 male and 1,294 female; mean age, 46.6±11.3 years) who underwent surgery for thyroid cancer at our institution between 2006 and 2015, we retrospectively enrolled 150 PTC patients (29 male and 121 female; mean age, 69.4±4.2 years). To identify the risk factors for recurrence, we analyzed age, gender, multiplicity, size, number, extrathyroidal extension (ETE) of the tumor, lymph node metastasis (LNM), type of surgery, and the dose of radioactive ablation using a Cox regression model to identify hazard ratios (HRs). Results Among the 115 asymptomatic patients with PTCs detected by screening ultrasonography (n=86), other cross-sectional imaging modalities (computed tomography or positron emission tomography-computed tomography, n=13), or incidentally through a surgical specimen (n=16), 78 patients were confirmed to have papillary thyroid microcarcinomas (PTMCs). The other 35 patients presented with palpable neck masses (n=25), vocal cord palsy (n=9) or blood-tinged sputum (n=1). During the follow-up period (mean, 43.6 months), 17 patients (12.5%) experienced recurrence in the neck. None of the patients died due to PTC-related recurrence or distant metastasis during the follow-up period. Cox regression analysis demonstrated that tumor size (HR, 2.12; P<0.001) and LNM (central LNM: HR, 9.08; P=0.004; lateral LNM: HR, 14.71; P=0.002; both central and lateral LNM: HR, 58.41; P<0.001) significantly increased the recurrence rate. ETE, LNM, and recurrence were significantly less frequent in PTMCs than in non-PTMC (all P<0.001). Conclusion PTCs of small size and absent LNM showed significantly better prognoses in patients 65 years and older.
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Affiliation(s)
- Eun Sil Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Younghen Lee
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyungsuk Seo
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Gil Soo Son
- Department of Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Soon Young Kwon
- Department of Otolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Young-Sik Kim
- Department of Pathology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Ji-A Seo
- Division of Endocrinology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Nan Hee Kim
- Division of Endocrinology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Inseon Ryoo
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung-Hye You
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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The Factors Involved in Bilateral Central Lymph Node Metastasis of Isthmus Papillary Thyroid Cancer. ACTA ACUST UNITED AC 2017. [DOI: 10.3342/kjorl-hns.2016.17335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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108
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Ito Y, Miyauchi A, Oda H. Low-risk papillary microcarcinoma of the thyroid: A review of active surveillance trials. Eur J Surg Oncol 2017; 44:307-315. [PMID: 28343733 DOI: 10.1016/j.ejso.2017.03.004] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/01/2016] [Accepted: 03/09/2017] [Indexed: 12/15/2022] Open
Abstract
Papillary microcarcinoma (PMC) of the thyroid is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm. Many autopsy studies on subjects who died of non-thyroidal diseases reported latent small thyroid carcinoma in up to 5.2% of the subjects. A mass screening study for thyroid cancer in Japanese adult women detected small thyroid cancer in 3.5% of the examinees. This incidence was close to the incidence of latent thyroid cancer and more than 1000 times the prevalence of clinical thyroid cancer in Japanese women reported at that time. The question of whether it was correct to treat such PMCs surgically then arose. In 1993, according to Dr. Miyauchi's proposal, Kuma Hospital initiated an active surveillance trial for low-risk PMC as defined in the text. In 1995, Cancer Institute Hospital in Tokyo, Japan, started a similar observation trial. The accumulated data from the trials at these two institutions strongly suggest that active surveillance (i.e., observation without immediate surgery) can be the first-line management for low-risk PMC. Although our data showed that young age and pregnancy might be risk factors of disease progression, we think that these patients can also be candidates for active surveillance, because all of the patients who showed progression signs were treated successfully with a rescue surgery, and none of them died of PTC. In this review, we summarize the data regarding the active surveillance of low-risk PMC as support for physicians and institutions that are considering adopting this strategy.
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Affiliation(s)
- Y Ito
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - A Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan.
| | - H Oda
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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109
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Lin JD, Lin SF, Chen ST, Hsueh C, Li CL, Chao TC. Long-term follow-up of papillary and follicular thyroid carcinomas with bone metastasis. PLoS One 2017; 12:e0173354. [PMID: 28278295 PMCID: PMC5344403 DOI: 10.1371/journal.pone.0173354] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/19/2017] [Indexed: 12/23/2022] Open
Abstract
The aims of this study were to investigate papillary and follicular thyroid carcinomas with bone metastasis in various clinical presentations and to determine the prognostic factors after multimodality treatment. A retrospective analysis was performed of 3,120 patients with papillary and follicular thyroid carcinoma. Of these patients, 131 (including 97 women, 71.8%) were diagnosed with bone metastasis and underwent follow-up at the Chang Gung Medical Center. Patients with bone metastasis were categorized into two groups. Group A was comprised of patients who were diagnosed with bone metastasis either before thyroidectomy or within 6 months of the initial thyroidectomy (90 patients, 68.7%). Group B was comprised of patients with bone metastasis who received a diagnosis 6 months post-thyroidectomy in the follow-up period (41 patients, 31.3%). After a mean follow-up period of 8.4 ± 7.0 years, there were 88 deaths (67.2%) attributed to thyroid cancer and 13 patients (9.9%) achieved disease-free status. A multivariate analysis showed that older age, early diagnosis, and brain metastasis were each associated with a poor prognosis. The difference in disease-specific mortality rates between groups A and B was significant (p < 0.0001). In conclusion, papillary and follicular thyroid cancers with bone metastasis have a high rate of mortality. Despite this high mortality, 9.9% patients still had an excellent response to treatment.
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Affiliation(s)
- Jen-Der Lin
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan, R.O.C.
- * E-mail:
| | - Shu-Fu Lin
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan, R.O.C.
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Departments of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan, R.O.C.
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan, R.O.C.
| | - Chia-Lin Li
- Healthy Aging Research Center, Chang Gung University, Taoyuan County, Taiwan, R.O.C.
| | - Tzu-Chieh Chao
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan County, Taiwan, R.O.C.
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Abstract
Differentiated thyroid cancer (DTC) includes more than 90% of all thyroid carcinoma and its incidence is growing, mainly due to an increase in the incidence of papillary thyroid cancer (PTC) for the widespread use of neck ultrasonography. Areas covered: Several prognostic factors should be considered during the management of PTC in order to provide the most effective treatment. The most important prognostic factors in PTC include personal and pathological features such as patient's age, gender, hystotype, tumor size, extrathyroidal extension, lymph node involvement, presence of local or distant metastases and molecular analyses. We performed a search in the PubMed database for studies published in English since 1960 using the terms: 'thyroid cancer', 'prognostic factors', 'age', 'gender', 'hystotype', 'tumor size', 'extrathyroidal extension', 'lymph node', 'metastases' and 'molecular analyses'. Expert commentary: Prognostic factors can guide clinicians during the treatment and follow-up of DTC patients, but it is now evident that the risk of recurrence or death must be evaluated periodically, on the basis of individual risk, according to the response to initial therapy or the subsequent therapy required during follow-up.
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Affiliation(s)
- Fabio Maino
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Raffaella Forleo
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
| | - Furio Pacini
- a Department of Medical, Surgical and Neurological Sciences , University of Siena , Siena , Italy
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Lee JH, Chung YS, Lee YD. A variation in recurrence patterns of papillary thyroid cancer with disease progression: A long-term follow-up study. Head Neck 2017; 39:767-771. [DOI: 10.1002/hed.24684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 10/31/2016] [Accepted: 11/17/2016] [Indexed: 11/09/2022] Open
Affiliation(s)
- Joon-Hyop Lee
- Thyroid and Endocrine Surgery Section, Department of Surgery; Gachon University Gil Medical Center; Incheon Republic of Korea
| | - Yoo Seung Chung
- Thyroid and Endocrine Surgery Section, Department of Surgery; Gachon University Gil Medical Center; Incheon Republic of Korea
| | - Young Don Lee
- Thyroid and Endocrine Surgery Section, Department of Surgery; Gachon University Gil Medical Center; Incheon Republic of Korea
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112
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Lee YH, Lee YM, Sung TY, Yoon JH, Song DE, Kim TY, Baek JH, Ryu JS, Chung KW, Hong SJ. Is Male Gender a Prognostic Factor for Papillary Thyroid Microcarcinoma? Ann Surg Oncol 2017; 24:1958-1964. [PMID: 28130621 DOI: 10.1245/s10434-017-5788-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Male gender is a prognostic factor of poor outcome in papillary thyroid carcinoma (PTC). We investigated the prognostic role of male gender in papillary thyroid microcarcinoma (PTMC). METHODS We included 2930 patients who underwent surgery at Asan Medical Center for PTC. Clinicopathologic characteristics from the patients' medical records were compared for male and female PTC patients. Independent prognostic factors for recurrence in PTC and PTMC were evaluated after propensity score matching analysis. The median follow-up period was 82 months. RESULTS Recurrence and death were more common in male patients with PTC than in female patients with PTC (12.6 vs. 9.6%, p = 0.03 and 2.2 vs. 0.6%, p < 0.001, respectively). However, there was no difference in disease-free survival between male and female PTMC patients (p = 0.57). Multivariate analysis after propensity score matching revealed that male gender is not an independent prognostic factor of recurrence in PTMC (hazard ratio [HR] 1.5, 95% confidence interval 0.75-5.33, p = 0.17), but that it is an independent prognostic factor in PTC >1 cm (HR = 3.06, 95% confidence interval 1.34-6.98, p = 0.008). CONCLUSIONS Male gender is an independent prognostic factor for recurrence in PTC >1 cm, but it is not a prognostic factor in PTMC.
