1
|
Lai HF, Hang JF, Kuo PC, Kuo CS, Yao SF, Chen JY, Lee CH. BRAF V600E Mutation Lacks Association with Poorer Clinical Prognosis in Papillary Thyroid Carcinoma. Ann Surg Oncol 2024; 31:3495-3501. [PMID: 38300401 DOI: 10.1245/s10434-024-14935-4] [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: 08/08/2023] [Accepted: 12/31/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Previous literatures showed wide range of prevalence of BRAF V600E in papillary thyroid carcinoma (PTC). The correlation of BRAF V600E mutation with aggressive tumor characteristics and poor prognosis is controversial. The present study was designed to evaluate the association between BRAF V600E mutation with clinicopathological factors and tumor recurrence. PATIENTS AND METHODS We performed a retrospective chart review of 672 patients who underwent thyroid surgery for PTC during 2013 and 2018. The prevalence of the BRAF V600E mutation was studied. Its correlation with clinicopathologic characteristics and aggressive features, including macroscopic extrathyroidal extension, lymph node metastasis, and distant metastasis, were analyzed with Fisher's exact test. RESULTS A total of 672 patients who underwent surgical treatment for PTC were included in this study with a mean age of 49.7 (± 13.2) years; 76.8% of the patients were detected with BRAF V600E mutation. Mean tumor size was 1.30 (± 1.07) cm. A significant association was demonstrated between negative BRAF V600E and larger primary tumor size, distant metastasis, and advanced staging (p < 0.05), whereas there was no significant association with age, sex, lymph node metastasis, extrathyroidal extension, and multicentricity. Kaplan-Meier curve showed similar disease-free survival rate between the two groups. CONCLUSIONS Negative BRAF V600E tumors show more aggressive behavior with a higher risk of developing distant metastasis in patients with PTC. The usefulness of BRAF in predicting the prognosis of PTC remains questionable. Further molecular analysis should be conducted for contribution to aggressive tumor phenotype.
Collapse
Affiliation(s)
- Hon-Fan Lai
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jen-Fan Hang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Po-Chung Kuo
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chin-Sung Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - San-Fan Yao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jui-Yu Chen
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
- Institute of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Chen-Hsen Lee
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| |
Collapse
|
2
|
Zuhur SS, Aggul H, Avci U, Erol S, Tuna MM, Uysal S, Akbaba G, Kilinc F, Catak M, Tekin S, Ozturk BO, Yavuz HC, Kadioglu P, Cinar N, Bayraktaroglu T, Topcu B, Altuntas Y, Elbuken G. The impact of microscopic extrathyroidal extension on the clinical outcome of classic subtype papillary thyroid microcarcinoma: a multicenter study. Endocrine 2024; 83:700-707. [PMID: 37736822 DOI: 10.1007/s12020-023-03533-1] [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: 07/05/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Despite the presumed overdiagnosis of papillary thyroid microcarcinoma (PTMC) which has resulted in a new trend toward less-extensive surgery and a preference for active surveillance, the impact of microscopic extrathyroidal extension (mETE) on the clinical outcomes of PTMC is still controversial. This study assessed the impact of mETE on the clinical outcomes of patients with classic subtype PTMC. METHODS The data of consecutive patients who underwent thyroidectomy and were histopathologically diagnosed as classic subtype PTMC were analyzed. Cox's proportional hazards model was used to assess the impact of contributing variables on persistent/recurrent disease. Disease-free survival was estimated using the Kaplan-Meier method. RESULTS This study included 1013 patients (84% females), with a mean follow-up period of 62.5 ± 35.3 months. Patients with mETE had a significantly higher rate of locoregional persistent/recurrent disease than patients without mETE (9.8% vs 2.1%, p < 0.001). The disease-free survival rate was significantly lower in patients with mETE than in those without (90.2% vs 97%, Log-Rank p < 0.001). Furthermore, mETE and neck lymph node involvement were independent predictors of persistent/recurrent disease in multivariate analysis (HR: 2.43, 95% CI:1.02-5.81, p = 0.043; HR: 4.38, 95% CI: 1.7-11.2, p = 0.002, respectively). CONCLUSIONS In patients with the classic subtype of PTMC, mETE is an independent predictor of persistent/recurrent disease and is associated with a lower DFS rate. However, neck lymph node involvement is the strongest predictor of persistent/recurrent disease. Therefore, PTMCs with mETE and neck lymph node involvement are at a higher risk of persistent/recurrent disease than individuals lacking both characteristics.
Collapse
Affiliation(s)
- Sayid Shafi Zuhur
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
| | - Hunkar Aggul
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Ugur Avci
- Department of Endocrinology and Metabolism, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Selvinaz Erol
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mazhar Muslum Tuna
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Serhat Uysal
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Gulhan Akbaba
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Faruk Kilinc
- Department of Endocrinology and Metabolism, Faculty of Medicine, Elazig Firat University, Elazig, Turkey
| | - Merve Catak
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Sakin Tekin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Beyza Olcay Ozturk
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Halise Cinar Yavuz
- Department of Endocrinology and Metabolism, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Pinar Kadioglu
- Department of Endocrinology and Metabolism, Cerrahpasa Medical Faculty, Istanbul University- Cerrahpasa, Istanbul, Turkey
| | - Nese Cinar
- Department of Endocrinology and Metabolism, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Taner Bayraktaroglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Birol Topcu
- Department of Biostatistics, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| | - Yuksel Altuntas
- Department of Endocrinology and Metabolism, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gulsah Elbuken
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey
| |
Collapse
|
3
|
Ren L, Hu Y, Hu Y, Xiao D, Sun J, Zhu B, Zhang C. Impact factors of benefiting from initial 131 I ablation in patients with intermediate-risk differentiated thyroid carcinoma: a study based on a re-evaluation of therapeutic response. Nucl Med Commun 2024; 45:188-195. [PMID: 38165164 DOI: 10.1097/mnm.0000000000001807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study was carried out to confirm whether patients with intermediate-risk differentiated thyroid cancer (DTC) could benefit from initial 131 I ablation and to identify the factors that impacted the benefit. METHODS We retrospectively assessed a cohort of 548 patients with intermediate-risk DTC who were classified into structural incomplete response (SIR), biochemical incomplete response (BIR), indeterminate response (IDR), and excellent response (ER) groups according to the ATA guidelines (version 2015). A downgrade in the classification, such as from initial SIR to final BIR, IDR, or ER, from BIR to IDR or ER, and from initial IDR to final ER, was defined as benefiting from initial 131 I ablation (benefit group). Non-downgraded classification meant non-benefit. RESULTS 64.78% of patients benefited from the initial 131 I ablation in the final re-evaluation. Gender (OR = 0.038, P = 0.002), interval time (OR = 0.038, P = 0.002) and serum ps-Tg (OR = 0.961, P = 0.001) were independent prognostic factors for benefiting from initial 131 I ablation, with the cutoff value were 5 months and 19.08 ng/ml. CONCLUSION Patients with intermediate-risk DTC could benefit from initial 131 I ablation. Female patients with intermediate-risk DTC whose interval time <5 months and ps-Tg <19.08 ng/ml were more likely to benefit. Early 131 I ablation for such patients is beneficial for achieving a complete therapeutic response.
Collapse
Affiliation(s)
- Li Ren
- Department of Nuclear Medicine, School of Laboratory Medicine, Bengbu Medical University
| | - Yongquan Hu
- Department of Nuclear Medicine, School of Laboratory Medicine, Bengbu Medical University
- Department of Nuclear Medicine, the First Affiliated Hospital of Bengbu Medical University
| | - Yehuan Hu
- School of Laboratory Medicine, Bengbu Medical University
| | - Da Xiao
- School of Laboratory Medicine, Bengbu Medical University
| | - Junjie Sun
- Department of Nuclear Medicine, School of Laboratory Medicine, Bengbu Medical University
| | - Bo Zhu
- Department of Pathology, the First Affiliated Hospital of Bengbu Medical University
| | - Congli Zhang
- Department of Anesthesiology, the First Affiliated Hospital, Bengbu Medical University, Bengbu, China
| |
Collapse
|
4
|
O'Brien O, Hilmi O, Wright S, McArthur C. Value of surveillance ultrasound following hemithyroidectomy. J Laryngol Otol 2024; 138:232-236. [PMID: 37309205 DOI: 10.1017/s0022215123001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND There is limited evidence or agreement on the benefit, duration and frequency of post-operative surveillance neck ultrasound in patients with differentiated thyroid cancer treated with hemithyroidectomy alone. This study's primary aim was to assess the benefit of neck ultrasound in this situation, with a secondary aim to assess the detection of malignancy in the contralateral lobe in patients undergoing completion surgery. METHODS A retrospective observational study was conducted involving patients who had differentiated thyroid cancer found at diagnostic hemithyroidectomy between 1 December 2013 and 31 December 2016. RESULTS Of 105 patients, 74 underwent completion thyroidectomy. Thirty-five per cent of these patients had malignancy identified in the contralateral lobe, the majority were unsuspected sonographically. Of 31 hemithyroidectomy patients, 1 had a nodule classified as 'U3' (indeterminate) at the first ultrasound surveillance, ultimately identified as incidental papillary microcarcinomas on completion thyroidectomy. There was no other disease recurrence or malignancy at a median of 3.8 years' follow up. CONCLUSION The findings indicate a limited role for ultrasound follow up of patients with differentiated thyroid cancer treated with hemithyroidectomy alone.
Collapse
Affiliation(s)
- Owen O'Brien
- Radiology, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Omar Hilmi
- ENT Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - Sylvia Wright
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | | |
Collapse
|
5
|
Abelleira E, Jerkovich F. Dynamic risk assessment in patients with differentiated thyroid cancer. Rev Endocr Metab Disord 2024; 25:79-93. [PMID: 38015344 DOI: 10.1007/s11154-023-09857-7] [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] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
The current approach for patients with differentiated thyroid carcinoma should be individualized according to the risk of recurrence, and this stratification could be used to identify the risk of persistent/recurrent disease in three scenarios: preoperatively, immediately postoperatively, and during long-term follow-up. The initial risk of recurrence will tailor the management of the patient in the preoperative and immediate postoperative settings, while the dynamic risk, which considers the responses to treatment, could guide the decision-making process for remnant ablation and long-term management.This review provides a summary of the existing information regarding the dynamic risk of recurrence and recommended management for patients with differentiated thyroid cancer. The application of this approach is essential to avoid unnecessary treatments for most patients who will have a favorable prognosis. On the other hand, it allows specific therapeutic interventions for those patients at high risk of recurrence. In the future, analysis of tumor biology and prospective studies will surely improve the accuracy of recurrence risk prediction.
