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Wang D, Yang Y, He Y, Yang H, Yang L. Natural History and Prognostic Model of Untreated Papillary Thyroid Cancer: A SEER Database Analysis. Cancer Control 2024; 31:10732748241253956. [PMID: 38756002 PMCID: PMC11102674 DOI: 10.1177/10732748241253956] [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: 11/04/2023] [Revised: 03/27/2024] [Accepted: 04/24/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE This investigation leveraged the SEER database to delve into the progression patterns of PTC when left untreated. Furthermore, it aimed to devise and authenticate a nomogram for prognosis prediction for such patients. METHODS We extracted data from the SEER database, focusing on PTC-diagnosed individuals from 2004-2020. To discern disease progression intervals, median survival times across stages were gauged, and the disease progression time was estimated by subtracting the median survival time of a more severe stage from its preceding stage. Prognostic determinants in the training set were pinpointed using both univariate and multivariate Cox regression. Using these determinants, a prognostic nomogram was crafted. RESULTS In untreated PTC patients, those in stages I and II had a favorable prognosis, with 10-year overall survival rates of 86.34% and 66.03%, respectively. Patients in stages III and IV had a relatively poorer prognosis. The median survival time of stage III, stage IVA, stage IVB and stage IVC patients was 108months, 43 months, 20 months and 8 months, respectively. The deduced progression intervals from stages III-IVC were 65, 23, and 12 months. In the training set, age, tumor stage, gender, and marital status were identified as independent risk factors influencing the prognosis of untreated PTC, and a nomogram was constructed using these variables. CONCLUSION In the absence of treatment intervention, early-stage PTC progressed slowly with an overall favorable prognosis. However, in mid to advanced-stage PTC, as tumor stage increased, disease progression accelerated, and prognosis gradually worsened. Age, tumor stage, marital status, and gender were independent risk factors influencing the prognosis of untreated PTC, and the nomogram based on these factors demonstrated good prognostic capability.
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Affiliation(s)
- Dasong Wang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Yan Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Yu He
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Hongwei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
| | - Lei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, Suining, China
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Hussein MH, Toraih EA, Ohiomah IE, Siddeeque N, Comeaux M, Landau MB, Anker A, Jishu JA, Fawzy MS, Kandil E. Navigating Choices: Determinants and Outcomes of Surgery Refusal in Thyroid Cancer Patients Using SEER Data. Cancers (Basel) 2023; 15:3699. [PMID: 37509360 PMCID: PMC10378250 DOI: 10.3390/cancers15143699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
With thyroid cancer being a prevalent endocrine cancer, timely management is essential to prevent malignancy and detrimental outcomes. Surgical intervention is a popular component of the treatment plan, yet patients often refuse to undergo such procedures even if clinicians explicitly recommend them. This study gathers data from the Surveillance, Epidemiology, and End Results database (2000-2019) to learn more about the sociodemographic factors that predict the likelihood of surgical intervention. A total of 176,472 patients diagnosed with either papillary or follicular thyroid cancer were recommended surgery, of which 470 were refused. Cancer-specific mortality and overall mortality were determined with the Kaplan-Meier method and univariate and multivariate Cox proportional hazards regression model. Mortality rates for patients who delayed surgery (≥4 months vs. <4 months) were determined using similar methods. The findings reveal that surgical delay or refusal increased overall mortality. The surgical refusal was associated with increased thyroid cancer-specific mortality. However, the impact on thyroid cancer-specific mortality for those who delay surgery was not as pronounced. Significant sociodemographic determinants of surgical refusal included age greater than or equal to 55 years, male sex, being unmarried, race of Asian and Pacific Islander, and advanced tumor staging. The results underscore the importance of patient education, shared decision-making, and access to surgical interventions to optimize outcomes in thyroid cancer management.
