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van de Berg DJ, Rodriguez Schaap PM, Jamaludin FS, van Santen HM, Clement SC, Vriens MR, van Trotsenburg ASP, Mooij CF, Bruinstroop E, Kruijff S, Peeters RP, Verburg FA, Netea-Maier RT, Nieveen van Dijkum EJM, Derikx JPM, Engelsman AF. The Definition of Recurrence of Differentiated Thyroid Cancer: A Systematic Review of the Literature. Thyroid 2024. [PMID: 39283824 DOI: 10.1089/thy.2024.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
Background: Recurrence is a key outcome to evaluate the treatment effect of differentiated thyroid carcinoma (DTC). However, no consistent definition of recurrence is available in current literature or international guidelines. Therefore, the primary aim of this systematic review was to delineate the definitions of recurrence of DTC, categorized by total thyroidectomy with radioactive iodine ablation (RAI), total thyroidectomy without RAI and lobectomy, to assess if there is a generally accepted definition among these categories. Methods: This study adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. In December 2023, a systematic literature search in MEDLINE and EMBASE was performed for studies reporting on the recurrence of DTC, from January 2018 to December 2023. Studies that did not provide a definition were excluded. Primary outcome was the definition of recurrence of DTC. Secondary outcome was whether studies differentiated between recurrence and persistent disease. Two independent investigators screened the titles and abstracts, followed by full-text assessment and data extraction. The study protocol was registered in PROSPERO, CRD42021291753. Results: In total, 1450 studies were identified. Seventy studies met the inclusion criteria, including 69 retrospective studies and 1 randomised controlled trial (RCT). Median number of patients in the included studies was 438 (range 25-2297). In total, 17 studies (24.3%) reported on lobectomy, 4 studies (5.7%) on total thyroidectomy without RAI, and 49 studies (70.0%) with RAI. All studies defined recurrence using one or a combination of four diagnostic modalities cytology/pathology, imaging studies, thyroglobulin (-antibodies), and a predetermined minimum tumor-free time span. The most common definition of recurrence following lobectomy was cytology/pathology-proven recurrence (47.1% of this subgroup), following total thyroidectomy with RAI was cytology/pathology-proven recurrence and/or anomalies detected on imaging studies (22.4% of this subgroup). No consistent definition was found following total thyroidectomy without RAI. Nine studies (12.9%) differentiated between recurrence and persistent disease. Conclusion: Our main finding is that there is no universally accepted definition for recurrence of DTC in the current studies across any of the treatment categories. The findings of this study will provide the basis for a future, international Delphi-based proposal to establish a universally accepted definition of recurrence of DTC. A uniform definition could facilitate global discussion and enhance the assessment of treatment outcomes regarding recurrence of DTC.
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Affiliation(s)
- Daniël J van de Berg
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pedro M Rodriguez Schaap
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Faridi S Jamaludin
- Amsterdam University Medical Centers, University of Amsterdam, Medical Library AMC, Amsterdam, The Netherlands
| | - Hanneke M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht University Medical Center, University of Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center, Utrecht, The Netherlands
| | - Sarah C Clement
- Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht University Medical Center, University of Utrecht, Utrecht, The Netherlands
| | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - A S Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Christiaan F Mooij
- Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Eveline Bruinstroop
- Department of Endocrinology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Romana T Netea-Maier
- Division of Endocrinology, Department of Internal Medicine, Radboud Medical Center, Radboud University Nijmegen, Nijmegen, The Netherlands
- Research Center for Functional Genomics, Biomedicine and Translation Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton F Engelsman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Allelein S, Ehlers M, Thoma T, Mattes-György K, Antke C, Mamlins E, Muchalla M, Giesel F, Schott M. Thyroglobulin Antibodies and Tumor Epitope-Specific Cellular Immunity in Papillary Thyroid Cancer. Horm Metab Res 2024; 56:424-428. [PMID: 38621693 DOI: 10.1055/a-2278-6549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Papillary thyroid carcinoma (PTC) is characterized by T cell infiltration and frequently by the presence of anti-thyroglobulin antibodies (TgAbs). The role of cellular immunity and of TbAbs in this context is a matter of debate. The aim of our study was to correlate the presence of TgAbs, tumor epitope-specific T cells and the clinical outcome of PTC patients. We studied n=183 consecutive patients with a diagnosis of PTC which were treated with total thyroidectomy plus 131I ablation. During a follow-up of in mean 97 months, most of the PTC patients had no signs of tumor relapse (n=157 patients). In contrast, one patient had serum Tg levels above the detection limit and<1 ng/ml, two patients Tg serum levels≥1 ng/ml and<2 ng/ml and n=23 patients had Tg serum levels≥2 ng/ml. Morphological signs of tumor recurrence were seen in 14 patients; all of these patients had serum Tg levels≥2 ng/ml. Importantly, with the exception of one patient, all TgAb positive PTC patients (n=27) had no signs of tumor recurrence as the serum Tg levels were below the assays functional sensitivities. Tetramer analyses revealed a higher number of tumor epitope-specific CD8+T cells in TgAb positive patients compared to TgAb negative PTC patients. In summary, we show that the occurrence of TgAbs may have an impact on the clinical outcome in PTC patients. This might be due to a tumor epitope-specific cellular immunity in PTC patients.