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Affiliation(s)
- Yi Ho Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Ho Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Suk Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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113
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Niemann AC, Reid AT, Smith J, Hammond J, DeBolle SA, Wei I, Soong-Ho Lee C, Hughes DT. Association of patient age with high-risk pathologic features in papillary thyroid cancer. J Surg Res 2016; 211:228-232. [PMID: 28501122 DOI: 10.1016/j.jss.2016.12.021] [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: 05/15/2016] [Revised: 12/09/2016] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Certain patient demographics and histopathologic features are risk factors for papillary thyroid cancer (PTC) recurrence after initial treatment. Our objective was to determine whether very young age is associated with aggressive pathologic features in patients with PTC. MATERIALS AND METHODS A retrospective analysis was performed for PTC patients who underwent surgical treatment at the University of Michigan between 2006 and 2012. Patients with known distant metastases were excluded. Demographics, high-risk pathologic features (capsular or vascular invasion, extrathyroidal extension, lymph node metastases, and extranodal extension), and disease recurrence were analyzed. RESULTS 632 PTC patients were included in the analysis. Median age was 49 y (range 10-87). Tumors in patients aged <25 y had higher rates of extranodal extension (P = 0.002) compared with patients aged 25-44 y. Patients aged <25 y had more vascular invasion (P < 0.001) and lymph node metastasis (P = 0.001) than tumors in patients aged between 45-75 y. Patients aged >75 y had higher rates of vascular invasion (P < 0.001) and extrathyroidal extension (P = 0.001) compared with patients aged 45-75 y and more extrathyroidal extension (P < 0.001) than patients aged 25-44 y. There were no differences in tumor characteristics between the <25 and >75 age groups. CONCLUSIONS PTC patients aged <25 y of age or older than 75 y exhibit higher rates of aggressive histopathologic features compared to PTC patients aged between 25-75 y.
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Affiliation(s)
- Adam C Niemann
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Alexander T Reid
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Joshua Smith
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - James Hammond
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - Iris Wei
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | | | - David T Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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114
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Prognostic Significance of the Proportion of Tall Cell Components in Papillary Thyroid Carcinoma. World J Surg 2016; 41:742-747. [DOI: 10.1007/s00268-016-3784-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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115
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Lim YC, Liu L, Chang JW, Koo BS. Lateral lymph node recurrence after total thyroidectomy and central neck dissection in patients with papillary thyroid cancer without clinical evidence of lateral neck metastasis. Oral Oncol 2016; 62:109-113. [DOI: 10.1016/j.oraloncology.2016.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/31/2016] [Accepted: 10/15/2016] [Indexed: 02/07/2023]
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116
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Chereau N, Trésallet C, Noullet S, Godiris-Petit G, Tissier F, Leenhardt L, Menegaux F. Prognosis of papillary thyroid carcinoma in elderly patients after thyroid resection: A retrospective cohort analysis. Medicine (Baltimore) 2016; 95:e5450. [PMID: 27893690 PMCID: PMC5134883 DOI: 10.1097/md.0000000000005450] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The size of the elderly population and the incidence of papillary thyroid carcinoma (PTC) in this group appear to be rapidly increasing, although published information based on more detailed older age groupings are lacking.This study aimed to determine the clinical features and outcomes of elderly patients in PTC.All consecutive patients who received surgery for PTC in our Department from 1978 to 2014 were included. We compared 3 patient groups: young (<65 years), older (65-75 years), and very old patients (>75 years). Total thyroidectomy was performed with lymph node (LN) dissection in most cases, and radioiodine therapy was administered as needed.A total of 3835 patients (3257 young patients, 450 older patients, and 128 very old patients) were identified. Very old patients were more likely to have advanced (III/IV) tumor, nodes, metastases (TNM) stage, greater tumor size, number of tumors, and extracapsular invasion compared with young and older patients. For the 2289 patients with LN dissection (60%), metastatic LNs were more frequent in the very old group (44%) than in the other groups (34% young and 33% older patients) (P = 0.01). Very old patients had more frequent distant metastases (5%) than the older (2%) and young groups (1%) (P < 0.001). The overall postoperative morbidity was not significantly different between the 3 age groups. Recurrence was documented in 202 (6.2%) young, 29 (6.4%) older, and 15 (11.7%) very old PTC patients (P = 0.04). The 5-year disease-free survival was 81.3% for very old, 92.9% for older, and 94.7% for young group (P < 0.001).Very old patients should be considered high-risk PTC patients and their therapeutic strategy may benefit from aggressive treatment.
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Affiliation(s)
| | | | | | | | - Frederique Tissier
- Department of Endocrinology, Hôpital de la Pitié Salpêtrière – Université Pierre et Marie Curie (Paris VI) – APHP, Paris, France
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Yoo JY, Stang MT. Current Guidelines for Postoperative Treatment and Follow-Up of Well-Differentiated Thyroid Cancer. Surg Oncol Clin N Am 2016; 25:41-59. [PMID: 26610773 DOI: 10.1016/j.soc.2015.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Well-differentiated thyroid cancer is increasing in incidence but the disease-specific mortality remains very low. The only effective adjuvant treatment is radioactive iodine ablation. Guidelines regarding the use and dosage of radioactive iodine depend on pathologic features of the primary and metastatic tumor that define risk. Long-term treatment includes thyroid-stimulating hormone suppression and surveillance with serum thyroglobulin and radiologic assessment for nodal recurrence.
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Affiliation(s)
- Jenny Y Yoo
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufman Building, Suite 101, Pittsburgh, PA 15213, USA
| | - Michael T Stang
- Division of Endocrine Surgery, Department of Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufman Building, Suite 101, Pittsburgh, PA 15213, USA.
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de Castro TP, Waissmann W, Simões TC, de Mello RCR, Carvalho DP. Predictors for papillary thyroid cancer persistence and recurrence: a retrospective analysis with a 10-year follow-up cohort study. Clin Endocrinol (Oxf) 2016; 85:466-74. [PMID: 26834009 DOI: 10.1111/cen.13032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/25/2016] [Accepted: 01/26/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aimed to determine outcome predictors of papillary thyroid cancer (PTC) persistence and recurrence, separately. CONTEXT The factors contributing to either persistence or recurrence of PTC are poorly defined, as both outcomes are usually evaluated together. DESIGN AND PATIENTS In this 10-year follow-up cohort study, 190 PTC patients were evaluated (18-85 years old; registered from 1 January 1990 to31 December 1999 at a Brazilian Cancer Care referral Hospital). After initial surgery, we examined persistence (disease detected up to 1 year), recurrence (disease detected after 1 year) and PTC-free status (disease absence during follow-up). MEASUREMENTS Outcome predictors were modelled using multinomial logit regression analysis. RESULTS The univariate analysis showed that persistence and recurrence were significantly associated with lymph node metastasis (OR = 12·33; OR = 2·84, respectively), local aggressiveness (OR = 5·22; OR = 3·35) and extrathyroidal extension (OR = 5·07; OR = 7·11). Persistence was associated with male sex (OR = 3·49), age above 45 years old at diagnosis (OR = 1·03), macroscopic lymph node metastasis (OR = 5·85), local aggressiveness (OR = 5·22), each 1-cm tumour size increase (OR = 1·34), a cancer care referral hospital as the place of initial surgery (OR = 2·3), thyroidectomy or near total thyroidectomy(OR = 3·03) and neck dissection (OR = 3·19). Recurrence was associated with the time of radioactive iodine ((131) I) therapy (OR = 3·71). After data modelling, persistence was associated with macroscopic lymph node metastasis (OR = 6·17), 1-cm increases in tumour size (OR = 1·30) and thyroidectomy or near total thyroidectomy (OR = 3·82), while recurrence was associated with surgery at referral hospital (OR = 3·79). CONCLUSIONS The best predictors of persistence were tumour size and macroscopic lymph node metastasis; when the initial surgery is of quality, the recurrence depends more on tumour's biology aspects.