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Affiliation(s)
- Mohammad H Hussein
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman A Toraih
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Ifidon E Ohiomah
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Marie Comeaux
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Allison Anker
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Jessan A Jishu
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Manal S Fawzy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
- Department of Biochemistry, Faculty of Medicine, Northern Border University, Arar 91431, Saudi Arabia
| | - Emad Kandil
- Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Parvathareddy SK, Siraj AK, Annaiyappanaidu P, Siraj N, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Bilateral multifocality is an independent predictor of patients' outcome in Middle Eastern papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2023; 13:1060301. [PMID: 36686467 PMCID: PMC9846198 DOI: 10.3389/fendo.2022.1060301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background Tumor multifocality is frequently seen in Papillary thyroid carcinoma (PTC). However, few studies have analysed the impact of bilateral multifocality in PTC. The incidence of bilateral multifocality, its clinico-pathological associations and prognostic impact in PTC from Middle Eastern ethnicity remains unestablished. Methods We retrospectively evaluated 1283 patients who underwent total thyroidectomy for PTC. Bilateral and unilateral multifocality were decided based on the final pathology result. Primary outcome was recurrence free survival (RFS). Risk factors for bilateral multifocality were analyzed by multivariate logistic regression analysis. Results Multifocal PTC was found in 54.3% (697/1283) of patients. Among the 697 multifocal PTCs, 210 patients (30.1%) had unilateral multifocal PTC and 487 patients (69.9%) had bilateral multifocality. Bilateral multifocality was significantly associated with older age at diagnosis (p = 0.0263), male gender (p = 0.0201), gross extrathyroidal extension (p = 0.0332), larger primary tumor size (>4cm; p = 0.0002), lateral lymph node metastasis (p = 0.0008), distant metastasis at diagnosis (p = 0.0195) and recurrence (p = 0.0001). Bilateral multifocality was also found to be an independent predictor of RFS (Hazard ratio = 1.60; 95% Confidence Interval = 1.05 - 2.55; p = 0.0300). Multivariate logistic regression analysis demonstrated tumor diameter >4cm to be the only independent risk factors for bilaterality in multifocal PTC (Odds ratio = 1.86; 95% Confidence Interval = 1.13 - 3.07; p = 0.0155). Conclusions Incidence of bilateral multifocality is high in Middle Eastern PTC. Tumor diameter >4cm can be considered as a predictive factor for bilateral multifocal PTC. Bilateral multifocality appears to be an important prognostic factor for PTC and an independent predictor of RFS. Therefore, patients with bilateral multifocal PTC may benefit from more frequent follow-up to identify recurrences earlier.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Padmanaban Annaiyappanaidu
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nabil Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Birkenbeuel JL, Lehrich BM, Goshtasbi K, Abiri A, Hsu FPK, Kuan EC. Refusal of Surgery in Pituitary Adenoma Patients: A Population-Based Analysis. Cancers (Basel) 2022; 14:cancers14215348. [PMID: 36358767 PMCID: PMC9656152 DOI: 10.3390/cancers14215348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 12/04/2022] Open
Abstract
We characterized the clinical and sociodemographic factors predictive of surgery refusal in pituitary adenoma (PA) patients. We queried the National Cancer Database (NCDB) to identify adult PA patients treated from 2004−2015 receiving or refusing surgery. Multivariate logistic regression and Cox proportional-hazards analysis identified clinical and/or sociodemographic factors predictive of surgery refusal or mortality, respectively. Of the 34,226 patients identified, 280 (0.8%) refused surgery. On multivariate logistic regression, age > 65 (OR: 2.64; p < 0.001), African American race (OR: 1.70; p < 0.001), Charlson-Deyo Comorbidity (C/D) Index > 2 (OR: 1.52; p = 0.047), and government insurance (OR: 2.03; p < 0.001) or being uninsured (OR: 2.16; p = 0.03) were all significantly associated with surgery refusal. On multivariate cox-proportional hazard analysis, age > 65 (HR: 2.66; p < 0.001), tumor size > 2 cm (HR: 1.30; p < 0.001), C/D index > 1 (HR: 1.53; p < 0.001), having government insurance (HR: 1.66; p < 0.001) or being uninsured (HR: 1.67; p < 0.001), and surgery refusal (HR: 2.28; p < 0.001) were all significant predictors of increased mortality. Macroadenoma patients receiving surgery had a significant increase in overall survival (OS) compared to those who refused surgery (p < 0.001). There are significant sociodemographic factors that influence surgery refusal in PA patients. An individualized approach is warranted that considers functional status, clinical presentations, and patient choice.
