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Abe JV, Park SY, Haiman CA, Le Marchand L, Hernandez BY, Ihenacho U, Wilkens LR. Reproductive Factors and Thyroid Cancer Risk: The Multiethnic Cohort Study. J Womens Health (Larchmt) 2024; 33:1158-1165. [PMID: 38775020 DOI: 10.1089/jwh.2023.0947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024] Open
Abstract
Background: Women are three times more likely to be diagnosed with thyroid cancer than men, with incidence rates per 100,000 in the United States of 20.2 for women and 7.4 for men. Several reproductive and hormonal factors have been proposed as possible contributors to thyroid cancer risk, including age at menarche, parity, age at menopause, oral contraceptive use, surgical menopause, and menopausal hormone therapy. Our study aimed to investigate potential reproductive/hormonal factors in a multiethnic population. Methods: Risk factors for thyroid cancer were evaluated among female participants (n = 118,344) of the Multiethnic Cohort Study. The cohort was linked to Surveillance, Epidemiology, and End Results cancer incidence and statewide death certificate files in Hawaii and California, with 373 incident papillary thyroid cancer cases identified. Exposures investigated include age at menarche, parity, first pregnancy outcome, birth control use, and menopausal status and type. Multivariable Cox proportional hazards models were used to obtain relative risk (RR) of papillary thyroid cancer and their 95% confidence intervals (CI). Covariates included age, race and ethnicity, reproductive history, body size, smoking, and alcohol consumption. Results: We observed a statistically significant increased risk of papillary thyroid cancer for oophorectomy (adjusted RR 1.58, 95% CI: 1.26, 1.99), hysterectomy (adjusted RR 1.65, 95% CI: 1.33, 2.04), and surgical menopause (adjusted RR 1.55, 95% CI: 1.22, 1.97), and decreased risk for first live birth at ≤20 years of age versus nulliparity (adjusted RR 0.66, 95% CI: 0.46, 0.93). These associations did not vary by race and ethnicity (p het > 0.44). Conclusion: The reproductive risk factors for papillary thyroid cancer reported in the literature were largely confirmed in all racial and ethnic groups in our multiethnic population, which validates uniform obstetric and gynecological practice.
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Affiliation(s)
- Janine V Abe
- Cancer Epidemiology Program, University of Hawai'i Cancer Center, Hawaii, USA
| | - Song-Yi Park
- Cancer Epidemiology Program, University of Hawai'i Cancer Center, Hawaii, USA
| | - Christopher A Haiman
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Loïc Le Marchand
- Cancer Epidemiology Program, University of Hawai'i Cancer Center, Hawaii, USA
| | - Brenda Y Hernandez
- Cancer Epidemiology Program, University of Hawai'i Cancer Center, Hawaii, USA
| | - Ugonna Ihenacho
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Lynne R Wilkens
- Cancer Epidemiology Program, University of Hawai'i Cancer Center, Hawaii, USA
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Eaglehouse YL, Darmon S, Shriver CD, Zhu K. Racial-Ethnic Comparison of Treatment for Papillary Thyroid Cancer in the Military Health System. Ann Surg Oncol 2024:10.1245/s10434-024-15941-2. [PMID: 39085551 DOI: 10.1245/s10434-024-15941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE We aimed to compare Asian or Pacific Islander, Black, Hispanic, and non-Hispanic White patients in treatment for papillary thyroid cancer (PTC) in the equal access Military Health System to better understand racial-ethnic cancer health disparities observed in the United States. METHODS We used the MilCanEpi database to identify a cohort of men and women aged 18 or older who were diagnosed with PTC between 1998 and 2014. Low- or high-risk status was assigned using tumor size and lymph node involvement. Treatment with surgery (e.g., thyroidectomy) overall and treatment by risk status [active surveillance (low-risk) or adjuvant radioactive iodine (RAI) (high-risk)] was compared between racial-ethnic groups using multivariable logistic regression and expressed as adjusted odds ratios (AOR) with 95% confidence intervals (CIs). RESULTS The study included 598 Asian, 553 Black, 340 Hispanic, and 2958 non-Hispanic White patients with PTC. Asian (AOR = 1.21, 95% CI 0.98, 1.49), Black (AOR = 1.07, 95% CI 0.87, 1.32), and Hispanic (AOR = 0.92, 95% CI 0.71, 1.19) patients were as likely as White patients to receive surgery. By risk status, there were no significant racial-ethnic differences in receipt of active surveillance or thyroidectomy for low-risk PTC or in thyroidectomy or total thyroidectomy with adjuvant RAI for high-risk PTC. CONCLUSIONS In the Military Health System, where patients have equal access to care, there were no overall racial-ethnic differences in surgical treatment for PTC. As American Thyroid Association guidelines evolve to include more conservative treatment, further research is warranted to understand potential disparities in active surveillance and surgical management in U.S. healthcare settings.
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Affiliation(s)
- Yvonne L Eaglehouse
- Department of Surgery, Murtha Cancer Center Research Program (MCCRP), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
| | - Sarah Darmon
- Department of Surgery, Murtha Cancer Center Research Program (MCCRP), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Craig D Shriver
- Department of Surgery, Murtha Cancer Center Research Program (MCCRP), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
- Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kangmin Zhu
- Department of Surgery, Murtha Cancer Center Research Program (MCCRP), F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Saoud C, Bailey GE, Graham AJ, Maleki Z. The Bethesda System for Reporting Thyroid Cytopathology in the African American population: A tertiary centre experience. Cytopathology 2024. [PMID: 39075743 DOI: 10.1111/cyt.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND The reported risk of malignancies (ROM) remains controversial for fine needle aspiration (FNA) of thyroid nodules in the African American (AA) population. Herein, the ROM along with frequency was assessed for each of the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) diagnostic categories. MATERIALS AND METHODS The electronic pathology archive of a large academic hospital was retrospectively searched for cytopathology reports of thyroid nodules in AA patients (2010-2019) and Non-African American (NAA) control cases. The patients' demographic, thyroid nodule characteristics, FNA results using TBSRTC and surgical diagnoses were recorded, whenever available. RESULTS Three hundred ninety-one cases were identified, 317 females (81.1%) and 74 males (18.9%) with median age 50.0 (SD = 14.4). The mean size of the nodules was 2.1 cm (SD = 1.4). The Bethesda categories were: 5.4% (I), 35.0% (II), 35.3% (III), 7.7% (IV), 3.3% (V) and 13.3% (VI). The overall ROM of thyroid nodules was 43.8% (89/203) on surgical follow-up (203/391). The ROM in each Bethesda categories were: 33.3% (I), 11.6% (II), 35.2% (III), 15.8% (IV), 83.3% (V) and 100% (VI) on surgical follow-up. The frequency of thyroid nodules was higher in AA females; however, the ROM was higher in AA males (48.3%) compared with AA females (41.2%). CONCLUSION The ROM in Categories I, II and III was higher than those reported in the TBSRTC while being similar in Categories IV, V and VI. The overall risk of thyroid malignancy in our AA patient population was higher than those in the literature. The overall ROM of thyroid nodules in AA males was higher than of AA females.
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Affiliation(s)
- Carla Saoud
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gabrielle E Bailey
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ashleigh J Graham
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zahra Maleki
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bytnar JA, Enewold L, Shriver CD, Zhu K. Incidence of papillary thyroid cancer: Comparison of the military and the general population by race and tumor stage/size. Cancer Epidemiol 2024; 89:102539. [PMID: 38340498 DOI: 10.1016/j.canep.2024.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND A previous study found higher papillary thyroid cancer incidence in the US military than the general population with larger differences among Black than White individuals. This study compared the two populations in the incidence by sex, race, tumor stage, and size to assess possible factors related to identified differences. METHODS Subjects were aged 18-59 in the military and general populations. Papillary thyroid cancer patients diagnosed during 1990-2013 were identified from the Department of Defense's Automated Central Tumor Registry (ACTUR) and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Age-adjusted rates and incidence rate ratios (IRR) comparing ACTUR to SEER were calculated. RESULTS Higher incidence rates in ACTUR than SEER were more obvious for Black (IRR=2.07, 95%CI=1.56-2.70) than White men (IRR=1.17, 95%CI=1.07-1.26) and for Black (IRR=2.30, 95%CI=1.91-2.71) than White women (IRR=1.50, 95%CI=1.38-1.64). Population differences by race were observed for localized tumors among both men and women and were larger for Black individuals. Differences were observed regardless of tumor size among Black men and White women, and in smaller tumors among Black women. CONCLUSION Higher incidence in the military than general population primarily in localized tumors suggests universal healthcare in the military may lead to earlier detection. The differences were larger among Blacks than Whites, suggesting universal access in the military may be more impactful among Black persons, who are less likely to have timely care than White persons in the general population. Nevertheless, observed differences for tumors > 2 cm suggest other factors may also play a role.
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Affiliation(s)
- Julie A Bytnar
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States
| | - Lindsey Enewold
- Division of Cancer Control & Population Science, National Cancer Institute, Rockville, MD, United States
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States; Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
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Regmi S, Farazi PA, Lyden E, Kotwal A, Ganti AK, Goldner W. Disparities in Thyroid Cancer Diagnosis Based on Residence and Distance From Medical Facility. J Endocr Soc 2024; 8:bvae033. [PMID: 38481601 PMCID: PMC10928505 DOI: 10.1210/jendso/bvae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Indexed: 04/07/2024] Open
Abstract
Context Rural-urban disparities have been reported in cancer care, but data are sparse on the effect of geography and location of residence on access to care in thyroid cancer. Objective To identify impact of rural or urban residence and distance from treatment center on thyroid cancer stage at diagnosis. Methods We evaluated 800 adults with differentiated thyroid cancer in the iCaRe2 bioinformatics/biospecimen registry at the Fred and Pamela Buffett Cancer Center. Participants were categorized into early and late stage using AJCC staging, and residence/distance from treating facility was categorized as short (≤ 12.5 miles), intermediate (> 12.5 to < 50 miles) or long (≥ 50 miles). Multivariable logistic regression was used to identify factors associated with late-stage diagnosis. Results Overall, 71% lived in an urban area and 29% lived in a rural area. Distance from home to the treating facility was short for 224 (28%), intermediate for 231 (28.8%), and long for 345 (43.1%). All 224 (100%) short, 226 (97.8%) intermediate, and 120 (34.7%) long distances were for urban patients; in contrast, among rural patients, 5 (2.16%) lived intermediate and 225 (65.2%) lived long distances from treatment (P < .0001). Using eighth edition AJCC staging, the odds ratio of late stage at diagnosis for rural participants ≥ 55 years was 2.56 (95% CI, 1.08-6.14) (P = .03), and for those living ≥ 50 miles was 4.65 (95% CI, 1.28-16.93) (P = .0075). Results were similar using seventh edition AJCC staging. Conclusion Older age at diagnosis, living in rural areas, and residing farther from the treatment center are all independently associated with late stage at diagnosis of thyroid cancer.
