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Cheong TY, Hong SD, Jung KW, So YK. The diagnostic predictive value of neutrophil-to-lymphocyte ratio in thyroid cancer adjusted for tumor size. PLoS One 2021; 16:e0251446. [PMID: 33974674 PMCID: PMC8112685 DOI: 10.1371/journal.pone.0251446] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/27/2021] [Indexed: 02/07/2023] Open
Abstract
The role of systemic inflammation has not been clearly defined in thyroid cancers. There have been conflicting reports on whether systemic inflammatory markers have predictive value for thyroid cancers. We aimed to evaluate the association between systemic inflammatory markers and clinicopathological factors in thyroid cancers and to assess their predictive value for thyroid cancers in detail. Five hundred thirty-one patients who underwent surgery for thyroid nodules were included. The patient population consisted of 99 individuals (18.6%) with benign thyroid nodules and 432 individuals (81.4%) with thyroid cancers. In 432 patients with thyroid cancers, neutrophil-to-lymphocyte ratio (NLR) was significantly higher in the cases with tumors greater than 2 cm than in those with tumors less than 2 cm. (p = 0.027). NLR and platelet-to-lymphocyte ratio (PLR) were significantly higher in cases with lateral lymph node metastasis (LNM) than in those without LNM (p = 0.007 and 0.090, respectively). The nodule size was significantly higher in benign thyroid nodules than in thyroid cancers (p < 0.001). When the cases were stratified by tumor size, NLR was a significant predictor of thyroid cancers in cases with nodules greater than 2 cm (Exp(B) = 1.85, 95% CI = 1.15–2.97, p = 0.011), but not in those with nodules less than 2 cm. In thyroid cancers, preoperative NLR was associated with pathological prognosticators such as tumor size and lateral lymph node metastasis. When the size difference between thyroid cancers and benign thyroid nodules was adjusted, NLR could be a significant predictor of thyroid cancers.
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Affiliation(s)
- Taek Yoon Cheong
- Department of Otorhinolaryngology–Head & Neck Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang-Si, Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun-Woo Jung
- Department of Otorhinolaryngology–Head & Neck Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang-Si, Korea
| | - Yoon Kyoung So
- Department of Otorhinolaryngology–Head & Neck Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang-Si, Korea
- * E-mail:
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102
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Póvoa AA, Teixeira E, Bella-Cueto MR, Batista R, Pestana A, Melo M, Alves T, Pinto M, Sobrinho-Simões M, Maciel J, Soares P. Genetic Determinants for Prediction of Outcome of Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2021; 13:2048. [PMID: 33922635 PMCID: PMC8122921 DOI: 10.3390/cancers13092048] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) usually presents an excellent prognosis, but some patients present with aggressive metastatic disease. BRAF, RAS, and TERT promoter (TERTp) genes are altered in PTC, and their impact on patient outcomes remains controversial. We aimed to determine the role of genetic alterations in PTC patient outcomes (recurrent/persistent disease, structural disease, and disease-specific mortality (DSM)). The series included 241 PTC patients submitted to surgery, between 2002-2015, in a single hospital. DNA was extracted from tissue samples of 287 lesions (primary tumors and metastases). Molecular alterations were detected by Sanger sequencing. Primary tumors presented 143 BRAF, 16 TERTp, and 13 RAS mutations. Isolated TERTpmut showed increased risk of structural disease (HR = 7.0, p < 0.001) and DSM (HR = 10.1, p = 0.001). Combined genotypes, BRAFwt/TERTpmut (HR = 6.8, p = 0.003), BRAFmut/TERTpmut (HR = 3.2, p = 0.056) and BRAFmut/TERTpwt (HR = 2.2, p = 0.023) showed increased risk of recurrent/persistent disease. Patients with tumors BRAFwt/TERTpmut (HR = 24.2, p < 0.001) and BRAFmut/TERTpmut (HR = 11.5, p = 0.002) showed increased risk of structural disease. DSM was significantly increased in patients with TERTpmut regardless of BRAF status (BRAFmut/TERTpmut, log-rank p < 0.001; BRAFwt/TERTpmut, log-rank p < 0.001). Our results indicate that molecular markers may have a role in predicting PTC patients' outcome. BRAFmut/TERTpwt tumors were prone to associate with local aggressiveness (recurrent/persistent disease), whereas TERTpmut tumors were predisposed to recurrent structural disease and DSM.
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Affiliation(s)
- Antónia Afonso Póvoa
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Vila Nova de Gaia, Portugal;
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Elisabete Teixeira
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Maria Rosa Bella-Cueto
- Department of Pathology, Parc Taulí Sabadell Hospital Universitari—Institut d’Investigació i Innovació Parc Taulí—I3PT—Universitat Autònoma de Barcelona, 08208 Barcelona, Spain;
| | - Rui Batista
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Ana Pestana
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Miguel Melo
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Department of Endocrinology, Centro Hospitalar Universitário de Coimbra,3000-075 Coimbra, Portugal
| | - Thalita Alves
- Laboratório de Endocrinologia Molecular e Translacional—Departamento de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil;
| | - Mafalda Pinto
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
| | - Manuel Sobrinho-Simões
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Jorge Maciel
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Vila Nova de Gaia, Portugal;
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-253 Porto, Portugal
| | - Paula Soares
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
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103
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Meng X, Wang ZF, Lou QY, Rankine AN, Zheng WX, Zhang ZH, Zhang L, Gu H. Long non-coding RNAs in head and neck squamous cell carcinoma: Diagnostic biomarkers, targeted therapies, and prognostic roles. Eur J Pharmacol 2021; 902:174114. [PMID: 33901464 DOI: 10.1016/j.ejphar.2021.174114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022]
Abstract
At present, emerging evidence shows that non-coding RNAs (ncRNAs) play crucial roles for development of multiple tumors. Amongst these ncRNAs, long non-coding RNAs (lncRNAs) play prominent roles in physiological and pathological processes. LncRNAs are RNA transcripts larger than 200 nucleotides and have been shown to serve important regulatory roles in different types of cancer via interactions with DNA, RNA and proteins. Head and neck squamous cell carcinoma (HNSCC) is one of the most malignant tumors with low survival rates in advanced stages. Recently, lncRNAs have been demonstrated to be involved in a wide range of biological processes, including proliferation, metastasis, and prognosis of HNSCC. Therefore, this review describes molecular mechanisms of up- or down-regulation of lncRNAs and expounds their functions in pathology and clinical practices in HNSCC. It also highlights their potential clinical applications as biomarkers for the diagnosis, prognosis, and treatment of HNSCC. However, studies on lncRNAs are still not comprehensive, and more investigations are needed in the future.
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Affiliation(s)
- Xiang Meng
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China.
| | - Zi-Fei Wang
- School of Stomatology, Anhui Medical University, Hefei, 230032, China.
| | - Qiu-Yue Lou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, China.
| | - Abigail N Rankine
- Clinical Medicine in Chinese (MBBS), Anhui Medical University, Hefei, 230032, China.
| | - Wan-Xin Zheng
- School of Stomatology, Anhui Medical University, Hefei, 230032, China.
| | - Zi-Hao Zhang
- School of Stomatology, Anhui Medical University, Hefei, 230032, China.
| | - Lei Zhang
- College & Hospital of Stomatology, Anhui Medical University, Key Lab. of Oral Diseases Research of Anhui Province, Hefei, 230032, China; Periodontal Department, Anhui Stomatology Hospital Affiliated to Anhui Medical University, Hefei, 230032, China.
| | - Hao Gu
- Department of Immunology, School of Basic Medical Sciences, Anhui Medical University, Hefei, 230032, China.
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104
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Wang N, Wen J, Ren W, Wu Y, Deng C. Upregulation of TRIB2 by Wnt/β-catenin activation in BRAF V600E papillary thyroid carcinoma cells confers resistance to BRAF inhibitor vemurafenib. Cancer Chemother Pharmacol 2021; 88:155-164. [PMID: 33860836 DOI: 10.1007/s00280-021-04270-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The BRAFV600E mutation is an oncogenic driver associated with aggressive tumor behaviors and increased mortality among patients with papillary thyroid cancer (PTC). Although the BRAF inhibitor vemurafenib gave promising results in BRAFV600E-mutant PTC, resistance development remains a major clinical challenge. This study aimed to explore the mechanisms underlying drug resistance in PTC. METHODS Two vemurafenib-resistant PTC cell lines (KTC1 and BCPAP) were established by continuous treatment with vemurafenib for 5 months. The knockdown and upregulation of Tribbles homolog 2 (TRIB2) in PTC cells were achieved by the transfection with short hairpin RNA against TRIB2 or recombinant lentiviral vector carrying TRIB2, respectively. The β-catenin inhibitor, ICG-001, was used for the inhibition of the Wnt/β-catenin signaling in PTC cells. RESULTS Vemurafenib-resistant PTC cells showed higher TRIB2 expression, upregulated ERK and AKT activation, enhanced invasive capacity, and increased epithelial-mesenchymal transition compared to the drug-sensitive groups. TRIB2 knockdown repressed the activation of ERK and AKT, inhibited invasion and EMT, and induced apoptosis of PTC cells. TRIB2 deficiency also enhanced the sensitivity of both PTC cells to vemurafenib. Vemurafenib-resistant PTC cells showed elevated expression of β-catenin in both cytoplasm and nucleus. The pre-incubation of cells with β-catenin inhibitor significantly inhibited TRIB2 expression, suppressed EMT, and repressed the activation of ERK and AKT in vemurafenib-resistant cells. CONCLUSION Our study showed that the upregulation of TRIB2 by the Wnt/β-catenin activation confers resistance to vemurafenib in PTC with BRAFV600 mutation. These findings support the potential use of TRIB2 as a therapeutic target for resistant PTC.
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Affiliation(s)
- Nianxue Wang
- Department of Immunology, Guizhou Medical University, Guiyang City, 550025, Guizhou Province, China
| | - Jing Wen
- Department of Ultrasonic Center, Affiliated Hospital of Guizhou Medical University, Guiyang City, 550004, Guizhou Province, China
| | - Wei Ren
- Department of Immunology, Guizhou Medical University, Guiyang City, 550025, Guizhou Province, China
| | - Yuting Wu
- Department of Pathology, Affiliated Hospital of Guizhou Medical University, No. 28 Guiyi Street, Guiyang City, 550004, Guizhou Province, China
| | - Chaonan Deng
- Department of Pathology, Affiliated Hospital of Guizhou Medical University, No. 28 Guiyi Street, Guiyang City, 550004, Guizhou Province, China.
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105
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Pekova B, Sykorova V, Mastnikova K, Vaclavikova E, Moravcova J, Vlcek P, Lastuvka P, Taudy M, Katra R, Bavor P, Kodetova D, Chovanec M, Drozenova J, Astl J, Hrabal P, Vcelak J, Bendlova B. NTRK Fusion Genes in Thyroid Carcinomas: Clinicopathological Characteristics and Their Impacts on Prognosis. Cancers (Basel) 2021; 13:1932. [PMID: 33923728 PMCID: PMC8073383 DOI: 10.3390/cancers13081932] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 12/18/2022] Open
Abstract
Chromosomal rearrangements of NTRK genes are oncogenic driver mutations in thyroid cancer (TC). This study aimed to identify NTRK fusion-positive thyroid tumors and to correlate them with clinical and pathological data and determine their prognostic significance. The cohort consisted of 989 different TC samples. Based on the detected mutation, samples were triaged, and those that were positive for a BRAF, HRAS, KRAS, NRAS, RET, RET/PTC or PAX8/PPARγ mutation were excluded from further analyses. NTRK fusion gene testing was performed in 259 cases, including 126 cases using next-generation sequencing. NTRK fusion genes were detected in 57 of 846 (6.7%) papillary thyroid carcinomas and in 2 of 10 (20.0%) poorly differentiated thyroid carcinomas. A total of eight types of NTRK fusions were found, including ETV6/NTRK3, EML4/NTRK3, RBPMS/NTRK3, SQSTM1/NTRK3, TPM3/NTRK1, IRF2BP2/NTRK1, SQSTM1/NTRK1 and TPR/NTRK1.NTRK fusion-positive carcinomas were associated with the follicular growth pattern, chronic lymphocytic thyroiditis and lymph node metastases. NTRK1-rearranged carcinomas showed a higher frequency of multifocality and aggressivity than NTRK3-rearranged carcinomas. Tumor size, presence of metastases, positivity for the NTRK3 or NTRK1 fusion gene and a late mutation event (TERT or TP53 mutation) were determined as factors affecting patient prognosis. NTRK fusion genes are valuable diagnostic and prognostic markers.