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Affiliation(s)
- Stephanie Allelein
- Division for Specific Endocrinology, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Margret Ehlers
- Division for Specific Endocrinology, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Taina Thoma
- Division for Specific Endocrinology, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany
| | | | - Christina Antke
- Clinic for Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Eduards Mamlins
- Clinic for Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Mareike Muchalla
- Division for Specific Endocrinology, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Frederik Giesel
- Clinic for Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matthias Schott
- Division for Specific Endocrinology, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany
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Zhao Y, Mu Z, Liang D, Zhang T, Zhang X, Sun D, Sun Y, Liang J, Lin Y. Prognostic value of postoperative anti-thyroglobulin antibody in patients with differentiated thyroid cancer. Front Endocrinol (Lausanne) 2024; 15:1354426. [PMID: 38721144 PMCID: PMC11076744 DOI: 10.3389/fendo.2024.1354426] [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: 12/12/2023] [Accepted: 04/03/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose Postoperative thyroglobulin (Tg) generally serves as a biomarker to monitor the recurrence or persistence of differentiated thyroid cancer (DTC), whereas it constrains to interference from anti-thyroglobulin antibody (TgAb). This study aimed to determine the value of postoperative TgAb as a surrogate for monitoring tumor status in DTCs with positive TgAb after successful radioactive iodine (RAI) remnant ablation. Methods We retrospectively enrolled DTC patients with positive (≥40 IU/mL, Roche) postoperative TgAb measurements. An index of TgAb change (ΔTgAb) was defined to describe the TgAb decrease rate. DTC status was defined as either no evidence of disease (NED) or persistent/recurrent disease (PRD). Univariate and multivariate binary logistic analyses were used to identify the independent risk factors of PRD. Receiver operating characteristic (ROC) curves were performed to determine the optimal cutoff values of each risk factor, and DeLong's test was conducted to compare their predictive powers. Kaplan-Meier curves were used to assess the impact of different TgAb trends in the first year on progression-free survival. Results Of the 232 patients enrolled, the median diagnosis age was 34 years (range, 18-62 years), with a male-to-female ratio of 1:4.66 (41/191). Among them, after a median follow-up of 44 months (range, 4-128 months),183 (78.87%) patients were evaluated as NED, while the other 49 (21.12%) had either persistent (n = 25) or recurrent disease (n = 24). Multivariate regression showed that ΔTgAb (P < 0.001) and lymph node metastasis (LNM) rate (P = 0.009) were independently relevant to the presence of PRD, with optimal cutoff values of 47.0% and 35.1%, respectively. It is important to note that there is a high negative predictive value (96.93%) of ΔTgAb with the cutoff of 47.0%. DeLong's test showed that ΔTgAb alone and the combination of ΔTgAb and LNM rate were significantly greater than the isolated LNM rate (both P < 0.001) in predicting NED, while there was no statistical difference of the predictive power between ΔTgAb and the combination (P = 0.203). Additionally, patients with ΔTgAb >47.0% had longer progression-free survival than those with ΔTgAb ≤47.0% (not reached vs. 50 months, P < 0.001), and those with ΔTgAb >47.0% or negative conversion within the first year after RAI ablation had longer progression-free survival. Conclusion Our study suggested that ΔTgAb could serve as a valuable indicator of disease status in DTC patients with positive TgAb. A ΔTgAb of >47.0% is conducive to identify those with NED and may help to obviate their overtreatment. The decrease rate and negative conversion of TgAb in the first year were good predictors of disease-free survival in patients.