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Affiliation(s)
- Sunita Regmi
- Kansas Department of Health and Environment, Bureau of Epidemiology and Public Health Informatics, Curtis State Office Building, 1000 SW Jackson ST., Suite 130, Topeka, KS 66612-1365, USA
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198, USA
- School of Medicine, European University Cyprus, 6 Diogenous Street, 2404 Engomi, Nicosia, Cyprus
| | - Elizabeth Lyden
- Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198, USA
| | - Anupam Kotwal
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Apar Kishor Ganti
- Department of Medicine, Division of Hematology and Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- VA Nebraska Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105-1850, USA
| | - Whitney Goldner
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Huang Y, Chan SJ, Wright JD, Kuo JH, McManus CM, Lee JA, Kuo EJ. Does the Adoption of Molecular Testing Cause Decreased Thyroidectomy Rates in a National Cohort? A Quasiexperimental Study of High- Versus Low-Adoption States. Thyroid 2024; 34:388-398. [PMID: 38251649 DOI: 10.1089/thy.2023.0651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Background: Over the last decade, the utilization of molecular testing (MT) for the evaluation of thyroid nodules has increased. Rates and patterns of adoption of MT and its effect on thyroidectomy rates nationally are unknown. Varying rates of MT adoption at the state level provide an opportunity to study the effects of MT on thyroidectomy rates using a quasiexperimental study design. Methods: We performed a retrospective analysis of American adult patients in the Merative™ MarketScan® Research Databases who underwent thyroid fine-needle aspiration (FNA) from 2011 to 2021. MT included commercially available DNA and RNA platforms and traditional targeted mutational analysis. Interrupted time series analysis was used to evaluate the inflection of MT adoption and thyroidectomy rates after 2015. Difference-in-differences (DID) analysis was used to causally analyze the effect of MT adoption on thyroidectomy rates in high-adoption (at least a 10% increase in MT utilization) versus low-adoption states (no more than 5% increase in MT utilization) from 2015 to 2021. Results: We identified 471,364 patients who underwent thyroid FNA. The utilization of MT increased over the study period from 0.01% [confidence interval, CI: 0.00% to 0.02%] to 10.1% [CI: 9.7% to 10.5%], in 2021, with an immediate (β2 = 1.61, p = 0.002) and deeper (β3 = 0.6, p < 0.001) increase in MT adoption after 2015. Utilization of MT was lower in black patients, the elderly, rural areas, and patients with Medicaid (p < 0.05). Thyroidectomy rates were inversely correlated with MT utilization (r = -0.98, p < 0.0001). From 2015 to 2021, the average MT utilization rate increased from 2.4% to 15.3% in high-adoption states and 1.6% to 5.6% in low-adoption states. In low-adoption states, thyroidectomy rates decreased more but to similar levels (18.5-13.2%) compared with high-adoption states (15.9-13.4%) with an adjusted DID rate of -3.3% [CI -5.6% to -0.8%]. Conclusions: The acceleration in adoption of MT after 2015 likely coincides with the publication of American Thyroid Association guidelines. Black, elderly, and rural patients are less likely to receive MT. Although thyroidectomy rates were inversely correlated with MT utilization, our study suggests that this correlation is not causal. The effect of MT on thyroidectomy rates may be overshadowed by decreasing aggressiveness of thyroid nodule evaluation.
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Affiliation(s)
- Yongmei Huang
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
| | - Stephanie J Chan
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - Jason D Wright
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York, USA
| | - Jennifer H Kuo
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - Catherine M McManus
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - James A Lee
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
| | - Eric J Kuo
- Department of Surgery, Division of GI/Endocrine Surgery, Columbia University, New York, New York, USA
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Hurst ZA, Liyanarachchi S, Brock P, He H, Nabhan F, Veloski C, Toland AE, Ringel MD, Jhiang SM. Presumed Pathogenic Germ Line and Somatic Variants in African American Thyroid Cancer. Thyroid 2024; 34:378-387. [PMID: 38062767 PMCID: PMC10951570 DOI: 10.1089/thy.2023.0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background: African American (AA) thyroid cancer patients have worse prognoses than European Americans (EA), which has been attributed to both health care disparities and possible genetic differences. We investigated the impact of both germ line and somatic variants on clinical outcome in a cohort of AA nonmedullary thyroid cancer (NMTC) patients who had received therapeutic intervention from cancer centers. Methods: Whole-exome sequencing was performed on DNA from available blood/normal tissues (N = 37) and paired tumor samples (N = 32) collected from 37 and 29 AA NMTC patients, respectively. Variants with Combined Annotation Depletion Dependent (CADD) score of ≥20 and VarSome Clinical classification of likely pathogenic or pathogenic were classified as presumed pathogenic germ line or somatic variants (PPGVs/PPSVs). PPGVs/PPSVs in cancer-related genes and PPGVs in cardiovascular risk genes were further investigated, and PPGVs/PPSVs associated with African (AFR) ancestry were identified. Results: Among 17 PPGVs identified in 16 cancer predisposition or known cancer-related genes, only WRN was previously known to associate with NMTC predisposition. Among PPSVs, BRAFV600E was most the prevalent and detected in 12 of the 29 (41%) tumors. Examining PPGVs/PPSVs among three patients who died from NMTC, one patient who died from papillary thyroid carcinoma/anaplastic thyroid carcinoma (PTC/ATC) led us to speculate that the PPGV ERCC4R799W may have increased the risk of PPSV TP53R273H acquisition. Among PPGVs identified in 18 cardiovascular risk genes, PPGVs in SC5NA, GYG1, CBS, CFTR, and SI are known to have causal and pathogenic implications in cardiovascular disease. Conclusion: In this cohort, most AA-NMTC patients exhibit favorable outcomes after therapeutic intervention given at cancer centers, suggesting that health care disparity is the major contributor for worse prognoses among AA-NMTC patients. Nevertheless, the clinical impact of PPGVs that might facilitate the acquisition of TP53 tumor mutations, and/or PPGVs that predispose individuals to adverse cardiovascular events, which could be exacerbated by therapy-induced cardiotoxicity, needs to be further explored. Integrated analysis of PPGV/PPSV profiles among NMTC patients with different stages of disease may help to identify NMTC patients who require close monitoring or proactive intervention.
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Affiliation(s)
- Zachary A. Hurst
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sandya Liyanarachchi
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Pamela Brock
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Huiling He
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Fadi Nabhan
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Colleen Veloski
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Amanda E. Toland
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Department of Cancer Biology and Genetics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Matthew D. Ringel
- Department of Molecular Medicine and Therapeutics, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sissy M. Jhiang
- Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Nourmahnad A, Raslan S, Ezeh UC, Rossborough J, Ma R, Anis MM. Association of Sociodemographic Factors on the Presentation and Management of Unilateral Vocal Fold Immobility. Laryngoscope 2024; 134:297-304. [PMID: 37515514 DOI: 10.1002/lary.30917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/12/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To determine the association of social determinants of health (SDOH) on the presentation and management of unilateral vocal fold immobility (UVFI). METHODS Retrospective chart review of 207 adult UVFI patients evaluated at a tertiary-care hospital between 2018 and 2019 was performed. Sociodemographic factors including gender, median household income, preferred language, and insurance type were recorded. Confounding clinical factors including etiology of UVFI, Voice Handicap Index-10 (VHI-10) score, laryngoscopic findings, and intervention history were extracted from medical records. Multivariable logistic regression was performed using sociodemographic and clinical factors. RESULTS Patient demographics and socioeconomic status were not associated with time to presentation. Patients presenting with glottic insufficiency and UVFI due to malignancy or recurrent laryngeal nerve (RLN) sacrifice had a shorter time to presentation. Higher household income was associated with greater number of interventions (p = 0.02), but neither income nor insurance type affected intervention type or timing. Female patients were less likely to undergo injection medialization laryngoplasty (odds ratio [OR] 0.25, p = 0.005). Older patients were more likely to undergo injection (OR 1.04, p = 0.027). Patients with large glottic gaps (OR 21.2, p = 0.014) and higher VHI-10 scores (OR 1.06, p = 0.047) were more likely to undergo surgery. CONCLUSION Higher household income was associated with greater number of interventions and longer duration of care at a private tertiary-care hospital. RLN sacrifice, known malignancy, and glottic insufficiency significantly reduced the time to presentation. Type of intervention received was a complex interplay of both demographic and clinical factors. Large prospective studies should examine the role of SDOH in the presentation and management of UVFI. LEVEL OF EVIDENCE 4 Laryngoscope, 134:297-304, 2024.
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Affiliation(s)
- Anahita Nourmahnad
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Hospital, Miami, Florida, U.S.A
| | - Shahm Raslan
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, U.S.A
| | - Uche C Ezeh
- University of Miami School of Medicine, Miami, Florida, U.S.A
| | | | - Ruixuan Ma
- Division of Biostatistics, Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida, U.S.A
| | - Mursalin M Anis
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Hospital, Miami, Florida, U.S.A
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Zweifler RS, Medina Mora LA, Sanchez Escobar JG, Liao E, Kuriloff D, Poretsky L. Recognizing the Impact of Ethnicity: Thyroid Neoplasia in Hispanic Americans. Endocr Pract 2023; 29:1017-1019. [PMID: 37633412 DOI: 10.1016/j.eprac.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Rebecca Susan Zweifler
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Luis Augusto Medina Mora
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Jose Gonzalo Sanchez Escobar
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Emilia Liao
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Daniel Kuriloff
- Division of Otolaryngology, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Leonid Poretsky
- Division of Endocrinology and Metabolism, Lenox Hill Hospital, Northwell Health, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York.
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10
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Wang YJ, Kang H, Zhao J, Hai T. Preoperative and intraoperative predictive methods in evaluation of central lymph node metastasis for papillary thyroid microcarcinoma. Asian J Surg 2023; 46:4465-4466. [PMID: 37173250 DOI: 10.1016/j.asjsur.2023.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Affiliation(s)
- Ya-Jun Wang
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China.
| | - Hua Kang
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Jing Zhao
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
| | - Tao Hai
- Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital of Capital Medical University, Beijing, 100053, China
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Ginzberg SP, Gasior JA, Passman JE, Ballester JMS, Finn CB, Karakousis GC, Kelz RR, Wachtel H. Disparities in Presentation, Treatment, and Survival in Anaplastic Thyroid Cancer. Ann Surg Oncol 2023; 30:6788-6798. [PMID: 37474696 DOI: 10.1245/s10434-023-13945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/27/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Disparities have been previously described in the presentation, management, and outcomes of other thyroid cancer subtypes; however, it is unclear whether such disparities exist in anaplastic thyroid cancer (ATC). METHODS We identified patients with ATC from the National Cancer Database (2004-2020). The primary outcomes were receipt of surgery, chemotherapy, and radiation. The secondary outcome was 1-year survival. Multivariable logistic and Cox proportional hazards regressions were used to assess the associations between sex, race/ethnicity, and the outcomes. RESULTS Among 5359 patients included, 58% were female, and 80% were non-Hispanic white. Median tumor size was larger in males than females (6.5 vs. 6.0 cm; p < 0.001) and in patients with minority race/ethnicity than in white patients (6.5 vs. 6.0 cm; p < 0.001). After controlling for tumor size and metastatic disease, female patients were more likely to undergo surgical resection (odds ratio [OR]: 1.20; p = 0.016) but less likely to undergo chemotherapy (OR: 0.72; p < 0.001) and radiation (OR: 0.76; p < 0.001) compared with males. Additionally, patients from minority racial/ethnic backgrounds were less likely to undergo chemotherapy (OR: 0.69; p < 0.001) and radiation (OR: 0.71; p < 0.001) than white patients. Overall, unadjusted, 1-year survival was 23%, with differences in treatment receipt accounting for small but significant differences in survival between groups. CONCLUSIONS There are disparities in the presentation and treatment of ATC by sex and race/ethnicity that likely reflect differences in access to care as well as patient and provider preferences. While survival is similarly poor across groups, the changing landscape of treatments for ATC warrants efforts to address the potential for exacerbation of disparities.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA.
| | - Julia A Gasior
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse E Passman
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Jacqueline M Soegaard Ballester
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlin B Finn
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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12
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Ginzberg SP, Soegaard Ballester JM, Wirtalla CJ, Pryma DA, Mandel SJ, Kelz RR, Wachtel H. Insurance-Based Disparities in Guideline-Concordant Thyroid Cancer Care in the Era of De-escalation. J Surg Res 2023; 289:211-219. [PMID: 37141704 PMCID: PMC10229451 DOI: 10.1016/j.jss.2023.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Prior studies have demonstrated insurance-based disparities in the treatment of well-differentiated thyroid cancer. However, it remains unclear whether these disparities have persisted in the era of the 2015 American Thyroid Association (ATA) management guidelines. The goal of this study was to assess whether insurance type is associated with the receipt of guideline-concordant and timely thyroid cancer treatment in a modern cohort. METHODS Patients diagnosed with well-differentiated thyroid cancer between 2016 and 2019 were identified from the National Cancer Database. Appropriateness of surgical and radioactive iodine treatment (RAI) was determined based on the 2015 ATA guidelines. Multivariable logistic regression and Cox proportional hazard regression analyses, stratified at age 65, were used to evaluate the associations between insurance type and appropriateness and timeliness of the treatment. RESULTS 125,827 patients were included (private = 71%, Medicare = 19%, Medicaid = 10%). Compared to privately insured patients, patients with Medicaid more frequently presented with tumors >4 cm in size (11% versus 8%, P < 0.001) and regional metastases (29% versus 27%, P < 0.001). However, patients with Medicaid were also less likely to undergo appropriate surgical treatment (odds ratio 0.69, P < 0.001), less likely to undergo surgery within 90 d of diagnosis (hazard ratio 0.80, P < 0.001), and more likely to be undertreated with RAI (odds ratio 1.29, P < 0.001). There were no differences in the likelihood of guideline-concordant surgical or medical treatment by insurance type in patients ≥65 y old. CONCLUSIONS In the era of the 2015 ATA guidelines, patients with Medicaid remain less likely to receive guideline-concordant, timely surgery and more likely to be undertreated with RAI compared to privately insured patients.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Chris J Wirtalla
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel A Pryma
- Department of Radiology, Division of Nuclear Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan J Mandel
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Soegaard Ballester JM, Finn CB, Ginzberg SP, Kelz RR, Wachtel H. Thyroid cancer pathologic upstaging: Frequency and related factors. Am J Surg 2023; 226:171-175. [PMID: 37019808 PMCID: PMC10518023 DOI: 10.1016/j.amjsurg.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Histopathologic assessment of thyroid tumors can lead to stage migration. We assessed frequency of pathologic upstaging, and associations with patient and tumor factors. METHODS Primary thyroid cancers treated between 2013 and 2015 were included from our institutional cancer registry. For tumor, nodal, and summary stage, upstaging was present when final pathologic stage was greater than clinical staging. Multivariate logistic regression and Chi-squared tests were performed. RESULTS 5,351 resected thyroid tumors were identified. Upstaging rates for tumor, nodal, and summary stage were 17.5% (n = 553/3156), 18.0% (n = 488/2705), and 10.9% (n = 285/2607), respectively. Age, Asian race, days to surgery, lymphovascular invasion, and follicular histology were significantly associated. Upstaging was significantly more common after total vs partial thyroidectomy, for tumor (19.4% vs 6.2%, p < 0.001), nodal (19.3% vs 6.4%, p < 0.001), and summary stages (12.3% vs 0.7%, p < 0.001). CONCLUSIONS Pathologic upstaging occurs in a considerable proportion of thyroid tumors, most commonly after total thyroidectomy. These findings can inform patient counseling.