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Affiliation(s)
- Barbora Pekova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Vlasta Sykorova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Karolina Mastnikova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Eliska Vaclavikova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Jitka Moravcova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Petr Vlcek
- Department of Nuclear Medicine and Endocrinology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Petr Lastuvka
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic; (P.L.); (M.T.)
| | - Milos Taudy
- Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic; (P.L.); (M.T.)
| | - Rami Katra
- Department of Ear, Nose and Throat, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Petr Bavor
- Department of Surgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Daniela Kodetova
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Motol University Hospital, 15006 Prague, Czech Republic;
| | - Martin Chovanec
- Department of Otorhinolaryngology, Charles University, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady, 10034 Prague, Czech Republic;
| | - Jana Drozenova
- Department of Pathology, Charles University, 3rd Faculty of Medicine, University Hospital Kralovske Vinohrady, 10034 Prague, Czech Republic;
| | - Jaromir Astl
- Department of Otorhinolaryngology and Maxillofacial Surgery, Military University Hospital, 16902 Prague, Czech Republic;
| | - Petr Hrabal
- Department of Pathology, Military University Hospital, 16902 Prague, Czech Republic;
| | - Josef Vcelak
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
| | - Bela Bendlova
- Department of Molecular Endocrinology, Institute of Endocrinology, 11694 Prague, Czech Republic; (V.S.); (K.M.); (E.V.); (J.M.); (J.V.); (B.B.)
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Hou X, Shi X, Zhang W, Li D, Hu L, Yang J, Zhao J, Wei S, Wei X, Ruan X, Zheng X, Gao M. LDHA induces EMT gene transcription and regulates autophagy to promote the metastasis and tumorigenesis of papillary thyroid carcinoma. Cell Death Dis 2021; 12:347. [PMID: 33795650 PMCID: PMC8017009 DOI: 10.1038/s41419-021-03641-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 02/01/2023]
Abstract
Papillary thyroid carcinoma (PTC) is one of the most common kinds of endocrine-related cancer and has a heterogeneous prognosis. Metabolic reprogramming is one of the hallmarks of cancers. Aberrant glucose metabolism is associated with malignant biological behavior. However, the functions and mechanisms of glucose metabolism genes in PTC are not fully understood. Thus, data from The Cancer Genome Atlas database were analyzed, and lactate dehydrogenase A (LDHA) was determined to be a potential novel diagnostic and therapeutic target for PTCs. The research objective was to investigate the expression of LDHA in PTCs and to explore the main functions and relative mechanisms of LDHA in PTCs. Higher expression levels of LDHA were found in PTC tissues than in normal thyroid tissues at both the mRNA and protein levels. Higher expression levels of LDHA were correlated with aggressive clinicopathological features and poor prognosis. Moreover, we found that LDHA not only promoted PTC migration and invasion but also enhanced tumor growth both in vitro and in vivo. In addition, we revealed that the metabolic products of LDHA catalyzed induced the epithelial-mesenchymal transition process by increasing the relative gene H3K27 acetylation. Moreover, LDHA knockdown activated the AMPK pathway and induced protective autophagy. An autophagy inhibitor significantly enhanced the antitumor effect of FX11. These results suggested that LDHA enhanced the cell metastasis and proliferation of PTCs and may therefore become a potential therapeutic target for PTCs.
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Affiliation(s)
- Xiukun Hou
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Xianle Shi
- grid.21729.3f0000000419368729Department of Medicine, Columbia Center for Human Development, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Wei Zhang
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Dapeng Li
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Linfei Hu
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Jihong Yang
- grid.21729.3f0000000419368729Department of Medicine, Columbia Center for Human Development, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Jingzhu Zhao
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Songfeng Wei
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Xi Wei
- grid.411918.40000 0004 1798 6427Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Xianhui Ruan
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Xiangqian Zheng
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
| | - Ming Gao
- grid.411918.40000 0004 1798 6427Department of Thyroid and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 300060 China
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Donaldson LB, Yan F, Morgan PF, Kaczmar JM, Fernandes JK, Nguyen SA, Jester RL, Day TA. Hobnail variant of papillary thyroid carcinoma: a systematic review and meta-analysis. Endocrine 2021; 72:27-39. [PMID: 33025563 PMCID: PMC8111367 DOI: 10.1007/s12020-020-02505-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The hobnail variant of papillary thyroid carcinoma (HVPTC) has emerged as a rare and aggressive variant of papillary thyroid carcinoma (PTC). We aim to determine the prevalence and clinicopathologic factors of HVPTC. METHODS A systematic review of the literature for studies examining HVPTC was performed. Four databases (PubMed, Scopus, OVID, Cochrane library) were queried from inception of databases through March 20th, 2020. RESULTS Sixteen studies with 124 cases of HVPTC were included. The mean age for all patients was 52.3 years. HVPTC had a prevalence of 1.08% out of all PTC cases, with a mean tumor size of 3.1 cm. In 62% and 50% of cases, lymphovascular invasion and extrathyroidal extension were present, respectively. Follow-up data, with a mean of 49.9 months, revealed a 66% rate of lymph node metastasis and 23% rate of distant metastasis. Tumors with ≥30% hobnail morphology had a 2.6-fold increased odds of developing lymph node metastasis compared with <30% hobnail morphology, however did not differ in rates of distant metastasis. Patients ≥55 years old had a 4.5-fold increased odds of distant metastasis and a 4.7-fold increased odds of lymphovascular invasion over patients <55. CONCLUSIONS High rates of locoregional and distant disease as well as high-risk pathological factors reveal the aggressive nature of HVPTC. Diagnostic criteria regarding percentage of hobnail morphology requires further refinement. Further studies are warranted in order to better understand how recognition of this high-risk variant impacts clinical treatment.
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Affiliation(s)
- Lane B Donaldson
- Head and Neck Tumor Center, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Flora Yan
- Head and Neck Tumor Center, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Patrick F Morgan
- Head and Neck Tumor Center, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - John M Kaczmar
- Head and Neck Tumor Center, Hollings Cancer Center, Department of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Jyotika K Fernandes
- Division of Endocrinology, Diabetes, and Medical Genetics, College of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Head and Neck Tumor Center, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Rachel L Jester
- Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Terry A Day
- Head and Neck Tumor Center, Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, 29425, USA.
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108
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Vianello F, Censi S, Watutantrige-Fernando S, Barollo S, Zhu YH, Albiger N, Bertazza L, Manso J, Carducci S, Benna C, Iacobone M, Galuppini F, Pennelli G, Mian C. The role of the size in thyroid cancer risk stratification. Sci Rep 2021; 11:7303. [PMID: 33790328 PMCID: PMC8012699 DOI: 10.1038/s41598-021-86611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Only a minority of cases of differentiated thyroid carcinoma (DTC) have a poor clinical outcome. Clinical outcomes and molecular aspects were assessed in: 144 DTC ≤ 40 mm without distant metastases (group 1); 50 DTC > 40 mm without distant metastases (group 2); and 46 DTC with distant metastases (group 3). Group 3 had a worse outcome than the other two groups: during the follow-up, patients more frequently had persistent disease, died, or underwent further treatment. The outcomes did not differ between groups 1 and 2. Group 3 had a higher prevalence of TERT promoter mutations than group 2 (32.6% vs 14%). Group 1 had a higher frequency of BRAF mutations than groups 2 or 3 (61.1% vs 16.0% and 26.1%, respectively), while RAS mutations were more common in group 2 than in groups 1 and 3 (16.0% vs 2.1% and 6.5%, respectively). Groups 1 and 2 shared the same outcome, but were genetically distinct. Only lymph node involvement, distant metastases, older age and (among the molecular markers) TERT promoter mutations were independent predictors of a worse outcome. Metastatic DTC had the worst outcome, while the outcome was identical for large and small non-metastatic DTC, although they showed different molecular patterns. TERT promoter mutations emerged as an independent factor pointing to a poor prognosis.
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Affiliation(s)
- Federica Vianello
- Department of Radiotherapy, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Susi Barollo
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Yi Hang Zhu
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Nora Albiger
- Department of Radiotherapy, Istituto Oncologico Veneto-IRCCS, Padua, Italy
| | - Loris Bertazza
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Jacopo Manso
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Sofia Carducci
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Clara Benna
- Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Maurizio Iacobone
- Endocrine Surgery Unit, Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Padua, Italy
| | - Francesca Galuppini
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Gianmaria Pennelli
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
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109
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Li X, Duan Y, Liu D, Liu H, Zhou M, Yue K, Shuai Y, Wang Y, Ji C, Jing C, Wu Y, Wang X. Diagnostic Model Incorporating Clinicopathological Characteristics of Delphian Lymph Node Metastasis Risk Profiles in Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:591015. [PMID: 33841323 PMCID: PMC8027498 DOI: 10.3389/fendo.2021.591015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/01/2021] [Indexed: 11/27/2022] Open
Abstract
The Delphian lymph node (DLN), also known as the prelaryngeal node, is one component of the central lymph node. The DLN has been well studied in laryngeal cancer, although its significance in papillary thyroid cancer (PTC) remains unclear. We retrospectively analyzed 936 patients with PTC who underwent thyroidectomy by a single surgeon in Tianjin Cancer Hospital from 2017 to 2019. Moreover, 250 PTC patients who underwent thyroidectomy by another surgeon in Tianjin Cancer Hospital from January 2019 to April 2019 were used as a validation cohort. Among the 936 patients with PTC, 581 patients (62.1%) had DLNs, of which 177 samples with metastasis (177/581, 30.5%) were verified. DLN metastasis was significantly correlated with sex, age, tumor size, bilateral cancer, multifocality, extrathyroidal extension, lymphovascular invasion and central and lateral neck lymph node metastasis. Multivariate analysis revealed that independent risk factors for DLN metastasis included age, gender, tumor size, extrathyroid extension, lymphovascular invasion and central lymph node metastasis, which determined the nomogram. In particular, tumor size was proven to be one of the most predominant single predictors. The diagnostic model had an area under the curve (AUC) of 0.829 (95% confidence interval, 0.804-0.854). The internal and external validations of the nomogram were 0.819 and 0.745, respectively. Our results demonstrate that DLN metastasis appears to be a critical parameter for predicting metastatic disease of the central compartments. Furthermore, this study provides a precise criterion for assessing DLN metastasis and has great clinical significance for treating PTC.