Collapse
Affiliation(s)
- Erika Abelleira
- Division of Endocrinology, Hospital de Clínicas José de San Martín (UBA), University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, C 1120, Argentina.
| | - Fernando Jerkovich
- Division of Endocrinology, Hospital de Clínicas José de San Martín (UBA), University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, C 1120, Argentina
| |
Collapse
|
6
|
Li X, Yan L, Xiao J, Li Y, Yang Z, Zhang M, Luo Y. Follow-up strategy of radiofrequency ablation for papillary thyroid microcarcinoma: defining a response-to-ablation system. Eur Radiol 2024; 34:761-769. [PMID: 37597031 DOI: 10.1007/s00330-023-10022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/24/2023] [Accepted: 06/12/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To define a response-to-ablation system based on dynamic risk stratification proposed by the 2015 American Thyroid Association guidelines for predicting clinical outcomes and guiding follow-up strategies for patients with low-risk papillary thyroid microcarcinoma (PTMC) who underwent radiofrequency ablation (RFA). METHODS This retrospective study reviewed patients with low-risk PTMC who underwent RFA between 2014 and 2018. We classified patients into three groups based on their response to therapy at the 1-year follow-up: complete, indeterminate, and incomplete. The primary endpoints were local tumor progression (LTP) and disease-free survival (DFS). RESULTS Among the 748 patients (mean age, 43.7 years ± 9.8; 586 women), 4.0% (30/748) had LTP during a median follow-up of 5 years. The response was complete in 80.2% (600/748) of the patients, indeterminate in 18.1% (135/748), and incomplete in 1.7% (13/748). The LTP rate in the final follow-up was 1% (6/600), 8.1% (11/135), and 100% (13/13), respectively. The risk of LTP was significantly different in the incomplete response group (HR, 1825.82; 95% CI: 458.27, 7274.36; p < 0.001) and indeterminate response group (HR, 8.12; 95% CI: 2.99, 22.09; p < 0.001) than in the complete response group. There were significant differences in DFS among groups (p < 0.001). The proportion of variation explained and C-index of the system was high (27.66% and 0.79, respectively). CONCLUSIONS We defined a response-to-ablation system that provides a new paradigm for the management of patients with PTMC who underwent RFA. Our data confirm that the system can effectively predict the risk of LTP and guide ongoing follow-up recommendations. KEY POINTS • The response-to-ablation system can classify patients with low-risk PTMC who underwent RFA into complete, indeterminate, or incomplete response categories. • Results suggest that, in this population, this system can identify three separate cohorts of patients who have significantly different clinical outcomes. • The response-to-ablation system will help better tailor the ongoing follow-up recommendations.
Collapse
Affiliation(s)
- Xinyang Li
- School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, 300071, Tianjin, China
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
| | - Yukun Luo
- School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, 300071, Tianjin, China.
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
| |
Collapse
|
7
|
Jasim MS, Hussein IH, Alidrisi HA, Mansour AA. Risk Stratification of Differentiated Thyroid Cancer: A Single-Center Study in Basrah. Cureus 2023; 15:e47990. [PMID: 38034160 PMCID: PMC10686578 DOI: 10.7759/cureus.47990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Differentiated thyroid cancer is a common endocrine cancer; most of it has an indolent course and favorable outcomes, with a subset of patients having the risk of disease recurrence, which can be assessed using the fixed American Thyroid Association (ATA) risk stratification system or the dynamic response to therapy risk stratification that can be modified during patients follow-up. Aim The aim of this article is to assess the risk stratification of patients having differentiated thyroid cancer. Methods This is a retrospective cross-sectional study in which we evaluated medical records of 75 patients having differentiated thyroid cancer to assess the baseline ATA risk of recurrence and compared it to the results of dynamic risk stratification in response to therapy at 6-12 months post-surgery and at the last visit. Thyroglobulin level, anti-thyroglobulin antibody, thyroid ultrasound, and cytopathological examination were used to determine dynamic response to therapy and divided subjects into four groups: excellent response (ER), biochemical incomplete response (BIR), structural incomplete response (SIR), and indeterminate response (IR). Results At baseline, 55 patients had low risk, 14 patients had intermediate risk, and six patients had high risk. At 6-12 months post-surgery, in the low-risk group, ER, BIR, and IR responses were observed in 56.4%, 5.5%, and 38.2% of patients, respectively, and none of them exhibited SIR. In the intermediate-risk group, ER, BIR, and IR responses were observed in 57.1%, 21.4%, and 21.4% of patients, respectively, and none exhibited SIR. Among the high-risk group, two patients had ER, two patients had BIR, one patient had IR, and one patient had SIR. At the last visit, ER, BIR, and IR were observed in 65.5%, 9.1%, and 25.5% of low-risk patients, respectively, and no patient developed SIR. In the intermediate-risk group, ER, BIR, and IR were observed in 50%, 21.4%, and 28.6% of patients, respectively, and no patients developed SIR. Among the high-risk group, three patients achieved ER, one had BIR, one had IR, and one had SIR. Conclusion Most of the differentiated thyroid cancers in this study are low-risk. Dynamic risk stratification appears to be an effective tool in the follow-up of this population of patients having differentiated thyroid cancer.
Collapse
Affiliation(s)
- Mahmod S Jasim
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
- Diabetes and Endocrinology, University of Basrah, College of Medicine, Basrah, IRQ
| | - Ibrahim H Hussein
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
- Diabetes and Endocrinology, University of Basrah, College of Medicine, Basrah, IRQ
| | - Haider A Alidrisi
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
- Diabetes and Endocrinology, University of Basrah, College of Medicine, Basrah, IRQ
| | - Abbas A Mansour
- Diabetes and Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Center, Basrah, IRQ
- Diabetes and Endocrinology, University of Basrah, College of Medicine, Basrah, IRQ
| |
Collapse
|
8
|
Valerio L, Dalmiglio C, Maino F, Mattii E, Trimarchi A, Cartocci A, Castagna MG. Dynamic Risk Stratification Integrated with ATA Risk System for Predicting Long-Term Outcome in Papillary Thyroid Cancer. Cancers (Basel) 2023; 15:4656. [PMID: 37760625 PMCID: PMC10526505 DOI: 10.3390/cancers15184656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In recent years, there has been a renewed interest in thyroid cancer management paradigms that use individualized risk assessments as the basis for treatment and follow-up recommendations. In this study, we assumed that the long-term follow-up of differentiated thyroid cancer patients might be better tailored by integrating the response to initial therapy with the America Thyroid Association (ATA) risk classes. METHODS This retrospective study included low- and intermediate-risk papillary thyroid cancer (PTC) patients followed up for a median time of 8 years and classified according to the response to initial therapy assessed 6-12 months after initial treatment. RESULTS After a median follow-up of 8 years, in the initial excellent response subgroup of PTC patients (n = 522), the rate of recurrent disease was significantly higher in intermediate-risk patients than in low-risk PTC patients (6.9% versus 1.2%, p = 0.0005). Similarly, in the initial biochemical incomplete response subgroup (n = 82), the rate of excellent response was significantly higher in low-risk PTC patients (58.0%) than in intermediate-risk PTC patients (33.3%) (p = 0.007). Finally, in the initial structural incomplete response subgroup (n = 66), the rate of excellent response was higher in low-risk patients (80.0%) than in intermediate-risk patients (46.4%) (p = 0.08). Moreover, all patients with initial indeterminate response had an excellent response at the last follow-up visit. ATA risk classes were independently associated with long-term outcome in each subgroup of patients classified dynamically after initial therapy and the overall prognostic performance, defined via ROC curve analysis, of response to initial therapy integrated with the ATA risk system (AUC: 0.89; 95% CI: 0.86-0.92) was significantly higher compared to the ATA risk stratification (AUC 0.69; 95% CI: 0.65-0.74, p < 0.001) or the dynamic risk stratification (DRS) systems alone (AUC: 0.86 95% CI: 0.82-0.90, p = 0.007). CONCLUSIONS This study of a large cohort of PTC patients showed that the initial ATA risk criteria may be useful for improving the risk-adapted management of PTC patients based on the response to initial therapy.
Collapse
Affiliation(s)
- Laura Valerio
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (L.V.)
| | - Cristina Dalmiglio
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (L.V.)
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (L.V.)
| | - Elisa Mattii
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (L.V.)
| | - Andrea Trimarchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (L.V.)
| | - Alessandra Cartocci
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy; (L.V.)
| |
Collapse
|
9
|
Bertol BC, Debortoli G, Dias FC, de Araújo JNG, Maia LSM, de Almeida BS, de Figueiredo-Feitosa NL, de Freitas LCC, Castelli EC, Mendes-Junior CT, Silbiger VN, Maciel LMZ, Donadi EA. HLA-G Gene Variability Is Associated with Papillary Thyroid Carcinoma Morbidity and the HLA-G Protein Profile. Int J Mol Sci 2023; 24:12858. [PMID: 37629044 PMCID: PMC10454351 DOI: 10.3390/ijms241612858] [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: 07/16/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Human leukocyte antigen (HLA)-G is an immune checkpoint molecule that is highly expressed in papillary thyroid carcinoma (PTC). The HLA-G gene presents several functional polymorphisms distributed across the coding and regulatory regions (5'URR: 5' upstream regulatory region and 3'UTR: 3' untranslated region) and some of them may impact HLA-G expression and human malignancy. To understand the contribution of the HLA-G genetic background in PTC, we studied the HLA-G gene variability in PTC patients in association with tumor morbidity, HLA-G tissue expression, and plasma soluble (sHLA-G) levels. We evaluated 185 PTC patients and 154 healthy controls. Polymorphic sites defining coding, regulatory and extended haplotypes were characterized by sequencing analyses. HLA-G tissue expression and plasma soluble HLA-G levels were evaluated by immunohistochemistry and ELISA, respectively. Compared to the controls, the G0104a(5'URR)G*01:04:04(coding)UTR-03(3'UTR) extended haplotype was underrepresented in the PTC patients, while G0104a(5'URR)G*01:04:01(coding)UTR-03(3'UTR) was less frequent in patients with metastatic and multifocal tumors. Decreased HLA-G tissue expression and undetectable plasma sHLA-G were associated with the G010102a(5'URR)G*01:01:02:01(coding)UTR-02(3'UTR) extended haplotype. We concluded that the HLA-G variability was associated with PTC development and morbidity, as well as the magnitude of the encoded protein expression at local and systemic levels.
Collapse
Affiliation(s)
- Bruna C. Bertol
- Postgraduate Program of Basic and Applied Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Guilherme Debortoli
- Department of Anthropology, University of Toronto at Mississauga, Mississauga, ON L5L 1C6, Canada;
| | - Fabrício C. Dias
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (F.C.D.); (L.S.M.M.); (B.S.d.A.)
| | - Jéssica N. G. de Araújo
- Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil; (J.N.G.d.A.); (V.N.S.)
| | - Luana S. M. Maia
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (F.C.D.); (L.S.M.M.); (B.S.d.A.)
| | - Bibiana S. de Almeida
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (F.C.D.); (L.S.M.M.); (B.S.d.A.)
| | - Nathalie L. de Figueiredo-Feitosa
- Division of Endocrinology and Metabolism, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (N.L.d.F.-F.); (L.M.Z.M.)
| | - Luiz Carlos C. de Freitas
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil;
| | - Erick C. Castelli
- Department of Pathology, School of Medicine, São Paulo State University, Botucatu 18618-687, Brazil;
| | - Celso T. Mendes-Junior
- Departamento de Química, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto 14049-900, Brazil;
| | - Vivian N. Silbiger
- Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil; (J.N.G.d.A.); (V.N.S.)
| | - Léa M. Z. Maciel
- Division of Endocrinology and Metabolism, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (N.L.d.F.-F.); (L.M.Z.M.)
| | - Eduardo A. Donadi
- Postgraduate Program of Basic and Applied Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (F.C.D.); (L.S.M.M.); (B.S.d.A.)
| |
Collapse
|
10
|
Bertol BC, Massaro JD, Debortoli G, Santos ALP, de Araújo JNG, Giorgenon TMV, Costa e Silva M, de Figueiredo-Feitosa NL, Collares CVA, de Freitas LCC, Soares EG, Neder L, Silbiger VN, Calado RT, Maciel LMZ, Donadi EA. BRAF, TERT and HLA-G Status in the Papillary Thyroid Carcinoma: A Clinicopathological Association Study. Int J Mol Sci 2023; 24:12459. [PMID: 37569841 PMCID: PMC10419559 DOI: 10.3390/ijms241512459] [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] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
As BRAF, TERT, HLA-G, and microRNAs have been individually associated with papillary thyroid carcinoma (PTC), we aimed to evaluate the individual and collaborative role of these markers in PTC in the same patient cohort. HLA-G and BRAF tumor expression was evaluated by immunohistochemistry. Using molecular methods, BRAFV600E and TERT promoter mutations were evaluated in thyroid fine needle aspirates. MicroRNA tumor profiling was investigated using massively parallel sequencing. We observed strong HLA-G (67.96%) while BRAF (62.43%) staining was observed in PTC specimens. BRAF overexpression was associated with poor response to therapy. The BRAFV600E (52.9%) and TERTC228T (13%) mutations were associated with extrathyroidal extension, advanced-age, and advanced-stage cancer. The TERT rs2853669 CC+TC genotypes (38%) were overrepresented in metastatic tumors. Nine modulated microRNAs targeting the BRAF, TERT, and/or HLA-G genes were observed in PTC and involved with cancer-related signaling pathways. The markers were individually associated with PTC features, emphasizing the synergistic effect of BRAFV600E and TERTC228T; however, their collaborative role on PTC outcome was not fully demonstrated. The differentially expressed miRNAs targeting the BRAF and/or HLA-G genes may explain their increased expression in the tumor milieu.