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Affiliation(s)
- Yihan Zhao
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing, China
- Department of Nuclear Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhuanzhuan Mu
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing, China
| | - Dongquan Liang
- Department of Psychology, Pepperdine University Graduate School of Education and Psychology, Los Angeles, CA, United States
| | - Teng Zhang
- Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing, China
| | - Di Sun
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing, China
| | - Yuqing Sun
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing, China
| | - Yansong Lin
- Department of Nuclear Medicine, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College (PUMC) Hospital, Chinese Academy of Medical Sciences & PUMC, Beijing, China
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Sanjari M, Ordooei M, Amirkhosravi L, Naghibzadeh-Tahami A, Nazemi S. The effect of positive thyroglobulin antibodies on the prognosis and treatment response in patients with papillary thyroid carcinoma. Heliyon 2024; 10:e26092. [PMID: 38384522 PMCID: PMC10879018 DOI: 10.1016/j.heliyon.2024.e26092] [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: 07/01/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Almost 15-30% of patients with papillary thyroid carcinoma (PTC) experience some degree of recurrence after treatment. Long-term follow-up and examination after thyroidectomy are very important in dealing with this issue. Serum thyroglobulin (Tg) level and neck ultrasound are the main part of follow-up for this purpose. The presence of thyroglobulin antibodies (TgAbs) leads to unreliable thyroglobulin (Tg) levels. The present study aims to evaluate the relationship between the simultaneous measurement of Tg and TgAb with long-term survival and response to treatment in these patients. This study was conducted by surveying available data from the medical records of 204 out of 600 patients over a 20-year period. In this research, 104 patients with positive TgAb were considered as the case group, and 100 patients with negative TgAb were selected as the control group. The relationship of TgAb titer was investigated with the staging, response to treatment (including the surgery number, number of radiotherapies, and dose of radioactive iodine), and recurrence in these patients. Also, the trend of TgAb changes was examined in the presence of high or low thyroglobulin levels during the follow-up period. Patients with high TgAb levels had more lymph node involvement, higher cumulative dose, a higher number of times received iodine, more surgical number, higher recurrence rate, and less excellent response (ER) to treatment during follow-ups. This effect of TgAb worsened in the presence of high Tg titer and remained up to 36 months. Overall, the baseline level of TgAb and its changes can be a suitable factor for predicting subsequent response to treatment and recurrence in patients with PTC. Accordingly, in cases with high TgAb and Tg levels, close follow-up should be considered up to Tg and TgAb normalization.
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Affiliation(s)
- Mojgan Sanjari
- Endocrinology and Metabolism Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Marzieh Ordooei
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ladan Amirkhosravi
- Endocrinology and Metabolism Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Naghibzadeh-Tahami
- Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Sarir Nazemi
- Department of Radiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
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Dos Santos Valsecchi VA, Betoni FR, Ward LS, Cunha LL. Clinical and molecular impact of concurrent thyroid autoimmune disease and thyroid cancer: From the bench to bedside. Rev Endocr Metab Disord 2024; 25:5-17. [PMID: 37889392 DOI: 10.1007/s11154-023-09846-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
The recent incorporation of immune checkpoint inhibitors targeting the PD-1 (programmed cell death receptor 1) and CTLA-4 (cytotoxic T lymphocyte antigen 4) pathways into the therapeutic armamentarium of cancer has increased the need to understand the correlation between the immune system, autoimmunity, and malignant neoplasms. Both autoimmune thyroid diseases and thyroid cancer are common clinical conditions. The molecular pathology of autoimmune thyroid diseases is characterized by the important impact of the PD-1/PD-L1 axis, an important inhibitory pathway involved in the regulation of T-cell responses. Insufficient inhibitory pathways may prone the thyroid tissue to a self-destructive immune response that leads to hypothyroidism. On the other hand, the PD-1/PD-L1 axis and other co-inhibitory pathways are the cornerstones of the immune escape mechanisms in thyroid cancer, which is a mechanism through which the immune response fails to recognize and eradicate thyroid tumor cells. This common mechanism raises the idea that thyroid autoimmunity and thyroid cancer may be opposite sides of the same coin, meaning that both conditions share similar molecular signatures. When associated with thyroid autoimmunity, thyroid cancer may have a less aggressive presentation, even though the molecular explanation of this clinical consequence is unclear. More studies are warranted to elucidate the molecular link between thyroid autoimmune disease and thyroid cancer. The prognostic impact that thyroid autoimmune disease, especially chronic lymphocytic thyroiditis, may exert on thyroid cancer raises important insights that can help physicians to better individualize the management of patients with thyroid cancer.
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Affiliation(s)
- Victor Alexandre Dos Santos Valsecchi
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Federal University of São Paulo, São Paulo, Brazil
- Division of Emergency Medicine and Evidence-Based Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Felipe Rodrigues Betoni
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Federal University of São Paulo, São Paulo, Brazil
- Division of Emergency Medicine and Evidence-Based Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Laura Sterian Ward
- Laboratory of Cancer Molecular Genetics, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Lucas Leite Cunha
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Federal University of São Paulo, São Paulo, Brazil.
- Division of Emergency Medicine and Evidence-Based Medicine, Federal University of São Paulo, São Paulo, Brazil.