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Affiliation(s)
- Xingchen Li
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Yuansheng Duan
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Dandan Liu
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Hongwei Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Mengqian Zhou
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Kai Yue
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Yanjie Shuai
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Yu Wang
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Chenyan Ji
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Chao Jing
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Yansheng Wu
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
| | - Xudong Wang
- Department of Maxillofacial & E.N.T. Oncology, Tianjin Medical University Cancer Institute & Hospital, Key Laboratory of Cancer Prevention and Therapy, Tianjin Cancer Institute, National Clinical Research Center of Cancer, Tianjin, China
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110
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Marotta DA, Morley TJ, Jabaay MJ, Grcevich LO, Gegg R. Branchial Cleft Cyst Harbors Metastatic Papillary Thyroid Carcinoma. Cureus 2021; 13:e13940. [PMID: 33880280 PMCID: PMC8051537 DOI: 10.7759/cureus.13940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Branchial cleft cysts are congenital anomalies which develop in utero, most commonly arising from the second branchial cleft. They are often asymptomatic lateral neck masses but can enlarge and become symptomatic in the setting of infection. The cystic cavity can form a potential space which can harbor infection and, in rare cases, malignant spread of primary tumors. Herein, we present a rare case of a 28-year-old male with an enlarging branchial cleft cyst of six months duration following an upper respiratory infection. Routine post-surgical histopathological examination of the excised mass revealed metastatic papillary thyroid carcinoma. To our knowledge, this case is one of five cases reported within the primary literature. This case draws attention to the occult nature of papillary thyroid carcinoma and the importance of routine histopathological examination of seemingly benign surgically excised lesions.
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Affiliation(s)
- Dario A Marotta
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA.,Department of Neurology, Division of Neuropsychology, University of Alabama, Birmingham, USA
| | - Timothy J Morley
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Maxwell J Jabaay
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Leah O Grcevich
- Department of Research, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Ryan Gegg
- Department of Otolaryngology, Ear, Nose and Throat (ENT) South, Dothan, USA
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111
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Kuchareczko A, Kopczyński J, Kowalik A, Hińcza K, Płusa A, Góźdź S, Kowalska A. Are molecular tests necessary to diagnose NIFTP? Genes Cancer 2021; 12:39-50. [PMID: 33884105 PMCID: PMC8045962 DOI: 10.18632/genesandcancer.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/28/2021] [Indexed: 12/15/2022] Open
Abstract
In 2016, encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) was
reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear
features (NIFTP). In 2018 the criteria for NIFTP were widened by the inclusion of the
complete lack of papillae. Secondary criteria, which include molecular examination, are
helpful but not required for NIFTP diagnose. The aim of this study was to assess the molecular background of NIFTP and to answer the
question if the aplication of revised criteria for NIFTP diagnosis is associated with the
lack of oncogenic mutation. Repeat histopathological assessment of 1117 cases of papillary thyroid carcinoma (PTC)
from 2000-2016 was conducted. Using initial (2016) and revised (2018) diagnostic criteria,
NIFTP was diagnosed in 23 and 13 patients respectively. 50 tumor genes hotspots mutation
analysis was conducted. BRAFV600E mutations were detected in
patients who fulfilled only initial NIFTP criteria. Other high-risk mutations
(TP53) were found in both groups of patients. The application of restrictive, revised diagnostic criteria for NIFTP negates the need
for BRAFV600E examination, but these tumors still can harbor
other high-risk oncogenic mutations nonetheless. Thus, molecular examination should be
considered as a necessary step in NIFTP diagnostic process.
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Affiliation(s)
| | | | - Artur Kowalik
- Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland.,Division of Medical Biology, Institute of Biology, Jan Kochanowski University, Kielce, Poland
| | - Kinga Hińcza
- Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Agnieszka Płusa
- Department of Pathology, Holycross Cancer Centre, Kielce, Poland.,Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland.,Department of Clinical Oncology, Holycross Cancer Centre, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland.,Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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Kondrotienė A, Daukša A, Pamedytytė D, Kazokaitė M, Žvirblienė A, Daukšienė D, Simanavičienė V, Klimaitė R, Golubickaitė I, Stakaitis R, Šarauskas V, Verkauskienė R, Žilaitienė B. Papillary Thyroid Carcinoma Tissue miR-146b, -21, -221, -222, -181b Expression in Relation with Clinicopathological Features. Diagnostics (Basel) 2021; 11:diagnostics11030418. [PMID: 33801319 PMCID: PMC8001862 DOI: 10.3390/diagnostics11030418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 11/28/2022] Open
Abstract
We analyzed miR-146b, miR-21, miR-221, miR-21, and miR-181b in formalin fixed paraffin-embedded papillary thyroid carcinoma (PTC) tissue samples of 312 individuals and evaluated their expression relationship with clinicopathological parameters. A higher expression of miR-21 was related to unifocal lesions (p < 0.011) and autoimmune thyroiditis (0.007). miR-221, miR-222 expression was higher in the PTC tissue samples with extrathyroidal extension (p = 0.049, 0.003, respectively). In a group of PTC patients with pT1a and pT1b sized tumors, the expression of miR-146b, miR-21, miR-221, and miR-222 in PTC tissue samples was lower than in patients with pT2, pT3, and pT4 (p = 0.032; 0.0044; 0.003; 0.001; 0.001, respectively). Patients with lymph node metastases had higher expression of miR-21, -221, -222, and -181b (p < 0.05). A high expression of miR-146b, miR-21, miR-221 panel was associated with decreased overall survival (OS) (Log rank p = 0.019). Univariate analysis revealed that presence of metastatic lymph nodes and high expression of miR-146b, miR-21, and miR-221 panels were associated with increased hazard of shorter OS. After multivariate analysis, only sex (male) and age (≥55 years) emerged as independent prognostic factors associated with shorter OS (HR 0.28 (95% CI 0.09–0.86) and HR 0.05 (95% CI 0.01–0.22), respectively). In conclusion, 5 analyzed miRs expression have significant relations to clinicopathologic parameters so further investigations of these molecules are expedient while searching for prognostic PTC biomarkers.
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Affiliation(s)
- Aistė Kondrotienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Albertas Daukša
- Institute of Digestive Research, Medical Academy, Faculty of Medicine, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Daina Pamedytytė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Mintautė Kazokaitė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Aurelija Žvirblienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Dalia Daukšienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Vaida Simanavičienė
- Institute of Biotechnology, Life Sciences Center, Vilnius University, LT-10257 Vilnius, Lithuania; (D.P.); (A.Ž.); (V.S.)
| | - Raimonda Klimaitė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Ieva Golubickaitė
- Department of Genetics and Molecular Medicine, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Rytis Stakaitis
- Laboratory of Molecular Neurooncology, Neuroscience Institute, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Valdas Šarauskas
- Department of Pathology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Rasa Verkauskienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
| | - Birutė Žilaitienė
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (A.K.); (M.K.); (D.D.); (R.K.); (R.V.)
- Correspondence: ; Tel.: +370-68649882
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Sugitani I, Ito Y, Takeuchi D, Nakayama H, Masaki C, Shindo H, Teshima M, Horiguchi K, Yoshida Y, Kanai T, Hirokawa M, Hames KY, Tabei I, Miyauchi A. Indications and Strategy for Active Surveillance of Adult Low-Risk Papillary Thyroid Microcarcinoma: Consensus Statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma. Thyroid 2021; 31:183-192. [PMID: 33023426 PMCID: PMC7891203 DOI: 10.1089/thy.2020.0330] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The question of how to manage patients with low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0) has recently become an important clinical issue. Two Japanese centers have conducted prospective clinical trials of active surveillance (AS) for low-risk PTMC since the 1990s, reporting favorable outcomes. This policy has thus seen gradual adoption worldwide to avoid overtreatment. Not all PTMCs are suitable for AS, however, and many physicians still hesitate to apply the management policy in daily clinical practice. A task force on management for PTMC created by the Japan Association of Endocrine Surgery collected and analyzed bibliographic evidence and has produced the present consensus statements regarding indications and concrete strategies for AS to facilitate the management of adult patients diagnosed with low-risk PTMC. Summary: These statements provide indications for AS in adult patients with T1aN0M0 low-risk PTMC. PTMCs with clinical lymph node metastasis, distant metastasis, recurrent laryngeal nerve (RLN) paralysis due to carcinoma invasion, or protrusion into the tracheal lumen warrant immediate surgery. Tumors suspected of aggressive subtypes on cytology are recommended for immediate surgery. Immediate surgery is also recommended for tumors adherent to the trachea or located along the course of the RLN. Practical strategies include diagnosis, decision-making, follow-up, and monitoring related to the implementation of AS. The rate of low-risk PTMC progression is lower in older patients. However, we recommend continuing AS as long as circumstances permit. Future tasks in optimizing management for low-risk PTMC are also described, including molecular markers and patient-reported outcomes. Conclusions: An appropriate multidisciplinary team is necessary to accurately evaluate primary tumors and lymph nodes at the beginning of and during AS, and to adequately reach a shared-decision with individual patients. If appropriately applied, AS of low-risk PTMC is a safe management strategy offering favorable outcomes and preserves quality of life at low cost.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Address correspondence to: Iwao Sugitani, MD, PhD, Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Dai Takeuchi
- Department of Breast and Endocrine Surgery, Nagoya University, Nagoya, Japan
| | | | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan
| | - Masanori Teshima
- Department of Otolaryngology, Head and Neck Surgery, Kobe University, Kobe, Japan
| | - Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University, Maebashi, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | - Isao Tabei
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Zhang Y, Zhang X, Li J, Cai Q, Qiao Z, Luo YK. Contrast-enhanced ultrasound: a valuable modality for extracapsular extension assessment in papillary thyroid cancer. Eur Radiol 2021; 31:4568-4575. [PMID: 33411051 DOI: 10.1007/s00330-020-07516-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of preoperative contrast-enhanced ultrasound (CEUS) to detect extracapsular extension (ECE) and identify the relationship between ECE and nodule enhancement patterns in patients with papillary thyroid cancer (PTC). METHODS Patients with suspected thyroid cancer underwent ultrasound (US) and CEUS examinations. The US and CEUS features of the PTC nodules and thyroid capsule were recorded and classified individually. The accuracy of US and CEUS in detecting ECE was compared individually, and its relationship with various tumour enhancement patterns was analysed. The presence or absence of ECE and cervical lymph node metastasis (LNM) was confirmed pathologically. RESULTS The final dataset included 119 patients with 124 PTC nodules. Seventy-two (60.5%) of these patients with PTC had no ECE (including 38 patients with single capsule invasion), while the remaining 52 had ECE. A significant difference was found in nodules with non-capsule invasion, single capsule invasion, and ECE between the cervical LNM and non-LNM groups (p < 0.01). Receiver operating characteristic curve analysis demonstrated that area under the curve (AUC) of ECE for cervical LNM was higher than that of capsule invasion (71.9% vs. 49.6%). Moreover, the CEUS images acquired to detect ECE showed higher AUC values than those of US images (79.4% vs. 65.8%) (p = 0.02). Among the PTC nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%). CONCLUSIONS Compared with conventional US, CEUS is a more valuable and non-invasive imaging modality to detect ECE. KEY POINTS • Single capsular invasion was a poor predictor of cervical lymph node metastasis, while extracapsular extension assessments were clinically significant for predicting cervical lymph node metastasis. • CEUS is better than conventional US in detecting extracapsular extension in papillary thyroid carcinoma (AUC: 79.4% vs. 65.8%) (p = 0.02). • Among the thyroid papillary carcinoma nodules with differential enhancement, hyper-enhanced nodules had the highest incidence of single capsule invasion (41.9%), while hypo-enhanced ones had a higher incidence of ECE (47.4%).