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Affiliation(s)
- Taciana Padilha de Castro
- Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
- Research Center for Health Work and Human Ecology - CESTEH-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - William Waissmann
- Research Center for Health Work and Human Ecology - CESTEH-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Taynãna César Simões
- Department of Epidemiology and Quantitative Methods in Health - DEMQS-ENSP/FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Rossana Corbo R de Mello
- Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
- Cancer Hospital 1, National Institute of Cancer INCA, Rio de Janeiro, RJ, Brazil
| | - Denise P Carvalho
- Department of Endocrinology, Medical School, Federal University of Rio de Janeiro - UFRJ, Rio de Janeiro, RJ, Brazil
- Carlos Chagas Filho Institute of Biophysics - IBCCF/UFRJ, Rio de Janeiro, RJ, Brazil
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Ito Y, Suzuki S, Ito KI, Imai T, Okamoto T, Kitano H, Sugitani I, Sugino K, Tsutsui H, Hara H, Yoshida A, Shimizu K. Tyrosine-kinase inhibitors to treat radioiodine-refracted, metastatic, or recurred and progressive differentiated thyroid carcinoma [Review]. Endocr J 2016; 63:597-602. [PMID: 27210070 DOI: 10.1507/endocrj.ej16-0064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Differentiated thyroid carcinoma (DTC) is generally indolent in nature and, even though it metastasizes to distant organs, the prognosis is normally excellent. In contrast, the overall survival (OS) of patients with radioactive iodine (RAI)-refractory and progressive metastases is dire, because no effective therapies have been available to control the metastatic lesions. However, recently, administration of tyrosine-kinase inhibitors (TKIs) has become a new line of therapy for RAI-refractory and progressive metastases. Previous studies have reported significant improvement regarding the progression-free survival rates of patients with metastatic lesions. However, TKIs cause various severe adverse events (AEs) that damage patients' quality of life and can even be life-threatening. Additionally, metastatic lesions may progress significantly after stopping TKI therapy. Therefore, it is difficult to determine who is a candidate for TKI therapy, as well as how and when physicians start and stop the therapy. The present review, created by Committee of pharmacological therapy for thyroid cancer of the Japanese Society of Thyroid Surgery (JSTS) and the Japan Association of Endocrine Surgeons (JAES) describes how to appropriately use TKIs by describing what we do and do not know about treatment using TKIs.
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Affiliation(s)
- Yasuhiro Ito
- Committee of Pharmacological Therapy for Thyroid Cancer of Japan Association of Endocrine Surgery (JAES) and Japanese Society of Thyroid Surgery (JSTS), Japan
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Thyroid computed tomography imaging: pictorial review of variable pathologies. Insights Imaging 2016; 7:601-17. [PMID: 27271508 PMCID: PMC4956631 DOI: 10.1007/s13244-016-0506-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 05/03/2016] [Accepted: 05/24/2016] [Indexed: 12/25/2022] Open
Abstract
Abstract Focal and diffuse thyroid abnormalities are commonly encountered during the interpretation of computed tomography (CT) exams performed for various clinical purposes. These findings can often lead to a diagnostic dilemma, as the CT reflects the nonspecific appearances. Ultrasound (US) examination has a superior spatial resolution and is considered the modality of choice for thyroid evaluation. Nevertheless, CT detects incidental thyroid nodules (ITNs) and plays an important role in the evaluation of thyroid cancer. In this pictorial review, we cover a wide spectrum of common and uncommon, incidental and non-incidental thyroid findings from CT scans. We also discuss the most common incidental thyroid findings, best practices for their evaluation, and recommendations for their management. In addition, we explore the role of imaging in the assessment of thyroid carcinoma (before and after treatment) and preoperative thyroid goiter, as well as localization of ectopic and congenital thyroid tissue. Teaching Points • Thyroid disorders tend to have non-specific CT appearances. • ITNs are common on neck CT. • ITN management depends on nodule size, age, health status, lymphadenopathy, and invasion. • CT is used in assessment of cancer extension, mass effect, invasion, and recurrence. • CT plays a role in preoperative planning in patients with symptomatic goiter.
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121
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Fraser S, Go C, Aniss A, Sidhu S, Delbridge L, Learoyd D, Clifton-Bligh R, Tacon L, Tsang V, Robinson B, Gill AJ, Sywak M. BRAFV600E Mutation is Associated with Decreased Disease-Free Survival in Papillary Thyroid Cancer. World J Surg 2016; 40:1618-24. [DOI: 10.1007/s00268-016-3534-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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122
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Lee YM, Sung TY, Kim WB, Chung KW, Yoon JH, Hong SJ. Risk factors for recurrence in patients with papillary thyroid carcinoma undergoing modified radical neck dissection. Br J Surg 2016; 103:1020-5. [PMID: 27121346 DOI: 10.1002/bjs.10144] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/09/2015] [Accepted: 02/05/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study evaluated the impact of lymph node-related factors on the risk of and site of recurrence in patients who had papillary thyroid carcinoma with lymph node metastasis in the lateral compartment (classified as pN1b). METHODS Patients underwent total thyroidectomy with unilateral modified radical neck dissection for classical papillary thyroid carcinoma. Risk factors for recurrence were evaluated according to the pattern of recurrence. RESULTS A total of 324 patients were included in the study. The median follow-up was 63 (range 14-181) months. Recurrence was detected in 47 patients (14·5 per cent). In the multivariable analysis, a maximum diameter of metastatic lymph nodes larger than 2·0 cm (hazard ratio (HR) 1·15, 95 per cent c.i. 1·06 to 1·25; P = 0·033) and a central compartment metastatic lymph node ratio of more than 0·42 (HR 3·35, 1·65 to 6·79; P < 0·001) were identified as independent risk factors for locoregional recurrence. Age 45 years or older (HR 5·69, 1·24 to 26·12; P = 0·025) and extranodal extension of metastasis (HR 12·71, 1·64 to 98·25; P = 0·015) were risk factors for distant metastasis. In subgroup analysis of locoregional recurrence, several lymph node-related factors affected the risk of recurrence according to the specific site of metastasis. CONCLUSION Lymph node-related factors are of importance for the risk of recurrence in patients with classical papillary thyroid carcinoma classified as pN1b.
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Affiliation(s)
- Y M Lee
- Departments of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - T Y Sung
- Departments of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - W B Kim
- Departments of Internal Medicine, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - K W Chung
- Departments of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - J H Yoon
- Departments of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
| | - S J Hong
- Departments of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea
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123
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Zhang W, Jiao D, Liu B, Sun S. Analysis of Risk Factors Contributing to Recurrence of Papillary Thyroid Carcinoma in Chinese Patients Who Underwent Total Thyroidectomy. Med Sci Monit 2016; 22:1274-9. [PMID: 27084873 PMCID: PMC4836308 DOI: 10.12659/msm.895564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Thyroid cancer is a very common endocrine malignancy, with a rate of total thyroidectomy reported to be up to 27.8%. However, studies analyzing the risk factors that contribute to recurrence of papillary thyroid carcinoma (PTC) after total thyroidectomy in China are still scarce. MATERIAL AND METHODS A total of 536 patients with PTC who underwent total thyroidectomy were retrospectively analyzed. Patients were divided into 2 groups: patients with no recurrent tumor were included in group 1 and patients with tumor recurrence were included in group 2. RESULTS Of 536 patients, 65 patients (12.1%) developed a recurrence of PTC, and 471 patients (87.9%) did not have a recurrence. Univariate analysis indicated that male sex, age ≥50 years, tumor ≥1 cm, poor differentiation, lymph node metastasis, bilaterality, and multifocality may be related to PTC recurrence. Additionally, the results of the logistic regression analysis indicated that male sex, age ≥50 years, primary tumor ≥1 cm, poor dedifferentiation of the tumor, lymph node metastasis, and multifocality may be independent factors contributing to PTC recurrence. CONCLUSIONS Male sex, age more than 50 years, primary tumor larger than 1 cm, poor dedifferentiation of the primary tumor, lymph node metastasis, and multifocality were found to increase the risk of PTC recurrence in patients who underwent total thyroidectomy. Additionally, it is necessary to use strictly aggressive and extensive surgery, as well as close monitoring, after the operation.