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Han N, Lu C, Li J, Wang C, Zhao Z, Zhang Y, Liu X, Si Z, Wang G, Wang Z, Li F, Wang X. Stimulated thyroglobulin and pre-ablation antithyroglobulin antibody products can predict the response to radioiodine therapy of TgAb-positive differentiated thyroid cancer patients: a retrospective study. Front Endocrinol (Lausanne) 2023; 14:1222470. [PMID: 37810895 PMCID: PMC10556735 DOI: 10.3389/fendo.2023.1222470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objective We aimed to explore the predictive value of stimulated thyroglobulin (sTg) and pre-ablation antithyroglobulin (pa-TgAb) products for the effect of radioiodine therapy (RAIT) on TgAb-positive differentiated thyroid cancer (DTC) patients. Methods In this study, we enrolled 265 patients with TgAb-positive DTC who underwent RAIT after total thyroidectomy (TT). Based on the last follow-up result, the patients were divided into two groups: the excellent response (ER) group and the non-excellent response (NER) group. We analyzed the factors related to the effect of RAIT. Results The ER group consisted of 197 patients. The NER group consisted of 68 patients. For the univariate analysis, we found that the maximal tumor diameter, whether with extrathyroidal extension (ETE), bilateral or unilateral primary lesion, multifocality, preoperative TgAb (preop-TgAb), pa-TgAb, sTg × pa-TgAb, initial RAIT dose, N stage, and surgical extent (modified radical neck dissection or not), showed significant differences between the ER group and NER group (all p-values <0.05). The receiver operating characteristic (ROC) curves showed that the cutoff value was 724.25 IU/ml, 424.00 IU/ml, and 59.73 for preop-TgAb, pa-TgAb, and sTg × pa-TgAb, respectively. The multivariate logistic regression analysis results indicated that pa-TgAb, sTg × pa-TgAb, initial RAIT dose, and N stage were independent risk factors for NER (all p-values <0.05). For the Kaplan-Meier analysis of disease-free survival (DFS), the median DFS of the patients with sTg × pa-TgAb < 59.73 and initial RAIT dose ≤ 100 mCi was significantly longer than that of the patients with sTg × pa-TgAb ≥ 59.73 (50.27 months vs. 48.59 months, p = 0.041) and initial RAIT dose >100 mCi (50.50 months vs. 38.00 months, p = 0.030). Conclusion We found the sTg and pa-TgAb conducts is a good predictor of the efficacy of RAIT in TgAb-positive DTC patients. It can play a very positive and important role in optimizing treatment, improving prognosis, and reducing the burden of patients.
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Affiliation(s)
- Na Han
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Chenghui Lu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiao Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Congcong Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zilong Zhao
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- Department of Nuclear Medicine, Ordos Central Hospital, Ordos, Inner Mongolia, China
| | - Yingying Zhang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xinfeng Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zengmei Si
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Guoqiang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zenghua Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Fengqi Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xufu Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Campopiano MC, Ghirri A, Prete A, Lorusso L, Puleo L, Cappagli V, Agate L, Bottici V, Brogioni S, Gambale C, Minaldi E, Matrone A, Elisei R, Molinaro E. Active surveillance in differentiated thyroid cancer: a strategy applicable to all treatment categories response. Front Endocrinol (Lausanne) 2023; 14:1133958. [PMID: 37152950 PMCID: PMC10157216 DOI: 10.3389/fendo.2023.1133958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Currently, the differentiated thyroid cancer (DTC) management is shifted toward a tailored approach based on the estimated risks of recurrence and disease-specific mortality. While the current recommendations on the management of metastatic and progressive DTC are clear and unambiguous, the management of slowly progressive or indeterminate disease varies according to different centers and different physicians. In this context, active surveillance (AS) becomes the main tool for clinicians, allowing them to plan a personalized therapeutic strategy, based on the risk of an unfavorable prognosis, and to avoid unnecessary treatment. This review analyzes the main possible scenarios in treated DTC patients who could take advantage of AS.
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Iglesias ML, Calabretta JM, Coggiola O, Califano I. Thyroglobulin antibodies: Trend over time and clinical impact in differentiated thyroid carcinoma with and without radioiodine ablation. ENDOCRINOL DIAB NUTR 2022; 69:702-708. [PMID: 36470645 DOI: 10.1016/j.endien.2022.11.005] [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] [Received: 07/20/2021] [Accepted: 11/04/2021] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Thyroglobulin antibodies (TgAb) trend may be considered a surrogate marker for thyroglobulin in differentiated thyroid carcinoma. The aim of this study is to analyse, in cases with positive TgAb, trend over time and its relationship with response to treatment. MATERIAL AND METHODS Retrospective and descriptive study of 100 patients with differentiated thyroid carcinoma and positive TgAb (measured by electrochemoluminiscense) after thyroidectomy. Assessment of response to initial treatment was performed 6-24 months after surgery. Status at last follow-up was evaluated. RESULTS After the first year nearly half of the patients showed a reduction in TgAb levels ≥50%, in 91% of these patients, status at last follow up was excellent response (65%) or indeterminate response due to decreasing TgAb levels (26%). At first assessment, indeterminate responses were found in 49% of cases, without significant differences among initial risk of recurrence category or whether radioiodine ablation was performed. At last evaluation (median 53.5 months), 15% of ablated low-risk patients had an indeterminate response (due to declining TgAb), vs 62% in the non-ablated low-risk group (p 0.03). Median time to negativization for post-surgical TgAb levels<100UI/ml was 11 months [3-94] vs 31 months [8-119] for patients with TgAb≥100UI/ml (p 0.0003). CONCLUSION A reduction of ≥50% in TgAb levels during the first year correlated with favourable outcomes. Non-ablated patients and patients with higher levels of post-surgical TgAb may need a longer time to achieve negative conversion.