Collapse
Affiliation(s)
- Bruna C. Bertol
- Postgraduate Program of Basic and Applied Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada
| | - Juliana D. Massaro
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (J.D.M.); (M.C.e.S.); (C.V.A.C.)
| | - Guilherme Debortoli
- Department of Anthropology, University of Toronto, Mississauga, ON L5L 1C6, Canada;
| | - André L. P. Santos
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (A.L.P.S.); (R.T.C.)
| | - Jéssica N. G. de Araújo
- Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil; (J.N.G.d.A.); (V.N.S.)
| | - Tatiana M. V. Giorgenon
- Division of Endocrinology and Metabolism, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (T.M.V.G.); (N.L.d.F.-F.); (L.M.Z.M.)
| | - Matheus Costa e Silva
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (J.D.M.); (M.C.e.S.); (C.V.A.C.)
| | - Nathalie L. de Figueiredo-Feitosa
- Division of Endocrinology and Metabolism, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (T.M.V.G.); (N.L.d.F.-F.); (L.M.Z.M.)
| | - Cristhianna V. A. Collares
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (J.D.M.); (M.C.e.S.); (C.V.A.C.)
| | - Luiz Carlos C. de Freitas
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil;
| | - Edson G. Soares
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (E.G.S.); (L.N.)
| | - Luciano Neder
- Department of Pathology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (E.G.S.); (L.N.)
| | - Vivian N. Silbiger
- Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal 59012-570, Brazil; (J.N.G.d.A.); (V.N.S.)
| | - Rodrigo T. Calado
- Department of Medical Imaging, Hematology, and Clinical Oncology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (A.L.P.S.); (R.T.C.)
| | - Léa M. Z. Maciel
- Division of Endocrinology and Metabolism, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (T.M.V.G.); (N.L.d.F.-F.); (L.M.Z.M.)
| | - Eduardo A. Donadi
- Postgraduate Program of Basic and Applied Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, Brazil; (J.D.M.); (M.C.e.S.); (C.V.A.C.)
| |
Collapse
|
11
|
Ilera V, Califano I, Cavallo A, Faure E, Vázquez A, Pitoia F. Is radioiodine ablation with 1.1 GBq (30 mCi) 131I necessary in low-risk thyroid cancer patients? Results from a long-term follow-up prospective study. Endocrine 2023; 80:606-611. [PMID: 36988853 DOI: 10.1007/s12020-023-03306-w] [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] [Received: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND In patients with low-risk differentiated thyroid cancer (DTC), remnant ablation with radioiodine (RA) after total thyroidectomy (TT) is controversial. No benefits have been demonstrated in terms of mortality or disease-free survival. Recent evidence found that RA did not improve mid-term outcomes. PURPOSE To evaluate initial response to treatment and long-term follow-up status in low-risk DTC patients after TT vs. TT + RA with 131I 1.11 GBq (30 mCi). METHODS Prospective multicenter non-randomized study; 174 low-risk DTC that underwent TT were recruited an divided in two groups according to RA (87 ablated and 87 non-ablated). Response to treatment was evaluated at 6-18 months after thyroidectomy and at the end of follow-up with measurements of thyroglobulin, and anti-thyroglobulin antibodies levels, and neck ultrasonography. RESULTS Baseline characteristics of both groups were similar. Ablated patients: median age 45.5 years, 84% females, 95.4% papillary thyroid carcinoma (PTC), mean tumor size 16 mm; non-ablated: median age 45 years, 88.5% females, 96.6% PTC, mean tumor size 14 mm. Response to initial treatment was similar between both groups, with < 2% of structural incomplete response. Final status was evaluated in 139 cases (median follow-up of 60 months). Among ablated patients, 82.8% had no evidence of disease (NED), 12% had an indeterminate response (IR) and 5% a biochemical incomplete response (BIR). Non-ablated patients had NED in 90%, IR in 8.7% and BIR in 1.2%. No statistical difference was found between groups (p = 0.29). No patient had evidence of structural disease at the end of follow-up. CONCLUSIONS Our findings support the recommendation against routine RA in low-risk DTC patients.
Collapse
Affiliation(s)
- Verónica Ilera
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Inés Califano
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Andrea Cavallo
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Faure
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Adriana Vázquez
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Fabián Pitoia
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889, (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina.
| |
Collapse
|
12
|
Jang A, Jin M, Kim CA, Jeon MJ, Lee YM, Sung TY, Kim TY, Kim WB, Shong YK, Kim WG. Serum thyroglobulin testing after thyroid lobectomy in patients with 1-4 cm papillary thyroid carcinoma. Endocrine 2023:10.1007/s12020-023-03346-2. [PMID: 36913171 DOI: 10.1007/s12020-023-03346-2] [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] [Received: 11/17/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND The role of measuring serum thyroglobulin (Tg) levels in patients who have undergone lobectomy has not been proven. The goal of this research is to see if serum Tg levels can predict the recurrence of papillary thyroid carcinoma (PTC) after lobectomy. METHODS The 463 patients with 1-4 cm PTC who underwent lobectomy between January 2005 and December 2012, were included in this retrospective cohort study. Postoperative serum Tg levels and neck ultrasound were evaluated every 6-12 months after lobectomy during a median 7.8-year follow-up period. The receiver operating characteristic (ROC) curve and its area under the ROC curve (AUC) was used to assess the diagnostic performance of serum Tg levels. RESULTS During the follow-up, the structural recurrent disease was confirmed in 30 patients (6.5%). The serum Tg levels measured by initial Tg, maximal Tg, and last Tg did not differ statistically between the recurrence and non-recurrence groups. According to our findings, serial patterns of serum maximal Tg variations in 30 patients with recurrence showed no obvious trend and no rising trend toward recurrence before detecting recurrence. The AUC was 54.5% (IQR 43.1%-65.9%) in the ROC curve analysis, indicating that it was not significantly different from the random classifier. CONCLUSION Serum Tg levels did not differ significantly between the recurrence and non-recurrence groups, and there was no tendency for the recurrence group to increase Tg levels. In patients with PTC who underwent lobectomy, monitoring Tg levels regularly provides little benefit in predicting recurrence.
Collapse
Affiliation(s)
- Ahreum Jang
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Meihua Jin
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Chae A Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Min Ji Jeon
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Tae Yong Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Won Bae Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Young Kee Shong
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Won Gu Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
| |
Collapse
|
13
|
Scherer HC, Fernandes PM, Scheffel RS, Zanella AB, Maia AL, Dora JM. Papillary Thyroid Microcarcinoma: Insights from a Cohort of 257 Thyroidectomized Patients. Horm Metab Res 2023; 55:161-168. [PMID: 36796412 DOI: 10.1055/a-2008-0824] [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: 02/18/2023]
Abstract
Papillary thyroid microcarcinoma management evolved, and less aggressive strategies are now considered. Questions, however, remain on these tumors' behavior, particularly on developing countries' real ground healthcare scenarios. Our aim is to gather insights on the natural history of papillary thyroid microcarcinoma on patients treated with thyroidectomy in Brazil. Consecutive patients diagnosed with papillary thyroid microcarcinoma had their clinical characteristics, interventions, and outcomes described. Patients were classified as incidental or nonincidental based on the diagnosis after or before surgery, respectively. A sum of 257 patients were included, 84.0% of which were women, and the mean age was of 48.3±13.5 years. The mean tumor size was of 0.68±0.26 cm, 30.4% were multifocal, 24.5% had cervical metastasis, and 0.4% distant metastasis. The nonincidental and incidental tumors differed in tumor size (0.72±0.24 and 0.60±0.28 cm, respectively, p=0.003) and in presence of cervical metastasis (31.3% and 11.9%, respectively, p<0.001). Male sex, nonincidental diagnosis, and younger age were independent predictors of cervical metastasis. After 5.5 years (P25-75 2.5-9.7) of follow-up, only 3.8% of patients had persistent structural disease (3.4% cervical). Predictors of persistent disease at multivariate analysis included cervical metastasis and multicentricity. In conclusion, incidental and nonincidental papillary thyroid microcarcinoma patients of the population studied displayed excellent outcomes. Cervical metastasis and multicentricity were frequent findings and prognostic factors for persistent disease.
Collapse
Affiliation(s)
| | | | - Rafael Selbach Scheffel
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - André Borsatto Zanella
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Endocrinology, Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Ana Luiza Maia
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jose Miguel Dora
- Thyroid Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Abstract
Differentiated thyroid carcinoma (DTC) is the most common endocrine cancer. Particularly the incidence of small clinically indolent tumors has been increasing significantly during the last decades because of increased diagnostic scrutiny, while the DTC-related mortality remained unchanged. In light of the increased awareness of the significant risk of detecting clinically indolent tumors and the potential harm and burden associated with overly diagnosis and the treatment, the approach towards management of DTC recently underwent a critical appraisal. The focus lays on reducing the unnecessary burden for patients with very low risk DTC and the correct identification of those who require treatment that is more intensive and/or follow-up. Management of DTC includes a range of different modalities, making multidisciplinary collaboration expedient. In this review, we elaborate on the recent developments in diagnosis, staging and management of DTC with specific focus on the more individualized risk assessment-based approach.