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Affiliation(s)
- Yan Zhang
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xia Zhang
- Department of Oncology, Division of First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Li
- Department of Pathology, Division of First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qian Cai
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi Qiao
- Department of Surgery, Division of First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yu Kun Luo
- Department of Ultrasound, Division of First Medical Center, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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115
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Siraj AK, Parvathareddy SK, Qadri Z, Siddiqui K, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Annual Hazard Rate of Recurrence in Middle Eastern Papillary Thyroid Cancer over a Long-Term Follow-Up. Cancers (Basel) 2020; 12:cancers12123624. [PMID: 33287340 PMCID: PMC7761718 DOI: 10.3390/cancers12123624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 01/02/2023] Open
Abstract
Predicting the pattern of recurrence in papillary thyroid cancer (PTC) is necessary to establish optimal surveillance and treatment strategies. We analyzed changes in hazard rate (HR) for tumor recurrence over time in 1201 unselected Middle Eastern PTC patients. The changes in risk were further analyzed according to clinical variables predictive of early (≤5 years) and late (>5 years) recurrence using Cox regression analysis to identify patient populations that remain at risk. Tumor recurrence was noted in 18.4% (221/1201) patients. The annualized hazard of PTC recurrence was highest during the first 5 years (2.8%), peaking between 1 and 2 years (3.7%), with a second smaller peak between 13 and 14 years (3.2%). Patients receiving radioactive iodine (RAI) therapy had lower recurrence hazard compared to those who did not (1.5% vs. 2.7%, p = 0.0001). Importantly, this difference was significant even in intermediate-risk PTC patients (0.7% vs. 2.3%; p = 0.0001). Interestingly, patients aged ≥55 years and having lymph node metastasis were at persistent risk for late recurrence. In conclusion, we confirmed the validity of the double-peaked time-varying pattern for recurrence risk in Middle Eastern PTC patients and our findings could help in formulating individualized treatment and surveillance plans.
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Affiliation(s)
- Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
| | - Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
| | - Zeeshan Qadri
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
| | - Khawar Siddiqui
- Department of Pediatric Hematology-Oncology, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
- Correspondence: ; Tel.: +966-1-205-5167
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Hayashi T, Hirokawa M, Higuchi M, Kudo T, Ito Y, Miyauchi A. Needle Tract Implantation Following Fine-Needle Aspiration of Thyroid Cancer. World J Surg 2020; 44:378-384. [PMID: 31515571 DOI: 10.1007/s00268-019-05161-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Needle tract implantation (NTI) can occur after thyroid fine-needle aspiration cytology (FNAC). To date, no studies enrolling a large number of patients and studying the cumulative incidence (CI) of NTI have been published. This study analyzed the clinicopathological features of NTI and calculated the CI. METHODS A total of 11,745 patients who underwent first FNAC, resection for thyroid carcinomas and related lymph node metastases, and postoperative ultrasonography in Kuma Hospital between 2006 and 2017 were evaluated. NTI was defined as macroscopically visible and/or sonographically detected recurrent tumors at the sites of the previous aspiration. Lymphovascular invasion and/or nodal metastasis were excluded. RESULTS We found 22 NTI-THY (originated from aspiration of thyroid tumors) and 8 NTI-LN (originating from lymph nodes) cases with CI of 0.15% and 0.37%, and 0.37% and 0.58% at 5 and 10 years after FNAC, respectively. A large percentage (53%) of cases are presented as more aggressive histologic subtypes than their original tumors. Of these NTI patients, 4 (12.1%) died of disease and 10 (33.3%) developed distant metastases but remained alive with stable disease, three (9.1%) developed local recurrences, and the remaining 15 (10%) were free of recurrence. CONCLUSIONS We demonstrated for the first time the CI and detailed clinicopathological features of thyroid NTI associated with possible histological transformation. Despite the low CI, the risk of death and distant metastases increase manifold in NTI patients than that in patients without recurrence. Therefore, NTI could be an important prognostic variable and impact patient survival.
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Affiliation(s)
- Toshitetsu Hayashi
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, 8-2-35 Shimoyamate-Dori, Chuo-Ku, Kobe, 650-0011, Japan.
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, 8-2-35 Shimoyamate-Dori, Chuo-Ku, Kobe, 650-0011, Japan
| | - Miyoko Higuchi
- Department of Clinical Laboratory, Kuma Hospital, Kobe, 650-0011, Japan
| | - Takumi Kudo
- Department of Internal Medicine, Kuma Hospital, Kobe, 650-0011, Japan
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe, 650-0011, Japan
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Rodriguez Schaap PM, Botti M, Otten RHJ, Dreijerink KMA, Nieveen van Dijkum EJM, Bonjer HJ, Engelsman AF, Dickhoff C. Hemithyroidectomy versus total thyroidectomy for well differentiated T1-2 N0 thyroid cancer: systematic review and meta-analysis. BJS Open 2020; 4:987-994. [PMID: 33022150 PMCID: PMC7709359 DOI: 10.1002/bjs5.50359] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Evidence for limiting the extent of surgery in patients with low-risk thyroid cancer is lacking. METHODS A systematic search was performed according to the PRISMA and MOOSE guidelines to assess the effect of total thyroidectomy (TT) with or without radioactive iodine (RAI) treatment versus hemithyroidectomy (HT) on recurrence and overall mortality in patients with differentiated (papillary or follicular) T1-2 N0 thyroid cancer. PubMed, Embase and Cochrane databases were searched, and two authors independently assessed the articles. RESULTS A total of ten eligible articles were identified. All were observational cohort series, representing a total of 23 134 patients, of which 17 699 were available for meta-analysis. Six studies included patients who had TT followed by RAI treatment. The pooled recurrence rate after TT ± RAI and HT was 2·3 and 2·8 per cent respectively (odds ratio (OR) 1·12, 95 per cent c.i. 0·82 to 1·53; P = 0·48). The pooled 20-year overall survival rate after TT ± RAI was 96·8 per cent, compared with 97·4 per cent for HT (OR 1·30, 0·71 to 2·37; P = 0·40). Overall, higher complication rates were found in the TT ± RAI group. CONCLUSION Recurrence rates after HT for treatment of well differentiated T1-2 N0 thyroid cancer were similar to those after TT ± RAI, with a lower incidence of treatment-related complications.
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Affiliation(s)
| | - M. Botti
- Department of General SurgeryUniversity of Pavia, IRCSS Fondazione Policlinico San MatteoPaviaItaly
| | - R. H. J. Otten
- Medical Library, Amsterdam University Medical Centre, location VUmc, Cancer Centre AmsterdamAmsterdamthe Netherlands
| | | | | | | | | | - C. Dickhoff
- Department of SurgeryAmsterdamthe Netherlands
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Li M, Zhang Z, Li L, Wang X. An algorithm to quantify intratumor heterogeneity based on alterations of gene expression profiles. Commun Biol 2020; 3:505. [PMID: 32917965 PMCID: PMC7486929 DOI: 10.1038/s42003-020-01230-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 08/18/2020] [Indexed: 12/23/2022] Open
Abstract
Intratumor heterogeneity (ITH) is a biomarker of tumor progression, metastasis, and immune evasion. Previous studies evaluated ITH mostly based on DNA alterations. Here, we developed a new algorithm (DEPTH) for quantifying ITH based on mRNA alterations in the tumor. DEPTH scores displayed significant correlations with ITH-associated features (genomic instability, tumor advancement, unfavorable prognosis, immunosuppression, and drug response). Compared to DNA-based ITH scores (EXPANDS, PhyloWGS, MATH, and ABSOLUTE), DEPTH scores had stronger correlations with antitumor immune signatures, cell proliferation, stemness, tumor advancement, survival prognosis, and drug response. Compared to two other mRNA-based ITH scores (tITH and sITH), DEPTH scores showed stronger and more consistent associations with genomic instability, unfavorable tumor phenotypes and clinical features, and drug response. We further validated the reliability and robustness of DEPTH in 50 other datasets. In conclusion, DEPTH may provide new insights into tumor biology and potential clinical implications for cancer prognosis and treatment.
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Affiliation(s)
- Mengyuan Li
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.,Cancer Genomics Research Center, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.,Big Data Research Institute, China Pharmaceutical University, Nanjing, 211198, China
| | - Zhilan Zhang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.,Cancer Genomics Research Center, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.,Big Data Research Institute, China Pharmaceutical University, Nanjing, 211198, China
| | - Lin Li
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.,Cancer Genomics Research Center, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China.,Big Data Research Institute, China Pharmaceutical University, Nanjing, 211198, China
| | - Xiaosheng Wang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China. .,Cancer Genomics Research Center, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, 211198, China. .,Big Data Research Institute, China Pharmaceutical University, Nanjing, 211198, China.
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Kuo CY, Yang PS, Chien MN, Cheng SP. Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer. Eur Thyroid J 2020; 9:256-262. [PMID: 33088794 PMCID: PMC7548880 DOI: 10.1159/000506474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Extrathyroidal extension may not be accurately recognized during thyroidectomy and can increase the risk of positive margins and even recurrence. This study aimed to investigate the preoperative factors associated with extrathyroidal extension. METHODS We analyzed 887 patients with papillary thyroid cancer (PTC) who underwent surgery in the period of 2005-2017. Binary logistic regression analyses and generalized additive models were used to identify associations. RESULTS Minimal extrathyroidal extension was present in 233 (26%) patients and advanced extrathyroidal extension was found in 60 (7%) patients. Age, BMI, and tumor size were independent predictors of all or advanced extrathyroidal extension. Among the 493 patients whose BRAF mutation status was available, age (OR = 1.025), BMI (OR = 1.091), tumor size (OR = 1.544), and BRAF V600E mutation (OR = 2.311) were independently associated with extrathyroidal extension. CONCLUSIONS Older age, a greater BMI, a larger tumor size, and presence of the BRAF mutation were predictive of extrathyroidal extension. These factors should be taken into consideration in decision-making before surgery is performed.
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Affiliation(s)
- Chi-Yu Kuo
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Po-Sheng Yang
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Ming-Nan Chien
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
- Department of Pharmacology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- *Shih-Ping Cheng, MD, PhD, Department of Surgery, MacKay Memorial Hospital, 92 Chung-Shan North Rd., Section 2, Taipei 10449 (Taiwan),
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Zurikat RO, Khader M, Azzam MI, Zahid ZM, Daoud SF, Nusirat SF, Albsoul N, Al-Natsheh MA, Al-Abbadi MA. Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP): a 13-year retrospective review at Jordan University Hospital. Endocrine 2020; 69:339-346. [PMID: 32319013 DOI: 10.1007/s12020-020-02299-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Noninvasive follicular neoplasm with papillary-like nuclear features (NIFTP) is the term to describe what was previously known as encapsulated follicular variant of papillary thyroid carcinoma. This new paradigm shift was agreed upon by experts in the field. The objective of this study is to evaluate cases previously diagnosed as follicular adenomas, follicular variant of papillary thyroid carcinoma and hyperplastic nodules to be reclassified as NIFTP according to the new criteria. Furthermore, the clinical follow-up of these NIFTP cases is evaluated. METHODS This retrospective study reviewed potential NIFTP cases over the last 13 years, at Jordan University Hospital. RESULTS A total of 811 thyroid surgery reports were identified and revised to identify the potential NIFTP cases. The review yielded 173 cases identified as potential NIFTP cases. Further pathological slide review resulted in a revised diagnosis of 32 cases of NIFTP according to the new criteria. The NIFTP cases comprised 4% of the total number of thyroidectomy cases and 16.1% of the total pool of previously diagnosed papillary thyroid carcinoma cases at our institution. While 111 cases retained their original diagnosis. Follow-up showed that all patients are alive and well with no evidence of disease. CONCLUSION Patients with NIFTP are not uncommon and the diagnosis is made only after a thorough evaluation of excision. Therefore, initial conservative management of solitary thyroid nodules suspicious for NIFTP in the form of lobectomy is recommended to avoid unnecessary total thyroidectomies. Our follow-up of NIFTP cases is similar to all previous reports.
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Affiliation(s)
- Rajai O Zurikat
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Majd Khader
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Muayad I Azzam
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Zaid M Zahid
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Samer F Daoud
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Salam F Nusirat
- School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Nader Albsoul
- Department of General Surgery, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Motaz A Al-Natsheh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan
| | - Mousa A Al-Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, University of Jordan, Queen Rania Street, Jubaiha, Amman, Jordan.