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Affiliation(s)
| | - Caitlin B Finn
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Sara P Ginzberg
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.
| | - Heather Wachtel
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, USA.
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14
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Chen DW, Lang BHH, McLeod DSA, Newbold K, Haymart MR. Thyroid cancer. Lancet 2023; 401:1531-1544. [PMID: 37023783 DOI: 10.1016/s0140-6736(23)00020-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 04/08/2023]
Abstract
The past 5-10 years have brought in a new era in the care of patients with thyroid cancer, with the introduction of transformative diagnostic and management options. Several international ultrasound-based thyroid nodule risk stratification systems have been developed with the goal of reducing unnecessary biopsies. Less invasive alternatives to surgery for low-risk thyroid cancer, such as active surveillance and minimally invasive interventions, are being explored. New systemic therapies are now available for patients with advanced thyroid cancer. However, in the setting of these advances, disparities exist in the diagnosis and management of thyroid cancer. As new management options are becoming available for thyroid cancer, it is essential to support population-based studies and randomised clinical trials that will inform evidence-based clinical practice guidelines on the management of thyroid cancer, and to include diverse patient populations in research to better understand and subsequently address existing barriers to equitable thyroid cancer care.
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Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian H H Lang
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Donald S A McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Kate Newbold
- Thyroid Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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15
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Abstract
For thyroid cancer clinical trials, the inclusion of participants from diverse patient populations is uniquely important given existing racial/ethnic disparities in thyroid cancer care. Since 2011, a paradigm shift has occurred in the treatment of advanced thyroid cancer with the approval of multiple systemic therapies by the US Food and Drug Administration based on their use in the clinical trials setting. Although these clinical trials recruited patients from up to 164 sites in 25 countries, the inclusion of racial/ethnic minority patients remained low. In this mini-review, we provide an overview of barriers to accessing cancer clinical trials, framed in the context of why patients with thyroid cancer may be uniquely vulnerable. Multilevel interventions and increased funding for thyroid cancer research are necessary to increase access to and recruitment of under-represented patient populations into thyroid cancer clinical trials.
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Affiliation(s)
- Debbie W Chen
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI 48106, USA
| | - Francis P Worden
- Division of Hematology and Medical Oncology, University of Michigan, Ann Arbor, MI 48106, USA
| | - Megan R Haymart
- Correspondence: Megan R. Haymart, MD, Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Bldg 16, Rm 408E, Ann Arbor, MI 48106, USA.
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16
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Ginzberg SP, Soegaard Ballester JM, Wirtalla CJ, Morales KH, Pryma DA, Mandel SJ, Kelz RR, Wachtel H. Racial and Ethnic Disparities in Appropriate Thyroid Cancer Treatment, Before and After the Release of the 2015 American Thyroid Association Guidelines. Ann Surg Oncol 2023; 30:2928-2937. [PMID: 36749501 DOI: 10.1245/s10434-023-13158-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/12/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND The 2015 American Thyroid Association (ATA) guidelines reduced the recommended extent of therapy for low-risk thyroid cancers. Little is known about the impact of these changes on overall treatment patterns and on previously described racial/ethnic disparities in guideline-concordant care. This study aimed to assess trends in thyroid cancer care before and after release of the 2015 guidelines, with particular attention to racial/ethnic disparities. METHODS Patients with well-differentiated thyroid cancer were identified from the National Cancer Database (2010-2018). An interrupted time series design was used to assess trends in treatment before and after the 2015 guidelines. Appropriateness of surgical and radioactive iodine (RAI) treatment was determined based on the ATA guidelines, and the likelihood of receiving guideline-concordant treatment was compared between racial/ethnic groups. RESULTS The study identified 309,367 patients (White 74%, Black 8%, Hispanic 9%, Asian 6%). Between 2010 and 2015, the adjusted probability of appropriate surgery was lower for Black (- 2.1%; p < 0.001), Hispanic (- 1.0%; p < 0.001), and Asian (- 2.1%; p < 0.001) patients than for White patients. After 2015, only Hispanic patients had a lower probability of undergoing appropriate surgical therapy (- 2.6%; p = 0.040). Similarly, between 2010 and 2015, the adjusted probability of receiving appropriate RAI therapy was lower for the Hispanic (- 3.6%; p < 0.001) and Asian (- 2.4%; p < 0.001) patients than for White patients. After 2015, the probability of appropriate RAI therapy did not differ between groups. CONCLUSIONS Between 2010 and 2015, patients from racial/ethnic minority backgrounds were less likely than White patients to receive appropriate surgical and RAI therapy for thyroid cancer. After the 2015 guidelines, racial/ethnic disparities in treatment improved.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | | | | | - Knashawn H Morales
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel A Pryma
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Susan J Mandel
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
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17
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Vasconcelos LAFD, Assis RCD, Araújo ABM, Sousa TMTD, Valentim AB, Arruda SPM, Maia CSC. Food Intake of Patients with Thyroid Nodules: a Brazilian Food Guides-Based Analysis. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Introduction: The thyroid gland has the function of secreting hormones that play an important role in metabolism. Alterations in this function may bring complications to individuals, among them thyroid nodules. The prevalence of thyroid nodules is higher in white people, older adults, women, smokers, with accumulated body fat and larger waist circumference. Objective: The aim of this study was to compare dietary intake of patients with benign (BN) and malignant (MN) thyroid nodules. Method: A cross-sectional study was conducted with 62 patients. Dietary intake was assessed using 24-hour dietary recall, according to the 2006 and 2014 Dietary Guidelines for the Brazilian Population. Mean consumption of each food group was compared between patients with BN and MN by Student’s t-test. Results: The sample consisted mostly of females with mean age of 43 years old. Based in the 2006 Guide, patients with BN and MN presented low consumption of fruits, vegetables, milk and dairy products, and high consumption of meat. Total caloric intake (p=0.03) and of the group of sugars and sweets (p=0.03) were higher among individuals with MN compared with BN. Considering the 2014 Guide, the highest caloric contribution for the diet was from minimally processed foods from minimally processed foods group. Conclusion: Patients with MN had higher energy intake of sugars and sweets. For all other food groups investigated, no significant difference between individuals with MN and BN was encountered.
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18
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Moon PK, Chakoma T, Ma Y, Megwalu UC. Thyroid Cancer Incidence, Clinical Presentation, and Survival Among Native Hawaiian and Other Pacific Islanders. Otolaryngol Head Neck Surg 2022:1945998221118538. [PMID: 35943808 DOI: 10.1177/01945998221118538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the incidence, clinical presentation, and survival in Native Hawaiian and other Pacific Islander (NHPI) patients with well-differentiated thyroid cancer. STUDY DESIGN This population-based incidence analysis and retrospective cohort study utilized data from the Surveillance, Epidemiology, and End Results database. SETTING Incidence analysis included patients diagnosed between 1990 and 2014, while the cohort to study clinical presentation and survival comprised patients diagnosed between 2004 and 2015. METHODS Incidence rates and trends were compared among NHPI, Asian, and non-Hispanic White (NHW) populations. Clinical presentation was assessed via multivariable logistic regression. Survival was assessed per Cox regression. RESULTS Recent incidence trends (2009-2014) show that the rate of increase remained consistent among NHPI patients (annual percentage change, 3.67%; 95% CI, 2.66%-4.69%), while it slowed in the NHW population and plateaued among Asians as compared with previous years. NHPI patients were more likely to present with distant metastasis than NHW patients (odds ratio, 3.37; 95% CI, 1.97-5.36) and Asian patients (odds ratio, 1.82; 95% CI, 1.05-2.97). NHPI race was also associated with advanced T stage and nodal metastasis as compared with the NHW race. Survival outcomes were similar among NHPI, NHW, and Asian patients. CONCLUSION Well-differentiated thyroid cancer incidence has increased at a higher rate for the NHPI population as opposed to the NHW and Asian populations in recent years. NHPI patients are more likely to present with advanced disease when compared with NHW and Asian patients. These results highlight the importance of disaggregating the often-combined Asian/Pacific Islander group in epidemiologic studies.
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Affiliation(s)
- Peter K Moon
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Tatenda Chakoma
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Yifei Ma
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Stanford, California, USA
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19
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Le M, Odate T, Vuong HG, Mochizuki K, Kondo T. Clinical detection of "extremely low-risk" follicular thyroid carcinoma: A population-based study of 7304 patients. Laryngoscope Investig Otolaryngol 2022; 7:1235-1242. [PMID: 36000060 PMCID: PMC9392379 DOI: 10.1002/lio2.834] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background Previous studies have not been consistent in the risk of metastasis in follicular thyroid carcinoma (FTC). Therefore, we conducted a large population study to stratify the risk of distant metastasis in FTC patients using only clinical parameters. Methods We extracted FTC patients from The Surveillance, Epidemiology, and End Results (SEER) database and divided them into training and validation cohorts. Results The two cohorts consisted of 4913 and 2391 patients, respectively. We developed a nomogram and risk table based on a logistic regression model using algorithm-selected variables. Receiver Operating Characteristic (ROC) analyses showed high discriminatory power in the training and validation cohorts (Area under the curve [AUC] of 0.85 and 0.84, respectively). Extremely low, low, intermediate, and high-risk groups had 0.3%, 1%, 3.5%, and 16.7% risk of distant metastasis, respectively. Conclusions Our risk scoring table can separates patients into four risk groups and efficiently detect patients with almost no risk of metastasis.
