1
|
Joshi P, Chang J, Scola WH, Shah H, Remer LF, Lew JI. Incidental Thyroid Malignancy in Surgical Patients With Benign Thyroid Disease. J Surg Res 2024; 302:778-783. [PMID: 39216460 DOI: 10.1016/j.jss.2024.07.117] [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: 03/06/2024] [Revised: 07/14/2024] [Accepted: 07/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION The rate of incidental thyroid malignancy (ITM) has increased in recent decades. However, the factors associated with ITM remain uncertain. This study analyzes the rate of ITM in patients after surgical resection for benign thyroid disease (BTD) without preoperative suspicion of thyroid malignancy and its associated sociodemographic factors. MATERIALS AND METHODS A retrospective study of prospectively collected data reviewed data from 2528 patients who underwent initial thyroidectomy for BTD at a tertiary academic medical hospital between 2011 and 2022. Patients were excluded if they had a known history of thyroid cancer, radiation exposure, suspicious thyroid ultrasound features, and/or fine needle aspiration results. ITM rate was analyzed along with patient demographics, body mass index (BMI), tumor size, and invasive features. RESULTS Among 345 patients with BTD (mean 53.6 y, SD = 14.5), 22.9% (79/345) had ITM on final histopathology. Most patients were women (87.0%), White (87.0%), and Hispanic (56.8%), with an average BMI of 29.6 (SD = 6.56). BTD type was associated with ITM (P < 0.001), with nontoxic multinodular goiter exhibiting the highest incidence (36.0%). Higher BMI emerged as a predictor of higher rate of ITM (OR = 1.057, P = 0.007). Other sociodemographic variables did not show significant associations. CONCLUSIONS The study identified a higher rate of ITM than previously reported as well as an association between higher BMI and increased rate of ITM. This highlights a potential link between obesity and ITM not previously identified. Patients with higher BMI and BTD may benefit from further surveillance.
Collapse
Affiliation(s)
- Priyashma Joshi
- Weill Cornell Medicine Department of Surgery, New York, New York; University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
| | - Jonathan Chang
- University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - William H Scola
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Hana Shah
- Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Lindsay F Remer
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - John I Lew
- Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| |
Collapse
|
2
|
Choi YM, Kim MJ, Lee J, Kwak MK, Jeon MJ, Kim TY, Hong EG, Kim WB, Kim WG. Long-Term Changes in the Mortality Rates of Thyroid Cancer in Korea: Analysis of Korean National Data from 1985 to 2020. Endocrinol Metab (Seoul) 2023; 38:588-595. [PMID: 37679950 PMCID: PMC10613776 DOI: 10.3803/enm.2023.1723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/03/2023] [Accepted: 07/25/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGRUOUND Thyroid cancer mortality has been largely overlooked as relatively stable given the large gap between thyroid cancer incidence and mortality. This study evaluated long-term trends in age-standardized mortality rates (ASMRs) throughout Korea and compared them with mortality data reported by the Surveillance, Epidemiology, and End Results (SEER). METHODS Cancer-specific mortality data from 1985 to 2020 were obtained from Statistics Korea. ASMRs from thyroid cancer were calculated based on the Korean mid-year resident registration population of 2005. We assessed SEER*Explorer and downloaded the mortality data. RESULTS The ASMR increased from 0.19 to 0.77/100,000 between 1985 and 2002 but decreased continuously to 0.36/100,000 in 2020. The annual percent change (APC) in the ASMR between 1985 and 2003 and between 2003 and 2020 was 6.204 and -4.218, respectively, with similar patterns observed in both men and women. The ASMR of the SEER showed a modest increase from 1988 to 2016 and then stabilized. In subgroup analysis, the ASMR of the old age group (≥55 years) increased significantly from 0.82 in 1985 to 3.92/100,000 in 2002 (APC 6.917) but then decreased again to 1.86/100,000 in 2020 (APC -4.136). ASMRs according to the age group in the SEER showed a relatively stable trend even in the elderly group. CONCLUSION The ASMR of thyroid cancer in Korea had increased from 1985 to 2002 but has since been steadily decreasing. This trend was mainly attributed to elderly people aged 55 or over. The absolute APC value of Korea was much higher than that of the SEER.