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Kwon JH, Yi JW. Correlation between telomerase reverse transcriptase messenger RNA expression and survival of patients with papillary thyroid carcinoma. Surgery 2020; 169:43-49. [PMID: 32641280 DOI: 10.1016/j.surg.2020.04.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/14/2020] [Accepted: 04/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Telomerase reverse transcriptase promoter mutations were recently found to be associated with poorer prognosis in patients with papillary thyroid carcinoma. Correlation between telomerase reverse transcriptase messenger RNA expression and survival of patients with papillary thyroid carcinoma has not been determined. METHODS Clinical information, somatic mutations, and RNA sequencing of 492 papillary thyroid carcinoma patients were obtained from The Cancer Genome Atlas. Correlations between messenger RNA expression and clinicopathologic variables were evaluated. Recursive partitioning regression trees were used to find cutoffs predicting survival. Differentially expressed gene analysis was performed by Edge-R, and Database for Annotation, Visualization and Integrated Discovery 6.7 was used to pathway analysis. RESULTS Telomerase reverse transcriptase messenger RNA expression was positively correlated with stages II and IV and high MACIS Prognostic Score for Papillary Thyroid Carcinoma. Using a telomerase reverse transcriptase messenger RNA level of 2.854 as a cutoff, patients with higher telomerase reverse transcriptase messenger RNA expression showed poorer overall survival (hazard ratio = 20.7). The higher telomerase reverse transcriptase messenger RNA group showed upregulation of 2,255 genes, with enrichment of carcinogenic pathways. CONCLUSION Higher telomerase reverse transcriptase messenger RNA expression was associated with poorer survival in patients with papillary thyroid carcinoma and was a better predictor for death than telomerase reverse transcriptase promoter mutations. Measuring telomerase reverse transcriptase messenger RNA expression in thyroid cancer tissue may allow early identification of papillary thyroid carcinoma patients with worse overall survival.
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Affiliation(s)
- Jae Hyun Kwon
- Department of Surgery, Inha University Hospital & College of Medicine, Incheon, Korea
| | - Jin Wook Yi
- Department of Surgery, Inha University Hospital & College of Medicine, Incheon, Korea.
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ciRS-7 Promotes the Proliferation and Migration of Papillary Thyroid Cancer by Negatively Regulating the miR-7/Epidermal Growth Factor Receptor Axis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9875636. [PMID: 32685551 PMCID: PMC7327576 DOI: 10.1155/2020/9875636] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/17/2020] [Accepted: 03/11/2020] [Indexed: 12/29/2022]
Abstract
Purpose The incidence of papillary thyroid cancer (PTC) is increasing, and traditional diagnostic methods are unsatisfactory. Therefore, identifying novel prognostic markers is very important. ciRS-7 has been found to play an important role in many cancers, but its role in PTC has not been reported. This study was performed to evaluate the biological role and mechanism of ciRS-7 in PTC. Material and Methods. The expression of ciRS-7 in PTC tissues and the matched adjacent tissues was determined by quantitative reverse transcription polymerase chain reaction (qRT-PCR). The PTC cell lines (TPC-1 and BCPAP) were used to evaluate the role of ciRS-7. ciRS-7-siRNA and overexpression plasmid were constructed and transfected into PTC cells. A CCK-8 assay and colony formation assay were performed to explore the effects of ciRS-7 on cell proliferation. Annexin V/PI staining and FACS detection were used to detect cell apoptosis. Wound healing assay was performed to detect cell migration. A transwell assay was conducted to explore the effects of ciRS-7 on invasion and migration. Western blotting was performed to evaluate protein expression. The luciferase reporter system was used to determine the underlying mechanism of miR-7. Result ciRS-7 was highly expressed in PTC tissues and cell lines compared with the corresponding controls. In vitro study showed that ciRS-7 silencing suppressed proliferation, migration, and invasion of TPC-1 and BCPAP. Mechanistically, the effects of ciRS-7 on invasion and migration may be related to epithelial-mesenchymal transition (EMT). ciRS-7 silencing could attenuate effects on PTC cells induced by miR-7 knockdown. Epidermal growth factor receptor (EGFR), which was demonstrated to be a target of miR-7, decreased significantly in ciRS-7-siRNA PTC cells. Overexpression of EGFR also attenuated effects of PTC cells induced by silencing ciRS-7. Conclusion ciRS-7 was significantly upregulated in PTC tissues, and it promoted the progression of PTC by regulating the miR-7/EGFR axis. ciRS-7 is a promising prognostic biomarker and therapeutic target in PTC.
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Tsukagoshi M, Harimoto N, Araki K, Kubo N, Watanabe A, Igarashi T, Ishii N, Yajima T, Sano T, Shirabe K. Liver metastasis from papillary thyroid carcinoma treated by laparoscopic hepatectomy 43 years after resection of the primary tumor: a case report. Surg Case Rep 2020; 6:142. [PMID: 32556940 PMCID: PMC7303250 DOI: 10.1186/s40792-020-00906-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) generally has a good prognosis, while liver metastasis from PTC is rare and difficult to diagnose. Case presentation A 67-year-old woman was diagnosed with PTC and underwent a left hemithyroidectomy 43 years ago. Two years ago, thoracoscopic right middle lobectomy was performed for a lung tumor, and pathology reports confirmed a metastatic lung tumor of PTC. The patient was followed up regularly with computed tomography, and a liver tumor measuring 16 mm was found in the lateral segment of the liver. Fluorodeoxyglucose positron emission tomography (FDG-PET) was negative for liver tumor. However, FDG uptake was observed at the nodule outside the right lobe of the thyroid gland, suggesting metastasis to the right supraclavicular lymph node. Laparoscopic partial S2 hepatectomy was performed without complications. The final diagnosis was metastatic liver tumor from PTC, and the surgical margins were free of tumor. Postoperatively, the patient underwent complementary thyroidectomy and right supraclavicular lymph node dissection, followed by I-131 ablation. The final diagnosis was PTC of 7 mm and 4 mm and lymph node metastasis of 9 mm. The patient is currently doing well and has had no recurrence 1 year after surgery. Conclusions This case demonstrates that liver metastases from PTC may be found after long-term follow-up, and liver resection might be the most appropriate treatment.
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Affiliation(s)
- Mariko Tsukagoshi
- Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norio Kubo
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Akira Watanabe
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takamichi Igarashi
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Toshiki Yajima
- Department of Innovative Cancer Immunotherapy, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takaaki Sano
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Stojanović S, Šelemetjev S, Đorić I, Rončević J, Janković Miljuš J, Živaljević V, Išić Denčić T. Elevated BANCR expression levels have different effects on papillary thyroid carcinoma progression depending on the presence of the BRAFV600E mutation. Eur J Surg Oncol 2020; 46:1835-1842. [PMID: 32651027 DOI: 10.1016/j.ejso.2020.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/14/2020] [Accepted: 05/31/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The role of BRAF-activated non-protein coding RNA (BANCR) in papillary thyroid carcinoma (PTC) is controversial, its clinical significance is unclear and no study has correlated the presence of the BRAFV600E mutation in PTC with BANCR expression. METHODS BANCR levels in PTC and matched nonmalignant thyroid epithelial tissues from 85 patients were determined using quantitative RT-PCR. BRAFV600E was detected by mutant allele-specific PCR amplification. The results were correlated with clinicopathological characteristics of the patients. RESULTS The presence of BRAFV600E associates with lower relative BANCR expression (RBE) in PTC (p = 0.008). RBE is down-regulated in BRAFV600E positive PTC, while it is unchanged or up-regulated in BRAFV600E negative PTC compared to the levels in paired nonmalignant tissue (p = 0.001). At the cut-off of 31.3%, sensitivity of fold change of BANCR for the presence of BRAFV600E is 68.0% and specificity is 67.2%. In BRAFV600E positive PTC up-regulated BANCR predicts lymph node metastasis (p = 0.001), while in BRAFV600E negative PTCs high RBE predicts thyroid capsule invasion (p = 0.028). CONCLUSIONS Depending on the presence of BRAFV600E, elevated BANCR levels demonstrated different effects on lymphatic spreading and local PTC invasion. Therefore, BANCR could be a useful prognostic biomarker in risk stratification of PTC patients.
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Affiliation(s)
- Stefana Stojanović
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade, Serbia
| | - Sonja Šelemetjev
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade, Serbia
| | - Ilona Đorić
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade, Serbia
| | - Jelena Rončević
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade, Serbia
| | - Jelena Janković Miljuš
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade, Serbia
| | - Vladan Živaljević
- Center for Endocrine Surgery, Institute of Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, Belgrade, Serbia
| | - Tijana Išić Denčić
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade, Serbia.
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Bumber B, Potroško V, Vugrinec O, Ferenčaković M, Gršić K. Hypocalcemia After Completion Thyroidectomy for Papillary Thyroid Carcinoma. Acta Clin Croat 2020; 59:136-145. [PMID: 34219896 PMCID: PMC8212615 DOI: 10.20471/acc.2020.59.s1.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Surgical management of papillary thyroid carcinoma (PTC) includes total thyroidectomy and lobectomy. After lobectomy, a reoperation called completion thyroidectomy is occasionally required. Postoperative hypocalcemia is the most common complication associated with thyroid surgery. Our main goal was to determine if there is a significant difference between the incidence rate of postoperative hypocalcemia in patients who underwent total thyroidectomy for PTC compared with patients who underwent completion thyroidectomy for PTC. Apart from that, we analyzed the following potential predictive factors for the occurrence of hypocalcemia: sex, age, size of tumor, side of tumor, maximum diameter of individual lobe, occult metastasis, and operating surgeon. The study involved 340 patients who underwent surgery for PTC at the Department of ENT and Head and Neck Surgery, Zagreb University Hospital Centre, between February 25, 2013 and January 3, 2016. Postoperative hypocalcemia incidence rates were higher in the total thyroidectomy group than in the completion thyroidectomy group (37.8% and 29.0%, respectively). However, these differences were not statistically significant. Every analyzed potential predictive factor was proven not to have any correlation with postoperative hypocalcemia. This study demonstrated that there was no significant difference between postoperative hypocalcemia rates in patients who underwent completion thyroidectomy compared with patients who underwent total thyroidectomy for PTC.
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Affiliation(s)
| | - Valentino Potroško
- 1Department of Otorhinolaryngology - Head & Neck Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Koprivnica community health center, Koprivnica, Croatia; 3Faculty of agriculture, University of Zagreb, Department of Animal Science, Zagreb, Croatia
| | - Ozren Vugrinec
- 1Department of Otorhinolaryngology - Head & Neck Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Koprivnica community health center, Koprivnica, Croatia; 3Faculty of agriculture, University of Zagreb, Department of Animal Science, Zagreb, Croatia
| | - Maja Ferenčaković
- 1Department of Otorhinolaryngology - Head & Neck Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Koprivnica community health center, Koprivnica, Croatia; 3Faculty of agriculture, University of Zagreb, Department of Animal Science, Zagreb, Croatia
| | - Krešimir Gršić
- 1Department of Otorhinolaryngology - Head & Neck Surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Koprivnica community health center, Koprivnica, Croatia; 3Faculty of agriculture, University of Zagreb, Department of Animal Science, Zagreb, Croatia
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Juweid ME, Tulchinsky M, Mismar A, Momani M, Zayed AA, Al Hawari H, Albsoul N, Mottaghy FM. Contemporary considerations in adjuvant radioiodine treatment of adults with differentiated thyroid cancer. Int J Cancer 2020; 147:2345-2354. [PMID: 32319676 DOI: 10.1002/ijc.33020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/14/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022]
Abstract
Differentiated thyroid cancer (DTC) is the most common endocrine malignancy with a growing incidence worldwide. The initial conventional management is surgery, followed by consideration of 131 I treatment that includes three options. These are termed remnant ablation (targeting benign thyroid remnant), adjuvant (targeting presumed microscopic DTC) and known disease (targeting macroscopic DTC) treatments. Some experts mostly rely on clinicopathologic assessment for recurrence risk to select patients for the 131 I treatment. Others, in addition, apply radioiodine imaging to guide their treatment planning, termed theranostics (aka theragnostics or radiotheragnostics). In patients with low-risk DTC, remnant ablation rather than adjuvant treatment is generally recommended and, in this setting, the ATA recommends a low 131 I activity. 131 I adjuvant treatment is universally recommended in patients with high-risk DTC (a primary tumor of any size with gross extrathyroidal extension) and is generally recommended in intermediate-risk DTC (primary tumor >4 cm in diameter, locoregional metastases, microscopic extrathyroidal extension, aggressive histology or vascular invasion). The optimal amount of 131 I activity for adjuvant treatment is controversial, but experts reached a consensus that the 131 I activity should be greater than that for remnant ablation. The main obstacles to establishing timely evidence through randomized clinical trials for 131 I therapy include years-to-decades delay in recurrence and low disease-specific mortality. This mini-review is intended to update oncologists on the most recent clinical, pathologic, laboratory and imaging variables, as well as on the current 131 I therapy-related definitions and management paradigms, which should optimally equip them for individualized patient guidance and treatment.