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Affiliation(s)
- Jack L. Birkenbeuel
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
| | - Brandon M. Lehrich
- Medical Scientist Training Program, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
| | - Arash Abiri
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
| | - Frank P. K. Hsu
- Department of Neurosurgery, University of California, Irvine, CA 92868, USA
| | - Edward C. Kuan
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, CA 92868, USA
- Department of Neurosurgery, University of California, Irvine, CA 92868, USA
- Correspondence: ; Tel.: +1-714-456-5753
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Hu X, Ye H, Yan W, Sun Y. Factors Associated With Patient's Refusal of Recommended Cancer Surgery: Based on Surveillance, Epidemiology, and End Results. Front Public Health 2022; 9:785602. [PMID: 35111717 PMCID: PMC8801711 DOI: 10.3389/fpubh.2021.785602] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/22/2021] [Indexed: 02/01/2023] Open
Abstract
Objectives Most non-metastatic cancer patients can harvest a preferable survival after surgical treatment, however, patients sometimes refuse the recommended cancer-directed surgery. It is necessary to uncover the factors associated with patent's decision in taking cancer surgery and explore racial/ethnic disparities in surgery refusal. Methods Based on the Surveillance, Epidemiology and End Results (SEER)-18 program, we extracted data of non-metastatic cancer patients who didn't undergo surgery. Ten common solid cancers were selected. Four racial/ethnic categories were included: White, black, Hispanic, and Asian/Pacific Islander (API). Primary outcome was patient's refusal of surgery. Multivariable logistic regression models were used, with reported odds ratio (OR) and 95% confidence interval (CI). Results Among 318,318 patients, the incidence of surgery refusal was 3.5%. Advanced age, female patients, earlier cancer stage, uninsured/Medicaid and unmarried patients were significantly associated with higher odds of surgery refusal. Black and API patients were more likely to refuse recommended surgery than white patients in overall cancer (black-white: adjusted OR, 1.18; 95% CI, 1.11–1.26; API-white: adjusted OR, 1.56; 95% CI, 1.41–1.72); those racial/ethnic disparities narrowed down after additionally adjusting for insurance type and marital status. In subgroup analysis, API-white disparities in surgery refusal widely existed in prostate, lung/bronchus, liver, and stomach cancers. Conclusions Patient's socioeconomic conditions reflected by insurance type and marital status may play a key role in racial/ethnic disparities in surgery refusal. Oncological surgeons should fully consider the barriers behind patient's refusal of recommended surgery, thus promoting patient-doctor shared decision-making and guiding patients to the most appropriate therapy.
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Affiliation(s)
- Xianglin Hu
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- *Correspondence: Xianglin Hu
| | - Hui Ye
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Wangjun Yan
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Wangjun Yan
| | - Yangbai Sun
- Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
- Yangbai Sun
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Aydemirli MD, Snel M, van Wezel T, Ruano D, Obbink CMH, van den Hout WB, Schepers A, Morreau H. Yield and costs of molecular diagnostics on thyroid cytology slides in the Netherlands, adapting the Bethesda classification. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00293. [PMID: 34505415 PMCID: PMC8502216 DOI: 10.1002/edm2.293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 12/29/2022]
Abstract
Objective To evaluate our institutional experience with molecular diagnostics (MD) on thyroid cytology smears, evaluate the costs and describe MD guided clinical management of indeterminate Bethesda III/V thyroid nodules. Methods We performed a retrospective review of 164 Bethesda III or V thyroid cytopathology reports subjected to MD from 2013 to 2020, that altered Bethesda classification or management. MD consisted of mutation and gene fusion analysis by next‐generation sequencing (NGS) of morphologically analysed and selected cytological slides. Findings were modelled to nationwide data on Bethesda incidences from ‘the Dutch Pathology Registry’ PALGA, and costs were estimated. Results 82 of 164 cases received an upgrade in Bethesda class. Twenty cases changed from Bethesda III to IV/V, 62 from Bethesda III or V to VI, and 72 remained unaltered. We estimate net savings with implementing MD, by preventing 454 repeat cytology and 326 (diagnostic) hemithyroidectomies, to be at least 2 million Euro annually in the Netherlands. Per Bethesda III and V patient, net savings would be about 100 Euro and 4100 Euro, respectively. Conclusion NGS‐based MD on nucleic acids extracted directly from cytology slides is a feasible and cost saving tool for personalized management in indeterminate Bethesda III/V thyroid cytology. Based on the interpretation of our retrospective data, we assume that this approach results in less disease burden for the patient, reduced surgical interventions and complication risks, reduced sick leave, among others. Further evaluation of structural implementation of the presented approach in routine thyroid Bethesda III/V cytology in a prospective setting is warranted.
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Affiliation(s)
- Mehtap Derya Aydemirli
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke Snel
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dina Ruano
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Wilbert B van den Hout
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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Salem J, Shamil E, Ffolkes L, Ofo E. Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: demonstrating the natural progression of a rare and misunderstood disease. BMJ Case Rep 2021; 14:14/7/e241086. [PMID: 34312124 PMCID: PMC8314697 DOI: 10.1136/bcr-2020-241086] [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: 11/04/2022] Open
Abstract
Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid in a 46-year-old woman.
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Affiliation(s)
- Joseph Salem
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Eamon Shamil
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Lorrette Ffolkes
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Enyinnaya Ofo
- Ear, Nose and Throat Department, St George's University Hospitals NHS Foundation Trust, London, UK
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