Collapse
Affiliation(s)
- Yun Mi Choi
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Jiwoo Lee
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Mi Kyung Kwak
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Gyoung Hong
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Kuchareczko A, Kopczyński J, Kowalik A, Hińcza-Nowak K, Walczyk A, Pałyga I, Trybek T, Szymonek M, Gąsior-Perczak D, Gadawska-Juszczyk K, Mikina E, Płachta I, Suligowska A, Płusa A, Chrapek M, Łopatyński T, Góźdź S, Kowalska A. A Significance of Concomitant BRAF V600E and TERT Mutations in Polish Patients with Papillary Thyroid Microcarcinoma: A Retrospective Cohort Study Based on 430 Cases. Thyroid 2022; 32:1372-1381. [PMID: 35950639 DOI: 10.1089/thy.2022.0155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: The incidence of papillary thyroid cancer is increasing worldwide due to more frequent pathological detection of papillary thyroid microcarcinomas (PTMC), which are cancers measuring 1 cm or less in diameter. In rare cases, the course of PTMC can be aggressive, with an increased risk of recurrence/persistent disease. The aim of this study of Polish patients diagnosed with PTMC was to assess the impact of concomitant B-type Raf kinas-activating mutation in codon 600 of exon 15 (BRAFV600E) and telomerase reverse transcriptase (TERT) hotspot mutations on clinicopathological features, response to treatment, potential recurrence, and the final outcome. Methods: A retrospective analysis of the 430 PTMC cases diagnosed during 2001-2020 at a single center was performed. All PTMC cases were assessed histopathologically, and analyses of BRAFV600E and TERT promoter were performed based on DNA isolated from tumor blocks. Results: There were 29/430 (6.7% [confidence interval: 4.6-9.5]) patients in whom the TERTC228T and/or TERTC250T mutations coexisted with the BRAFV600E mutation. A statistical comparison between PTMC cases with concomitant BRAFV600E and TERT hotspot mutations and those without any of those mutations revealed no significant differences between the two groups with respect to risk stratification, response to primary treatment, clinical course, or final disease status. Conclusion: Regardless of the molecular background of PTMC, the overall response to therapy is excellent, and long-term disease-free survival rates can be achieved by most patients.
Collapse
Affiliation(s)
- Artur Kuchareczko
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | | | - Artur Kowalik
- Division of Medical Biology, Institute of Biology, Jan Kochanowski University, Kielce, Poland
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Kinga Hińcza-Nowak
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Agnieszka Walczyk
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Iwona Pałyga
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Tomasz Trybek
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Monika Szymonek
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Danuta Gąsior-Perczak
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | | | - Estera Mikina
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Izabela Płachta
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | | | - Agnieszka Płusa
- Department of Pathology, Holycross Cancer Centre, Kielce, Poland
| | - Magdalena Chrapek
- Department of Mathematics, Faculty of Natural Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Łopatyński
- Department of General, Oncologic and Metabolic Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Stanisław Góźdź
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Clinical Oncology, Holycross Cancer Centre, Kielce, Poland
| | - Aldona Kowalska
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| |
Collapse
|
4
|
Ma B, Chen X, Zhao Z, Yin X, Ji Q, Zhou Y, Ma C, Wang J. Coexisting CLT in PTC is an independent predictor of tumor aggressiveness for patients aged under 55: a retrospective analysis of 635 patients. BMC Endocr Disord 2022; 22:55. [PMID: 35255870 PMCID: PMC8900407 DOI: 10.1186/s12902-022-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was aimed at investigating the potential role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid cancer (PTC) aggressiveness for patients aged below 55, as well as to figure out factors influencing potential recurrence risk in different age groups. METHODS A total of 635 adult patients were retrospectively analyzed. 188 patients were diagnosed with coexistent CLT and the remaining 447 were classified as non-CLT. Then the characteristics of CLT-coexisted patients and non-CLT ones were compared respectively when patients were aged ≥ 55 years or below. The association among postoperative clinicopathological features were also analyzed using multivariate regression. In addition, the prognostic value of several variables relating to high-risk recurrence were estimated within different age groups. RESULTS When divided in two age groups (55 years as the borderline), non-CLT group (aged below 55 years) had a remarkable frequency of small size lesion (Dmax ≤ 1 cm) compared with CLT-coexisted patients (54.6% to 43.0%, p = 0.02). In addition, non-CLT patients tended to have intrathyroidal extension as opposed to those with coexistent CLT (20.2% to 28.2%, p = 0.05). In multivariate analysis, CLT still significantly acted as an independent risk factor of greater lesion size (Dmin > 1 cm) (OR = 1.7, p = 0.02) and mildly promoted gross extrathyroidal extension (ETE) (OR = 1.4, p = 0.06). However, associations didn't emerge in the characteristics mentioned above with CLT when patients were ≥ 55 years old. The prognostic value of CLT in high-risk recurrence was evident only in patients aged 35-44 years. (OR = 2.4, 95%CI:1.2-5.4, p = 0.02). Greater lesion size independently promoted gross ETE, no matter patients were aged above 55 years or not. Its prognostic value of high-risk recurrence was significant throughout all age groups. CONCLUSION These findings revealed that CLT coexistence might be the unfavorable factor of PTC aggressiveness in patients aged below 55 years. Its role as well as greater tumor size may potentially predict higher recurrence risk according to results figured out in the prediction model.