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Affiliation(s)
- Malik E Juweid
- Division of Nuclear Medicine/Department of Radiology and Nuclear Medicine, University of Jordan, Amman, Jordan
| | - Mark Tulchinsky
- Department of Radiology, Penn State University Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Ayman Mismar
- Department of General Surgery, University of Jordan, Amman, Jordan
| | - Munther Momani
- Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Ayman A Zayed
- Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Hussam Al Hawari
- Division of Endocrinology, Department of Medicine, University of Jordan, Amman, Jordan
| | - Nader Albsoul
- Department of General Surgery, University of Jordan, Amman, Jordan
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University of Aachen, Aachen, Germany
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Shi H, Guo LH, Zhang YF, Fu HJ, Zheng JY, Wang HX, Zhao CK, Xu HX. Suspicious ultrasound and clinicopathological features of papillary thyroid carcinoma predict the status of TERT promoter. Endocrine 2020; 68:349-357. [PMID: 32026251 DOI: 10.1007/s12020-020-02214-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/18/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the value of ultrasound (US) and clinicopathological features of papillary thyroid cancer (PTC) in predicting Telomerase Reverse Transcriptase (TERT) promoter mutations. METHODS Preoperative US images of 351 surgically confirmed PTCs were evaluated in terms of PTCs size and US features. The basic clinicopathological features were also retrieved. Univariate and multivariate analyses were performed to identify the risk factors for TERT promoter mutations. A scoring system was developed based on the cumulative number of risk factors. The area under the receiver operating characteristic curve (AUC) and cut-off value were calculated to evaluate the diagnostic performance of the scoring system for predicting TERT promoter mutations. RESULTS TERT promoter mutations were found in 4.84% (17/351) of patients with PTCs. Patient age >50 years (OR: 6.244, P = 0.006), multifocality (OR: 21.071, P = 0.022), taller-than-wide shape (OR: 4.934, P = 0.029), microlobulated margin (OR: 4786, P = 0.032), and capsule contact or involvement (OR: 4.668, P = 0.030) were independent risk factors for TERT promoter mutations. TERT promoter mutations were relevant to more suspicious US and clinicopathological features than TERT promoter wild-type PTC (median, 4 vs. 1, P < 0.001). The cut-off value was 2.5 and the associated AUC was 0.908 (P < 0.001). CONCLUSIONS The probability of TERT promoter mutations increases along with the suspicious US features and clinicopathological characteristics, which may help to recognize patients who deserve a different approach, in terms of management and follow-up, in view of the worst outcome associated to this mutation.
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Affiliation(s)
- Hui Shi
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Hui-Jun Fu
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Jia-Yi Zheng
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
- Department of Pathology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Han-Xiang Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, 200072, China
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Ultrasound Research and Education Institute, Tongji University Cancer Center, Tongji University School of Medicine, Shanghai, 200072, China.
- Thyroid Institute, Tongji University School of Medicine, Shanghai, 200072, China.
- Shanghai Center for Thyroid Diseases, Shanghai, 200072, China.
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Alsaud A, Mohamed S, Yassin MA, Ashour A, Obeidat K, Azrieh B. Acute Myeloid Leukemia after Low-Dose Radioiodine Therapy for Papillary Thyroid Carcinoma. Case Rep Oncol 2020; 13:207-211. [PMID: 32336971 PMCID: PMC7171228 DOI: 10.1159/000505686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 12/02/2022] Open
Abstract
Papillary thyroid carcinoma is the most common primary thyroid cancer. Most frequently treated with surgical resection, some cases require radioactive iodine (RAI) therapy. Studies have suggested that there is an increase in second primary malignancy after RAI therapy amongst thyroid cancer survivors including acute myeloid leukemia (AML) as an infrequent cancer related to RAI therapy; it has a higher relative risk ratio in patients on higher doses of radiation exposure. We would like to report a 30-year-old lady who was diagnosed with papillary thyroid carcinoma. She underwent total thyroidectomy and received a low-dose RAI <sup>131</sup>I therapy at a dose of 150 mCi, after which she developed therapy-related AML. Here we would like to highlight the association of AML with low-dose RAI as an infrequent cause of a second primary tumor compared to high doses.
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129
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Ito Y, Miyauchi A, Yamamoto M, Masuoka H, Higashiyama T, Kihara M, Miya A. Subset analysis of the Japanese risk classification guidelines for papillary thyroid carcinoma. Endocr J 2020; 67:275-282. [PMID: 31776303 DOI: 10.1507/endocrj.ej19-0387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Guidelines published by the Japan Association of Endocrine Surgeons (JAES)/Japanese Society of Thyroid Surgery (JSTS) for patients with papillary thyroid carcinoma describe four risk classes (very low-, low-, intermediate- and high-risk) for deciding on therapeutic strategies. Here, we investigate cause-specific survival (CSS) of high- and intermediate-risk patients, taking their age into consideration. CSS of intermediate-risk patients ≥55 years was poorer than that of those <55 years (p < 0.0001) (20-year CSS rates, 96.9% vs. 98.7%). CSS of intermediate-risk patients <55 years was excellent but still poorer (p = 0.0152) than that of low- or very low-risk patients (20-year CSS rates, 100%). CSS of high-risk patients <55 years (20-year CSS rates, 96.0%) was similar (p = 0.7412) to that of intermediate-risk patients ≥55 years, while high-risk patients ≥55 years (20-year CSS rates, 80.6%) showed much poorer prognosis (p < 0.0001) than the others. In high-risk patients <55 years, distant metastasis (M1), extrathyroid extension (Ex), node metastasis ≥3 cm, and extranodal tumor extension, and in those ≥55 years, M1, Ex, and tumor size >4 cm were regarded as prognostic factors on multivariate analysis. We therefore conclude that 1) prognosis of high-risk patients ≥55 years should be carefully treated because of significantly poor prognosis, 2) prognostic factors of high-risk patients vary according to patient age, and 3) overtreatment of intermediate-risk patients and young high-risk patients should be avoided; however, appropriate treatment strategies need to be established, considering that their prognoses are excellent, but still poorer than low- or very low-risk patients.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamatedori, Chuo-ku, Kobe, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamatedori, Chuo-ku, Kobe, Hyogo 650-0011, Japan
| | - Masatoshi Yamamoto
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamatedori, Chuo-ku, Kobe, Hyogo 650-0011, Japan
| | - Hiroo Masuoka
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamatedori, Chuo-ku, Kobe, Hyogo 650-0011, Japan
| | - Takuya Higashiyama
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamatedori, Chuo-ku, Kobe, Hyogo 650-0011, Japan
| | - Minoru Kihara
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamatedori, Chuo-ku, Kobe, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamatedori, Chuo-ku, Kobe, Hyogo 650-0011, Japan
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130
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VE1 Immunohistochemistry Improves the Limit of Genotyping for Detecting BRAFV600E Mutation in Papillary Thyroid Cancer. Cancers (Basel) 2020; 12:cancers12030596. [PMID: 32150939 PMCID: PMC7139976 DOI: 10.3390/cancers12030596] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
Detection of BRAFV600E is useful for making diagnosis and risk stratification of papillary thyroid carcinoma (PTC). Molecular testing, however, is not always available for routine clinical use. To assess the clinical utility and reliability of VE1 immunohistochemistry (IHC) for detecting BRAFV600E mutation in PTC, VE1 IHC was performed on the tissue microarrays of 514 patients with PTC and was compared with Sanger sequencing results. Of 514 PTC cases, 433 (84.2%) were positive for VE1 expression. Among 6 discordant cases between VE1 IHC and Sanger sequencing, 3 initial VE1-false negative cases turned out to be true false negative on repeat testing, and 3 VE1-false positive cases showed BRAFV600E mutation using digital PCR analysis. PTCs with low variant allele fraction were positive for VE1 IHC but were not detected using sequencing. VE1 IHC showed 99.3% sensitivity, 100% specificity, 100% positive predictive value, and 96.4% negative predictive value. The BRAFV600E mutation was significantly associated with older age, multifocality, extrathyroidal extension, lymph node metastasis, and advanced tumor stage. In conclusion, VE1 IHC is a reliable method for detecting BRAFV600E mutation in PTC specimens.
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131
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Makazlieva T, Vaskova O, Stojanoski S, Nevena M, Miladinova D, Stefanovska VV. Prognostic factors in thyroid carcinomas: a 17-year outcome study. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:30-37. [PMID: 31576963 PMCID: PMC10522284 DOI: 10.20945/2359-3997000000175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 07/28/2019] [Indexed: 11/23/2022]
Abstract
Objectives The aim of our study was to evaluate the survival rate of all thyroid carcinomas (TCs) diagnosed in the 1999-2015 period in the Republic of North Macedonia and to analyze the prognostic influence of several characteristics on development of distant metastases, as well as to analyze the prognostic effect of seven clinical and constitutional features on mortality. Material and methods A retrospective analysis of medical data from all TCs diagnosed in 1999-2015 was performed. The survival rate of all types of TCs was estimated using the Kaplan Meier method. Univariate and multivariate logistic regression analysis was applied for evaluation of the predictive role of seven clinical and constitutional characteristics for development of distant metastases, and the univariate Cox-proportional model was applied for evaluation of the predictors for mortality. Results A total of 422 TC cases were diagnosed in the 17-year period, with an average survival time of 212.99 months. Results of the univariate regression analysis showed that dimension at initial ultrasound and histopathological type of tumor were significantly predictive variables for distant metastases. Multifocal tumors vs. unifocal tumors < 15 mm significantly increased the probability of distant metastases by 7.401 (p = 0.005, 95% CI = 1.817-30.190) times. Age, initial lymph node involvement, number of radioiodine therapies, and histopathology of the tumor were selected as independent significant predictors for mortality. Conclusion Our results showed an excellent overall prognosis of thyroid tumors in the Macedonian population. The dimension of the tumor, multifocality, and histopathological type were the most relevant prognostic predictive features for development of distant metastases.