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Affiliation(s)
- Wei Zhang
- Department of Breast and Thyroid Surgery, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - De Jiao
- Department of Breast and Thyroid Surgery, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Baoguo Liu
- Department of Breast and Thyroid Surgery, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Shanping Sun
- Department of Breast and Thyroid Surgery, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
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Urken ML, Haser GC, Likhterov I, Wenig BM. The Impact of Metastatic Lymph Nodes on Risk Stratification in Differentiated Thyroid Cancer: Have We Reached a Higher Level of Understanding? Thyroid 2016; 26:481-8. [PMID: 26892765 DOI: 10.1089/thy.2015.0544] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The revised American Thyroid Association (ATA) management guidelines for differentiated thyroid cancer emphasize a variety of clinicopathologic features of metastatic lymph nodes in determining the risk of recurrence. The mere presence of a positive node is not sufficient to confer reliable prognostic significance. The number and size of lymph nodes, as well as the presence of extranodal extension (ENE), impact risk stratification. Moreover, the presence of clinically evident lymph nodes is important for determining risk of recurrence. A patient's place on the risk spectrum has ramifications for the management of differentiated thyroid cancer. However, there are inherent inconsistencies in the identification and characterization of metastatic lymph nodes. Moreover, the significance of ENE must be clarified. SUMMARY There are many obstacles to the consistent reporting of metastatic lymph nodes. What constitutes a "clinically evident" lymph node has not been well defined, lacks precision, and varies depending on clinical context, as well as the experience of the surgeon and the ultrasonographer. The number of lymph nodes sampled by surgeons and reported by pathologists may vary from institution to institution. The literature on ENE has been limited by the fact that the definition of ENE has not been standardized. Nevertheless, 17/19 manuscripts reviewed herein suggest that ENE confers a worse prognosis. The ATA risk stratification for metastatic lymph nodes published in the 2015 guidelines combines clinicopathological features that are variably identified and reported across institutions. This review brings into question the significance of the number of nodes with ENE, a factor that is used as an important stratifying variable in the latest guidelines. CONCLUSIONS Metastatic lymph nodes do not all carry the same prognostic significance, but a risk assignment based on the ATA guidelines is limited by a lack of standardization in clinical and pathologic definitions, lymph node sampling, and reporting. This study reviews the limitations of prior studies on ENE and concludes that the body of the evidence reported in those studies suggests that ENE increases the risk of recurrence. The impact of ENE in lymph nodes in thyroid cancer risk stratification should be reconsidered.
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Affiliation(s)
- Mark L Urken
- 1 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| | - Grace C Haser
- 2 Department of Otolaryngology-Head and Neck Surgery, Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York
| | - Ilya Likhterov
- 1 Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| | - Bruce M Wenig
- 3 Department of Pathology, Mount Sinai Beth Israel , New York, New York
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125
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Heaton CM, Chang JL, Orloff LA. Prognostic Implications of Lymph Node Yield in Central and Lateral Neck Dissections for Well-Differentiated Papillary Thyroid Carcinoma. Thyroid 2016; 26:434-40. [PMID: 26825749 DOI: 10.1089/thy.2015.0318] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between lymph node yield (LNY) from central (CND) and lateral (LND) neck dissections and risk of recurrence in patients undergoing primary surgery for well-differentiated papillary thyroid carcinoma (WDPTC). METHODS Clinical data were reviewed from all patients with biopsy-proven WDPTC who underwent primary total thyroidectomy with CND or LND at the authors' institution from 2005 to 2009. Patient demographics and tumor characteristics were obtained, and clinical data with at least five-year follow-up were used. Within the CNDs and LNDs, total number of nodes removed (LNY), total positive nodes removed, and the ratio of positive lymph nodes to LNY were determined. RESULTS One hundred fifty-two patients were included in the study, with average follow-up of 69 months. Of 125 patients who underwent CND, 20 had central neck disease recurrence. The LNY of patients with central neck recurrence was significantly less than those who had no recurrence (2.5 vs. 10.3; p < 0.0001). Of 71 patients who underwent LND, 23 had ipsilateral lateral neck disease recurrence. The LNY of patients with lateral neck recurrence was significantly less than those who did not recur (10.5 vs. 24.6; p < 0.0001). Higher rates of recurrence were associated with smaller LNY in both groups. For both groups, lower LNY remains predictive of recurrence on multivariate analysis controlling for pT stage, pN stage, American Joint Committee on Cancer stage, and radioactive iodine treatment. CONCLUSIONS Higher LNY in CNDs and LNDs is associated with lower rates of papillary thyroid carcinoma recurrence in the central and lateral neck. To minimize the risk of recurrence and the need for secondary therapy with revision surgery and/or radiation, surgeons should perform thorough, compartment-oriented CNDs and LNDs when nodal surgery is undertaken.
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Affiliation(s)
- Chase M Heaton
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco , San Francisco, California
| | - Jolie L Chang
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco , San Francisco, California
| | - Lisa A Orloff
- 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University , Stanford, California
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126
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Lo TEN, Uy AT, Maningat PDD. Well-Differentiated Thyroid Cancer: The Philippine General Hospital Experience. Endocrinol Metab (Seoul) 2016; 31:72-9. [PMID: 26754584 PMCID: PMC4803565 DOI: 10.3803/enm.2016.31.1.72] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/22/2015] [Accepted: 10/15/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Well-differentiated thyroid cancer (WDTC) is the most common form of thyroid malignancy. While it is typically associated with good prognosis, it may exhibit higher recurrence and mortality rates in selected groups, particularly Filipinos. This paper aims to describe the experience of a Philippine Hospital in managing patients with differentiated thyroid cancer. METHODS We performed a retrospective cohort study of 723 patients with WDTC (649 papillary and 79 follicular), evaluating the clinicopathologic profiles, ultrasound features, management received, tumor recurrence, and eventual outcome over a mean follow-up period of 5 years. RESULTS The mean age at diagnosis was 44±13 years (range, 18 to 82), with a majority of cases occurring in the younger age group (<45 years). Most tumors were between 2 and 4 cm in size. The majority of papillary thyroid cancers (PTCs, 63.2%) and follicular thyroid cancers (FTCs, 54.4%) initially presented as stage 1, with a greater proportion of FTC cases (12.7% vs. 3.7%) presenting with distant metastases. Nodal metastases at presentation were more frequent among patients with PTC (29.9% vs. 7.6%). A majority of cases were treated by complete thyroidectomy, followed by radioactive iodine therapy and thyroid stimulating hormone suppression, resulting in a disease-free state. Excluding patients with distant metastases at presentation, the recurrence rates for papillary and FTC were 30.1% and 18.8%, respectively. CONCLUSION Overall, PTC among Filipinos was associated with a more aggressive and recurrent behavior. FTC among Filipinos appeared to behave similarly with other racial groups.