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Affiliation(s)
- María Laura Iglesias
- Endocrinology Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina.
| | - Juan Matías Calabretta
- Endocrinology Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina
| | - Osvaldo Coggiola
- Biochemistry Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina
| | - Inés Califano
- Endocrinology Department, Instituto de oncología Angel H. Roffo, Avenida. San Martín 5481, C1417DTB Buenos Aires, Argentina
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Iglesias ML, Calabretta JM, Coggiola O, Califano I. Thyroglobulin antibodies: Trend over time and clinical impact in differentiated thyroid carcinoma with and without radioiodine ablation. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xi C, Zhang GQ, Song HJ, Shen CT, Hou LY, Qiu ZL, Luo QY. Change in Antithyroglobulin Antibody Levels is a Good Predictor of Responses to Therapy in Antithyroglobulin Antibody-Positive Pediatric Papillary Thyroid Carcinoma Patients. Int J Endocrinol 2022; 2022:7173919. [PMID: 35311033 PMCID: PMC8930237 DOI: 10.1155/2022/7173919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Antithyroglobulin antibodies (TgAbs) could be used as a surrogate tumor marker of TgAb-positive-differentiated thyroid carcinoma. This study aims to determine whether the change in TgAb levels over time could be used as a predictor of responses to therapy in pediatric papillary thyroid carcinoma (PTC) patients. METHODS We retrospectively analyzed the records of 48 pediatric PTC patients with TgAb levels ≥50 IU/ml 6 months after initial 131I treatment. Suppressed thyroglobulin (Tg) levels 6 months after initial 131I treatment were used to divide the patients into positive Tg (P-Tg, Tg ≥ 0.2 ng/ml) and negative Tg (N-Tg, Tg < 0.2 ng/ml) groups. Responses to therapy were classified as the acceptable response (AR) group and the not acceptable response (NAR) group. RESULTS Of 48 enrolled patients with 58 months (range, 24-143 months) of follow-up, 28 patients had NAR and 20 patients had AR. TgAb levels were decreasing ≥50% in 28 patients, decreasing <50% in 8 patients, and increasing in 12 patients. Multivariate analysis showed that high initial risk stratification and TgAb levels decreasing <50% or increasing were significantly associated with NAR (p < 0.05). Changes in Tg levels were also associated with NAR in the P-Tg group (p < 0.05). CONCLUSION Changes in TgAb levels over time could be used as a predictor of responses to therapy in TgAb-positive pediatric PTC patients. Changes in Tg levels over time are also associated with NAR to therapy in both TgAb-positive and Tg-positive pediatric PTC patients.
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Affiliation(s)
- Chuang Xi
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Guo-Qiang Zhang
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Hong-Jun Song
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Chen-Tian Shen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Li-Ying Hou
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Zhong-Ling Qiu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
| | - Quan-Yong Luo
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China
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Liu P, Lin J, Nie Y, Cao Z, Xu X. Awareness of thyroid cancer among medical students: A questionnaire-based study. Sci Prog 2021; 104:368504211023654. [PMID: 34128740 PMCID: PMC10358495 DOI: 10.1177/00368504211023654] [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] [Indexed: 11/17/2022]
Abstract
To investigate whether medical students acquire enough knowledge about thyroid cancer (TC). It was a cross-sectional study in a Chinese medical college based on a questionnaire about the knowledge of TC and thyroid self-examination. Medical students enrolled were grouped into preclinical medical students (PMS) and clinical medical students (CMS) according to their grades. A total of 337 questionnaires were distributed and 274 effective responses were collected with 129 from PMS and 145 from CMS. The percentage of thyroid self-examination in CMS was higher than that of PMS (55.8% vs 11.6%, p < 0.001). Generally, CMS had better comprehension of TC, including prognosis (97.2% vs 64.5%, p < 0.001), diagnosis (95.6% vs 33.1%, p < 0.001), and surgery indications (82.1% vs 58.1%, p = 0.001). There was no significant difference between PMS and CMS on the acquaintance of the risk factors. However, more CMS stated that the below 5% of thyroid nodules might turn malignant (45.5% vs 6.5%, p < 0.001), and more CMS suggested that people without nodules should receive TC screening tests (62.1% vs 41.9%, p = 0.001). Medical education on TC was effective in teaching clinical knowledge. Medical school should focus more on preclinical general health education and clinical practices education in the future.
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Affiliation(s)
- Penghao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinkan Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongdu Nie
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zenghan Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiequn Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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de Jonge H, Iamele L, Maggi M, Pessino G, Scotti C. Anti-Cancer Auto-Antibodies: Roles, Applications and Open Issues. Cancers (Basel) 2021; 13:813. [PMID: 33672007 PMCID: PMC7919283 DOI: 10.3390/cancers13040813] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 12/11/2022] Open
Abstract
Auto-antibodies are classically associated with autoimmune diseases, where they are an integral part of diagnostic panels. However, recent evidence is accumulating on the presence of auto-antibodies against single or selected panels of auto-antigens in many types of cancer. Auto-antibodies might initially represent an epiphenomenon derived from the inflammatory environment induced by the tumor. However, their effect on tumor evolution can be crucial, as is discussed in this paper. It has been demonstrated that some of these auto-antibodies can be used for early detection and cancer staging, as well as for monitoring of cancer regression during treatment and follow up. Interestingly, certain auto-antibodies were found to promote cancer progression and metastasis, while others contribute to the body's defense against it. Moreover, auto-antibodies are of a polyclonal nature, which means that often several antibodies are involved in the response to a single tumor antigen. Dissection of these antibody specificities is now possible, allowing their identification at the genetic, structural, and epitope levels. In this review, we report the evidence available on the presence of auto-antibodies in the main cancer types and discuss some of the open issues that still need to be addressed by the research community.