Collapse
Affiliation(s)
- Pepijn van Houten
- Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Romana T Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.
| | - Johannes W Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
16
|
Xu S, Huang H, Huang Y, Qian J, Wang X, Xu Z, Liu S, Liu J. Comparison of Lobectomy vs Total Thyroidectomy for Intermediate-Risk Papillary Thyroid Carcinoma With Lymph Node Metastasis. JAMA Surg 2023; 158:73-79. [PMID: 36449303 PMCID: PMC9713681 DOI: 10.1001/jamasurg.2022.5781] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022]
Abstract
Importance Surgical treatment of patients with papillary thyroid cancer (PTC) by either lobectomy or total thyroidectomy (TT) has long been a topic of debate, especially for patients with intermediate-risk PTC. Objective To compare recurrence-free survival (RFS) for patients with PTC and lymph node metastasis after lobectomy vs TT. Design, Setting, and Participants This retrospective cohort study included a review of patients with PTC treated from January 1, 2000, to December 31, 2017. Propensity score matching (PSM) was performed between patients treated with lobectomy and TT. This study involved a single institute in a cancer referral center. Enrolled were adult patients (aged 18-75 years) with unilateral PTC and ipsilateral clinical lateral neck metastasis (cN1b). Patients with the following characteristics were excluded: a lymph node yield less than 20, primary tumor size greater than 4 cm, gross extrathyroidal extension, metastatic lymph node size greater than 3 cm, and distant metastasis. Data analysis was performed from April 1 to April 30, 2022. Exposures Lobectomy and TT. Main Outcomes and Measures The primary outcome was the association between extent of surgery and RFS, assessed using Cox proportional hazards regression models. Results A total of 946 patients with PTC (mean [SD] age, 37.0 [12.1] years, 630 female individuals [66.6%]) were analyzed. Lobectomy (624 [66.0%]) was negatively correlated with the frequencies of older age (≥65 years, 17 [2.7%]), female sex (393 [63.0%]), multifocality (132 [21.2%]), minor extrathyroidal extension (259 [41.5%]), number of metastatic lymph nodes (median [range], 9 [6-14] nodes), and radioactive iodine ablation (0). After PSM with treatment period and potential prognostic factors (age, sex, primary tumor size, multifocality, minor extrathyroidal extension, number of lymph node metastases and lymph node ratio), 265 pairs of patients were available for analysis. After a median (range) follow-up of 60 (9-150) months in the lobectomy group and 58 (8-161) months in the TT group, 21 (7.9%) and 17 (6.4%) structural recurrences were identified in the lobectomy and TT groups, respectively. Lobectomy was not associated with significantly compromised 5-year RFS rate (lobectomy, 92.3% vs TT, 93.7%; adjusted hazard ratio, 1.10; 95% CI, 0.58-2.11; P = .77). Power analysis indicated that the test had 90% power to detect a more than 4.9% RFS difference. No significant difference in RFS was observed between patients treated with TT and radioactive iodine ablation (n = 75) and their counterparts (adjusted hazard ratio, 0.59; 95% CI, 0.14-2.41; P = .46). Conclusions and Relevance Results of this cohort study suggest that patients with PTC and lymph node metastasis had a similar RFS after lobectomy vs those who had TT. If radioactive iodine ablation is not going to be performed, lobectomy may be an effective alternative option.
Collapse
Affiliation(s)
- Siyuan Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxin Qian
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengang Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
17
|
van Velsen EFS, Peeters RP, Stegenga MT, van Kemenade FJ, van Ginhoven TM, van Balkum M, Verburg FA, Visser WE. Evaluating Disease Specific Survival Prediction of Risk Stratification and TNM Systems in Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2022; 108:e267-e274. [PMID: 36508298 DOI: 10.1210/clinem/dgac721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many countries have national guidelines for the management of differentiated thyroid cancer (DTC), including a risk stratification system to predict recurrence of disease. Studies whether these guidelines could also have relevance, beyond their original design, in predicting survival are lacking. Additionally, no studies evaluated these international guidelines in the same population, nor compared them to the TNM system. Therefore, we investigated the prognostic value of six stratification systems employed by ten International guidelines, and the TNM system with respect to predicting disease specific survival (DSS). METHODS We retrospectively studied adult patients with DTC from a Dutch university hospital. Patients were classified using the risk classification described in the British, Dutch, French, Italian, Polish, Spanish, European Society of Medical Oncology, European Thyroid Association, and 2009 and 2015 American Thyroid Association (ATA) guidelines, and the latest TNM system. DSS was analyzed using the Kaplan-Meier method, and the statistical model performance using the C-index, AIC, BIC and PVE. RESULTS We included 857 patients with DTC (79% PTC, 21% FTC). Median follow-up was 9 years, and 67 (7.8%) died due to DTC. The Dutch guideline had the worst statistical model performance, while the 2009 ATA/2014 British guideline had the best. However, the (adapted) TNM system outperformed all stratification systems. CONCLUSIONS In a European population of patients with DTC, out of ten International guidelines employing six risk of recurrence stratification systems and one mortality based stratification system, our optimized age-adjusted TNM system (8th edition) outperformed all other systems.
Collapse
Affiliation(s)
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine
| | - Merel T Stegenga
- Academic Center for Thyroid Diseases, Department of Internal Medicine
| | | | - Tessa M van Ginhoven
- Erasmus MC Cancer Institute, Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands
| | - Mathé van Balkum
- Academic Center for Thyroid Diseases, Department of Internal Medicine
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine
| |
Collapse
|
18
|
Díaz-Soto G, Fernández-Velasco P, Torres Torres B, López Gómez JJ, García Calvo S, de Luis Román D. Evolution of suppressing TSH therapy at diagnosis and in the long-term follow-up in a cohort of differentiated thyroid cancer. ENDOCRINOLOGIA, DIABETES Y NUTRICION 2022; 69:844-851. [PMID: 36470820 DOI: 10.1016/j.endien.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/09/2021] [Indexed: 12/05/2022]
Abstract
INTRODUCTION To evaluate the adequacy of TSH suppression therapy (TSHst) at the first disease assessment and the last follow-up visit. METHODS Retrospective observational study of those patients under follow-up of DTC in a reference hospital. RESULTS 216 patients (79.2% women) were evaluated, with a mean age 59.0 ± 13.1 years-old and a mean follow-up of 6.9 ± 4.3 years. 88.4% were papillary carcinomas. At diagnosis, 69.2% had a low risk of recurrence (RR) compared to 13.6% with a high RR. Dynamic risk stratification (DRS) classified patients at first disease assessment and the last visit as excellent response (ER) in 60.0% and 70.7%, respectively. Those patients with ER in the first and last follow-up control maintained TSHst in 30.7% and 16.3% of the cases, respectively (p < 0.001). The factors associated with maintaining TSHst at the last control were younger age, higher RR at diagnosis, DRE at follow-up, presence of multifocality and histological vascular invasion (p < 0.05). In a logistic regression analysis adopting tsTSH at follow-up as the dependent variable, exclusively age (β = -0.062; p < 0.001), RR at diagnosis (β = 1.074; p < 0.05) and EDR during follow-up (β = 1.237; p < 0.05) maintained statistical significance. CONCLUSIONS Despite the current recommendations, 30.7% of patients with low RR and initial ER are under TSHst. This percentage reduced to 16.3% in those patients with ER after a mean follow-up of 6.9 years. Age, baseline RR, and DRE during follow-up were associated to maintaining tsTSH.
Collapse
Affiliation(s)
- Gonzalo Díaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
| | - Pablo Fernández-Velasco
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Beatriz Torres Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Juan José López Gómez
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Susana García Calvo
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Daniel de Luis Román
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| |
Collapse
|
19
|
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
|
20
|
Marotta V, Cennamo M, La Civita E, Vitale M, Terracciano D. Cell-Free DNA Analysis within the Challenges of Thyroid Cancer Management. Cancers (Basel) 2022; 14:cancers14215370. [PMID: 36358788 PMCID: PMC9654679 DOI: 10.3390/cancers14215370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Simple Summary Liquid biopsy is a minimally invasive method that emerged as a new promising tool for improving diagnosis, risk stratification, follow-up, and treatment of cancer patients. To date, the majority of the research in the area of liquid biopsy has focused on plasma-based cell-free DNA as a potential surrogate for tumor DNA obtained from a tissue biopsy. In the last decades, breakthrough advancements have been performed in the knowledge of thyroid cancer genetics, and the role of molecular characterization in clinical decision-making is continuously rising, from diagnosis completion to the personalization of treatment approach. Hence, it is expectable for cell-free DNA to be applicable in thyroid cancer management. This review aims to investigate the cell-free DNA utility for thyroid cancer patients’ care. Abstract Thyroid cancer is the most frequent endocrine malignancy with an increasing incidence trend during the past forty years and a concomitant rise in cancer-related mortality. The circulating cell-free DNA (cfDNA) analysis is a patient’s friendly and repeatable procedure allowing to obtain surrogate information about the genetics and epigenetics of the tumor. The aim of the present review was to address the suitability of cfDNA testing in different forms of thyroid cancer, and the potential clinical applications, as referred to the clinical weaknesses. Despite being limited by the absence of standardization and by reproducibility and validity issues, cfDNA assessment has great potential for the improvement of thyroid cancer management. cfDNA may support the pre-surgical definition of thyroid nodules by complementing invasive thyroid fine needle aspiration cytology. In addition, it may empower risk stratification and could be used as a biomarker for monitoring the post-surgical disease status, both during active surveillance and in the case of anti-tumor treatment.
Collapse
Affiliation(s)
- Vincenzo Marotta
- UOC Clinica Endocrinologica e Diabetologica, AOU San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy
- Correspondence: ; Tel.: +39-333-852-1005
| | - Michele Cennamo
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Mario Vitale
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Università di Salerno, 84081 Baronissi, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| |
Collapse
|
21
|
Ward LS, Scheffel RS, Hoff AO, Ferraz C, Vaisman F. Treatment strategies for low-risk papillary thyroid carcinoma: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:522-532. [PMID: 36074944 PMCID: PMC10697645 DOI: 10.20945/2359-3997000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023]
Abstract
Increasingly sensitive diagnostic methods, better understanding of molecular pathophysiology, and well-conducted prospective studies have changed the current approach to patients with thyroid cancer, requiring the implementation of individualized management. Most patients with papillary thyroid carcinoma (PTC) are currently considered to have a low risk of mortality and disease persistence/recurrence. Consequently, current treatment recommendations for these patients include less invasive or intensive therapies. We used the most recent evidence to prepare a position statement providing guidance for decisions regarding the management of patients with low-risk PTC (LRPTC). This document summarizes the criteria defining LRPTC (including considerations regarding changes in the TNM staging system), indications and contraindications for active surveillance, and recommendations for follow-up and surgery. Active surveillance may be an appropriate initial choice in selected patients, and the criteria to recommend this approach are detailed. A section is dedicated to the current evidence regarding lobectomy versus total thyroidectomy and the potential pitfalls of each approach, considering the challenges during long-term follow-up. Indications for radioiodine (RAI) therapy are also addressed, along with the benefits and risks associated with this treatment, patient preparation, and dosage. Finally, this statement presents the best follow-up strategies for LRPTC after lobectomy and total thyroidectomy with or without RAI.
Collapse
Affiliation(s)
- Laura Sterian Ward
- Laboratório de Genética Molecular do Câncer, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Rafael Selbach Scheffel
- Unidade de Tireoide, Hospital de Clínicas de Porto Alegre, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Departamento de Farmacologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Ana O Hoff
- Unidade de Oncologia Endócrina, Instituto do Câncer do Estado de São Paulo (Icesp), Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Carolina Ferraz
- Divisão de Endocrinologia, Departamento de Medicina, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brasil; Faculdade de Ciências Médicas da Santa Casa, São Paulo, SP, Brasil
| | - Fernanda Vaisman
- Serviço de Oncologia Endócrina, Instituto Nacional do Câncer do Rio de Janeiro (Inca), Rio de Janeiro, RJ, Brasil,
- Faculdade de Medicina, Serviço de Endocrinologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
22
|
Cadena-Piñeros E, Escobar JV, Carreño JA, Rojas JG. Second Adjuvant Radioiodine Therapy after Reoperation for Locoregionally Persistent or Recurrent Papillary Thyroid Carcinoma. World J Nucl Med 2022; 21:290-295. [DOI: 10.1055/s-0042-1750404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Introduction Differentiated thyroid carcinoma (DTC) has increased incidence. Intermediate- and high-risk patients have lymph node relapse rate ranging from 10 to 50%, and receive multiple reinterventions, increasing the morbidity of the disease. Currently, there are no established guidelines for the use of second radioactive iodine (RAI) therapy after the reintervention for local recurrence.