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Affiliation(s)
- Minh‐Khang Le
- Department of PathologyUniversity of YamanashiYamanashiJapan
| | - Toru Odate
- Department of PathologyUniversity of YamanashiYamanashiJapan
| | - Huy Gia Vuong
- Department of PathologyOklahoma University Health Sciences CenterOklahoma CityOklahomaUSA
| | - Kunio Mochizuki
- Department of PathologyUniversity of YamanashiYamanashiJapan
| | - Tetsuo Kondo
- Department of PathologyUniversity of YamanashiYamanashiJapan
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20
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Chen B, Xie Z, Duan X. Thyroid cancer incidence trend and association with obesity, physical activity in the United States. BMC Public Health 2022; 22:1333. [PMID: 35831811 PMCID: PMC9281136 DOI: 10.1186/s12889-022-13727-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND State-level racial/ethnic and age differences and the temporal trend of thyroid cancer (TC) incidence in the USA remain unknown. Our research purposes include: Characterizing state-level temporal variation in TC incidence; examining the disparities of TC incidence by state-level race/ethnicity and age; performing an ecological correlation between TC incidence and obesity/physical activity. METHODS TC incidence data during 2000-2017 were extracted from the United States cancer statistics. Using joinpoint regression to evaluate TC incidence trends. Annual percent change (APC), average APC (AAPC) and incidence rates were calculated. The obesity prevalence and physical activity level at the state-level were extracted from Behavioral Risk Factor Surveillance System, and the association between state-level AAPC of TC and obesity/physical activity was tested by Pearson correlation coefficient. RESULTS We found that the TC incidence had shown an overall downward trend in recent years, but 10 states continued increasing. There were significant differences in state-level race/ethnicity (non-Hispanic Whites as a reference) and age group (45-59 age group as a reference) incidence: Incidence Rate Ratio (IRR) was 0.4-1.2 for non-Hispanic Blacks, 0.7-1.6 for non-Hispanic Asian and Pacific Islanders, 0.4-1.2 for non-Hispanic American Indians/Alaskan Natives, and 0.5-1.3 for Hispanics. High IRR in young people were distributed in northern USA, while in older people were distributed in south. The state-level obesity/physical activity level and AAPC had a weak correlation (r = 0.34, P = 0.016) and inverse weak correlation (r = -0.29, P = 0.037), respectively. The AAPC of states with a consistent increasing trend had an extremely strong correlation with obesity prevalence (r = 0.80, p = 0.006), and an inverse strong correlation with physical activity level (r = -0.65, P = 0.04). CONCLUSIONS Thyroid cancer incidence in 10 states continued increasing. State-level variation in race/ethnicity and age group incidence were found. Lifestyle and environmental factors may interfere with the incidence trend of TC in the USA.
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Affiliation(s)
- Biaoyou Chen
- Department of Head and Neck Surgery, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, 530021, China
| | - Zhaomin Xie
- Department of Medical Oncology, Cancer Hospital of Shantou University Medical College, 22 Xinling Road, Shantou, 515031, China
| | - Xuwei Duan
- Department of Head and Neck Surgery, Guangxi Medical University Cancer Hospital, 71 Hedi Road, Nanning, 530021, China
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21
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Zhong M, Khan FZ, He X, Cui L, Lei K, Ge M. Impact of Lung Metastasis versus Metastasis of Bone, Brain, or Liver on Overall Survival and Thyroid Cancer-Specific Survival of Thyroid Cancer Patients: A Population-Based Study. Cancers (Basel) 2022; 14:cancers14133133. [PMID: 35804903 PMCID: PMC9265095 DOI: 10.3390/cancers14133133] [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] [Received: 05/07/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 12/24/2022] Open
Abstract
We investigate the impact of lung metastasis versus metastasis of bone, brain, or liver on overall survival (OS) and thyroid cancer-specific survival (TCSS) in patients with thyroid cancer (TC). Therefore, de-identified SEER 18 registry data of primary TC patients diagnosed between 2010 and 2016 were analyzed. The primary outcome was the prognosis of TC patients with lung metastasis compared with other sites. The secondary outcomes included the prognosis comparison between patients with and without surgery and between single and multiple metastasis sites. Isolated lung metastasis was associated with worse OS and TCSS than bone metastasis (both p < 0.05) and was associated with worse OS than liver metastasis (p = 0.0467). Surgery performed either for the primary or distant site was associated with better OS and TCSS in patients with metastasis of lung or bone (p < 0.05). Isolated lung metastasis was related to better OS and TCSS than lung−liver, lung−brain, and lung−other multiple metastases. The multivariable analysis revealed that age < 55 years, surgery to the primary site, and to the distant site(s) were associated with better outcomes, while T4 and Tx were associated with worse outcomes. Nevertheless, it revealed that the other race (i.e., any race other than white, black, or unknown) and male gender were associated with better TCSS only (p < 0.05). Isolated lung metastasis is associated with a worse prognosis in TC patients compared with bone or liver metastasis. Surgery performed either for the primary or distant site(s) is associated with better survival outcomes in TC patients with metastasis of lung or bone.
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Affiliation(s)
- Miaochun Zhong
- Department of Clinical Medicine, Medical College of Soochow University, Suzhou 215006, China;
- Department of General Surgery, Cancer Center, Division of Breast Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
| | - Farhana Zerin Khan
- Department of Pediatric Surgery, Square Hospital Pvt. Ltd., Dhaka 1205, Bangladesh;
| | - Xianghong He
- Public Basic Courses Department, Guangdong University of Science and Technology, Dongguan 523083, China;
| | - Lingfei Cui
- Department of General Surgery, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China;
| | - Kefeng Lei
- Department of General Surgery, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China;
- Correspondence: (K.L.); (M.G.); Tel.: +86-185-2959-8502 (K.L.); +86-137-7783-1634 (M.G.)
| | - Minghua Ge
- Department of Clinical Medicine, Medical College of Soochow University, Suzhou 215006, China;
- Department of Head and Neck & Thyroid Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
- Correspondence: (K.L.); (M.G.); Tel.: +86-185-2959-8502 (K.L.); +86-137-7783-1634 (M.G.)
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22
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Abstract
Thyroid disease affects an estimated 20 million Americans, with 1 in 8 women developing a thyroid disorder during her lifetime. Although most patients with thyroid cancer have a good prognosis and effective treatments for benign thyroid disease are available, disparities exist in thyroid care and result in worse outcomes for racial and ethnic minorities. Inequities in the diagnosis and treatment of thyroid disease are due to the complex interplay of systems-, physician-, and patient-level factors. Thus, innovative strategies that take an ecological approach to addressing racial disparities are needed to achieve equitable care for all patients with thyroid disease.
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Affiliation(s)
- Debbie W Chen
- Department of Internal Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 451, Ann Arbor, MI 48106, USA.
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Kerr CE, Ferrell J, Kitano M, Koek W, Dahia PLM, Velez J, Francis G. Thyroid nodules of indeterminate cytology in Hispanic/Latinx patients. Head Neck 2022; 44:1842-1848. [PMID: 35583054 DOI: 10.1002/hed.27100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/01/2022] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Behavior of differentiated thyroid cancer (DTC) varies among ethnic groups. Recommended management of thyroid nodules with indeterminate cytology (TN-IC) is based on molecular analysis from predominantly non-Hispanic white patients. We hypothesized that TN-IC in Hispanic/Latinx patients would have different features, management, and outcomes and that molecular testing might perform differently in Hispanic/Latinx patients. METHODS Retrospective chart review was performed on 127 TN-IC analyzed with Afirma. Patient characteristics were compared using linear model ANOVA and Fisher's exact test. RESULTS Out of 127 TN-IC, 71 (56%) were Hispanic/Latinx. Hispanic/Latinx had a greater prevalence of diabetes, but Afirma results (benign or suspicious) were similar between ethnic groups. Fourteen patients had malignant pathology. Their management and outcomes were similar across groups. The negative predictive value for our cohort (97.9%) was similar to published data. CONCLUSIONS Data from our predominantly-Hispanic/Latinx cohort suggest that Afirma performs similarly in Hispanic/Latinx and non-Hispanic white patients with TN-IC.
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Affiliation(s)
- Catherine E Kerr
- Department of Pediatric Endocrinology, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Jay Ferrell
- Department of Otolaryngology, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Mio Kitano
- Department of Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Wouter Koek
- Department of Cell Systems and Anatomy, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Patricia L M Dahia
- Division of Hematology and Medical Oncology, Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA
| | - Jorge Velez
- Department of Endocrinology, University Health System, San Antonio, Texas, USA
| | - Gary Francis
- Department of Pediatric Endocrinology, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
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McLeod DSA, Bedno SA, Cooper DS, Hutfless SM, Ippolito S, Jordan SJ, Matos PG, Neale RE, Sabini E, Whiteman DC, Ladenson PW, Caturegli P. Pre-existing Thyroid Autoimmunity and Risk of Papillary Thyroid Cancer: A Nested Case-Control Study of US Active-Duty Personnel. J Clin Oncol 2022; 40:2578-2587. [PMID: 35417260 DOI: 10.1200/jco.21.02618] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Thyroid autoimmunity has been associated with differentiated thyroid cancer although multiple potential biases might have influenced the results of previous studies. METHODS We conducted a case-control study nested within the cohort of US active-duty personnel 1996-2014 to assess the association between thyroid autoimmunity, defined by serology, and thyroid cancer diagnosis. The primary exposure was thyroid peroxidase (TPO) antibody status 7-10 years before the thyroid cancer index date. We also assessed whether diagnosis of thyroid autoimmunity mediated any associations identified and if thyroid cancer features differed by autoimmunity status. RESULTS Among 451 incident cases of papillary thyroid cancer and matched controls (median age 36 years, 61.4% men), TPO antibody positivity (v negative) 7-10 years prediagnosis was associated with thyroid cancer (odds ratio [OR] 1.90 [95% CI, 1.33 to 2.70]). Exploratory analyses suggested an increasing risk of thyroid cancer with higher TPO antibody titer (TPO antibody 550-1,399 IU/mL: OR 2.95 [95% CI, 1.37 to 6.36]; and ≥ 1,400 IU/mL: OR 3.91 [95% CI, 1.66 to 9.24]). Positive TPO antibody status remained associated with thyroid cancer after those with diagnosed autoimmunity were excluded, and the association was not mediated by diagnosis of thyroid autoimmunity. Among the cases with diagnosed autoimmunity, 58% thyroid cancers were ≤ 10 mm diameter. CONCLUSION Longstanding prior thyroid autoimmunity up to 10 years before thyroid cancer diagnosis was associated with papillary thyroid cancer risk. The results could not be fully explained by diagnosis of thyroid autoimmunity although when autoimmunity had been identified, thyroid cancers were diagnosed at a very early stage.
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Affiliation(s)
- Donald S A McLeod
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sheryl A Bedno
- Department of Public Health, Womack Army Medical Center, Fort Bragg, NC.,Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan M Hutfless
- Departments of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD
| | - Silvia Ippolito
- Endocrine Unit, Department of Medicine and Surgery, University of Insubria-Ospedale Di Circolo Di Varese, ASST Dei Sette Laghi, Viale Borri, Varese, Italy
| | - Susan J Jordan
- School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | | | - Rachel E Neale
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Population Health, University of Queensland, Brisbane, Queensland, Australia
| | - Elena Sabini
- Division of Immunology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Patrizio Caturegli
- Division of Immunology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Clinical Factors Predictive of Lymph Node Metastasis in Thyroid Cancer Patients: A Multivariate Analysis. J Am Coll Surg 2022; 234:691-700. [PMID: 35290290 DOI: 10.1097/xcs.0000000000000107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Early-stage thyroid cancers have excellent survival. However, lymph node metastases (LNM) confer a worse prognosis and are not always known preoperatively. Therefore, investigation on the clinical and histological factors predictive of LNM in thyroid cancers was conducted to tailor the extent of surgery and radioactive iodine therapy. STUDY DESIGN Multivariate logistic regressions were performed based on retrospective data from thyroid cancer patients seen between 2013 and 2020 at a single institution. RESULTS Among 913 patients, mean age was 49.4 years, 76.5% were female, 58.3% were White, 21.2% were Black, and 27.9% had LNM. In the multivariate analyses in which the outcome was LNM, White (odds ratio [OR] 1.74, 95% CI 0.98 to 3.15, p = 0.064) and Hispanic patients (OR 2.36, 95% CI 0.97 to 5.77, p = 0.059) trended toward higher risk of LNM compared to Black patients, whereas age (OR 0.98, 95% CI 0.97 to 1.00, p = 0.008) showed protective effect. Tumor size (OR 1.04, 95% CI 1.01 to 1.07, p = 0.007), extrathyroidal extension (OR 2.46, 95% CI 1.53 to 3.97, p < 0.001), lymphovascular invasion (OR 6.30, 95% CI 3.68 to 11.14, p < 0.001), and multifocality (OR 1.47, 95% CI 1.01 to 2.12, p = 0.042) were associated with higher risk of LNM. In another model with outcome as >5 LNM, tumor size (OR 1.07, 95% CI 1.03 to 1.11, p = 0.001), age (OR 0.95, 95% CI 0.93 to 0.97, p < 0.001), extrathyroidal extension (OR 3.20, 95% CI 1.83 to 5.61, p < 0.001), and lymphovascular invasion (OR 6.82, 95% CI 3.87 to 12.17, p < 0.001) remained significant predictors. CONCLUSION Our analyses demonstrated and confirmed that age, tumor size, extrathyroidal extension, and lymphovascular invasion are independent predictors of significant LNM, thereby conferring higher risk of recurrence. Risk of LNM based on these patient characteristics should be considered when planning an operative approach.