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Affiliation(s)
- Tom Edward N Lo
- Section of Endocrinology and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
| | - Abigail T Uy
- Section of Endocrinology and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Patricia Deanna D Maningat
- Section of Endocrinology and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
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Mutalib NSA, Yusof AM, Mokhtar NM, Harun R, Muhammad R, Jamal R. MicroRNAs and Lymph Node Metastasis in Papillary Thyroid Cancers. Asian Pac J Cancer Prev 2016; 17:25-35. [DOI: 10.7314/apjcp.2016.17.1.25] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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128
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Mendoza ES, Lopez AA, Valdez VAU, Cunanan EC, Matawaran BJ, Kho SA, Sero-Gomez MH. Predictors of incomplete response to therapy among Filipino patients with papillary thyroid cancer in a tertiary hospital. J Endocrinol Invest 2016; 39:55-62. [PMID: 26036600 DOI: 10.1007/s40618-015-0319-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/21/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although survival rate in papillary thyroid cancer (PTC) is high, the risk of persistence and recurrence together with the dramatic rise in its incidence cannot be overemphasized. Filipinos are considered to be at greater risk for negative outcomes. A paradigm shift in the management of PTC introduces re-stratification based on response to therapy which was reported to have better correlation with long-term outcome. The study aimed to identify predictors of incomplete response after thyroidectomy and radioiodine therapy among patients with PTC. The results of the study may have important implications in our understanding of the disease process allowing more aggressive treatment and monitoring of certain subgroups of patients. METHODOLOGY Retrospective review of 225 patients with PTC (59% ATA low risk, 30 % ATA intermediate risk and 11% ATA high risk) who underwent thyroidectomy and radioiodine therapy was performed. Thirteen variables were considered (age, gender, histopathological variant, stage, extent of disease, MACIS score, AMES score, primary tumour size, lymph node, lymphovascular invasion, bilaterality, multifocality and preoperative TSH level). Logistic regression analysis using Backward Wald algorithm was used to identify independent predictors of incomplete response to therapy after 24 months. RESULTS Of the 225 patients, 69 (31%) had incomplete response. Biochemical and structural (predominantly thyroid bed, lung and bone) incomplete response was observed in 6 and 63 patients, respectively. Incomplete response was documented in 8, 54 and 92% of low-, intermediate- and high-risk patients based on ATA recommendation. Incomplete response was significantly dependent on gender, lymph node involvement and location, extent of malignancy and multifocality taking into account the size of concurrent tumours (p < 0.05). The model was found to have high sensitivity (71%) and specificity (96%). CONCLUSION A significant fraction of PTC patients experienced incomplete response to therapy. Our data suggest that male gender, lateral or mediastinal lymph node involvement, class III extent of disease by De Groot and multifocality with concurrent tumour or tumours more than 1 cm are major predictors of incomplete response. Not all predictors of recurrence and mortality are consistent predictors of treatment response which may be equally important in a disease with low mortality but significant morbidity like PTC.
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Affiliation(s)
- E S Mendoza
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - A A Lopez
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - V A U Valdez
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - E C Cunanan
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - B J Matawaran
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - S A Kho
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
| | - M H Sero-Gomez
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila, Philippines.
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Marković M, Paunović I, Dragaš M, Božić V, Ilić N, Končar I, Davidović L. Giant Posttraumatic Cervical Hematoma: Acute Presentation of Papillary Thyroid Carcinoma in an Adolescent. Med Princ Pract 2016; 25:385-7. [PMID: 27111810 PMCID: PMC5588419 DOI: 10.1159/000445117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 03/01/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe a rare case of acute presentation of papillary thyroid carcinoma (PTC). CLINICAL PRESENTATION AND INTERVENTION A 19-year-old male presented with an expanding cervical mass following blunt trauma. A computed tomography scan revealed a mass suspected to be hematoma that was compressing the vessels and thereby deviating the trachea. Immediate surgery was performed. Neither vascular injury nor active bleeding was seen; instead, a solid, hematoma-like tumefaction in the right thyroid lobe was revealed. A total thyroid lobectomy was performed. A histologic paraffin section confirmed a PTC that was permeated by hematoma. CONCLUSION This was a unique case of an acute, life-threatening presentation of previously asymptomatic PTC in an adolescent.
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Affiliation(s)
- Miroslav Marković
- Department of Surgery, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
- *Miroslav Marković, MD, PhD, Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Koste Todorovica 8, RS—11000 Belgrade (Serbia), E-Mail
| | - Ivan Paunović
- Department of Surgery, Belgrade, Serbia
- Center for Endocrine Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Dragaš
- Department of Surgery, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
| | - Vesna Božić
- Institute of Pathology, Faculty of Medicine, University of Belgrade, Serbia
| | - Nikola Ilić
- Department of Surgery, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
| | - Igor Končar
- Department of Surgery, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
| | - Lazar Davidović
- Department of Surgery, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
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130
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Lo TEN, Canto AU, Maningat PDD. Risk Factors for Recurrence in Filipinos with Well-Differentiated Thyroid Cancer. Endocrinol Metab (Seoul) 2015; 30:543-50. [PMID: 26485470 PMCID: PMC4722410 DOI: 10.3803/enm.2015.30.4.543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/12/2015] [Accepted: 08/19/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The incidence of well-differentiated thyroid cancer (WDTC) has increased in recent years. Despite its excellent prognosis, increasing morbidity from recurrent diseases continues to affect long-term outcomes. Among at-risk populations, Filipinos have the highest incidence of thyroid cancer worldwide, characterized by a highly aggressive and recurrent form of disease. Here, we sought to identify risk factors associated with disease recurrence among Filipinos with WDTC. METHODS This retrospective cohort study examined 723 patients diagnosed with WDTC seen at Philippine General Hospital. Affected individuals were classified based on the presence or absence of disease recurrence. Multivariate logistic regression analyses were used to determine significant predictors of recurrence. RESULTS Multiple risk factors, including age >45 years (odds ratio [OR], 1.44), multifocality of cancer (OR, 1.43), nodal involvement (OR, 4.0), and distant metastases at presentation (OR, 2.78), were significantly associated with a recurrence of papillary thyroid cancer (PTC). In contrast, follicular variant histology (OR, 0.60) and postsurgical radioactive iodine therapy (OR, 0.31) were protective for PTC recurrence. Distant metastases at presentation (OR, 19.4) and postsurgical radioactive iodine therapy (OR, 0.41) were associated with follicular thyroid cancer (FTC) recurrence. CONCLUSION Lymph node metastases at presentation was the strongest predictor of recurrence in PTC, whereas distant metastases at presentation was the strongest for FTC recurrence. Among Filipinos, stratification of WDTC patients based on recurrence risk factors identified in this study will be helpful in guiding the intensity of treatment strategies and long-term thyroid cancer surveillance.
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Affiliation(s)
- Tom Edward Ngo Lo
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
| | - Abigail Uy Canto
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Patricia Deanna D Maningat
- Section of Endocrinology Diabetes and Metabolism, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
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131
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Veronese N, Luchini C, Nottegar A, Kaneko T, Sergi G, Manzato E, Solmi M, Scarpa A. Prognostic impact of extra-nodal extension in thyroid cancer: A meta-analysis. J Surg Oncol 2015; 112:828-33. [DOI: 10.1002/jso.24070] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/01/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Nicola Veronese
- Geriatrics Division; Department of Medicine; University of Padova; Padova Italy
| | - Claudio Luchini
- Department of Pathology and Diagnostics; University and Hospital Trust of Verona; Verona Italy
| | - Alessia Nottegar
- Department of Pathology and Diagnostics; University and Hospital Trust of Verona; Verona Italy
| | - Takuma Kaneko
- Department of Molecular Pathology; Tohoku University School of Medicine; Sendai Japan
| | - Giuseppe Sergi
- Geriatrics Division; Department of Medicine; University of Padova; Padova Italy
| | - Enzo Manzato
- Geriatrics Division; Department of Medicine; University of Padova; Padova Italy
| | - Marco Solmi
- Department of Neurosciences; University of Padova; Padova Italy
| | - Aldo Scarpa
- Department of Pathology and Diagnostics; University and Hospital Trust of Verona; Verona Italy
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132
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Enomoto K, Sakata Y, Izumi K, Takenaka Y, Nagai M, Takeda K, Enomoto Y, Uno A. Strong Neck Accumulation of 131I Is a Predictor of Incomplete Low-Dose Radioiodine Remnant Ablation Using Recombinant Human Thyroid-Stimulating Hormone. Medicine (Baltimore) 2015; 94:e1490. [PMID: 26426611 PMCID: PMC4616877 DOI: 10.1097/md.0000000000001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/21/2015] [Accepted: 08/10/2015] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to identify the factors that predict incomplete low-dose radioiodine remnant ablation (RRA) with recombinant human thyroid-stimulating hormone (rhTSH) and to report the adverse events associated with this treatment. Between 2012 and 2014, 43 consecutive patients with thyroid cancer received low-dose RRA with rhTSH after total thyroidectomy. We retrospectively investigated the adverse events during low-dose RRA and during diagnostic whole body scan (DxWBS) using rhTSH, and analyzed the rate of RRA completion and the associations between RRA completion and various clinical/pathological factors. Complete RRA was seen in 33 (76.7%) patients, and incomplete RRA was observed in 10 (23.3%). Patients with incomplete RRA had stronger neck accumulation of 131I than those with complete RRA (P < 0.001). Adverse events at RRA and DxWBS were seen in 12 and 9 patients, respectively. All events at RRA were grade 1, with one exception (grade 2 vertigo after rhTSH administration). The rate of adverse events at DxWBS was significantly higher in patients with adverse events seen at RRA (risk ratio, 3.778, P = 0.008). Strong neck accumulation of 131I is significant independent predictor of incomplete low-dose RRA. The risk of adverse events at DxWBS was higher in patients who experienced adverse events at RRA than in those who did not.