Materials and Methods This is a retrospective review of the medical records of 1,299 patients treated from January 2016 to July 2019 with DTC. We included 48 patients who received total thyroidectomy, RAI remnant ablation, surgery to remove the locally recurrent/persistent papillary thyroid carcinoma (PTC), and received a second RAI therapy.
Results There were no significant differences between thyroglobulin (Tg) levels before reoperation (Tg0), Tg levels postoperatively (Tg1), and Tg levels after 6 months of second adjuvant RAI therapy (Tg2). However, we evidenced a 69.79% drop in first Tg levels (Tg0: 24.7 vs. Tg1: 7.56, p=0.851) and 44.4% decrease in second Tg levels (Tg1: 7.56 vs. Tg2: 4.20, p=0.544). Also, 77.1% of the patients did not have another documented recurrence. The median relapse-free time was 10.9 months (range: 1.3–58.2 months).
Conclusion The results of the study cannot assess that a second RAI treatment after reoperation for locoregionally persistent or recurrent disease have a significant impact on treatment outcomes in intermediate- or high-risk patients with PTC. However, the 77.1% of patients have not presented a second documented recurrence and the median values of Tg and TgAb levels showed a substantial decrease after surgery and second RAI treatment.
Collapse
Affiliation(s)
- Enrique Cadena-Piñeros
- Department of Head and Neck, National Cancer Institute, Bogotá, D.C., Colombia
- Department of Otorhinolaryngology, National University of Colombia and National University Hospital of Colombia, Bogotá, D.C., Colombia
- Department of Otorhinolaryngology and Head and Neck, Marly Clinic, Bogotá, D.C., Colombia
| | - Judith Vásconez Escobar
- Department of Head and Neck, National Cancer Institute, Bogotá, D.C., Colombia
- Department of Medicine, Universidad Militar Nueva Granada, Bogotá, D.C, Colombia
| | - Jose A. Carreño
- Department of Cancer Clinical Research, National Cancer Institute, Bogotá, D.C., Colombia
| | - Julian G. Rojas
- Department of Nuclear Medicine, National Cancer Institute, Bogotá, D.C., Colombia
| |
Collapse
|
23
|
Ghali MS, El Ansari W, Abdelaal A, Al Hassan MS. Behaviour and epidemiology of differentiated thyroid cancer among filipinos in and outside the Philippines: Comparison between Qatar, Canada and Philippines. Ann Med Surg (Lond) 2022; 81:104202. [PMID: 36147099 PMCID: PMC9486373 DOI: 10.1016/j.amsu.2022.104202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background No study assessed the behaviour/epidemiology of differentiated thyroid cancer (DTC) among Filipinos in the Middle East/north Africa; or compared such behaviour with Filipino DTC patients in and outside the Philippines. Materials and methods Retrospective review of all adult Filipinos with DTC diagnosed between 2015 and 2020 at our institution [papillary TC (PTC, n = 110); follicular TC (FTC, n = 4)]. Chi-square or t-test compared the frequency, demography, history, ultrasound, laboratory and histopathology of PTC vs FTC; and compared the epidemiology of DTC among Filipinos in Qatar vs Canada (1 study) vs the Philippines (3 studies). Results DTC frequency was ≈43.84 cases/100,000 Filipinos in Qatar. Males had more aggressive disease in terms of lymphovascular invasion, number of nodules, stage IV disease and metastases. PTC and FTC were similar, but more PTC patients presented with solid tumors and higher number of involved lymph nodes. DTC behaviour among Filipinos in Qatar vs Canada was fairly homogenous. Conversely, DTC among Filipinos in Qatar vs Philippines exhibited many dissimilarities: Qatar had significantly younger patients, less hyperthyroid/thyrotoxicity symptoms and neck swelling at presentation, fewer solid nodules, micro-calcifications, and multi-nodular disease; smaller tumors; more stage I and less stage IV disease; and no distant metastasis (P 0.01 to < 0.0001). Conclusions DTC epidemiology among Filipinos in Qatar and Canada was fairly homogenous. Conversely, DTC in Qatar vs the Philippines was dissimilar. DTC among Filipinos in Qatar has presentations that could be misinterpreted as non-suspicious. This warrants additional practices for earlier detection among Filipinos. Epidemiology of differentiated thyroid cancer among Filipinos living Qatar vs Canada has considerable similarities. Epidemiology of differentiated thyroid cancer among Filipinos living Qatar vs the Philippines appears to be heterogenous. Differentiated thyroid cancer among Filipinos living in Qatar has presentations that could erroneously be misinterpreted as non-malignant by unsuspecting health worker, and seemingly lower tumor load compared to those living in the Philippines. Thyroid lesions among Filipinos in Qatar should be taken seriously, warranting additional practices for earlier detection among Filipinos.
Collapse
Affiliation(s)
- Mohamed Said Ghali
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of General Surgery, Ain Shams University, Cairo, Egypt
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine – Qatar, Doha, Qatar
- Corresponding author. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, 3050, Qatar.
| | - Abdelrahman Abdelaal
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed S. Al Hassan
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
24
|
Zhao H, Liu CH, Cao Y, Zhang LY, Zhao Y, Zhang X, Lin YS, Xia Y, Liu YW, Liu HF, Li XY. An immediate postoperative response to therapy assessment can help avoid unnecessary RAI therapy. Front Oncol 2022; 12:947710. [PMID: 36033466 PMCID: PMC9411644 DOI: 10.3389/fonc.2022.947710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background Radioiodine (RAI) therapy plays a vital role in the postoperative treatment of differentiated thyroid cancer (DTC) patients underwent total thyroidectomy (TT). However, even in the presence of capsular invasion and lymph node metastasis prognosis can be excellent and a postoperative RAI treatment might not be necessary for all patients. Therefore, this study explored the criteria for avoiding unnecessary RAI therapy in these patients. Method We applied response to therapy assessment immediately after surgery and prospectively recruited 179 excellent or indeterminate response DTC patients with capsular invasion and/or LNM who underwent TT without RAI therapy. During the follow-up, thyroglobulin (Tg), thyroglobulin antibody (TgAb) levels, and cervical ultrasonography were collected and analyzed. Disease-free survival (DFS) was calculated using the Kaplan-Meier method. In addition, response to therapy assessments was performed on patients during each follow-up. Results The mean follow-up period was 29.85 ± 17.44 months, and the 3- and 5-year DFS for all the patients was 99.3% in each. At the last follow-up, 165 (92.2%) patients had excellent responses, while 12 (6.7%) had an indeterminate response, and one (0.6%) each had biochemical and incomplete responses. No significant difference was observed in response to therapy between the subgroups of LNM and tumor invasion (P>0.05). For patients with capsular invasion and a number of metastatic lymph nodes ≤5 and >5, the proportions of recorded excellent responses were 95.9%, 91.0%, and 85.7%, respectively. Better responses were observed in females (excellent response: 95.5%, P=0.023), patients with stimulated Tg (s-Tg) ≤1ng/ml (excellent response: 100%, P<0.001), s-Tg ≤ 2ng/ml (excellent response: 98.4%, P<0.001), and excellent response for the immediate postoperative assessment (excellent response: 98.5%, P=0.004). Conclusions The current study suggested that the response to therapy assessment immediately applied postoperatively could help avoid unnecessary RAI therapy among DTC patients with capsular invasion and/or LNM. Moreover, excellent response patients and patients with indeterminate response and s-Tg ≤ 2ng/ml could be managed without RAI therapy.
Collapse
Affiliation(s)
- Hao Zhao
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chun-Hao Liu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue Cao
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-Yang Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ya Zhao
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Zhang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan-Song Lin
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu Xia
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yue-Wu Liu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hong-Feng Liu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiao-Yi Li
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Xiao-Yi Li,
| |
Collapse
|
25
|
Cui L, Feng D, Zhu C, Li Q, Li W, Liu B. Clinical outcomes of multifocal papillary thyroid cancer: A systematic review and meta‐analysis. Laryngoscope Investig Otolaryngol 2022; 7:1224-1234. [PMID: 36000032 PMCID: PMC9392403 DOI: 10.1002/lio2.824] [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: 12/21/2021] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Methods Results Level of Evidence Conclusion
Collapse
Affiliation(s)
- Likun Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head & Neck Surgery Peking University Cancer, Hospital & Institute Beijing China
| | - Dongdong Feng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head & Neck Surgery Peking University Cancer, Hospital & Institute Beijing China
| | - Chaofan Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head & Neck Surgery Peking University Cancer, Hospital & Institute Beijing China
| | - Qiuyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head & Neck Surgery Peking University Cancer, Hospital & Institute Beijing China
| | - Wenqing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology Peking University Cancer Hospital & Institute Beijing China
| | - Baoguo Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Head & Neck Surgery Peking University Cancer, Hospital & Institute Beijing China
| |
Collapse
|
26
|
Jang SW, Park JH, Kwon HJ, Yoon JH. Optimal cutoff values of primary tumour size to better predict long-term outcomes in patients with papillary thyroid carcinoma undergoing total thyroidectomy: A preliminary study using restricted cubic spline analysis. Clin Endocrinol (Oxf) 2022; 96:888-895. [PMID: 34908183 DOI: 10.1111/cen.14657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/23/2021] [Accepted: 12/03/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Primary tumour size (PTS) is known to be a significant prognostic factor in patients with papillary thyroid carcinoma (PTC) undergoing thyroidectomy. Although cutoff values of 2 and 4 cm are widely used in surgical extent decision and long-term outcomes predictions, the effectiveness of arbitrary cutoff values in stratifying patients for target outcomes is questionable. This study aimed to determine new optimal cutoffs of PTS. DESIGN, PATIENT AND MEASUREMENTS Patients (n = 529) with PTC who underwent total thyroidectomy were retrospectively reviewed. After risk factor analysis for structural recurrence, the optimal cutoffs of PTS were automatically calculated using restricted cubic spline analysis and X-tile software. Subgroups were classified based on the newly determined cutoff values. Both the recurrence-free survival (RFS) and the proportion of patients in each response-to-therapy category, using the dynamic risk stratification system (DRS), were compared between the subgroups. RESULTS PTS was confirmed as an independent risk factor for structural recurrence. The optimal cutoff values were calculated as 1.4 and 3.0 cm. The subgroups stratified using these newly determined cutoffs showed significantly different RFS and DRS based on the response to initial therapy, but the subgroups classified using the cutoffs of 2 and 4 cm did not. CONCLUSIONS The newly determined cutoff values of PTS may be useful in better stratifying patients with PTC undergoing thyroidectomy for target outcomes and can be considered as a new definition in staging and risk stratification systems.