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Radhakrishnan A, Reyes-Gastelum D, Abrahamse P, Gay B, Hawley ST, Wallner LP, Chen DW, Hamilton AS, Ward KC, Haymart MR. Physician Specialties Involved in Thyroid Cancer Diagnosis and Treatment: Implications for Improving Health Care Disparities. J Clin Endocrinol Metab 2022; 107:e1096-e1105. [PMID: 34718629 PMCID: PMC8852205 DOI: 10.1210/clinem/dgab781] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Little is known about provider specialties involved in thyroid cancer diagnosis and management. OBJECTIVE Characterize providers involved in diagnosing and treating thyroid cancer. DESIGN/SETTING/PARTICIPANTS We surveyed patients with differentiated thyroid cancer from the Georgia and Los Angeles County Surveillance, Epidemiology and End Results registries (N = 2632, 63% response rate). Patients identified their primary care physicians (PCPs), who were also surveyed (N = 162, 56% response rate). MAIN OUTCOME MEASURES (1) Patient-reported provider involvement (endocrinologist, surgeon, PCP) at diagnosis and treatment; (2) PCP-reported involvement (more vs less) and comfort (more vs less) with discussing diagnosis and treatment. RESULTS Among thyroid cancer patients, 40.6% reported being informed of their diagnosis by their surgeon, 37.9% by their endocrinologist, and 13.5% by their PCP. Patients reported discussing their treatment with their surgeon (71.7%), endocrinologist (69.6%), and PCP (33.3%). Physician specialty involvement in diagnosis and treatment varied by patient race/ethnicity and age. For example, Hispanic patients (vs non-Hispanic White) were more likely to report their PCP informed them of their diagnosis (odds ratio [OR]: 1.68; 95% CI, 1.24-2.27). Patients ≥65 years (vs <45 years) were more likely to discuss treatment with their PCP (OR: 1.59; 95% CI, 1.22-2.08). Although 74% of PCPs reported discussing their patients' diagnosis and 62% their treatment, only 66% and 48%, respectively, were comfortable doing so. CONCLUSIONS PCPs were involved in thyroid cancer diagnosis and treatment, and their involvement was greater among older patients and patients of minority race/ethnicity. This suggests an opportunity to leverage PCP involvement in thyroid cancer management to improve health and quality of care outcomes for vulnerable patients.
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Affiliation(s)
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
| | - Paul Abrahamse
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brittany Gay
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sarah T Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lauren P Wallner
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Debbie W Chen
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Kevin C Ward
- Department of Epidemiology, Emory University, Atlanta, GA 30322, USA
| | - Megan R Haymart
- Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI 48109, USA
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Alseddeeqi E, Altinoz A, Oulhaj A, Suliman A, Ahmed L. Incidence of thyroid cancer in Abu Dhabi, UAE: A registry-based study. J Cancer Res Ther 2022. [DOI: 10.4103/jcrt.jcrt_999_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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28
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Megwalu UC, Osazuwa-Peters N, Moon P, Palaniappan LP. Thyroid Cancer Incidence Trends Among Filipinos in the United States. Laryngoscope 2021; 132:1495-1502. [PMID: 34910822 DOI: 10.1002/lary.29986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To analyze thyroid cancer incidence trends among Filipinos relative to non-Filipino Asians and non-Hispanic Whites in the US. STUDY DESIGN Population-based analysis of cancer incidence data. METHODS Population-based analysis of cancer incidence data from Surveillance, Epidemiology, and End Results 9 detailed Asian/Pacific Islander subgroup incidence and population datasets. Adult patients aged 20 and older with thyroid cancer diagnosed in 2004 to 2014 were included. Annual percent change (APC) of the incidence rates were calculated using joinpoint regression analysis. RESULTS The incidence rates were 19.57 (95% CI 19.03-20.12) per 100,000 for Filipinos, 10.45 (95% CI 10.22-10.68) per 100,000 for non-Filipino Asians, and 13.94 (95% CI 13.85-14.02) per 100,000 for non-Hispanic Whites. The highest increase was seen among non-Hispanic Whites (average APC 5.04, 95% CI 4.61-5.46). Incidence rates of tumors ≤ 2 cm remained stable among Filipinos but increased in non-Filipino Asians (average APC 5.38, 95% CI 2.51-8.34) and non-Hispanic Whites (average APC 5.81 95% CI 4.52-7.11). CONCLUSION Filipinos have high incidence of thyroid cancer compared with other racial/ethnic groups. However, non-Hispanic Whites have the highest increase in incidence rates, resulting in a significant narrowing of the gap in incidence rates between Filipinos and non-Hispanic Whites. This is most likely due to enhanced detection of small tumors in non-Hispanic Whites. Laryngoscope, 2021.
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Affiliation(s)
- Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, U.S.A.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, U.S.A.,Duke Cancer Institute, Duke University, Durham, North Carolina, U.S.A.,Duke Global Health Institute, Durham, North Carolina, U.S.A
| | - Peter Moon
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Latha P Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California, U.S.A
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29
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Lee AW, Mendoza RA, Aman S, Hsu R, Liu L. Thyroid cancer incidence disparities among ethnic Asian American populations, 1990-2014. Ann Epidemiol 2021; 66:28-36. [PMID: 34774744 DOI: 10.1016/j.annepidem.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Asian/Pacific Islanders (APIs) are at high risk of thyroid cancer, hence we examined thyroid cancer's incidence among disaggregated API subgroups in the United States (U.S.) to identify potential ethnic-specific disparities. METHODS Data from 1990 to 2014 in the Surveillance, Epidemiology, and End Results Program (SEER) were used to compare age-adjusted incidence rates (AAIRs) of thyroid cancer for seven API ethnic subgroups to non-Hispanic whites (NHWs) using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Sex, age, tumor histotype, and year of diagnosis were considered. Trends were evaluated using average annual percent change (AAPC) statistics. RESULTS The highest AAIRs (per 100,000 person-years) were among Filipinos (female AAIR=20.49, male AAIR=7.06) and the lowest among Japanese (female AAIR=8.36, male AAIR=3.20). However, Filipinos showed significantly lower incidence of medullary tumors when compared to NHWs (female IRR=0.60, 95% CI 0.40-0.87, male IRR=0.26, 95% CI 0.26-0.51). The largest increasing trends were among Asian Indian/Pakistanis for females (AAPC=5.19, 95% CI 3.81 to 6.58) and Koreans for males (AAPC=4.57, 95% CI 3.14 to 6.03). CONCLUSIONS There are clear differences in thyroid cancer incidence and trends when U.S. API ethnic subgroups are examined separately. Disaggregating APIs in research can provide critical information for understanding thyroid cancer risk.
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Key Words
- average annual percent change, APC, annual percent change, API, Asian/Pacific Islander, ASIR, age-specific incidence rate, CI, confidence interval, ICD-O-3, International Classification of Diseases for Oncology, Third Edition, IRR, incidence rate ratio, NHW, non-Hispanic white, NOS, not otherwise specified002C SEER, Surveillance, Epidemiology, and End Results Program, U.S., United States
- thyroid cancer, Asian Americans, racial/ethnic disparities, AAIR, age-adjusted incidence rate, AAPC
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Affiliation(s)
- Alice W Lee
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA.
| | - Roy A Mendoza
- Department of Biological Sciences, California State University, Fullerton, 800 N. State College Blvd., MH-112, Fullerton, CA, 92831, USA
| | - Shehla Aman
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA
| | - Robert Hsu
- Department of Oncology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, USA; Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA, 90033, USA
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30
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Zheng H, Lai V, Lu J, Kang JK, Felger EA, Carroll NM, Burman KD, Wartofsky L, Rosen JE. Comparing the rate and extent of malignancy in surgically excised thyroid nodules across race and ethnicity. Am J Surg 2021; 223:617-623. [PMID: 34600740 DOI: 10.1016/j.amjsurg.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Few studies have compared the features of thyroid cancer among races and ethnicities. We hypothesized that race and ethnicity may influence the frequency and features of thyroid malignancy in thyroid nodules. METHOD This was a retrospective chart review of patients between 2013 and 2020 who underwent thyroidectomy. RESULTS In the analysis of 2737 patients, thyroid cancer was less prevalent among Blacks (24.0% vs Whites 52.1%, Hispanics 58.7%, Asians 71.7%, and Others 57.9%, p < 0.001). Thyroid cancer in Blacks was less likely to have extrathyroidal extension (9.7% vs Whites 18.6%, Hispanics 25.8%, Asians 18.2%, and Others 17.8%, p = 0.01), overall nodal involvement (12.4% vs Whites 31.1%, Hispanics 37.5%, Asians 36.3%, and Others 30.1%, p < 0.01), and lateral neck metastasis (4.4% vs Whites 10.8%, Hispanics 6.3%, Asians 13.2%, and Others 9.6%, p = 0.02). CONCLUSIONS Race and ethnicity may play important roles in the risk of malignancy as well as in the extent of thyroid cancer.
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Affiliation(s)
- Hui Zheng
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA; MedStar-Georgetown University Hospital, Department of Surgery, 3800 Reservoir Rd NW, Washington, DC, 20007, USA.
| | - Victoria Lai
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Jana Lu
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Jin K Kang
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA; MedStar-Georgetown University Hospital, Department of Surgery, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Erin A Felger
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Nancy M Carroll
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
| | - Kenneth D Burman
- MedStar-Washington Hospital Center, Section of Endocrinology, 110 Irving St NW, Washington DC, 20010, USA
| | - Leonard Wartofsky
- MedStar Health Research Institute, Thyroid Cancer Unit, 100 Irving St NW, Washington, DC, 20010, USA
| | - Jennifer E Rosen
- MedStar-Washington Hospital Center, Division of Endocrine Surgery, 110 Irving St NW, Washington, DC, 20010, USA
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31
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Song N, Liu Q, Wilson CL, Sapkota Y, Ehrhardt MJ, Gibson TM, Morton LM, Chanock SJ, Neglia JP, Arnold MA, Michael JR, Gout AM, Mulder HL, Easton J, Bhatia S, Armstrong GT, Zhang J, Delaney A, Hudson MM, Robison LL, Yasui Y, Wang Z. Polygenic Risk Score Improves Risk Stratification and Prediction of Subsequent Thyroid Cancer after Childhood Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:2096-2104. [PMID: 34465587 DOI: 10.1158/1055-9965.epi-21-0448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/05/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subsequent thyroid cancer (STC) is one of the most common malignancies in childhood cancer survivors. We aimed to evaluate the polygenic contributions to STC risk and potential utility in improving risk prediction. METHODS A polygenic risk score (PRS) was calculated from 12 independent SNPs associated with thyroid cancer risk in the general population. Associations between PRS and STC risk were evaluated among survivors from St. Jude Lifetime Cohort (SJLIFE) and were replicated in survivors from Childhood Cancer Survivor Study (CCSS). A risk prediction model integrating the PRS and clinical factors, initially developed in SJLIFE, and its performance were validated in CCSS. RESULTS Among 2,370 SJLIFE survivors with a median follow-up of 28.8 [interquartile range (IQR) = 21.9-36.1] years, 65 (2.7%) developed STC. Among them, the standardized PRS was associated with an increased rate of STC [relative rate (RR) = 1.57; 95% confidence interval (CI) = 1.24-1.98; P < 0.001]. Similar associations were replicated in 6,416 CCSS survivors, among whom 121 (1.9%) developed STC during median follow-up of 28.9 (IQR = 22.6-34.6) years (RR = 1.52; 95% CI = 1.25-1.83; P < 0.001). A risk prediction model integrating the PRS with clinical factors showed better performance than the model considering only clinical factors in SJLIFE (P = 0.004, AUC = 83.2% vs. 82.1%, at age 40), which was further validated in CCSS (P = 0.010, AUC = 72.9% vs. 70.6%). CONCLUSIONS Integration of the PRS with clinical factors provided a statistically significant improvement in risk prediction of STC, although the magnitude of improvement was modest. IMPACT PRS improves risk stratification and prediction of STC, suggesting its potential utility for optimizing screening strategies in survivorship care.
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Affiliation(s)
- Nan Song
- St. Jude Children's Research Hospital, Memphis, Tennessee.,College of Pharmacy, Chungbuk National University, Cheongju, Republic of South Korea
| | - Qi Liu
- University of Alberta, Edmonton, Alberta, Canada
| | | | - Yadav Sapkota
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | | | | | | | | | | | | | | | - John Easton
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Jinghui Zhang
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Angela Delaney
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | | | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaoming Wang
- St. Jude Children's Research Hospital, Memphis, Tennessee.