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Affiliation(s)
- Keisuke Enomoto
- From the Otolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka, Japan
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133
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Daignault CP, Palmer EL, Scott JA, Swan JS, Daniels GH. Papillary Thyroid Carcinoma Metastasis to the Lumbar Spine Masquerading as a Schmorl's Node. Nucl Med Mol Imaging 2015; 49:217-22. [PMID: 26279695 DOI: 10.1007/s13139-015-0320-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/15/2015] [Accepted: 01/18/2015] [Indexed: 11/26/2022] Open
Abstract
A Schmorl's node is a common incidental finding encountered during radiologic imaging. Despite the vertebral body being a common site of metastatic disease, a lytic lesion adjacent to an endplate with typical imaging features can often confidently be called a Schmorl's node. This is a case report of a patient with a single well-defined FDG-avid papillary thyroid carcinoma metastasis to the spine that had imaging findings characteristic of a Schmorl's node on CT and MRI. This case is important to consider as it demonstrates that the imaging characteristics of metastatic disease and Schmorl's nodes can overlap.
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Affiliation(s)
- Cory P Daignault
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA ; Department of Radiology, Division of Nuclear Medicine, UMass Memorial Medical Center, 55 Lake Ave N, Worcester, MA 01655 USA
| | - Edwin L Palmer
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - James A Scott
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - John S Swan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
| | - Gilbert H Daniels
- Thyroid Unit and Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 USA
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134
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Significance of the Extracapsular Spread of Metastatic Lymph Nodes in Papillary Thyroid Carcinoma. Clin Exp Otorhinolaryngol 2015; 8:289-94. [PMID: 26330926 PMCID: PMC4553362 DOI: 10.3342/ceo.2015.8.3.289] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/12/2014] [Accepted: 07/23/2014] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The extracapsular spread (ECS) of metastatic lymph nodes is associated with aggressive tumor behavior, and is regarded as a major risk factor for local recurrence in patients with head and neck squamous cell carcinoma. However, the significance of ECS of metastatic lymph nodes has not been well established in well-differentiated thyroid carcinoma. The purpose of this study was to examine this question. METHODS A retrospective review was performed of 335 patients with papillary thyroid carcinoma who underwent total thyroidectomy with lymph node dissection from April 2001 to December 2009. We analyzed various clinical characteristics, pathologic factors, and the size, number, and ECS of foci in metastatic lymph nodes. RESULTS On pathologic review, 201 of the patients (56.6%) had lymph node metastasis. This was significantly related to age and tumor size. ECS was noted in 64 of these 201 patients (31.8%), and was significantly related to male gender, tumor size, presence of extrathyroidal extension, metastatic lymph node size, and focus size. Recurrence occurred in 13 patients (3.9%), and the presence of ECS was significantly related to recurrence. CONCLUSION ECS of metastatic lymph nodes is an important prognostic factor for loco-regional recurrence in papillary thyroid carcinoma.
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135
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Takami H, Ito Y, Okamoto T, Onoda N, Noguchi H, Yoshida A. Revisiting the guidelines issued by the Japanese Society of Thyroid Surgeons and Japan Association of Endocrine Surgeons: a gradual move towards consensus between Japanese and western practice in the management of thyroid carcinoma. World J Surg 2015; 38:2002-10. [PMID: 24671301 DOI: 10.1007/s00268-014-2498-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In 2010, the Japanese Society of Thyroid Surgeons (JSTS) and Japanese Association of Endocrine Surgeons (JAES) established new guidelines entitled "Treatment of Thyroid Tumors." Since then, several new studies, including those that address the treatment of differentiated thyroid carcinoma (DTC) have been published, and the DTC treatment policy not only of Japanese physicians but those in Western countries has continued to evolve. METHODS We selected six clinical questions regarding the treatment of DTC and revisited them based on newly published data from Western countries and Japan. RESULTS More data have accumulated about treatment of low-risk papillary microcarcinoma. It has become clear that conservative treatment (observation) of low-risk papillary microcarcinoma in elderly patients is an acceptable alternative to immediate surgery. Total thyroidectomy versus hemithyroidectomy for low-risk papillary thyroid carcinoma (PTC) has become an important issue, and some publications after 2010 indicated that hemithyroidectomy is adequate for these low-risk patients. Unfortunately, no published manuscripts on prophylactic central node dissection offered good evidence regarding its indications or included a large number of patients. Also, it was not evident that prophylactic lateral node dissection improves cause-specific survival, although it might reduce lymph node recurrence especially in PTC patients with large tumors, distant metastases, or clinical central node metastases. Although completion total thyroidectomy was not recommended for minimally invasive follicular thyroid carcinoma in our guidelines, it may be better to perform it in elderly patients and those with a large tumor or extensive vascular invasion. Radioactive iodine (RAI) ablation after total thyroidectomy is still performed almost routinely in many Western institutions, although recent studies showed that ablation is not beneficial in low-risk patients. In Japan, because of legal restrictions, most patients did not undergo RAI ablation, and their prognoses are excellent. CONCLUSIONS Recently, policy for treating DTCs has changed not only in Western countries but also in Japan, resulting in a gradual move toward consensus between Western practice and ours. We will continue to present the best treatments for patients with thyroid carcinoma each time we revise our guidelines.
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136
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Hoang JK, Nguyen XV, Davies L. Overdiagnosis of thyroid cancer: answers to five key questions. Acad Radiol 2015; 22:1024-9. [PMID: 26100186 DOI: 10.1016/j.acra.2015.01.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 01/02/2015] [Accepted: 01/08/2015] [Indexed: 02/02/2023]
Abstract
Thyroid cancer fulfills the criteria for overdiagnosis by having a reservoir of indolent cancers and practice patterns leading to the diagnosis of incidental cancers from the reservoir. The occurrence of overdiagnosis is also supported by population-based data showing an alarming rise in thyroid cancer incidence without change in mortality. Because one of the activities leading to overdiagnosis is the workup of incidental thyroid nodules detected on imaging, it is critical that radiologists understand the issue of overdiagnosis and their role in the problem and solution. This article addresses 1) essential thyroid cancer facts, 2) the evidence supporting overdiagnosis, 3) the role of radiology in overdiagnosis, 4) harms of overdiagnosis, and 5) steps radiologists can take to minimize the problem.
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137
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Jeon MJ, Kim WG, Jang EK, Choi YM, Song DE, Sung TY, Yoon JH, Chung KW, Hong SJ, Ryu JS, Han JM, Kim TY, Shong YK, Kim WB. Sub-Classification of Lateral Cervical Lymph Node Metastasis in Papillary Thyroid Carcinoma by Pathologic Criteria. PLoS One 2015; 10:e0133625. [PMID: 26186205 PMCID: PMC4505852 DOI: 10.1371/journal.pone.0133625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/30/2015] [Indexed: 11/18/2022] Open
Abstract
Background Lateral cervical lymph node (LCLN) metastasis, or pathologic N1b disease, is an important risk factor in papillary thyroid carcinoma (PTC). However, many patients have favorable prognosis even with pathologic N1b patients in clinical practice. The study aims to identify high- and intermediate-risk groups based on initial pathologic characteristics in these patients. Patients This study included 518 classical PTC patients confirmed as pathologic N1b at initial surgery between 2001 and 2010. All patients underwent a single fixed activity (5.6 GBq) of radioactive I-131 remnant ablation. Results Patients with a primary tumor larger than 4 cm, gross extrathyroidal extension, metastatic LN larger than 3 cm, or greater than 10 metastatic LCLN were classified as high-risk group. These comprehensive pathologic criteria were retrieved from cox proportional hazard models. Twenty two percent of patients (n = 113) were classified as high-risk and 78% (n = 405) as intermediate-risk group. Successful ablation was identified in only 32% of the patients in the high-risk group and 61% in the intermediate-risk group (p < 0.001). The difference between the two risk groups was independent to gender. There was a significant difference in disease-free survival between the high- and intermediate- risk N1b groups during 5.1 years of median follow-up (84% vs. 59%, p < 0.001). Distant metastasis was more prevalent in the high-risk group (20%) than in the intermediate-risk group (4%, p < 0.001). Conclusions The prognosis of PTC patients with LCLN metastasis varies depending on initial pathologic characteristics. We proposed the comprehensive pathologic criteria for sub-classification of N1b into high- and intermediate-risk groups and this sub-classification may permit personalized management of N1b PTC patients.