Collapse
Affiliation(s)
- Sung Woo Jang
- Division of Thyroid-Endocrine Surgery, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jae Hyun Park
- Division of Thyroid-Endocrine Surgery, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hyeong Ju Kwon
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong Ho Yoon
- Division of Thyroid-Endocrine Surgery, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| |
Collapse
|
27
|
Giles Şenyürek Y, İşcan Y, Sormaz İC, Poyrazoğlu Ş, Tunca F. The Role of American Thyroid Association Pediatric Thyroid Cancer Risk Stratification and BRAFV600E Mutation in Predicting the
Response to Treatment in Papillary Thyroid Cancer Patients ≤18 Years Old. J Clin Res Pediatr Endocrinol 2022; 14:196-206. [PMID: 35135184 PMCID: PMC9176084 DOI: 10.4274/jcrpe.galenos.2022.2021-10-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the role of risk stratification by the American Thyroid Association (ATA) pediatric thyroid cancer risk levels and BRAFV600E mutation to predict the response to treatment in papillary thyroid cancer (PTC) patients ≤18 years old. METHODS Clinical outcomes during a median period of 6 (2-21.8) years were assessed in 70 patients, according to ATA pediatric risk stratification, BRAFV600E mutation status, and dynamic risk stratification (DRS) at final follow-up. RESULTS Of 70 patients, 44 (63%), 14 (20%), and 12 (17%) were classified initially as low-, intermediate-, and high-risk, respectively. BRAFV600E mutation analysis data was available in 55 (78.6%) patients, of whom 18 (32.7%) had the BRAFV600E mutation. According to the final DRS, 61 (87%), two (3%), six (9%), and one (1%) patients were classified as an excellent, incomplete biochemical, incomplete structural, and indeterminate response, respectively. All ATA low-risk patients showed excellent response to treatment, whereas the rate of excellent response was 65.4% in intermediate- and high-risk levels (p<0.001). The rates of excellent response in BRAFV600E positive and negative patients were 83% and 92%, respectively (p=0.339). The rate of locoregional recurrence was significantly higher in BRAFV600E positive vs negative patients (33.3% vs 2.7% respectively, p=0.001). CONCLUSION ATA pediatric risk stratification is effective in predicting response to treatment in PTC patients ≤18 years old. The presence of BRAFV600E mutation was highly predictive for recurrence but had no significant impact on the rate of excellent response to treatment at final follow-up.
Collapse
Affiliation(s)
- Yasemin Giles Şenyürek
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey,* Address for Correspondence: İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey Phone: +90 542 804 92 32 E-mail:
| | - Yalın İşcan
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey
| | - İsmail Cem Sormaz
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey
| | - Şükran Poyrazoğlu
- İstanbul University, İstanbul Faculty of Medicine, Department of Pediatrics, Unit of Pediatric Endocrinology, İstanbul, Turkey
| | - Fatih Tunca
- İstanbul University, İstanbul Faculty of Medicine, Department of Surgery, İstanbul, Turkey
| |
Collapse
|
28
|
do Prado Padovani R, Chablani SV, Tuttle RM. Radioactive iodine therapy: multiple faces of the same polyhedron. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:2359-3997000000461. [PMID: 35551676 PMCID: PMC9832850 DOI: 10.20945/2359-3997000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022]
Abstract
The incidence of differentiated thyroid carcinoma (DTC) has increased in recent decades with early stage, low risk papillary thyroid cancer (PTC) being detected and diagnosed. As a result, the psychological, financial, and clinical ramifications of overdiagnosis and excessively aggressive therapy are being increasingly recognized with many authorities calling for a re-evaluation of the traditional "one size fits all" management approaches. To address these critical issues, most thyroid cancer guidelines endorse a more risk adapted management strategy where the intensity of therapy and follow up is matched to the anticipated risk of recurrence and death from DTC for each patient. This "less is more" strategy provides for a minimalistic management approach for properly selected patients with low-risk DTC. This has re-kindled the long-standing debate regarding the routine use of radioactive iodine therapy (RIT) in DTC. Although recent guidelines have moved toward a more selective use of RIT, particular in patients with low-intermediate risk DTC, the proper selection of patients, the expected benefit, and the potential risks continue to be a source of ongoing controversy and debate. In this manuscript, we will review the wide range of clinical, imaging, medical team, and patient factors that must be considered when evaluating individual patients for RIT. Through a review of the current literature evaluating the potential benefits and risks of RIT, we will present a risk adapted approach to proper patient selection for RIT which emphasizes peri-operative risk stratification as the primary tool that clinicians should use to guide initial RIT management recommendations.
Collapse
|
29
|
Evolución del tratamiento supresor de la TSH al diagnóstico y en el seguimiento en una cohorte de carcinoma diferenciado de tiroides. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.008] [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: 11/22/2022]
|
30
|
Pérez-Fernández L, Sastre J, Zafón C, Oleaga A, Castelblanco E, Capel I, Galofré JC, Guadalix-Iglesias S, De la Vieja A, Riesco-Eizaguirre G. Validation of dynamic risk stratification and impact of BRAF in risk assessment of thyroid cancer, a nation-wide multicenter study. Front Endocrinol (Lausanne) 2022; 13:1071775. [PMID: 36714606 PMCID: PMC9880445 DOI: 10.3389/fendo.2022.1071775] [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: 10/16/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The dynamic risk stratification (DRS) is a relatively new system in thyroid cancer that considers the response to primary treatment to improve the initial risk of recurrence. We wanted to validate DRS system in a nationwide multicenter study and explore if the incorporation of BRAFV600E into DRS helps to better categorize and predict outcomes. MATERIALS AND METHODS Retrospective study of 685 patients from seven centers between 1991 and 2016, with a mean age of 48 years and a median follow-up time of 45 months (range 23-77). The overall BRAFV600E prevalence was 53.4%. We classified patients into four categories based on DRS ('excellent', 'indeterminate', 'biochemical incomplete', and 'structural incomplete' response). Cox regression was used to calculate adjusted hazard ratios (AHR) and proportions of variance explained (PVEs). RESULTS We found 21.6% recurrences and 2.3% cancer-related deaths. The proportion of patients that developed recurrence in excellent, indeterminate, biochemical incomplete and structural incomplete response to therapy was 1.8%, 54%, 91.7% and 96.2% respectively. Considering the outcome at the end of the follow up, patients showed no evidence of disease (NED) in 98.2, 52, 33.3 and 25.6% respectively. Patients in the structural incomplete category were the only who died (17.7%). Because they have similar outcomes in terms of NED and survival, we integrated the indeterminate and biochemical incomplete response into one unique category creating the 3-tiered DRS system. The PVEs of the AJCC/TNM staging, ATA risk classification, 4-tiered DRS, and 3-tiered DRS to predict recurrence at five years were 21%, 25%, 57% and 59% respectively. BRAFV600E was significantly associated with biochemical incomplete response (71.1 vs 28.9%) (HR 2.43; 95% CI, 1.21 to 5.23; p=0.016), but not with structural incomplete response or distant metastases. BRAF status slightly changes the AHR values of the DRS categories but is not useful for different risk grouping. CONCLUSIONS This is the first multicenter study to validate the 4-tiered DRS system. Our results also show that the 3-tiered DRS system, by integrating indeterminate and biochemical incomplete response into one unique category, may simplify response to therapy keeping the system accurate. BRAF status does not provide any additional benefit to DRS.
Collapse
Affiliation(s)
| | - Julia Sastre
- Department of Endocrinology, Hospital Universitario de Toledo, Toledo, Spain
| | - Carles Zafón
- Diabetes and Metabolism Research Unit (VHIR) and Department of Endocrinology, Hospital Vall d’Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Amelia Oleaga
- Department of Endocrinology and Nutrition, Basurto University Hospital, Bilbao, Spain
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | - Ismael Capel
- Endocrinology Department, Parc Taulí Sabadell University Hospital, Sabadell Barcelona, Spain
| | - Juan C. Galofré
- Department of Endocrinology, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Antonio De la Vieja
- Endocrine Tumor Unit (UFIEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Ciber de Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Garcilaso Riesco-Eizaguirre
- Ciber de Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario de Móstoles, Madrid, Spain
- Endocrinology Molecular Group, Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
- *Correspondence: Garcilaso Riesco-Eizaguirre,
| |
Collapse
|
31
|
Chen WC, Chou CK, Chang YH, Chiang PL, Lim LS, Chi SY, Luo SD, Lin WC. Efficacy of radiofrequency ablation for metastatic papillary thyroid cancer with and without initial biochemical complete status. Front Endocrinol (Lausanne) 2022; 13:933931. [PMID: 35992153 PMCID: PMC9381930 DOI: 10.3389/fendo.2022.933931] [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: 05/01/2022] [Accepted: 07/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The application of radiofrequency ablation (RFA) for recurrent thyroid cancer has been demonstrated to effectively manage lesions at critical locations, such as abutting the trachea, with limited complications. Comprehensive investigation of both biochemical (B) and structural (S) change after RFA remains limited. We herein present the first single-center experience of RFA for the treatment of locoregional recurrent thyroid cancer in Taiwan. DESIGN 23 patients were enrolled, and the treatment responses after RFA were divided into four groups (E, S(+), B(+), and SB(+)), and then compared. The RFA technique, follow-up strategy, changes in pre-and post-operative status, and complications are presented. The volume reduction rate at 1, 3, and 6 months, and the differing responses between lesions abutting/not abutting the trachea are also discussed. RESULTS In patients with pre-RFA structural and biochemical incomplete (SB(+)) status, presenting with lesion with an initial maximum diameter of >3.2cm, a higher rate of structural incomplete status at the 6-month follow-up was noted in ROC analysis, with a sensitivity of 57% and specificity of 91%. Favorable structural remission after RFA was noted, and 60.9% of patients achieved biochemical complete status. No significant correlation was noted between the trachea-abutted lesion number and complete remission (p= 0.474). No significant difference in RFA efficacy was noted between the lesions abutting/not abutting the trachea. CONCLUSIONS This retrospective study reveals that RFA can achieve both structural and biochemical improvements for locoregionally recurrent thyroid cancer, with a low complication rate. Nearly half of the patients achieved an excellent response after RFA, while a favorable treatment response can be achieved despite the lesion abutting the trachea, with a mean VRR of 84.74%.
Collapse
Affiliation(s)
- Wen-Chieh Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Pi-Ling Chiang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lay-San Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shun-Yu Chi
- Division of General Surgery and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- *Correspondence: Wei-Che Lin,
| |
Collapse
|
32
|
Thyroglobulin and thyroid cancer. Cancer Biomark 2022. [DOI: 10.1016/b978-0-12-824302-2.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
33
|
Jin M, Ahn J, Lee YM, Sung TY, Song DE, Kim TY, Chung KW, Ryu JS, Kim WB, Shong YK, Jeon MJ, Kim WG. Clinical implications of age and excellent response to therapy in patients with high-risk differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2021; 95:882-890. [PMID: 34160840 DOI: 10.1111/cen.14543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/24/2021] [Accepted: 06/09/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with American Thyroid Association (ATA) high-risk differentiated thyroid carcinoma (DTC) have poor clinical outcomes. This study aimed to evaluate the clinical implications of age and response to therapy classification in patients with ATA high-risk DTC. DESIGN AND PATIENTS This study included 222 patients with high-risk DTC who initially underwent therapy between 2000 and 2010 in a single tertiary center in Korea. We evaluated the prognostic parameters associated with progression-free survival (PFS) and disease-specific survival (DSS) with a focus on age and achieving an excellent response (ER). RESULTS During the median follow-up period of 11.3 years, disease progression was detected in 77 patients (34.7%), and disease-specific mortality was reported in 31 patients (14.0%). Older age (≥55 years) and not achieving ER (not-ER) were independent risk factors associated with PFS (age, p < .001; not-ER, p < .001) and DSS (age, p < .001; not-ER, p = .015). Of the 74 patients in the ER group, 7 (9.5%) displayed disease progression and 1 (1.4%) died from DTC. There were no significant differences in PFS and DSS according to age in the ER group. However, older patients had significantly worse PFS and DSS than younger patients in the not-ER group (p = .002 and p < .001, respectively). CONCLUSIONS Response to therapy classification is important for predicting PFS and DSS in patients with high-risk DTC. Patients in the ER group had a relatively good prognosis, but disease progression occurred in 9.5% of patients. Age was a key predictor of both PFS and DSS in high-risk patients who did not achieve ER.