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Association of medicaid expansion of the Affordable Care Act with the stage at diagnosis and treatment of papillary thyroid cancer: A difference-in-differences analysis. Am J Surg 2021; 222:562-569. [PMID: 33541689 DOI: 10.1016/j.amjsurg.2021.01.016] [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: 08/25/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The Affordable Care Act's (ACA) Medicaid expansion has increased insurance coverage and improved various cancer outcomes. Its impact in papillary thyroid cancer (PTC) remains unclear. METHODS Non-elderly patients (40-64 years-old) with PTC living in low-income areas either in a 2014 expansion, or a non-expansion state were identified from the National Cancer Database between 2010 and 2016. Insurance coverage, stage at diagnosis, and RAI administration were analyzed using a difference-in-differences analysis. RESULTS 10,644 patients were included. Compared with non-expansion states, the percentage of uninsured patients (adjusted-DD -2.6% [95%-CI -4.3to-0.8%],p = 0.004) and patients with private insurance decreased, and those with Medicaid coverage increased (adjusted-DD 9.7% [95%-CI 6.9-12.5%],p < 0.001) in expansion states after ACA implementation. The percentage of patients with pT1 did not differ between expansion and non-expansion states; neither did the use of RAI. CONCLUSIONS Medicaid expansion has resulted in a smaller uninsured population in PTC patients, but without earlier disease presentation nor change in RAI treatment.
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Sawant R, Hey SY, Hulse K, Hay A, Gibb FW, Adamson R, Nixon IJ. Clinicopathological features of Differentiated Thyroid Cancer presenting in the UK versus internationally: An observational cohort study. Clin Otolaryngol 2021; 46:522-529. [PMID: 33346406 DOI: 10.1111/coa.13699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/28/2020] [Accepted: 12/06/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Very little data are available regarding differentiated thyroid cancer (DTC) managed in the UK, and no UK patients are included in the evidence base upon which international guidelines are based. Therefore, the aim of this study was to compare the clinicopathological features of patients with DTC presenting in a UK population with international patient cohorts. PATIENTS AND METHODS Data were collected from a prospectively held multi-disciplinary team records from January 2009 to December 2016. The local cohort was compared with cohorts from across the world based on clinicopathological features. Ethical approval was obtained by Lothian Caldicott Guardian (Ref 16 133). RESULTS 444 cases were diagnosed locally with a median age of 48 years (range 16-86 years). 78% of patients were female. 25% of our patients had follicular carcinoma with an overall N1 rate of 20%. Distant disease was recorded in 5% cases. In comparison with international data, our local cohort had a higher rate of follicular thyroid carcinoma. Variation was seen in terms of age, gender distribution, primary tumour size, nodal and distant disease. In Korea, where thyroid cancer screening has been undertaken, smaller tumours, higher rates of nodal disease and lower rates of distant disease are described. CONCLUSION In our centre, a higher rate of males is treated with larger primary disease and a higher percentage of follicular carcinoma. The reasons for this geographic variation in clinicopathological features in the UK are unclear. As a result, caution should be applied in translating the international move towards a more conservative approach to DTC in the UK in comparison with other areas of the world.
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Affiliation(s)
- R Sawant
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - S Y Hey
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - K Hulse
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - A Hay
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - F W Gibb
- Department of Endocrinology, NHS Lothian, Edinburgh, UK
| | - R Adamson
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - I J Nixon
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, Edinburgh, UK
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Solis-Pazmino P, Salazar-Vega J, Lincango-Naranjo E, Garcia C, Koupermann GJ, Ortiz-Prado E, Ledesma T, Rojas T, Alvarado-Mafla B, Carcamo C, Ponce OJ, Brito JP. Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador. BMC Cancer 2021; 21:42. [PMID: 33419403 PMCID: PMC7791844 DOI: 10.1186/s12885-020-07735-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/15/2020] [Indexed: 01/15/2023] Open
Abstract
Background In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador. Methods From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records. Results Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients’ median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15–5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine. Conclusion Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador.
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Affiliation(s)
- Paola Solis-Pazmino
- Otolaryngology Head and Neck Department, Stanford University, Palo Alto, California, USA.,Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador
| | - Jorge Salazar-Vega
- CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Endocrinology Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador.,One Health Research Group, Universidad de las Americas, Quito, Ecuador, 170137, Quito, Ecuador
| | - Eddy Lincango-Naranjo
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Universidad Central del Ecuador, Medical School, Quito, Ecuador
| | - Cristhian Garcia
- CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Surgery Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Gabriela Jaramillo Koupermann
- CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Molecular Biology Department, Hospital de Especialidades Eugenio Espejo, Quito, Ecuador
| | - Esteban Ortiz-Prado
- One Health Research Group, Universidad de las Americas, Quito, Ecuador, 170137, Quito, Ecuador.
| | - Tannya Ledesma
- CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Universidad Central del Ecuador, Medical School, Quito, Ecuador
| | - Tatiana Rojas
- CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Universidad San Francisco de Quito, Quito, Ecuador
| | | | - Cesar Carcamo
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Oscar J Ponce
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA.,CaTaLiNa (Thyroid Cancer in LatinAmerica), Quito, Ecuador.,Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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35
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Kassotis CD, Herkert NJ, Hammel SC, Hoffman K, Xia Q, Kullman SW, Sosa JA, Stapleton HM. Thyroid Receptor Antagonism of Chemicals Extracted from Personal Silicone Wristbands within a Papillary Thyroid Cancer Pilot Study. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2020; 54:15296-15312. [PMID: 33185092 PMCID: PMC7819617 DOI: 10.1021/acs.est.0c05972] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Research suggests that thyroid cancer incidence rates are increasing, and environmental exposures have been postulated to be playing a role. To explore this possibility, we conducted a pilot study to investigate the thyroid disrupting bioactivity of chemical mixtures isolated from personal silicone wristband samplers within a thyroid cancer cohort. Specifically, we evaluated TRβ antagonism of chemical mixtures extracted from wristbands (n = 72) worn by adults in central North Carolina participating in a case-control study on papillary thyroid cancer. Sections of wristbands were solvent-extracted and analyzed via mass spectrometry to quantify a suite of semivolatile chemicals. A second extract from each wristband was used in a bioassay to quantify TRβ antagonism in human embryonic kidney cells (HEK293/17) at concentrations ranging from 0.1 to 10% of the original extract (by volume). Approximately 70% of the sample extracts tested at a 1% extract concentration exhibited significant TRβ antagonism, with a mean of 30% and a range of 0-100%. Inhibited cell viability was noted in >20% of samples that were tested at 5 and 10% concentrations. Antagonism was positively associated with wristband concentrations of several phthalates, organophosphate esters, and brominated flame retardants. These results suggest that personal passive samplers may be useful in evaluating the bioactivities of mixtures that people contact on a daily basis. We also report tentative associations between thyroid receptor antagonism, chemical concentrations, and papillary thyroid cancer case status. Future research utilizing larger sample sizes, prospective data collection, and measurement of serum thyroid hormone levels (which were not possible in this study) should be utilized to more comprehensively evaluate these associations.
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Affiliation(s)
- Christopher D Kassotis
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Nicholas J Herkert
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Stephanie C Hammel
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Qianyi Xia
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
| | - Seth W Kullman
- Toxicology Program, North Carolina State University, Raleigh, North Carolina 27695, United States
| | - Julie Ann Sosa
- Department of Surgery, University of California at San Francisco, San Francisco, California 94143, United States
| | - Heather M Stapleton
- Nicholas School of the Environment, Duke University, Durham, North Carolina 27708, United States
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36
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Abstract
Until recently, thyroid cancer was one of the most rapidly increasing cancers in the United States. Disparities exist in many aspects of thyroid cancer care as a result of the multifactorial interplay of systemic, patient, and physician factors. To better understand the management of thyroid cancer in populations at risk for health disparities and subsequently implement changes that will lead to health equity for all patients with thyroid cancer, health services research with innovative approaches is necessary.
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Affiliation(s)
- Debbie W. Chen
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan R. Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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37
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Deligiorgi MV, Panayiotidis MI, Trafalis DT. Prophylactic lymph node dissection in clinically N0 differentiated thyroid carcinoma: example of personalized treatment. Per Med 2020; 17:317-338. [PMID: 32588744 DOI: 10.2217/pme-2019-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Considering the 'differentiated thyroid carcinoma (DTC) epidemic', the indolent nature of DTC imposes a treatment paradigm shift toward elimination of recurrence. Lymph node metastases in cervical compartments, encountered in 20-90% of DTC, are the main culprit of recurrent disease, affecting 5-30% of patients. Personalized risk-stratified cervical prophylactic lymph node dissection (PLND) at initial thyroidectomy in DTC with no clinical, sonographic or intraoperative evidence of lymph node metastases (clinically N0) has been advocated, though not unanimously. The present review dissects the controversy over PLND. Weighing the benefit yielded from PLND up against the PLND-related morbidity is so far hampered by the inconsistent profit yielded by PLND and the challenging patient selection. Advances in tailoring PLND are anticipated to empower optimal patient care.
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Affiliation(s)
- Maria V Deligiorgi
- Department of Pharmacology - Clinical Pharmacology Unit, National & Kapodistrian University of Athens, Faculty of Medicine, Building 16, 1st Floor, 75 Mikras Asias, 11527-Goudi, Athens, Greece
| | - Mihalis I Panayiotidis
- Department of Applied Sciences, Group of Translational Biosciences, Faculty of Health & Life Sciences, Northumbria University, Ellison Building A516, Newcastle Upon Tyne, NE1 8ST, UK.,Department of Electron Microscopy & Molecular Pathology, Cyprus Institute of Neurology & Genetics, 1683 Nicosia, Cyprus
| | - Dimitrios T Trafalis
- Department of Pharmacology - Clinical Pharmacology Unit, National & Kapodistrian University of Athens, Faculty of Medicine, Building 16, 1st Floor, 75 Mikras Asias, 11527-Goudi, Athens, Greece
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Comiskey DF, He H, Liyanarachchi S, Sheikh MS, Genutis LK, Hendrickson IV, Yu L, Brock PL, de la Chapelle A. Variants in LRRC34 reveal distinct mechanisms for predisposition to papillary thyroid carcinoma. J Med Genet 2020; 57:519-527. [PMID: 32051256 DOI: 10.1136/jmedgenet-2019-106554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/25/2019] [Accepted: 12/11/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) demonstrates high heritability and a low somatic mutation burden relative to other cancers. Therefore, the genetic risk predisposing to PTC is likely due to a combination of low penetrance variants. A recent genome-wide association study revealed the association of PTC with a missense variant, rs6793295, at 3q26 in a gene called Leucine Repeat Rich Containing 34 (LRRC34). METHODS We report the mechanisms of PTC risk at 3q26 using a combination of overexpression, mass spectroscopy, knockdown, transcriptome profiling, migration assays and genetic analysis. RESULTS We observed differential binding of wild-type and missense LRRC34 to RANBP1. Overexpression of missense LRRC34 reduced RanGTP levels and increased apoptosis. We also identified a second linkage disequilibrium (LD) block upstream of LRRC34 containing regulatory variants with allele-specific expression. Transcriptome profiling of LRRC34 knockdown cells showed changes in genes involved with cellular movement. LRRC34 knockdown reduced the migration of thyroid cancer cell lines. Lastly, we assessed the relative contribution of PTC risk from each locus using haplotype analysis. CONCLUSIONS Our study demonstrates two separate mechanisms, one in G protein signalling and the other in transcriptional control, dictating PTC risk at 3q26 using both biochemical and genetic techniques.