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Affiliation(s)
| | | | | | | | - Claudia Scotti
- Unit of Immunology and General Pathology, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy; (H.d.J.); (L.I.); (M.M.); (G.P.)
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Lee ZJO, Eslick GD, Edirimanne S. Investigating Antithyroglobulin Antibody As a Prognostic Marker for Differentiated Thyroid Cancer: A Meta-Analysis and Systematic Review. Thyroid 2020; 30:1601-1612. [PMID: 32345152 DOI: 10.1089/thy.2019.0368] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Serum thyroglobulin (Tg) is used in the follow-up of patients with differentiated thyroid cancers (DTC), but the presence of antithyroglobulin antibodies (TgAbs) makes Tg measurements unreliable. TgAb decline after total thyroidectomy and persistent/increasing levels may indicate cancer persistence/recurrence. Hence, we aimed to determine whether TgAb might be a reliable prognostic marker for DTC. Methods: We conducted a meta-analysis and systematic review. A comprehensive literature search was performed to identify studies of patients with DTC with known TgAb status and prognostic outcomes in five databases (Medline, Embase, PubMed, Google Scholar, and Scopus). We used a random-effects model to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs) for TgAb status and its association with DTC prognosis. Results: After analysis of 34 studies, we found that TgAb+ patients have a higher risk of lymph node metastasis (OR = 1.18 [CI 1.47-2.25]) and cancer persistence/recurrence (OR = 2.78 [CI 1.55-4.98]) than TgAb- patients. However, no significant differences in mean/median tumor size, risk of extrathyroidal extension, tumor multifocality, and cancer mortality were found between the two groups. In a comparison of TgAb trends, patients with persistent/increasing TgAb levels were found to have a higher risk of cancer persistence/recurrence (OR = 9.90 [CI 4.36-22.50]) and cancer mortality (OR = 15.18 [CI 2.99-77]) than patients with decreasing TgAb levels. Conclusions: TgAb positivity and persistent/increasing trends were associated with compromised DTC prognosis. These results suggest that TgAb may be used as a prognostic marker in the follow-up of patients with DTC.
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Affiliation(s)
- Zhao Jian Oswald Lee
- Department of Surgery, Nepean Clinical School, University of Sydney, Penrith, Australia
| | - Guy D Eslick
- Department of Surgery, Nepean Clinical School, University of Sydney, Penrith, Australia
- The Whiteley-Martin Research Centre, Discipline of Surgery, University of Sydney, Penrith, Australia
| | - Senarath Edirimanne
- Department of Surgery, Nepean Clinical School, University of Sydney, Penrith, Australia
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Gambale C, Elisei R, Matrone A. Management and follow-up of differentiated thyroid cancer not submitted to radioiodine treatment: a systematic review. MINERVA ENDOCRINOL 2020; 45:306-317. [PMID: 32623845 DOI: 10.23736/s0391-1977.20.03240-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The treatment of differentiated thyroid cancer (DTC) has been changing. In low (LR) and intermediate (IR) risk DTC, surgery is becoming more conservative and the usefulness of radioiodine (131I) has been questioned. An increasing number of patients are treated with lobectomy or total thyroidectomy (TTx), but without 131I. Consequently, the management and the follow-up of these patients need to be revised. EVIDENCE ACQUISITION We reviewed the available data about the management of these growing categories of patients. We focused on the emerging roles of the conventional tools in the follow-up [thyroglobulin (Tg), thyroglobulin antibodies (TgAb) and neck ultrasound (US)]. Moreover, we evaluated the changes in the use of levothyroxine (L-T4) therapy, and the role of the ongoing risk re-stratification. EVIDENCE SYNTHESIS Tg, TgAb and neck US continue to represent the cornerstone of the follow-up, however, a change in their interpretation is needed. In particular, the absolute value of Tg and TgAb lost their clinical meaning, while their trend over time acquired a greater value. At variance, the diagnostic role of neck US is becoming very relevant for the early identification of the local recurrences. In addition, L-T4 therapy should be personalized according with the type of surgery, the age of patients and their comorbidities. CONCLUSIONS Management of DTC treated with lobectomy or TTx but without 131I is worldwide changing. The evidences suggest that in this setting of patients with LR or IR of recurrences, a relaxed surveillance could represent the most reasonable choice.