Collapse
Affiliation(s)
- Meihua Jin
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jonghwa Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
34
|
Thyroglobulin Levels in Patients who have Undergone Hemithyroidectomy for Differentiated Thyroid Cancer. An Assessment of Levels and Trends at a Tertiary Referral Centre. South Asian J Cancer 2021; 11:52-57. [PMID: 35833051 PMCID: PMC9273327 DOI: 10.1055/s-0041-1733315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
AbstractSerum thyroglobulin (Tg) and thyroglobulin antibody (TgAb) levels are used to monitor patients with differentiated thyroid cancer (DTC) after total thyroidectomy with or without radioiodine (RAI) ablation. However, they are also measured in patients who are treated with thyroid lobectomy (TL)/hemithyroidectomy (HT). Data on the levels of Tg and its trend in those undergoing TL/HT is sparse in India. We reviewed retrospective data of DTC patients who underwent TL/HT and were followed-up with postoperative Tg levels between 2015 and 2020. Out of 247 patients, 17 had undergone either TL or HT, which included papillary thyroid cancer (n = 12), follicular thyroid cancer (n = 4), and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 1 patient. All patients with DTC had tumor size < 4 cm (T1/2, clinical N0, Mx). The median follow-up was 15 months (range, 1–125) and the median Tg level was 7.5 ng/mL (interquartile range [IQR]; 3.6, 7.5) and ranged from 0.9 to 36.7 ng/mL. The median thyroid-stimulating hormone (TSH) level was 2.03 IU/L (IQR; 1.21, 3.59) and it ranged from 0.05 to 8.54 IU/L. As of last follow-up, none of them underwent completion thyroidectomy; however, eight patients had a decline in Tg ranging from 8 to 64%, four patients had increase in Tg ranging from 14 to 145%, three patients had stable Tg, and one of them had an increase in TgAb titers. As per American Thyroid Association (ATA) response-to-treatment category, six patients had indeterminate response, five patients had biochemical incomplete response, four patients had excellent response, and two did not have follow-up Tg and TgAb levels. While absolute values of Tg were well below 30 ng/mL in almost all patients with HT/TL, the Tg trends were difficult to predict, and only 23% of patients were able to satisfy the criteria for “excellent response” on follow-up. We suggest keeping this factor in mind in follow-up and while counselling for HT in patients with low-risk DTC.
Collapse
|
35
|
Nobre GM, Tramontin MY, Treistman N, Alves PA, Andrade FA, Bulzico DA, Corbo R, Vaisman F. Pregnancy has no significant impact on the prognosis of differentiated thyroid cancer. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:768-777. [PMID: 34762783 PMCID: PMC10065402 DOI: 10.20945/2359-3997000000413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the impact of pregnancy on differentiated thyroid carcinomas (DTC) behavior. METHODS Retrospective study of patients diagnosed with DTC before or during pregnancy and treated with standard therapy. In women diagnosed with DTC before pregnancy, we evaluated the occurrence of progression according to categories of response to therapy based on imaging and non-stimulated thyroglobulin (TG) levels. RESULTS Of 96 analyzed patients, 76 became pregnant after DTC treatment and 20 were diagnosed with DTC during pregnancy. Among women who became pregnant after a DTC diagnosis, no difference was observed regarding response to therapy before and after pregnancy. Disease progression after pregnancy was documented in six of these patients, while seven of them presented progression before pregnancy but were only treated after delivery. Patients with DTC diagnosed during pregnancy had a higher rate of distant metastases at diagnosis (30%) compared with the patients who became pregnant after DTC diagnosis (9.2%, p = 0.01). CONCLUSION Pregnancy had no impact on the natural course of DTC. Disease progression after pregnancy was limited and probably related to more aggressive disease and higher risk stratification at diagnosis. Still, mild disease progression may have occurred asymptomatically in some patients.
Collapse
|
36
|
Abelleira E, Peñaloza MA, Jerkovich F, Bueno F, Pitoia F. Dynamic risk allows us to adequately select patients with differentiated thyroid cancer who do not require radioiodine treatment. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:315-321. [PMID: 34731559 PMCID: PMC10065346 DOI: 10.20945/2359-3997000000374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The treatment of patients with differentiated thyroid cancer (DTC) was modified in the last decade towards a more individualized approach according to the risk of recurrence (RR). We compared the outcomes of patients with low and intermediate RR (LRR and IRR) who received or did not receive radioiodine remnant ablation (RRA) after assessing the dynamic risk. Methods We included 307 DTC patients with LRR and IRR submitted to total thyroidectomy. All patients were reclassified according to the dynamic risk stratification (low or high). Patients with high dynamic risk received RRA (141 patients). Results LRR patients who received RRA presented a frequency of structural incomplete response (SIR) of 5% at the end of the follow-up, compared to 2% in those who did not receive it (p=0.353). IRR patients treated with RRA had a frequency of SIR of 22%, compared to 5% in patients without RRA (p=0.008). Conclusion This study demonstrates the usefulness of dynamic risk assessment to decide RRA in a cohort with a long-term follow-up. The lower prevalence of SIR at the end of the follow-up in patients who did not receive RRA highlights the adequate selection of those who would not benefit from RRA, even with an intermediate risk of recurrence.
Collapse
Affiliation(s)
- Erika Abelleira
- Division of Endocrinology, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Fernando Jerkovich
- Division of Endocrinology, University of Buenos Aires, Buenos Aires, Argentina
| | - Fernanda Bueno
- Division of Endocrinology, University of Buenos Aires, Buenos Aires, Argentina
| | - Fabián Pitoia
- Division of Endocrinology, University of Buenos Aires, Buenos Aires, Argentina,
| |
Collapse
|
37
|
Impact of Multifocality on the Recurrence of Papillary Thyroid Carcinoma. J Clin Med 2021; 10:jcm10215144. [PMID: 34768664 PMCID: PMC8584384 DOI: 10.3390/jcm10215144] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/31/2021] [Accepted: 10/31/2021] [Indexed: 12/24/2022] Open
Abstract
The incidence of thyroid cancer has dramatically increased over the last few decades, and up to 60% of patients have multifocal tumors. However, the prognostic impact of multifocality in patients with papillary thyroid carcinoma (PTC) remains unestablished and controversial. We evaluate whether multifocality can predict the recurrence of PTC. A total of 1249 patients who underwent total thyroidectomy for PTC at the Ewha Medical Center between March 2012 and December 2019 were reviewed. In this study, multifocality was found in 487 patients (39.0%) and the mean follow-up period was 5.5 ± 2.7 years. Multifocality was associated with high-risk features for recurrence, including extrathyroidal extension, lymph node metastasis, and margin involvement. After adjustment of those clinicopathological features, 10-year disease-free survival was 93.3% in patients with multifocal tumors, whereas those with unifocal disease showed 97.6% (p = 0.011). Multivariate Cox regression analysis indicated that male sex (HR 2.185, 95% CI 1.047–4.559), tumor size (HR 1.806, 95% CI 1.337–2.441), N1b LN metastasis (HR 3.603, 95% CI 1.207–10.757), and multifocality (HR 1.986, 95% CI 1.015–3.888) were independent predictors of recurrence. In conclusion, multifocality increased the risk of recurrence in patients with PTC. Patients with multifocal PTCs may need judicious treatment and follow-up approaches.
Collapse
|
38
|
Díaz-Soto G, Torres BT, López JJ, García S, Quiñones MÁ, de Luis D. Incidence and dynamic risk stratification in differentiated thyroid cancer in a high-resolution clinic, 2002-2017. ENDOCRINOL DIAB NUTR 2021; 68:636-641. [PMID: 34906344 DOI: 10.1016/j.endien.2021.11.021] [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: 07/14/2020] [Accepted: 10/21/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We evaluated the incidence, progression and the dynamic risk stratification in differentiated thyroid cancer (DTC) under follow-up in a high-resolution clinic (HRC). METHODS This was a retrospective observational study on incident cases in the tumor registry from 2002 to 2017 and their evolution under follow-up in HRC. RESULTS A total of 444 patients (78.5% women, 52.1±14.9 mean years old) were DTC diagnosed from 2002 to 2017. The incidence rate of DTC increased from 5.2 to 25.7×105 habitants/year in women and from 2.3 to 7.1×105 habitants/year in men (P<0.0001). This increased incidence was not associated with an increment in the incidental papillary microcarcinoma diagnosed (from 29.4% to 32%). In those patients undergoing follow-up at the HRC (84% papillary carcinomas), 65.7% were classified as being at a low risk of recurrence compared to 14.5% at high risk. Of those, 88.8% classified as making an excellent response at diagnosis remained disease-free at the final follow-up visit. However, those patients with an indeterminate or structurally incomplete response at diagnosis evolved to an excellent response in 55.8% and 42.9% of the cases, respectively, compared to 14.8% of those with a biochemically incomplete response (P<0.001) CONCLUSIONS: The increased incidence of DTC is similar to results published previously in other countries. Dynamic risk stratification systems adequately classify DTC patients and assess diagnostic and treatment procedures, especially in low-risk subgroups.
Collapse
Affiliation(s)
- Gonzalo Díaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, Spain.
| | - Beatriz Torres Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, Spain
| | - Juan José López
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, Spain
| | - Susana García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, Spain
| | - María Álvarez Quiñones
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Daniel de Luis
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, Spain; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, Spain
| |
Collapse
|
39
|
Xu S, Huang H, Zhang X, Huang Y, Guan B, Qian J, Wang X, Liu S, Xu Z, Liu J. Predictive Value of Serum Thyroglobulin for Structural Recurrence Following Lobectomy for Papillary Thyroid Carcinoma. Thyroid 2021; 31:1391-1399. [PMID: 34340593 DOI: 10.1089/thy.2021.0209] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: The value of serum thyroglobulin/antithyroglobulin (Tg/antithyroglobulin antibody [ATg]) for papillary thyroid carcinoma (PTC) surveillance after lobectomy was investigated. We aimed to examine the association between postlobectomy serum Tg/ATg and PTC structural recurrence and define applicable values for stratification. Methods: PTC patients who underwent lobectomy with adequate serum Tg/ATg data during 2000-2014 were selected. Predictive classifiers of recurrence using random forest were established combining different variables related to serum Tg (ATg-negative patients) or ATg (ATg-positive patients). Cutoff values were determined with receiver operating characteristic curves when applicable. Kaplan-Meier curve and Cox regression were performed to examine the predictive value of elevated Tg/ATg. Results: Of 1451 patients enrolled, 66 (6.3%) and 26 (6.5%) patients in the ATg-negative group (n = 1050) and ATg-positive group (n = 401) developed recurrence. The established classifier of serum Tg (n = 1050) showed a favorable association with recurrence (AUC = 0.81), while serum ATg did not (AUC = 0.72). The optimal cutoff values of the first Tg (FTg, measured 6-12 months after lobectomy) and last Tg (LTg, measured most recently) were 5.3 and 11.0 ng/mL, respectively. Elevated LTg patients had significantly higher recurrence rates than normal LTg patients (23.5% vs. 4.4%, p < 0.05). Patients with elevated FTg had significantly lower recurrence-free survival rates than patients with normal FTg in all ATg-negative patients, low-risk patients, and intermediate- to high-risk patients (according to the American Thyroid Association initial risk stratification) (n = 1050, 583, and 467, all p < 0.05). Multivariate analysis indicated patients with elevated FTg had twice the recurrent risk compared with those with normal FTg (hazard ratio = 2.052). Conclusions: Postlobectomy serum Tg has favorable value for predicting recurrence in PTC patients, and reasonable thresholds could identify patients at higher risk for recurrence during follow-up.