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Affiliation(s)
- Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- * E-mail:
| | - Eun Kyung Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yun Mi Choi
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Ho Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Min Han
- Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lin JD, Hsueh C, Chao TC. Long-Term Follow-Up of the Therapeutic Outcomes for Papillary Thyroid Carcinoma With Distant Metastasis. Medicine (Baltimore) 2015; 94:e1063. [PMID: 26131826 PMCID: PMC4504566 DOI: 10.1097/md.0000000000001063] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) patients with distant metastasis (DM) have variable clinical courses and therapeutic outcomes. Survival time after diagnosis of DM may be several months to years. Long-term follow-up is necessary to determine prognostic factors for survival in PTC with DM. The purpose of this study was to investigate the clinical features and therapeutic outcomes of PTC with DM after 10 years of follow-up. The study population consisted of 70 patients who underwent initial thyroidectomy before 2004 and had DM beyond the locoregional neck area. Of these 70 patients, 40 patients were diagnosed with DM before or within 9 months after initial thyroidectomy in first radioactive iodide (I) whole-body scintigraphy (group A), and 30 patients were diagnosed with DM during the follow-up period (group B). Patients with DM underwent 3.7 to 7.4 GBq I therapy every 6 to 12 months. After a mean follow-up period of 10.1 ± 0.9 years, the disease-specific mortality and remission rates were 70.0% (49/70) and 10% (7/70), respectively. The survival rates for patients in groups A and B were 72.5% and 96.7% at 1 year, 47.5% and 90.0% at 5 years, 40.0% and 70.0% at 10 years, 36.4% and 41.1% at 15 years, and 35.0% and 8.0% at 20 years, respectively. The percentage of male and older patients and patients with larger tumor size was higher in the mortality group than in the survival group, whereas the percentage of patients with I avid metastatic lesions (first DM) was lower in the mortality group. The percentage of patients with secondary primary cancers was higher in group B than in group A. In the multiple regression analysis, age and male gender were independently associated with disease-specific mortality. In conclusion, after a mean follow-up of 10.1 years, the disease-specific mortality rate for PTC with DM was 70.0%. Older patients and male PTC patients with DM need more aggressive treatment. The timing of DM diagnosis did not influence disease-specific mortality.
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Affiliation(s)
- Jen-Der Lin
- From the Division of Endocrinology and Metabolism, Departments of Internal Medicine, Pathology, and General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, R.O.C (J-DL, CH, T-CC)
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139
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Risk Factors for Re-recurrence After First Reoperative Surgery for Locoregional Recurrent/Persistent Papillary Thyroid Carcinoma. World J Surg 2015; 39:1943-50. [DOI: 10.1007/s00268-015-3052-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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140
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Suh YJ, Kwon H, Kim SJ, Choi JY, Lee KE, Park YJ, Park DJ, Youn YK. Factors Affecting the Locoregional Recurrence of Conventional Papillary Thyroid Carcinoma After Surgery: A Retrospective Analysis of 3381 Patients. Ann Surg Oncol 2015; 22:3543-9. [DOI: 10.1245/s10434-015-4448-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 02/04/2023]
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141
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VEGF-D and A Preoperative Serum Levels Predict Nodal and Distant Metastases in Differentiated Thyroid Cancer Patients. World J Surg 2015; 39:1742-9. [PMID: 25670042 DOI: 10.1007/s00268-015-3016-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Preoperative tumor aggressiveness biomarkers may help surgeons decide the extent of an operation. However, whether serum angiogenetic factors can be used to predict the prognosis of patients with differentiated thyroid cancer is still unclear. METHODS Seventy-six DTC patients were prospectively recruited. Preoperative serum samples were collected and measured for Tie-2, Ang-1, Ang-2, VEGF-A, and VEGF-D levels. The potential correlations between their serum levels and clinicopathologic features as well as their prognoses were analyzed. RESULTS Older age (>45 years old) and higher VEGF-A serum levels were independent predictors of extrathyroidal extension. The VEGF-D serum level was an independent factor for lymph node metastases and VEGF-A was an independent factor for distant metastases. None of these serum angiogenetic factors were significantly different between patients who were disease free and those with recurrences. The presence of lymph node metastases was the only independent factor for recurrence over the 2-year follow-up. CONCLUSION Preoperative serum VEGF-A and VEGF-D levels were significantly elevated in DTC patients with distant and lymph node metastases. These findings, when combined with other clinicopathological factors, may help in surgical decisions.
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142
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Raffaelli M, De Crea C, Sessa L, Fadda G, Bellantone C, Lombardi CP. Ipsilateral Central Neck Dissection Plus Frozen Section Examination Versus Prophylactic Bilateral Central Neck Dissection in cN0 Papillary Thyroid Carcinoma. Ann Surg Oncol 2015; 22:2302-8. [PMID: 25652046 DOI: 10.1245/s10434-015-4383-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ipsilateral central compartment node dissection (IpsiCCD) can reduce the morbidity of prophylactic bilateral central compartment node dissection (BilCCD) in papillary thyroid carcinoma (PTC) but it carries the risk of contralateral metastases being overlooked. Frozen section examination (FSE) of removed ipsilateral nodes has been proposed to intraoperatively assess nodal status. We compared IpsiCCD plus FSE and BilCCD in clinically unifocal and node negative PTC. METHODS One hundred patients were prospectively assigned to undergo total thyroidectomy (TT) plus BilCCD or TT plus IpsiCCD. In the IpsiCCD group, removed lymph nodes were sent for FSE. If FSE was positive for metastases, a BilCCD was accomplished. RESULTS The two groups included 50 patients each. Overall, occult lymph node metastases were found in 41 patients-20 in the IpsiCCD group and 21 in the BilCCD group. FSE correctly identified occult node metastases in 13 of 20 pN1a patients in the IpsiCCD group (overall accuracy 86 %). Seven node metastases were not detected at FSE-five were micrometastases (≤2 mm). Six of 13 patients in the IpsiCCD group who underwent BilCCD and 6 of 21 BilCCD pN1a patients had bilateral metastases. More patients in the BilCCD group showed transient hypocalcemia (27/50 vs. 18/50, respectively) [p = NS]. No patient experienced recurrent disease. CONCLUSIONS FSE of ipsilateral nodes is accurate in determining nodal status, allowing the extension of the central neck clearance to be reliably modulated. Routine IpsiCCD plus FSE of the ipsilateral nodes could be a valid alternative to prophylactic BilCCD since it allows accurate staging and may reduce morbidity.
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Affiliation(s)
- Marco Raffaelli
- Division of Endocrine and Metabolic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
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143
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Su DH, Chang SH, Chang TC. The impact of locoregional recurrences and distant metastases on the survival of patients with papillary thyroid carcinoma. Clin Endocrinol (Oxf) 2015; 82:286-94. [PMID: 24863061 DOI: 10.1111/cen.12511] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 12/23/2013] [Accepted: 05/18/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Some patients with papillary thyroid carcinoma (PTC) would suffer from locoregional recurrences or distant metastases. This study was aimed to elucidate the impacts of locoregional recurrences and distant metastases on these patients' survival. DESIGN Retrospective hospital-based cohort study. POPULATION Data were collected from 1636 subjects with PTC at National Taiwan University Hospital between 1985 and 2007. MEASUREMENTS Overall and disease-specific survival curves were estimated by the Kaplan-Meier method. Time-independent and time-dependent prognostic factors were included simultaneously in multivariate analyses using Cox models. RESULTS Overall survival (OS) rates at 10- and 20-years were 90% and 76%, respectively. The 10- and 20-year disease-specific survival (DSS) rates were 95% and 90%, respectively. Our multivariate analyses identified that older age, distant metastases (hazard ratio, HR: 6·69, 95% CI: 4·40-10·18), locoregional recurrences (HR: 1·88, 95% CI: 1·22-2·89), lymph node metastases, massive extrathyroid extension, male gender and larger tumour size (>4 cm) were significantly associated with poorer OS. Older age, distant metastases (HR: 15·03, 95% CI: 8·31-27·21), locoregional recurrences (HR: 3·63, 95% CI: 2·03-6·51), massive extrathyroid extension, male gender and larger tumour size (>4 cm) were independently related to worse DSS. The performance of high-dose (131) I ablation had a protective effect on OS and DSS. CONCLUSION The locoregional recurrences had a moderately harmful impact on OS and DSS, but age and distant metastases were the major decisive factors for OS and DSS. High-dose (131) I ablation had a protective role. However, lymph node dissection did not alter the prognosis whenever lymph node metastases only influenced OS.