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Affiliation(s)
- Carla Gambale
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rossella Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Antonio Matrone
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy -
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15
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Bueno F, Falcone MGG, Peñaloza MA, Abelleira E, Pitoia F. Dynamics of serum antithyroglobulin antibodies in patients with differentiated thyroid cancer. Endocrine 2020; 67:387-396. [PMID: 31650394 DOI: 10.1007/s12020-019-02112-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 10/02/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Serum antithyroglobulin antibodies (sTgAb) affect the reliability of Tg measurement in patients with thyroid cancer. We compared the outcome of patients with detectable and undetectable sTgAb, stratified according to the initial risk of recurrence (RR); also the response to treatment in patients with detectable sTgAb treated with total thyroidectomy (TT) with and without radioiodine remnant ablation (RA) and the sTgAb trend in the long-term follow-up according to the initial response. METHODS We included 432 patients submitted to TT, with or without RA; 106 patients had detectable sTgAb levels. Median follow-up was 53 months. RESULTS There were no statistically significant differences considering presentation between negative or positive sTgAb subjects. The frequency of structural incomplete response (SIR) in low, intermediate, and high RR was similar. Undetectable sTgAb in patients was achieved in a median of 16 months in ablated patients compared with 11 months in those without RA (p = 0.0232). Patients without RA had a higher rate of undetectable sTgAb during the first 12 months. A SIR was observed in 3% of patients with declining sTgAb, in 19% of those with stable levels, and in 43% with increasing sTgAb (p = 0.004). The status of no evidence of disease was achieved more frequently in patients with initial sTgAb levels < 200 mUI/l, independently of the initial RR. CONCLUSIONS There was no impact of sTgAb on the initial clinical presentation and the response to therapy in low-risk patients treated with or without RA. sTgAb trend is more useful than an absolute value to predict a SIR.
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Affiliation(s)
- Fernanda Bueno
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | | | - Mirna Angela Peñaloza
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | - Erika Abelleira
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina
| | - Fabián Pitoia
- Division of Endocrinology, Hospital de Clínicas-University of Buenos Aires, Buenos Aires, Argentina.
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Xiao Y, Zhou Q, Xu Y, Yuan SL, Liu QA. Positive thyroid antibodies and risk of thyroid cancer: A systematic review and meta-analysis. Mol Clin Oncol 2019; 11:234-242. [PMID: 31341621 PMCID: PMC6636211 DOI: 10.3892/mco.2019.1886] [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] [Received: 01/17/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Previous studies assessing the association between thyroid antibodies and the risk of thyroid cancer (TC) have produced inconsistent results. The present study therefore conducted a meta-analysis of the available data. PubMed, Embase and the Cochrane Library were searched for the retrieval of relevant studies and a meta-analysis was conducted to systematically evaluate the association between positive thyroid antibodies and the risk of TC. This search identified 16 articles containing 17 studies on thyroglobulin antibodies (TgAb), which involved a total of 34,488 patients. Positive TgAb was associated with an increased risk of TC [odds ratio (OR)=1.93, 95% confidence interval (CI)=1.64–2.27, I2=67.2%]. Whether to adjust for confounding factors (gender and thyroid nodule number) was the main cause of heterogeneity. A stronger association between positive TgAb and an increased risk of TC was identified in the studies with an unadjusted thyroid nodule number (OR=2.14, 95% CI=1.82–2.52), as compared to those with an adjusted thyroid nodule number (OR=1.61, 95% CI=1.29–2.00; P=0.04). In addition, 12 studies on thyroid peroxidase antibodies (TPOAb) involving 30,007 patients were included. Positive TPOAb was associated with an increased risk of TC (OR=1.50, 95%CI=1.16–1.95, I2=83.0%). No significant heterogeneity was observed in the PTC group. Positive TgAb is an independent risk factor for TC. The association between positive TPOAb and increased risk of TC needs to be further studied.