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Affiliation(s)
- Tanja Makazlieva
- Institute of Pathophysiology and Nuclear MedicineMedical FacultyUniversity Ss Cyril and MethodiusSkopjeRepublic of North MacedoniaInstitute of Pathophysiology and Nuclear Medicine, Medical Faculty, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Olivija Vaskova
- Institute of Pathophysiology and Nuclear MedicineMedical FacultyUniversity Ss Cyril and MethodiusSkopjeRepublic of North MacedoniaInstitute of Pathophysiology and Nuclear Medicine, Medical Faculty, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Sinisha Stojanoski
- Institute of Pathophysiology and Nuclear MedicineMedical FacultyUniversity Ss Cyril and MethodiusSkopjeRepublic of North MacedoniaInstitute of Pathophysiology and Nuclear Medicine, Medical Faculty, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Manevska Nevena
- Institute of Pathophysiology and Nuclear MedicineMedical FacultyUniversity Ss Cyril and MethodiusSkopjeRepublic of North MacedoniaInstitute of Pathophysiology and Nuclear Medicine, Medical Faculty, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Daniela Miladinova
- Institute of Pathophysiology and Nuclear MedicineMedical FacultyUniversity Ss Cyril and MethodiusSkopjeRepublic of North MacedoniaInstitute of Pathophysiology and Nuclear Medicine, Medical Faculty, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Vesna Velikj Stefanovska
- Institute of Epidemiology and Statistics with Medical InformaticsUniversity Ss Cyril and MethodiusSkopjeRepublic of North MacedoniaInstitute of Epidemiology and Statistics with Medical Informatics, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
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Hirokawa T, Arimasu Y, Chiba T, Fujiwara M, Kamma H. Clinicopathological significance of the single nucleotide polymorphism, rs2853669 within the TERT promoter in papillary thyroid carcinoma. Pathol Int 2020; 70:217-223. [PMID: 31943527 DOI: 10.1111/pin.12900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/15/2019] [Indexed: 11/29/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy. Point mutations in the telomerase reverse transcriptase (TERT) promoter, C228T and C250T and oncogene BRAFV600E have been investigated as risk factors for PTC. However, little research has been done on the single nucleotide polymorphism rs2853669 in the TERT promoter in PTC. This study aimed to clarify the clinicopathological significance of rs2853669 in Japanese patients with PTC. The genetic frequencies of rs2853669, C228T, C250T and BRAFV600E were investigated in 58 patients with PTC and compared with the clinicopathological parameters of PTC. rs2853669, C228T, C250T and BRAFV600E were found in 58.6%, 17.2%, 5.2% and 37.0% of the PTC patients, respectively. PTC with rs2853669 and C228T were associated only with tumor sizes larger than 2.0 cm (P < 0.05). Furthermore, the coexistence of rs2853669 and C228T was strongly associated with tumor size (P < 0.01), with an odds ratio of 6.4 (P < 0.05). We showed that rs2853669, as well as C228T, may be a risk factor for the aggressiveness of PTC, and the coexistence of these mutations might represent greater risk.
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Affiliation(s)
- Tatsuya Hirokawa
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Yuu Arimasu
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Tomohiro Chiba
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Masachika Fujiwara
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
| | - Hiroshi Kamma
- Department of Pathology, School of Medicine, Kyorin University, Tokyo, Japan
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134
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Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on Fundamental Mechanisms of Thyroid Cancer. Front Endocrinol (Lausanne) 2020; 11:102. [PMID: 32231639 PMCID: PMC7082927 DOI: 10.3389/fendo.2020.00102] [Citation(s) in RCA: 193] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/17/2020] [Indexed: 12/21/2022] Open
Abstract
The incidence of thyroid cancer (TC) has increased worldwide over the past four decades. TC is divided into three main histological types: differentiated (papillary and follicular TC), undifferentiated (poorly differentiated and anaplastic TC), and medullary TC, arising from TC cells. This review discusses the molecular mechanisms associated to the pathogenesis of different types of TC and their clinical relevance. In the last years, progresses in the genetic characterization of TC have provided molecular markers for diagnosis, risk stratification, and treatment targets. Recently, papillary TC, the most frequent form of TC, has been reclassified into two molecular subtypes, named BRAF-like and RAS-like, associated to a different range of cancer risks. Similarly, the genetic characterization of follicular TC has been proposed to complement the new histopathological classification in order to estimate the prognosis. New analyses characterized a comprehensive molecular profile of medullary TC, raising the role of RET mutations. More recent evidences suggested that immune microenvironment associated to TC may play a critical role in tumor invasion, with potential immunotherapeutic implications in advanced and metastatic TC. Several types of ancillary approaches have been developed to improve the diagnostic value of fine needle aspiration biopsies in indeterminate thyroid nodules. Finally, liquid biopsy, as a non-invasive diagnostic tool for body fluid genotyping, brings a new prospective of disease and therapy monitoring. Despite all these novelties, much work remains to be done to fully understand the pathogenesis and biological behaviors of the different types of TC and to transfer this knowledge in clinical practice.
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Affiliation(s)
- Alessandro Prete
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Patricia Borges de Souza
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Marina Muzza
- Division of Endocrinology and Metabolism IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nicole Nucci
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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He J, Tian Z, Yao X, Yao B, Liu Y, Yang J. A novel RNA sequencing-based risk score model to predict papillary thyroid carcinoma recurrence. Clin Exp Metastasis 2019; 37:257-267. [DOI: 10.1007/s10585-019-10011-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022]
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136
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Baerbock N, Mittelstädt A, Jähne J. Morbidity and long-term survival in patients with cervical re-exploration for papillary thyroid carcinoma. Innov Surg Sci 2019; 4:91-99. [PMID: 31709300 PMCID: PMC6817731 DOI: 10.1515/iss-2018-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/05/2019] [Indexed: 01/15/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) has a favorable prognosis following one-stage surgical therapy, whereas two-stage resections bear the risk of increased morbidity and possibly impaired prognosis. To further elucidate the value of surgical re-exploration in PTC, a retrospective study was performed. Methods The study involved 187 patients with PTC who underwent total thyroidectomy with central lymph node dissection between 2001 and 2011. The number of two-stage surgeries, the rates of recurrent laryngeal nerve paralysis (RLNP) as well as hypocalcemia, and the long-term survival were assessed. Results Two-stage surgeries were performed in 43%. No statistically significant difference was seen between the one- and two-stage resection groups regarding the rate of RLNP (transient 5.6% vs. 6.3%, permanent 2.6% vs. 0%) nor for hypocalcemia (transient 25.2% vs. 18.8%, permanent 14.0% vs. 22.5%). The 10-year recurrence-free survival was 95.5% and the 10-year disease-specific survival was 98.9% with no difference between groups. Conclusion Even though two-stage surgeries do not lead to a higher incidence of RLNP and hypocalcemia, optimal preoperative and intraoperative diagnostics have to be carried out to reduce the amount of completion surgeries.
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Affiliation(s)
- Nenia Baerbock
- Clinic of Anaesthesiology and Intensive Care, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Anke Mittelstädt
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Joachim Jähne
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Hannover, Germany
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Lin JK, Sakoda LC, Darbinian J, Socarras M, Chiao W, Calixto N, Quesenberry C, Gurushanthaiah D, Wang KH, Durr M. Risk of Mortality between Untreated and Treated Papillary Thyroid Cancer: A Matched Cohort Analysis. Ann Otol Rhinol Laryngol 2019; 129:265-272. [PMID: 31658833 DOI: 10.1177/0003489419885403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To examine the association between treatment status and mortality risk among patients with papillary thyroid cancer (PTC). METHODS We identified 3,679 adults with PTC. Thirty-one untreated patients were matched to 155 treated patients. Hazards ratios (HR) and 95% confidence intervals (CIs) were calculated to estimate all-cause and disease-specific mortality. A low-risk subgroup was analyzed for differences in all-cause mortality. RESULTS The adjusted HRs (95% CIs) for all-cause mortality at 5 and 10 years were 4.2 (1.7-10.3) and 4.1 (1.9-9.4) and for disease- specific mortality were 14.1 (3.4-59.3) and 10.2 (2.9-36.4), respectively, for untreated versus treated patients. The adjusted HRs (95% CIs) for all- cause mortality was 0.7 (0.1-6.4) for low-risk untreated versus matched treated patients. CONCLUSIONS Compared to treated patients, untreated PTC patients were at higher risk of death while low-risk untreated PTC patients had comparable rate of metastasis and no increased risk of all-cause mortality. Level of evidence: 3.
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Affiliation(s)
- Jonathan K Lin
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Lori C Sakoda
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Jeanne Darbinian
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | - Melissa Socarras
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Whitney Chiao
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Nathaniel Calixto
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Charles Quesenberry
- Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA
| | | | - Kevin H Wang
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Megan Durr
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
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Need for Completion Thyroidectomy in Patients Undergoing Lobectomy for Indeterminate and High-Risk Nodules: Impact of Intra-Operative Findings and Final Pathology. World J Surg 2019; 44:408-416. [PMID: 31531727 DOI: 10.1007/s00268-019-05189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Current guidelines increasingly suggest the use of thyroid lobectomy for indeterminate (Bethesda 3 and 4) and high-risk (Bethesda 5 and 6) thyroid nodules; however, the clinical reality is often very different. MATERIALS AND METHODS The aim of this study was to determine the rate of completion thyroidectomy (CTx) for indeterminate and high-risk thyroid nodules which are pre-operatively classified as suitable for unilateral resection (lobe eligible) based on current guidelines. Seven hundred consecutive patients with thyroid nodules and FNA cytology over four years (2015-2018) were reviewed. RESULTS Distribution of the dominant nodules by Bethesda was: non-diagnostic 3.9%, benign 28.1%, atypia of unknown significance 19.0%, follicular neoplasm 23.6%, suspicious for malignancy 6.1% and malignancy 19.3%. Of 298 indeterminate nodules, 68.8% (205/298) had relative but independent indications for a total thyroidectomy (TTx) and the remainder were candidates for lobectomy. For these lobe eligible patients, the overall risk of ultimately needing a TTx was 19.4% (18/93), comprising 4.3% (4/93) from intra-operative findings and 15.7% (14/89) from final pathology. Similarly, of 170 high-risk nodules, 63.5% (108/170) had upfront indications for a TTx and the remaining 62 nodules were lobe eligible. Of the patients taken to the operating room for a lobectomy, 21.0% (13/62) were upgraded to a TTx intra-operatively and 26.5% (13/49) post-operatively. The lobe success rate for indeterminate nodules was 25.2% and for high-risk nodules was 21.2%. The rate of CTx, or the proportion of patients needing a second operation was 15.7% (14/89) and 26.5% (13/49), respectively. CONCLUSIONS In counselling a patient for surgery, the risk of needing a more radical initial procedure or second surgery needs to be accurately explained. There are three points of care that can influence operative strategy, pre-operatively by way of high-risk clinical factors, intra-operatively via anatomical findings and post-operatively in response to unrecognized pathological features. Additionally, the patient's personal value judgment and level of risk aversion should be taken into consideration.
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139
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Tanaka A, Matsuse M, Saenko V, Nakao T, Yamanouchi K, Sakimura C, Yano H, Nishihara E, Hirokawa M, Suzuki K, Miyauchi A, Eguchi S, Yoshiura KI, Yamashita S, Nagayasu T, Mitsutake N. TERT mRNA Expression as a Novel Prognostic Marker in Papillary Thyroid Carcinomas. Thyroid 2019; 29:1105-1114. [PMID: 31286848 DOI: 10.1089/thy.2018.0695] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Telomerase reverse transcriptase (TERT) promoter mutations have been found in a subset of papillary thyroid carcinomas (PTCs) and are associated with tumor aggressiveness and worse prognosis. However, little is known about the status of TERT mRNA expression and its relationship between TERT promoter mutations and clinicopathological features. Methods: We analyzed 159 PTC samples for TERT promoter mutations using direct DNA sequencing. TERT expression was measured using quantitative reverse transcription polymerase chain reaction. To examine low allelic frequency of TERT promoter mutations with high sensitivity, we used droplet digital polymerase chain reaction (ddPCR). The relationship between the status of the TERT promoter mutation/expression and clinicopathological features including recurrence risk was statistically analyzed. Results:TERT promoter mutations were found in 20 cases (12.6%). However, TERT expression was observed not only in the mutation-positive tumors but also in 56 of 139 (40.3%) mutation-negative tumors. Among them, we detected low allelic frequency of TERT promoter mutations in three samples (5.4%) using ddPCR. We confirmed a significant association between TERT promoter mutations and aggressive clinicopathological features in this series. The risk of recurrence of TERT mutation-negative/expression-positive tumors was significantly higher than that of the mutation-negative/expression-negative tumors, suggesting that TERT expression even in absence of a mutation confers a negative influence on PTCs. Moreover, when we reclassified the mutation-negative cases into two groups based on the TERT expression levels: expression-negative/expression levels <80th percentile and expression levels >80th percentile because minimal expression may have a negligible clinical impact, a higher hazard ratio for recurrence was observed. Interestingly, TERT expression levels in the mutation-negative PTCs were inversely correlated with patient age and the presence of BRAF mutations. Conclusions: We confirm a strong correlation between the presence of TERT promoter mutations and aggressive clinicopathological features in this PTC series. In addition, there were PTCs showing high TERT mRNA expression even in the absence of TERT promoter mutations. These cases also showed a significantly higher recurrence rate. Since the TERT promoter mutations are observed only in elderly patients, TERT mRNA expression can be a useful prognostic marker especially in younger PTC patients.