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Affiliation(s)
- Daniel Forrest Comiskey
- Cancer Biology and Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Huiling He
- Cancer Biology and Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sandya Liyanarachchi
- Cancer Biology and Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mehek S Sheikh
- Cancer Biology and Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Luke K Genutis
- Cancer Biology and Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Isabella V Hendrickson
- Cancer Biology and Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lianbo Yu
- Center for Biostatistics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Pamela L Brock
- Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Albert de la Chapelle
- Cancer Biology and Genetics, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Loomans-Kropp HA, Dunn BK, Kramer BS, Pinsky P. Thyroid Incidentalomas in Association With Low-Dose Computed Tomography in the National Lung Screening Trial. Am J Epidemiol 2020; 189:27-33. [PMID: 31595954 DOI: 10.1093/aje/kwz219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/18/2019] [Indexed: 02/06/2023] Open
Abstract
Advances in cancer screening methods have opened avenues for incidental findings and cancer overdiagnosis. We performed a secondary analysis of the National Lung Screening Trial (enrollment from 2002-2004), a randomized controlled trial comparing low-dose computed tomography (LDCT; n = 26,722) with chest radiography (CXR; n = 26,732) for lung cancer detection, to examine incidental findings related to thyroid cancer (ThCa). Three screening rounds were included, and median follow-up was 6.6 years for LDCT and 6.5 years for CXR. Radiologists reported lung and non-lung-related abnormalities. In the LDCT arm, 5.7%, 4.7%, and 4.5% of participants had abnormalities above the diaphragm (AADs) detected at baseline, year 1, and year 2, respectively, compared with 2.3%, 1.5%, and 1.3% in the CXR arm. In the LDCT arm, 205 AADs (7.0%) were thyroid-related. Overall, 60 ThCas were reported, 35 in the LDCT arm and 25 in the CXR arm (P = 0.2). In the LDCT arm, participants with a prior AAD had a 7.8-fold increased risk (95% confidence interval: 4.0, 15.1) of ThCa compared with those who did not have an AAD. Early and persistent excess of ThCas diagnosed earlier in the LDCT arm suggests overdiagnosis. The use of sensitive screening modalities for early detection of lung cancer might result in the discovery of thyroid incidentalomas.
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Affiliation(s)
- Holli A Loomans-Kropp
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
- Gastrointestinal and Other Cancers Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barbara K Dunn
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Barnett S Kramer
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Paul Pinsky
- Early Detection Research Branch, Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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40
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Zhang D, Shi G, Qiu J, Shi C, Liang Y, Yuan L, Yong Z, Li J, Cao Y. Overexpression of long noncoding RNA ENST433110 inhibits cell proliferation and migration and enhances cell apoptosis of thyroid cancer cells. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1763480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Dongxin Zhang
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Guangqing Shi
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Juan Qiu
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Can Shi
- Department of Radiology, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Yan Liang
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Li Yuan
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Zhong Yong
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Jian Li
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Yan Cao
- Department of Nuclear Medicine, the Third Xiangya Hospital of Central South University, Changsha, People’s Republic of China
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Ullmann TM, Gray KD, Limberg J, Stefanova D, Moore MD, Buicko J, Finnerty B, Zarnegar R, Fahey TJ, Beninato T. Insurance Status Is Associated with Extent of Treatment for Patients with Papillary Thyroid Carcinoma. Thyroid 2019; 29:1784-1791. [PMID: 31502525 DOI: 10.1089/thy.2019.0245] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Health insurance has been shown to be a key determinant in cancer care, but it is unknown as to what extent insurance status affects treatments provided to papillary thyroid cancer (PTC) patients. We hypothesized that insured patients with PTC would have lower-risk tumors at diagnosis and be more likely to receive adjuvant therapies at follow-up. Methods: The American College of Surgeons' National Cancer Database was queried to identify all patients diagnosed with PTCs >2 mm in size from 2004 to 2015. Patients were grouped according to insurance status, and frequency of high-risk features and microcarcinoma at diagnosis were assessed. Multivariable analyses were used to identify independent predictors of more extensive treatment: total thyroidectomy (vs. lobectomy), lymphadenectomy, and radioactive iodine (RAI). Results: There were 190,298 patients who met inclusion criteria; the majority of patients had private insurance (139,675 [73.4%]) and were female (144,824 [76.1%]). Uninsured patients, as compared with privately insured patients, had higher rates of extrathyroidal extension of their cancers (25.2% vs. 18.9%, p < 0.001), lymphovascular invasion (16.2% vs. 12.0%, p < 0.001), and positive margins on final pathology (16.0% vs. 12.2%, p < 0.001). Conversely, patients with private insurance were 51% more likely to have microcarcinomas at diagnosis (odds ratio [OR] = 1.51 [confidence interval {CI} 1.35-1.68], p < 0.001) than uninsured patients, controlling for demographic, socioeconomic, and hospital factors. Private insurance was an independent predictor for treatment with total thyroidectomy (OR = 1.18 [CI 1.01-1.37], p < 0.05), formal lymphadenectomy (OR = 1.22 [CI 1.09-1.36], p < 0.001), and adjuvant RAI therapy (OR = 1.35 [CI 1.18-1.54], p < 0.001) as compared with no insurance, adjusted for socioeconomic, demographic, hospital, and oncologic differences. Patients with Medicare or Medicaid were no more likely to receive these treatments than uninsured patients. Conclusions: Privately insured patients have less aggressive PTCs at diagnosis, and they are more likely to be treated with total thyroidectomy, lymphadenectomy, and RAI compared with uninsured patients. Clinicians should take caution to ensure proper referral and follow-up for under- and uninsured patients to reduce disparities in treatment.
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Affiliation(s)
- Timothy M Ullmann
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Katherine D Gray
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Jessica Limberg
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Dessislava Stefanova
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Maureen D Moore
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Jessica Buicko
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Brendan Finnerty
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Rasa Zarnegar
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Thomas J Fahey
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
| | - Toni Beninato
- Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York
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Badhey AK, Moshier E, Jategaonkar A, Wong A, Echanique K, Chai RL. Unexpected high-risk pathologic features following thyroidectomy in the chinese immigrant population. Laryngoscope 2019; 130:1844-1849. [PMID: 31593307 DOI: 10.1002/lary.28319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/11/2019] [Accepted: 09/05/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare rates of unexpected high-risk pathologic features between Chinese and non-Asian patients who underwent thyroidectomy for papillary thyroid cancer. METHODS This was a retrospective cohort study at a tertiary academic urban medical center. Patients who underwent thyroidectomy for papillary carcinoma from 2015 to 2017 were included. Patient demographics, tumor characteristics, and tumor histopathology were analyzed. Primary outcome was the presence of adverse histopathologic features such as lymphovascular invasion (LVI) or microscopic/minimal extrathyroidal extension (mETE). Differences between the groups were analyzed using multivariate logistical regression analysis and propensity score-weighted analysis. RESULTS One hundred seventy-nine patients were included: 58 Chinese-born and 121 non-Asian. The median age of the cohort was 47 years old (36-58). Twenty-nine percent of patients were male, and 71% were female. There was no statistically significant difference between the two cohorts in rates of LVI, multifocality, extent of surgery, or presence of thyroiditis. Patients with mETE were more likely to have larger tumors (P = 0.00247). Both the multivariate and propensity-weighted models demonstrated that Chinese ancestry was independently associated with an increased rate of unexpected mETE (adjusted prevalence ratio, 2.52; 95% confidence interval, 1.82-3.48). CONCLUSION mETE is significantly higher in the immigrant Chinese compared to the non-Asian population. Given the high prevalence of unexpected mETE in the Chinese population, the added risk of this finding should be brought into the discussion during initial surgical planning. LEVEL OF EVIDENCE 3 Laryngoscope, 130:1844-1849, 2020.
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Affiliation(s)
- Arvind K Badhey
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Erin Moshier
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ameya Jategaonkar
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anni Wong
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristen Echanique
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A
| | - Raymond L Chai
- Department of Otolaryngology, Institute for Healthcare Delivery Science, Tisch Cancer Institute (TCI), Icahn School of Medicine at Mount Sinai, New York, New York
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43
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Spiegel E, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Pregnancy outcomes after thyroid cancer. J Perinat Med 2019; 47:710-716. [PMID: 31323010 DOI: 10.1515/jpm-2019-0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 06/21/2019] [Indexed: 12/16/2022]
Abstract
Background Thyroid cancer is one of the most common cancers in women of reproductive age. Our purpose was to evaluate the association between thyroid cancer and maternal and neonatal outcomes of pregnancy. Methods We conducted a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the US. A cohort consisting of women who delivered between 1999 and 2014 was created. Multivariate logistic regression, controlling for baseline maternal characteristics, was used to compare pregnancy complications and neonatal outcomes of pregnant women with thyroid cancer [International Classification of Diseases, ninth edition (ICD-9) code 193] diagnosed before or during pregnancy with those of the obstetric population without thyroid cancer. Results The study included 14,513,587 pregnant women, of which 581 women had a diagnosis of thyroid cancer (4/100,000). During the observation period, there was an upward trend in the prevalence of thyroid cancer among pregnant women, though not statistically significant (P = 0.147). Women with thyroid cancer were more likely to be Caucasian, belong to a higher income quartile, have private insurance, to be discharged from an urban teaching hospital and to have pre-gestational hypertension. Women with thyroid cancer had a greater chance of delivering vaginally, requiring transfusion of blood and developing venous thromboembolism (VTE). Neonates of mothers with thyroid cancer were not found to be at increased risk for the adverse neonatal outcomes examined, specifically, congenital malformations, intrauterine growth restriction, fetal death and preterm labor. Conclusion Pregnancies complicated by thyroid cancer have higher incidences of VTE and need for transfusions, with comparable overall newborn outcomes.
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Affiliation(s)
- Efrat Spiegel
- Jewish General Hospital, McGill University, Obstetrics and Gynecology, Montreal, Canada
| | - Andrea R Spence
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
| | - Haim Arie Abenhaim
- Jewish General Hospital, McGill University, Obstetrics and Gynecology, Montreal, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, QC, Canada
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Preoperative Ultrasonographic Staging of Papillary Thyroid Carcinoma With the Eighth American Joint Committee on Cancer Tumor-Node-Metastasis Staging System. Ultrasound Q 2019; 36:158-163. [PMID: 31478984 DOI: 10.1097/ruq.0000000000000469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of preoperative ultrasonography (US) in the staging of papillary thyroid carcinoma (PTC) according to the eighth AJCC TNM classification system, to determine the effect of the preoperative US staging in the management of PTC. PATIENTS AND METHODS Preoperative US was performed by 2 highly trained sonographers in 665 consecutive patients with PTC, and the T and N categories were determined preoperatively. The accuracy of preoperative US in clinical staging was evaluated based on the histopathological specimens according to the eighth AJCC TNM classification. Further analysis was performed to identify the high-risk factors of N1b stage. RESULTS Overall accuracy of preoperative US for T stage was 92.5% (615/665). The accuracy of sonographic evaluation for T was high except for the T4a. Overall accuracy of preoperative US for N stage was 59% (426/655). The accuracies of sonographic evaluation for N0, N1a, and N1b were 81.8% (274/335), 33.3% (70/250), and 87.5% (70/80), respectively. Of 250 N1a patients, 164 (65.6%) were underestimated by US. Univariate and multivariate analyses showed that larger tumor diameter, multifocality, and higher T stage significantly increase the risk of N1b stage (P < 0.01). CONCLUSIONS Preoperative US was useful for the evaluation in staging of PTC, but some limitations still existed. For higher-risk patients of N1b (larger tumor size, multifocality, and higher T stage), preoperative US examination for lateral neck region should be further emphasized, and prophylactic lateral nodal dissection should be determined based on both preoperative imaging results and intraoperative evaluation.
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Shi F, Liu Y, Li M, Wen P, Qian QQ, Fan Y, Huang R. Analysis of lncRNA and mRNA Transcriptomes Expression in Thyroid Cancer Tissues Among Patients With Exposure of Medical Occupational Radiation. Dose Response 2019; 17:1559325819864223. [PMID: 31384241 PMCID: PMC6661800 DOI: 10.1177/1559325819864223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Occupational exposure of radiation among medical radiation workers
contributes to the subsequent increased risk of thyroid cancer. Long
noncoding RNAs (lncRNAs) are emerging as important regulators of cancer
biology. However, little is known about lncRNA expression in thyroid cancer
tissues from patients who are exposed to medical occupational radiation. The
purpose of this study is to reveal the transcriptomes difference between
thyroid cancer tissues and adjacent nonneoplastic thyroid tissues. Methods: Microarray technology was used in this study. Quantitative reverse
transcription polymerase chain reaction was adopted to verify 6
differentially expressed lncRNAs. Gene ontology and pathway analyses were
performed using standard enrichment computational methods. Potential target
genes of the differentially expressed lncRNAs were predicted with 2
independent algorithms. Results: A total of 23 lncRNA and messenger RNA transcripts were found differentially
expressed in the thyroid cancer tissues (fold change ≥2.0,
P < .05). This differential lncRNA expression may
affect many pathways, including those involved in cysteine and methionine
metabolism, Huntington disease, propanoate metabolism, and
carcinogenesis. Conclusions: Our study provides a transcriptome-wide screening and analysis of the lncRNA
expression profile in thyroid cancer tissues from patients with medical
occupational radiation exposure and lays the foundation for further
investigation of lncRNAs related to thyroid cancer development and
carcinogenic risk of medical occupational radiation exposure.