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Affiliation(s)
- Yang Xiao
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China.,Department of General Surgery, Affiliated Changde Hospital, University of South China, Changde, Hunan 415003, P.R. China
| | - Quan Zhou
- Department of Science and Education, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Yong Xu
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Song-Lin Yuan
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Qing-An Liu
- Department of General Surgery, First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
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Role of thyroglobulin in the management of patients with differentiated thyroid cancer. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00325-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Matrone A, Latrofa F, Torregrossa L, Piaggi P, Gambale C, Faranda A, Ricci D, Agate L, Molinaro E, Basolo F, Vitti P, Elisei R. Changing Trend of Thyroglobulin Antibodies in Patients With Differentiated Thyroid Cancer Treated With Total Thyroidectomy Without 131I Ablation. Thyroid 2018; 28:871-879. [PMID: 29860933 DOI: 10.1089/thy.2018.0080] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroglobulin (Tg) antibodies (TgAb) can interfere with Tg measurement and can be used as "Tg surrogate" in patients with differentiated thyroid cancer (DTC) treated with total thyroidectomy (TTx) and radioiodine remnant ablation (RRA). In contrast, few data, and in patients usually followed for a short-term follow-up, have been reported about the changes of TgAb levels in patients treated with TTx but without RRA. The aims of this study were to evaluate the changes of TgAb levels in DTC patients treated with TTx but not RRA and to identify the factors that influence these changes. METHODS The change in TgAb levels in 107 DTC (<1 cm) patients submitted to TTx but not RRA was evaluated. Patients were followed for a median of 6.3 years, and all had at least three determinations of TgAb and neck ultrasound (nUS). RESULTS TgAb levels showed a progressive decrease during follow-up. Initial TgAb levels and degree of lymphocytic infiltration influenced the time but not the rate of TgAb disappearance. No influence on time and rate of the decrease in TgAb was observed when the association with thyroperoxidase antibodies (TPOAb) levels were considered. A TgAb cutoff value of 61.9 IU/mL at first postoperative evaluation was a good indicator for disappearance of the TgAb within six years. No tumor recurrence was observed in the series. In one case, the progressive increase in TgAb anticipated the reappearance of benign thyroid tissue with lymphocytic infiltration. CONCLUSIONS TgAb levels decline in the majority of DTC patients treated with TTx but not ablated with radioiodine. The levels decrease rapidly after the surgical treatment and continue to decrease over time. The time of disappearance is influenced by the initial TgAb levels and the degree of lymphocytic infiltration. No influence of the actual TPOAb levels has been observed. An increase in TgAb levels should not be overlooked, since it can indicate the presence or reappearance of either normal thyroid tissue or tumor recurrence.
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Affiliation(s)
- Antonio Matrone
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Francesco Latrofa
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Liborio Torregrossa
- 2 Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University of Pisa , Pisa, Italy
| | - Paolo Piaggi
- 3 Phoenix Epidemiology and Clinical Research Branch National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health , Phoenix, Arizona
| | - Carla Gambale
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Alessio Faranda
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Debora Ricci
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Laura Agate
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Eleonora Molinaro
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Fulvio Basolo
- 2 Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University of Pisa , Pisa, Italy
| | - Paolo Vitti
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
| | - Rossella Elisei
- 1 Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa , Pisa, Italy
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Viola D, Agate L, Molinaro E, Bottici V, Lorusso L, Latrofa F, Torregrossa L, Boldrini L, Ramone T, Vitti P, Elisei R. Lung Recurrence of Papillary Thyroid Cancer Diagnosed With Antithyroglobulin Antibodies After 10 Years From Initial Treatment. Front Endocrinol (Lausanne) 2018; 9:590. [PMID: 30356857 PMCID: PMC6190843 DOI: 10.3389/fendo.2018.00590] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/18/2018] [Indexed: 02/01/2023] Open
Abstract
Introduction: Papillary thyroid cancer (PTC) is the most common endocrine malignancy. More than 98% of patients achieve an excellent response with no evidence of clinical, biochemical, or structural disease after initial treatment. In these patients structural recurrence is rare, more frequently diagnosed in the first 5 years from initial treatment and almost invariably localized in neck lymph nodes. Patient: We report the case of a woman affected by PTC who presented with rapidly rising anti-thyroglobulin antibodies (TgAb) level after 10 years from clinical, morphological and biochemical remission. Diagnosis and Treatment: In 2003, a 56 year old patient was treated with total thyroidectomy and radioiodine remnant ablation (RRA) for a PTC (2 cm) with minimal extrathyroidal extension (T3N1aM0 according to the 6th AJCC TNM staging system) associated with diffuse lymphocytic thyroiditis. In 2004 the patient was free of disease defined as undetectable Tg after recombinant human TSH administration in the absence of TgAb and structural disease. Since February 2012 the appearance and progressive increase of TgAb titer was observed and in 2014 a 18FDG-PET scan documented three hypermetabolic lesions suggestive of lung micrometastases. The lung lesions were cytologically confirmed as PTC metastases. Both the primary tissue and the lung metastasis were positive for BRAF V600E mutation. The patient was treated with 131-radioiodine that showed radioiodine avid lung lesions that lose the ability to take up iodine at the following treatment. The patient is still alive and the lung lesions are growing slowly. Conclusions: Structural recurrence in patients that demonstrated an excellent response after initial treatment for PTC is extremely rare, and distant metastases exceptional but possible. This case is peculiar because recurrence was early identified after 10 years from initial treatment for the presence of detectable TgAb in a patient that had an histological diagnosis of lymphocytic thyroiditis but with an atypical clinical presentation (normal thyroid at neck ultrasound and undetectable TgAb and anti-thyroid peroxidase antibodies). For this reason TgAb should be tested with Tg in patients with a history of lymphocytic thyroiditis, either histological or humoral, also when TgAb is in the normal range and not suggestive of autoimmune thyroiditis.
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Affiliation(s)
- David Viola
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: David Viola
| | - Laura Agate
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eleonora Molinaro
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Bottici
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Loredana Lorusso
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesco Latrofa
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liborio Torregrossa
- Unit of Pathological Anatomy, Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Laura Boldrini
- Unit of Pathological Anatomy, Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Teresa Ramone
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Vitti
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Rossella Elisei
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