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Affiliation(s)
- Deng-Huang Su
- Department of Internal Medicine, Far-Eastern Polyclinic, Taipei, Taiwan; Division of Biostatistics, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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145
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The utility of lymph node mapping sonogram and thyroglobulin surveillance in post thyroidectomy papillary thyroid cancer patients. Surgery 2014; 156:1491-6; discussion 1496-7. [DOI: 10.1016/j.surg.2014.08.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/19/2014] [Indexed: 11/23/2022]
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146
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Lobectomy and prophylactic central neck dissection for papillary thyroid microcarcinoma: do involved lymph nodes mandate completion thyroidectomy? World J Surg 2014; 38:872-7. [PMID: 24305923 DOI: 10.1007/s00268-013-2348-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The present study was designed to investigate the necessity of completion thyroidectomy for patients who underwent thyroid lobectomy for low-risk papillary thyroid microcarcinoma (PTMC) that was later pathologically diagnosed as central lymph node (CLN) metastasis. METHODS Between 1986 and 2001, we assessed 551 patients who underwent thyroidectomy with prophylactic ipsilateral central compartment neck dissection, and 409 patients were followed-up completely. Thyroid lobectomy were performed in 281 and 128 patients, respectively. The patients were divided into two groups according to CLN metastasis. Clinicopathological profiles and follow-up details were investigated by retrospective chart review. RESULTS The CLN-positive and -negative groups were comprised of 43 (15.2 %) and 238 patients (84.8 %), respectively. The mean ages of the two groups were not significantly different (p > 0.05). The mean tumor size of the CLN-positive group (6.8 mm) was significantly larger than that of the CLN-negative group (5.6 mm; p < 0.05). Microscopic capsular invasion was significantly higher in the CLN-positive group (51.2 vs. 23.9 %; p < 0.05). Overall, 21 patients (7.4 %, 21/281) experienced recurrence. Among these, 2 (4.7 %, 2/43) and 19 (8.0 %, 19/238) were in the CLN-positive and -negative groups, respectively. There was no significant correlation between CLN metastasis and tumor recurrence. CONCLUSIONS Postoperative recurrence was lower in the CLN-positive group, and there was no significant correlation between CLN metastasis and tumor recurrence. Our results suggest that it is not necessary to perform completion thyroidectomy for PTMC patients who have undergone thyroid lobectomy and who have been pathologically diagnosed with CLN metastasis.
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147
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Robenshtok E, Farooki A, Grewal RK, Tuttle RM. Natural history of small radioiodine-avid bone metastases that have no structural correlate on imaging studies. Endocrine 2014; 47:266-72. [PMID: 24366637 DOI: 10.1007/s12020-013-0123-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
Bone metastases from differentiated thyroid cancer are generally resistant to radioiodine (RAI) therapy and are associated with poor prognosis. However, in a recent study from our group we noted a small subgroup of patients with RAI-avid bone metastases who had no structural correlate on imaging studies, and had no skeletal complications during follow-up. The purpose of this study was to better define the natural history and outcome of these patients. In a retrospective review of medical records at Memorial Sloan-Kettering Cancer Center, 288 patients were identified with bone metastases from thyroid cancer between 1960 and 2011. Out of this group, 14 patients who had a RAI-avid bone metastasis without structural correlate on CT or MRI were included in the study. After a median follow-up period of 5 years (range 2-14 years) all patients were alive, none had evidence of structural bone metastases, and none had experienced skeletal-related events. The final disease status was: no evidence of disease in 6 patients (43 %), stable biochemical persistence in 2 patients (14 %), stable structural disease in 5 patients (36 %), and one patient with slowly progressive disease. To conclude, RAI-avid bone metastases with no structural correlate on high-resolution imaging studies often resolve following RAI treatment, do not cause skeletal-related complications, and do not have a major prognostic significance. Recognition of this unique type of bone metastases is important as it is not associated with the same poor prognosis and resistance to RAI therapy that is associated with structurally identifiable bone metastases.
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Affiliation(s)
- Eyal Robenshtok
- Endocrinology, Memorial Sloan Kettering Cancer Center, New York, 10021, USA,
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148
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Luster M, Weber T, Verburg FA. Differentiated thyroid cancer-personalized therapies to prevent overtreatment. Nat Rev Endocrinol 2014; 10:563-74. [PMID: 24981455 DOI: 10.1038/nrendo.2014.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The concept of individualized therapy is rapidly gaining recognition in the management of patients with differentiated thyroid cancer (DTC). This Review provides an overview of the most important elements of this paradigm shift in DTC management and discusses the implications for clinical practice. In the majority of patients with DTC who have an inherently good prognosis, the extent of surgery, the dosage of (131)I therapy and the use of levothyroxine therapy are all aspects suitable for individualization, on the basis of both the stage of disease and the response to treatment. In individuals with advanced disease, newer imaging techniques, advances in (131)I therapy and the use of targeted molecular therapies (such as multitargeted kinase inhibitors) have provided new options for the personalized care of patients, for whom until recently no effective therapies were available. Individualized therapies could reduce adverse effects, including the sometimes debilitating hypothyroidism that used to be required before initiation of (131)I treatment, and major salivary gland damage, a common and unpleasant side effect of (131)I therapy. Highly individualized interdisciplinary treatment of patients with DTC might lead to improved outcomes with reduced severity and frequency of complications and adverse effects. However, in spite of ongoing research, personalized therapies remain in their infancy.
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Affiliation(s)
- Markus Luster
- University Hospital Giessen and Marburg, Department of Nuclear Medicine, Baldingerstrasse, 35033 Marburg, Germany
| | - Theresia Weber
- University Hospital Ulm, Department of Surgery, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Frederik A Verburg
- University Hospital Aachen, Department of Nuclear Medicine, Paulelsstrasse 30, 52074 Aachen, Germany
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149
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 725] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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Clain JB, Scherl S, Dos Reis L, Turk A, Wenig BM, Mehra S, Karle WE, Urken ML. Extrathyroidal extension predicts extranodal extension in patients with positive lymph nodes: an important association that may affect clinical management. Thyroid 2014; 24:951-7. [PMID: 24443878 DOI: 10.1089/thy.2013.0557] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND While there is consensus that significant extrathyroidal extension (ETE) (T4) should upstage a patient with well-differentiated thyroid cancer, the importance of minimal ETE (T3) remains controversial. Additionally, the importance of nodal metastases on prognosis has come under scrutiny. Recent publications highlight the importance of size, number of positive nodes, and, in particular, the presence of extranodal extension (ENE) as measures of disease aggressiveness. In this study, we examined whether ETE is a predictor of ENE. METHODS A retrospective review was conducted from January 2004 to March 2013. All node-positive patients who underwent total or completion thyroidectomy were included. Histologic features defined by the College of American Pathologists (CAP) protocol for thyroid carcinoma were recorded. RESULTS A total of 193 patients qualified for review. Patients who were found to have ETE were 12 times more likely to have lymph nodes in the primary setting with ENE than patients with intrathyroidal primary tumors (p<0.000). After exclusion of all T4 cases (n=6), patients with minimal ETE were 13 times more likely to have ENE than those with no ETE (p<0.000). Twenty percent of microcarcinomas with ETE demonstrated ENE. CONCLUSION We have found that the biology of the primary tumor is conferred to the lymph node in that the presence of ETE leads to a significantly higher incidence of ENE. Awareness of this relationship should be accounted for in the management of primary and recurrent lymph nodes. This study shows that minimal ETE is a significant predictor of ENE. Although long-term survival and recurrence follow-up is not available for the majority of patients in this series, the presence of ENE as a surrogate for more aggressive disease biology and its strong association with minimal ETE supports the upstaging of patients with minimal ETE.
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Affiliation(s)
- Jason B Clain
- 1 Department of Otolaryngology, THANC Foundation , New York, New York
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