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Affiliation(s)
- Feng Shi
- Internal Medicine Department of Thyroid and Radionuclide Therapy, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Ying Liu
- Internal Medicine Department of Thyroid and Radionuclide Therapy, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Min Li
- Internal Medicine Department of Thyroid and Radionuclide Therapy, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Peng Wen
- Internal Medicine Department of Thyroid and Radionuclide Therapy, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Qiu Qin Qian
- Internal Medicine Department of Thyroid and Radionuclide Therapy, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Yibin Fan
- Zhejiang provincial people's hospital, People's Hospital of Hangzhou Medical College, Hangzhou, People's Republic of China
| | - Ruixue Huang
- Department of Occupational and Environmental Health, School of Public Health, Central South University, Changsha, People's Republic of China
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Tortolero-Luna G, Torres-Cintrón CR, Alvarado-Ortiz M, Ortiz-Ortiz KJ, Zavala-Zegarra DE, Mora-Piñero E. Incidence of thyroid cancer in Puerto Rico and the US by racial/ethnic group, 2011-2015. BMC Cancer 2019; 19:637. [PMID: 31253133 PMCID: PMC6599344 DOI: 10.1186/s12885-019-5854-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/19/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Puerto Rico has the highest incidence rate of thyroid cancer (TC) in the Americas and the third highest rate worldwide. The purpose of this study was to compare the burden of TC between the population of PR and United States (US) non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and US Hispanics (USH) during the period 2011-2015. METHODS TC data for the period 2011-2015 was obtained from the Puerto Rico Central Cancer Registry (PRCCR) and the Surveillance Epidemiology and Ends Results Program (SEER) 18 Registries Research Data. TC was categorized in: papillary carcinoma (PTC), and other TC histologic types. Data was analyzed by sex, age groups, and histologic type. Racial/ethnic differences by sex, age, and histologic types were assessed using the Standardized Rate Ratio (SRR) and its 95% CI. RESULTS During the period 2011-2015 there were 5175 and 65,528 cases of TC diagnosed in PR and the US, respectively. The overall age-adjusted incidence rate of PTC was almost two-fold higher in PR than in the US (25.8/100,000 vs. 12.9/100,000). Among PR women, the incidence rate of PTC was 40.0/100,000 compared to 19.4/100,000 in US. PR women had 83% increased risk of being diagnosed with PTC than NHW women, a 2.25-fold increased risk than USH, and 3.45-fold increased risk than NHB women. For men, PR had 34% increased risk of being diagnosed with PTC than NHW men, 2.2-fold increased risk than USH men, and 3.2-fold higher risk than in NHB men. CONCLUSION Further research is needed to understand this disparity in the island. This research should address the extent of overdiagnosis in PR, the role of health insurance status and insurance type, characteristics of the healthcare delivery system as well as the role of patient and environmental factors.
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Affiliation(s)
- Guillermo Tortolero-Luna
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PO Box 70344, San Juan, PR 00936-8344 Puerto Rico
| | - Carlos R. Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Mariela Alvarado-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Social Sciences, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen J. Ortiz-Ortiz
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PO Box 70344, San Juan, PR 00936-8344 Puerto Rico
| | - Diego E. Zavala-Zegarra
- Puerto Rico Central Cancer Registry, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Edna Mora-Piñero
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PO Box 70344, San Juan, PR 00936-8344 Puerto Rico
- Department of Surgery, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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Li N, Cui M, Yu P, Li Q. Correlations of lncRNAs with cervical lymph node metastasis and prognosis of papillary thyroid carcinoma. Onco Targets Ther 2019; 12:1269-1278. [PMID: 30863094 PMCID: PMC6388952 DOI: 10.2147/ott.s191700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background Cervical lymph node metastasis is an important prognostic indicator for papillary thyroid carcinoma (PTC) and affects treatment strategies for PTC. lncRNAs essentially contribute to the biological functions of tumors. This study aimed to identify the lncRNAs associated with cervical lymph node metastasis and prognosis of PTC and their potential pathophysiological mechanisms. Materials and methods PTC-associated lncRNAs were selected from The Cancer Genome Atlas database, and correlations among lncRNAs, lymph node metastasis, tumor staging, and prognosis of PTC were analyzed in silico. These correlations were then validated through quantitative reverse transcription PCR (qRT-PCR) and immunohistochemistry (IHC). Results In silico analysis showed that FAM95B1 and UCA1 were significantly correlated with cervical lymph node metastasis, tumor staging, and PTC prognosis (P<0.05). qRT-PCR analysis revealed high UCA1 expression in PTC tissues and correlations between UCA1 expression levels and cervical lymph node metastasis and tumor staging in PTC, that is, higher UCA1 expression resulted in poorer PTC prognosis. IHC analysis revealed that a high expression of UCA1 was accompanied by a high expression of metastasis-related proteins (MMP-2 and MMP-9), thereby validating the correlation of UCA1 expression with metastasis. Conclusion FAM95B1 and UCA1 expression was significantly correlated with the occurrence and progression of PTC. The expression levels of UCA1 significantly affected the prognosis of PTC patients and were significantly correlated with tumor staging and cervical lymph node metastasis.
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Affiliation(s)
- Na Li
- Department of Endocrinology and Metabolism, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150080, China, .,Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, China
| | - Mingming Cui
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, Heilongjiang 150081, China
| | - Ping Yu
- Department of Endocrinology and Metabolism, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150080, China,
| | - Qiang Li
- Department of Endocrinology and Metabolism, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150080, China,
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Zhang XY, Song HJ, Qiu ZL, Shen CT, Chen XY, Sun ZK, Wei WJ, Zhang GQ, Luo QY. Pulmonary metastases in children and adolescents with papillary thyroid cancer in China: prognostic factors and outcomes from treatment with 131I. Endocrine 2018; 62:149-158. [PMID: 30022382 DOI: 10.1007/s12020-018-1678-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/03/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) with pulmonary metastases is rare in children and adolescents. Unlike adults, limited data are available on children with this disease. Thus, this study evaluated the therapeutic efficacy and prognostic factors of individuals less than 21 years of age with pulmonary metastases from PTC. METHODS Seventy-six children and adolescents with pulmonary metastases from PTC treated with 131I were retrospectively analyzed. Therapeutic efficacy was evaluated by changes in serum thyroglobulin (Tg) and chest computed tomography (CT). Factors predictive of progression-free survival and overall survival were measured by the Kaplan-Meier method. RESULTS Among the 76 patients included in this study, 22.4% (17 of 76) were less than 15 years old and 65.8% (50 of 76) were female. Under the evaluation of stimulated serum Tg levels, RAI treatment were effective in 55.9% (38 of 68), stable in 26.5% (18 of 68) and ineffectvie in 17.6% (12 of 68) of patients. Changes on anatomical imaging suggested complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) in 8.5, 62.0, 15.5, and 14.1% of individuals, respectively. Univariate analysis showed that size and tumor doubling time of pulmonary metastases were independent factors affecting therapeutic efficacy. Extra-thyroidal extension, tumor diameter of pulmonary metastases and tumor doubling time were significant independent factors regarding progression-free survival rates, while only tumor doubling time and tumor diameter were significant risk factors associated with overall survival rate. CONCLUSIONS Radioactive iodine therapy is an effective treatment for children and adolescents with pulmonary metastases from PTC. Extra-thyroid extension was associated with disease progression while did not show significant influence on overall survival. Tumor doubling time and tumor diameter were the main factors influencing both progression-free survival and overall survival.
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Affiliation(s)
- Xin-Yun Zhang
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Hong-Jun Song
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Zhong-Ling Qiu
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China.
| | - Chen-Tian Shen
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Xiao-Yue Chen
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Zhen-Kui Sun
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Wei-Jun Wei
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Guo-Qiang Zhang
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China
| | - Quan-Yong Luo
- Department of Nuclear Medicine, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Jiao Tong University School of Medicine, 600# Yishan Road, 200233, Shanghai, China.
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49
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Huang M, Yan C, Wei H, Lv Y, Ling R. Clinicopathological characteristics and prognosis of thyroid cancer in northwest China: A population-based retrospective study of 2490 patients. Thorac Cancer 2018; 9:1453-1460. [PMID: 30209893 PMCID: PMC6209792 DOI: 10.1111/1759-7714.12858] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/02/2018] [Accepted: 08/04/2018] [Indexed: 02/06/2023] Open
Abstract
Background The specific clinical features of thyroid cancer patients in northwest China are unclear; therefore, we analyzed the clinicopathological characteristics and prognosis of this population. Methods Clinical characteristics including age, gender, blood type, histological type, and BRAFV600E gene mutation; and incidence; risk factors; surgical treatment; and prognosis were recorded. Results A total of 2490 thyroid cancer patients were included; 98% were diagnosed with papillary thyroid cancer (PTC). Weight, blood type, histological type, and BRAFV600E gene mutation rates were significantly different. Pediatric thyroid cancer patients had higher lymph node metastasis, lower BRAFV600E mutation, and 6.2–9.2% greater recurrence rates than adult patients. PTC and papillary thyroid microcarcinoma displayed similar features, while in other types, such as follicular and medullary thyroid cancer, there were variations. Multiple logistic analyses showed that age (odds ratio [OR] 0.957, 95% confidence interval [CI] 0.944–0.970; P < 0.001), focal status (OR 16.174, 95% CI 9.257–28.262; P < 0.001), pathology (OR 0.642, 95% CI 0.473–0.871; P = 0.004) and lymph node metastasis (OR 0.059, 95% CI 0.033–0.107; P < 0.001) were independent factors for BRAFV600E mutation. Conclusion Most real world clinicopathological features, treatment, and prognosis of thyroid cancer are similar to reported data, such as the higher incidence of disease in women and the larger proportion of PTC. However, the results in pediatric patients and those with BRAF gene mutations are controversial and require more clinical incidence.
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Affiliation(s)
- Meiling Huang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Changjiao Yan
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Hongliang Wei
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Yonggang Lv
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
| | - Rui Ling
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, China
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50
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Polednik KM, Simpson MC, Adjei Boakye E, Mohammed KA, J Dombrowski J, Varvares MA, Osazuwa-Peters N. Radiation and Second Primary Thyroid Cancer Following Index Head and Neck Cancer. Laryngoscope 2018; 129:1014-1020. [PMID: 30208210 DOI: 10.1002/lary.27467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS Radiation is thought to increase risk of developing second primary thyroid cancer (SPTC). This study estimated the rate of SPTC following index head and neck cancer (HNC) and determined whether radiation treatment among HNC survivors increased SPTC risk. STUDY DESIGN Retrospective data analysis. METHOD The Surveillance, Epidemiology, and End Results database (1975-2014) was queried for cases of index HNC (N = 127,563) that developed SPTC. Adjusted multivariable competing risk proportional hazards model tested risk of developing a SPTC following index HNC. Sensitivity analyses using proportional hazards models were also performed restricting data to patients who 1) received both radiation and chemotherapy and 2) radiation alone. RESULTS Only 0.2% of index HNC survivors (n = 229) developed SPTC, yielding a rate of 26.1 per 100,000 person-years. For every increasing year of age at diagnosis, patients were 3% less likely to develop an SPTC (adjusted hazard ratio [aHR] = 0.97, 95% CI: 0.96-0.98). Males were also less likely to develop an SPTC (aHR = 0.73, 95% CI: 0.55-0.96). Radiation (aHR = 0.92, 95% CI: 0.68-1.25), surgery (aHR = 0.79, 95% CI: 0.56-1.11), and chemotherapy (aHR = 1.13, 95% CI: 0.76-1.69) were not significantly associated with developing SPTC. The sensitivity models also did not find an association between treatment and risk of SPTC. CONCLUSIONS Rate of developing SPTC following index HNC was very low, and previous exposure to radiation did not significantly increase risk in our study population. More studies are needed to understand the increasing incidence of thyroid cancer across the United States. LEVEL OF EVIDENCE NA Laryngoscope, 129:1014-1020, 2019.
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Affiliation(s)
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Eric Adjei Boakye
- Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - Kahee A Mohammed
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.,Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - John J Dombrowski
- Department of Radiation Oncology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.,Saint Louis University Cancer Center, St. Louis, Missouri.,Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, U.S.A
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