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Affiliation(s)
- Aya Tanaka
- 1Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- 2Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Michiko Matsuse
- 1Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Vladimir Saenko
- 3Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Tomoe Nakao
- 1Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- 4Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosho Yamanouchi
- 5Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Chika Sakimura
- 5Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Yano
- 2Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Eijun Nishihara
- 6Department of Internal Medicine, Kuma Hospital, Kobe, Japan
| | - Mitsuyoshi Hirokawa
- 7Department of Diagnostic Pathology and Cytology, Kuma Hospital, Kobe, Japan
| | - Keiji Suzuki
- 1Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | | | - Susumu Eguchi
- 5Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko-Ichiro Yoshiura
- 9Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Shunichi Yamashita
- 1Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Takeshi Nagayasu
- 2Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Norisato Mitsutake
- 1Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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140
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Huang J, Sun W, Zhang H, Zhang P, Wang Z, Dong W, He L, Zhang T. Use of Delphian lymph node metastasis to predict central and lateral involvement in papillary thyroid carcinoma: A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2019; 91:170-178. [PMID: 30851206 DOI: 10.1111/cen.13965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Whether Delphian lymph node (DLN) metastasis is a reliable predictor of widespread lymph node metastasis in papillary thyroid carcinoma (PTC) remains controversial. This meta-analysis investigated the value of DLN metastasis for predicting central and lateral involvement in PTC. DESIGN AND METHODS A literature search using the PubMed, SCIE and the Chinese National Knowledge Infrastructure (CNKI) databases was conducted. Two reviewers independently extracted data and evaluated the studies for inclusion. Fixed-effects and random-effects models were used to analyse the data based on their heterogeneity. A sensitivity analysis was performed, and publication bias was assessed using Begg's funnel plot and Egger's linear regression test. RESULTS Data from 10 studies were analysed. The risk of central lymph node (CLN) metastasis was significantly higher in the DLN-positive group than in the DLN-negative group (OR = 9.05, 95% CI: 5.13-15.99) with moderate heterogeneity (P = 0.022, I2 = 53.5%). The risk of lateral lymph node (LLN) metastasis was significantly higher in the DLN-positive group than in the negative group (OR = 10.88, 95% CI: 7.60-15.58), with low heterogeneity (P = 0.603, I2 = 0.0%). Sensitivity analysis indicated that the results were stable and credible, and no publication bias was found. CONCLUSIONS Delphian lymph node metastasis is valuable for predicting central and lateral compartment involvement in patients with PTC. The DLN of PTC patients should be dissected intraoperatively and sent for frozen section consultation. If the result is positive, the CLNs should be thoroughly dissected and the LLNs should be further evaluated.
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Affiliation(s)
- Jiapeng Huang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ping Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Zhihong Wang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Liang He
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Ting Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
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141
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Miyauchi A, Ito Y. Conservative Surveillance Management of Low-Risk Papillary Thyroid Microcarcinoma. Endocrinol Metab Clin North Am 2019; 48:215-226. [PMID: 30717903 DOI: 10.1016/j.ecl.2018.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Most low-risk papillary thyroid microcarcinomas are indolent. Ten years of active surveillance at Kuma Hospital revealed that only 8.0% of patients showed enlargement of 3 mm or greater, whereas only 3.8% showed nodal metastasis. None, including those who underwent rescue surgery after the detection of progression, showed life-threatening recurrence or distant metastasis, and none died of thyroid carcinoma. Adverse events were significantly more frequent in patients who underwent immediate surgery than in those who had active surveillance. Medical costs were significantly higher. Therefore, active surveillance ought to be the primary method of low-risk papillary thyroid microcarcinoma management.
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Affiliation(s)
- Akira Miyauchi
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe 650-0011, Japan.
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe 650-0011, Japan
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142
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DiMarco AN, Wong MS, Jayasekara J, Cole-Clark D, Aniss A, Glover AR, Delbridge LW, Sywak MS, Sidhu SB. Risk of needing completion thyroidectomy for low-risk papillary thyroid cancers treated by lobectomy. BJS Open 2019; 3:299-304. [PMID: 31183445 PMCID: PMC6551396 DOI: 10.1002/bjs5.50137] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/27/2018] [Indexed: 12/30/2022] Open
Abstract
Background Low-risk differentiated thyroid cancers may, according to the American Thyroid Association (ATA) 2015 guidelines, be managed initially with lobectomy. However, definitive risk categorization requires pathological assessment of the specimen, resulting in completion thyroidectomy being recommended when discordance between preoperative and postoperative staging occurs. This study sought to establish the expected rate of completion thyroidectomy in patients with papillary thyroid cancer (PTC) treated by lobectomy. Methods Patients with PTC treated over 5 years (2013-2017 inclusive) and meeting the ATA criteria for lobectomy were identified from the prospectively developed database of a high-volume, university department of endocrine surgery. Concordance between the ATA initial and final recommendation, and the putative rate of completion thyroidectomy were calculated. Multivariable analysis was used to assess preoperative factors as predictors of the need for total thyroidectomy. Results Of 275 patients with PTC who met ATA preoperative criteria for lobectomy there was concordance between this and the final recommendation in 158 (57·5 per cent) and discordance in 117 (43·5 per cent). Most common reasons for discordance were: angioinvasion (30·8 per cent), local invasion (23·9 per cent) or both (20·5 per cent). Four patients (1·5 per cent) had permanent hypoparathyroidism. On multivariable analysis, age, sex, tumour size and family history did not independently predict the final treatment required. Conclusion Although many patients may be treated adequately with lobectomy, just under half would require completion thyroidectomy. Further work is needed on preoperative risk stratification but, before this, total thyroidectomy remains the treatment of choice for low-risk 1-4-cm PTC in the hands of high-volume thyroid surgeons who can demonstrate low complication rates.
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Affiliation(s)
- A N DiMarco
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia.,Department of Surgery and Cancer Imperial College London London UK
| | - M S Wong
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - J Jayasekara
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - D Cole-Clark
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - A Aniss
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - A R Glover
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - L W Delbridge
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - M S Sywak
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
| | - S B Sidhu
- Endocrine Surgery Unit, Faculty of Health Sciences University of Sydney Sydney New South Wales Australia
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Differentiated Thyroid Carcinoma and Late Onset of Lung Distant Metastasis. A Case Report. REPORTS 2019. [DOI: 10.3390/reports2010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Differentiated thyroid carcinoma (DTC), which includes the papillary and follicular variants, is a common neoplasm. DTC has a very high cure rate and is treated surgically, usually followed by ablation of the post-surgical remnant with radioiodine. Case Presentation: The case of a 68-year-old male patient who underwent a minimally invasive complete thyroidectomy on July 4, 2007 for capsulated follicular carcinoma with margins of excision exempted from neoplastic infiltration (AJCC 2002 pT2 PNX PMX) is presented. Discussion: As the patient showed the presence of a pulmonary metastasis after 11 years, the potential implications of DTC follow-up management are here summarized. Conclusions: Follow up must be continued throughout life.
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Yang J, Ma Y, Gong Y, Gong R, Li Z, Zhu J. Multiple Simultaneous Rare Distant Metastases as the Initial Presentation of Papillary Thyroid Carcinoma: A Case Report. Front Endocrinol (Lausanne) 2019; 10:759. [PMID: 31781034 PMCID: PMC6856955 DOI: 10.3389/fendo.2019.00759] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/21/2019] [Indexed: 02/05/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) commonly metastasizes to regional lymph nodes. However, they infrequently cause rare distant metastases (RDMs), with the exclusion of lungs and bone metastases. RDMs are seldom identified prior to a primary thyroid cancer diagnosis. Therefore, cases initially presenting with synchronously multiple RDMs from PTC are extremely infrequent. This is a rare case of a 48-year-old man with initial diaphragm, pancreatic, and liver tumors from PTC. Following resection of the tumors, an ultrasound-guided fine-needle aspiration (US-FNA) cytology of a mass in the thyroid's left lobe revealed PTC. After postoperative recovery for more than 4 months, physical examination identified an irregular large nodule in the thyroid's isthmus and left lobe, a swollen lymph node in the left neck, and a mass in the right parotid gland. Ultrasound reexamination revealed numerous hypoechoic masses as follows: one in the thyroid's isthmus and entire left lobe (7.3 × 5.9 × 5.1 cm) and multiple in the thyroid's right lobe (0.2-0.3 cm). Ultrasound examination also showed several swollen lymph nodes in the left neck, a mass in the left gluteus maximus, and several masses in both the bilateral parotid and salivary region. The US-FNA's pathological examination confirmed metastatic PTCs in the left gluteus maximus and bilaterally located in the parotid and salivary gland. 18-fluorodeoxyglucose positron-emission tomography and computed tomography scan revealed abnormal uptakes in numerous locations (e.g., the thyroid's isthmus and left lobe, bilateral parotid gland, subcutaneous tissues, etc.). The patient underwent palliative therapy, including total thyroidectomy, bilateral central neck dissection, left lateral neck dissection, and excision of the bilateral parotid and salivary gland. A whole-body scan post-therapeutic radioactive iodine ablation showed exclusive thyroid bed uptake. Subsequently, the patient underwent continuous thyroid stimulating hormone repression therapy and was treated with lenvatinib chemotherapy for ~8 months. The primary thyroid tumor, pancreatic metastasis, and cervical lymph node metastasis were both positive for BRAF V600E and TERT promoter (C288T) mutations. After 13 months of follow-up, the patient is currently in stable clinical conditions. In conclusion, the present case is an extremely rare occurrence of simultaneous multiple RDMs from PTC as the initial presentation.
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Abstract
Papillary thyroid microcarcinoma (PMC) is defined as papillary thyroid carcinoma ≤10 mm. Active surveillance of PMC without high-risk features, such as clinical node metastasis, distant metastasis, and clinical evidence of significant extrathyroid extension, was initiated in two Japanese hospitals in the mid-1990s. This strategy was incorporated into guidelines in Japan in 2010 and in the United States in 2015. In studies conducted by the two hospitals, most PMCs grew very slowly or did not grow, and none of the patients during active surveillance showed distant metastasis or died of thyroid carcinoma. Furthermore, none of the patients who underwent surgery after progression signs were detected showed significant recurrence. Therefore, we conclude that active surveillance should be the first line in management of low-risk PMC, because it is safer and less costly than immediate surgery. Active surveillance helps in avoiding adverse events of surgery and is an economical strategy.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan; ,
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan; ,
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Davies L, Sugino K, Sugitani I, Tomoda C. Re: "High Thyroid Cancer Mortality Rate in Japan: A Result of Nonaggressive Treatment Strategy, or Just an Aging Population?" By Magner (Thyroid 2018;28:818-819). Thyroid 2018; 28:820-822. [PMID: 29644937 DOI: 10.1089/thy.2018.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Iwao Sugitani
- 3 Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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