Collapse
Affiliation(s)
- Bing'e Ma
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiyi Chen
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, 210029, China
| | - Zhengping Zhao
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiaoyang Yin
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Qin Ji
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yifan Zhou
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Chaoqun Ma
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Jianhua Wang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China.
| |
Collapse
|
5
|
NR4A1 promotes LEF1 expression in the pathogenesis of papillary thyroid cancer. Cell Death Dis 2022; 8:46. [PMID: 35110542 PMCID: PMC8810957 DOI: 10.1038/s41420-022-00843-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/09/2022] [Accepted: 01/20/2022] [Indexed: 11/09/2022]
Abstract
The morbidity of papillary thyroid cancer (PTC) is on the rise, but its pathogenesis is still poorly understood. NR4A1 is a transcription factor primarily involving a wide range of pathophysiological responses, but its relationship with PTC malignancy remains unclear. This study demonstrates that high NR4A1 expression is strongly associated with poor survival outcomes in PTC patients. The depletion of NR4A1 significantly inhibited the proliferation of PTC cells by negating the LEF1-mediated oncogenic alteration. Mechanistically, NR4A1 directly binds to the promoter region of LEF1 and leads to crosstalk with histone acetylation and DNA demethylation to transcriptionally upregulate LEF1 expression, subsequently promoting downstream growth-related genes expressions in PTC. In the light of our findings, NR4A1 may be an emerging driving factor in PTC pathogenesis and progression.
Collapse
|
6
|
Herzog M, Beule AG, Lüers JC, Guntinas-Lichius O, Sowerby LJ, Bogdanov V, Grafmans D. Follow-up of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany. HNO 2021; 69:658-665. [PMID: 34086058 PMCID: PMC8176277 DOI: 10.1007/s00106-021-01075-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 11/26/2022]
Abstract
Purpose The SARS-CoV‑2 pandemic has affected the health and practice of otorhinolaryngologists (ORLs) for over 1 year. Follow-up data of a national survey with German ORLs were evaluated regarding differences between the two waves of the pandemic. Methods As in the initial survey, German ORLs were addressed via e‑mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association. All ORLs afflicted with SARS-CoV‑2 were invited to participate in a web-based survey. General data on infections and concomitant parameters were evaluated. Results Since the start of the pandemic, 129 ORLs reported testing positive for SARS-CoV‑2 in Germany. The ORLs infected during the first wave had a relative risk (RR) of 4.07 (95% CI: 3.20; 5.19) of contracting SARS-CoV‑2. During the second wave, the RR decreased to 0.35 (95% CI: 0.28; 0.45). The availability of personal protective equipment (PPE) increased from the first to the second wave along with an increased perception of protection in the professional environment. The source of infection shifted from infections via medical staff during the first wave to patients and household exposure during the second wave. Regular medical practice was resumed by clinicians and general practitioners in the second wave. Nevertheless, a proportionally lower infection rate was observed compared with the German population as a whole. Conclusion The data reflect a unique long-term survey of ORLs during the pandemic. Differences in the source of infection were seen between the first and second wave, confirming the need for appropriate PPE for medical professionals working in high-risk environments. Further strategies to reduce the risk of infection include consistent testing for SARS-CoV‑2 in healthcare professionals, patients, and the general public as well as vaccination of high-risk medical groups. Supplementary Information The online version of this paper (10.1007/s00106-021-01075-4) contains the German version of the COVID-19 questionnaire. The article and supplementary material are available at www.springermedizin.de. Please enter the title of the article in the search field. The additional material can be found at the article under “Ergänzende Inhalte”. ![]()
Collapse
Affiliation(s)
- Michael Herzog
- Dept. of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany.
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University, Halle-Wittenberg, Halle (Saale), Germany.
| | - Achim G Beule
- Dept. of Otorhinolaryngology, University Hospital Münster, Münster, Germany
- Dept. of Otorhinolaryngology, Head and Neck Surgery, University Medicine Greifswald, Greifswald, Germany
| | - Jan-Christoffer Lüers
- Dept. of Otorhinolaryngology, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Vasyl Bogdanov
- Dept. of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany
| | - Daniel Grafmans
- Dept. of Otorhinolaryngology, Head and Neck Surgery, Carl-Thiem-Klinikum, Thiemstr. 111, 03048, Cottbus, Germany
| |
Collapse
|