Collapse
Affiliation(s)
- Siyuan Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Hui Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiaohang Zhang
- State Grid Information & Telecommunication Group Co., Ltd., Beijing, P.R. China
| | - Ying Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Bei Guan
- Cooperative Innovation Center, Institute of Software, Chinese Academy of Sciences, Beijing, P.R. China
| | - Jiaxin Qian
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Zhengang Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| |
Collapse
|
40
|
Nam KT, Park JH, Moon GS, Yoon JH. Comparison of the abilities of staging and risk stratification systems to predict the long-term structural recurrence in patients with differentiated thyroid carcinoma after total thyroidectomy and radioactive iodine remnant ablation. Gland Surg 2021; 10:2200-2210. [PMID: 34422591 DOI: 10.21037/gs-21-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/14/2021] [Indexed: 11/06/2022]
Abstract
Background In patients with differentiated thyroid carcinoma (DTC), various staging and risk stratification systems have been applied to estimate long-term recurrence, which is a major issue during the postoperative follow-up period. However, the efficacy of these systems remains unclear in this context. Methods The present historical cohort study included 510 patients with DTC who underwent a total thyroidectomy followed by radioactive iodine (RAI) remnant ablation. Enrolled patients were categorized according to the 8th edition of American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) Tumor Node Metastasis (TNM) staging system, the 2015 American Thyroid Association (ATA) initial risk stratification system, and the dynamic risk stratification (DRS) system. The ability of each system to predict long-term structural recurrence was compared using proportion of variance explained (PVE) by logistic regression models. Results The median follow-up period was 108 months. Structural recurrence occurred in 7.6% of the patients (n=39/510). Disease-free survival (DFS) curves of the patients within each category in the TNM staging system, the ATA initial risk stratification system, and the DRS system were significantly different (P<0.001). The PVE of the DRS system (20.7%) was higher than those of the TNM staging system and the ATA initial risk estimates. Conclusions The DRS system may effectively predict long-term structural recurrence and guide long-term management and follow-up strategies in patients with DTC undergoing total thyroidectomy and RAI remnant ablation.
Collapse
Affiliation(s)
- Kyung Tae Nam
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jae Hyun Park
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Gil Seong Moon
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong Ho Yoon
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| |
Collapse
|
41
|
Bertol BC, Góes de Araújo JN, de Carvalho KTC, Gonzaga Dos Santos M, Martelli-Palomino G, de Figueiredo Feitosa NL, Maciel LMZ, Silbiger VN, Lucena-Silva N, Freitas JCDOC, Donadi EA. Polymorphisms at the IL17A and IL17RA genes are associated with prognosis of papillary thyroid carcinoma. Arch Med Res 2021; 53:163-169. [PMID: 34384609 DOI: 10.1016/j.arcmed.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 07/07/2021] [Accepted: 07/23/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Interleukin (IL)-17A has a dual role in tumor immunity, promotes anti-tumor responses and facilitates angiogenesis by interacting with IL-17 receptor A (IL-17RA). Although IL-17A has been associated with the pathogenesis of papillary thyroid carcinoma (PTC), the nucleotide variability at the IL17A and IL17RA genes is still poorly characterized. AIM To assess the contribution of the IL17A (-197 G >A, rs2275913) and IL17RA (-947 A >G, rs4819554) single nucleotide polymorphisms (SNP) on the development and progression of PTC and on IL-17 plasma levels. METHODS We studied 188 PTC patients and 170 healthy controls. SNPs were identified using PCR-amplified DNA and restriction fragment length polymorphism (RFLP) techniques. Plasma levels of IL-17A was evaluated in 83 PTC patients using ELISA. Statistical analyses were performed to evaluate the associations between SNPs and clinicohistopathological features of PTC and IL-17A levels. RESULTS No significant difference was observed regarding the allele and genotype distributions of both SNPs between PTC patients and controls. The IL17A GA was associated with poor biochemical and structural incomplete response to therapy, whereas no influence over the IL-17A expression was observed. The IL17RA AG was significantly associated with small-sized tumors, initial tumor stage at diagnosis and better response to therapy. CONCLUSIONS The IL17A SNP may predict an aggressive manifestation of PTC, whereas the IL17RA SNP was associated with a more favorable clinical outcome.
Collapse
Affiliation(s)
- Bruna Cristina Bertol
- Postgraduate Program of Basic and Applied Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil
| | | | | | - Marcos Gonzaga Dos Santos
- Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Gustavo Martelli-Palomino
- Department of Medicine, Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo. Ribeirão Preto-SP, Brazil
| | - Nathalie Lobo de Figueiredo Feitosa
- Department of Medicine, Division of Endocrinology and Metabolism, Ribeirão Preto Medical School, University of São Paulo. Ribeirão Preto-SP, Brazil
| | - Léa Maria Zanini Maciel
- Department of Medicine, Division of Endocrinology and Metabolism, Ribeirão Preto Medical School, University of São Paulo. Ribeirão Preto-SP, Brazil
| | - Vivian Nogueira Silbiger
- Postgraduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal-RN, Brazil; Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Norma Lucena-Silva
- Department of Immunology, Aggeu Magalhães Research Center, Oswaldo Cruz Foundation, Recife-PE, Brazil
| | - Janaina Cristiana de Oliveira Crispim Freitas
- Postgraduate Program of Pharmaceutical Sciences, Federal University of Rio Grande do Norte, Natal-RN, Brazil; Department of Clinical Analysis and Toxicology, Federal University of Rio Grande do Norte, Natal-RN, Brazil
| | - Eduardo Antônio Donadi
- Postgraduate Program of Basic and Applied Immunology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto-SP, Brazil; Department of Medicine, Division of Clinical Immunology, Ribeirão Preto Medical School, University of São Paulo. Ribeirão Preto-SP, Brazil
| |
Collapse
|
42
|
Ledwon A, Paliczka-Cieślik E, Syguła A, Olczyk T, Kropińska A, Kotecka-Blicharz A, Hasse-Lazar K, Kluczewska-Gałka A, Jarząb B, Handkiewicz-Junak D. Only peak thyroglobulin concentration on day 1 and 3 of rhTSH-aided RAI adjuvant treatment has prognostic implications in differentiated thyroid cancer. Ann Nucl Med 2021; 35:1214-1222. [PMID: 34363597 PMCID: PMC8494717 DOI: 10.1007/s12149-021-01663-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
Objective In patients with differentiated thyroid carcinoma (DTC), serum thyroglobulin levels measured at the time of remnant ablation after thyroid hormone withdrawal were shown to have prognostic value for disease-free status. We sought to evaluate serial thyroglobulin measurements at the time of recombinant human thyroid-stimulating hormone (rhTSH)-aided iodine 131 (131I) adjuvant treatment as prognostic markers of DTC. Methods Six hundred-fifty patients with DTC given total/near-total thyroidectomy and adjuvant radioiodine post-rhTSH stimulation were evaluated. Thyroglobulin was measured on day 1 (Tg1; at the time of the first rhTSH injection), day 3 (Tg3; 1 day after the second, final rhTSH injection), and day 6 (Tg6; 3 days post-radioiodine administration). Treatment failure was defined as histopathologically confirmed locoregional recurrence, or radiologically-evident distant metastases (signs of disease on computer tomography (CT) or magnetic resonance imaging (MRI), or abnormal foci of radioiodine or [18F] fluorodeoxyglucose ([18F]FDG) uptake. Results In univariate analysis, Tg1 (p < 0.001) and Tg3 (p < 0.001), but not Tg6, were significantly associated with structural recurrence. In multivariate analysis of the overall cohort, only Tg3 was independently associated with structural recurrence. In multivariate analysis of the subgroup (n = 561) with anti-Tg antibodies titers below the institutional cut-off, 115 IU/mL, Tg1 was an independent prognostic marker. Tg1 and Tg3 cutoffs to best predict structural recurrence were established at 0.7 ng/mL and 1.4 ng/mL, respectively. Conclusions Tg1 and Tg3, measurements made after rhTSH stimulation but before radioiodine treatment, independently predict a low risk of treatment failure in patients with DTC. Levels measured post-radioiodine application (e.g., Tg6) are highly variable, lack prognostic value, and hence can be omitted. Supplementary Information The online version contains supplementary material available at 10.1007/s12149-021-01663-y.
Collapse
Affiliation(s)
- Aleksandra Ledwon
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Ewa Paliczka-Cieślik
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Aleksandra Syguła
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Tomasz Olczyk
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Aleksandra Kropińska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Kotecka-Blicharz
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Kornelia Hasse-Lazar
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Aneta Kluczewska-Gałka
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Barbara Jarząb
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| |
Collapse
|
43
|
Lim ST, Jeon YW, Gwak H, Bae JS, Suh YJ. Nomogram for the Prediction of Biochemical Incomplete Response in Papillary Thyroid Cancer Patients. Cancer Manag Res 2021; 13:5641-5650. [PMID: 34285584 PMCID: PMC8286100 DOI: 10.2147/cmar.s320993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To develop a nomogram for predicting biochemical incomplete response (BIR) in the dynamic risk stratification (DRS) of papillary thyroid carcinoma (PTC) patients without structural recurrence, and to investigate its validity. Patients and Methods Overall, 1705 (1005 and 700 in the training and validation cohorts, respectively) PTC patients treated with total thyroidectomy without structural recurrence were included. multivariate logistic regression analyses were performed to determine the significant predictors of BIR in the training cohort. A nomogram was subsequently constructed for BIR risk prediction. Assessments for the predictive accuracy, discrimination, and calibration of the nomogram were performed. Subsequently, internal and external validations were conducted. Results In the multivariate analysis, age, sex, lymph node metastasis site, extrathyroidal extension, and lymphovascular invasion showed significant predictive value; using these predictive factors and tumor size, a nomogram for BIR risk prediction was constructed. In the training cohort, the nomogram showed good predictive performance and discrimination in the receiver operating characteristic (ROC) curve analysis, with an area under the curve (AUC) of 0.765. In internal validation, the bootstrap-corrected AUC was 0.76. The calibration plot showed good agreement between the predicted and actual observation. The Hosmer-Lemeshow (HL) test did not suggest a lack of fit (p=0.1613). In the external validation, the AUC was 0.828 in the ROC curve analysis; the calibration plot showed good quality, and the HL test did not suggest a lack of fit (p=0.2161). Conclusion The constructed nomogram may effectively predict the risk of BIR in DRS in PTC patients without structural recurrence. Level of Evidence Level 4.
Collapse
Affiliation(s)
- Seung Taek Lim
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ye Won Jeon
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hongki Gwak
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ja Seong Bae
- Division of Thyroid Surgical Oncology, Department of Surgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Jin Suh
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| |
Collapse
|
44
|
Gajowiec A, Chromik A, Furga K, Skuza A, Gąsior-Perczak D, Walczyk A, Pałyga I, Trybek T, Mikina E, Szymonek M, Gadawska-Juszczyk K, Kuchareczko A, Suligowska A, Jaskulski J, Orłowski P, Chrapek M, Góźdź S, Kowalska A. Is Male Sex A Prognostic Factor in Papillary Thyroid Cancer? J Clin Med 2021; 10:jcm10112438. [PMID: 34072690 PMCID: PMC8199349 DOI: 10.3390/jcm10112438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 12/30/2022] Open
Abstract
Identifying risk factors is crucial for predicting papillary thyroid cancer (PTC) with severe course, which causes a clinical problem. The purpose of this study was to assess whether male sex can be such a predictive factor and to verify whether including it as a predictive factor of high initial risk of recurrence/persistence would help to enhance the value of the American Thyroid Association initial risk stratification system (ATA). We retrospectively analyzed 1547 PTC patients (1358 females and 189 males), treated from 1986 to 2018. The relationship between sex and clinicopathological features, response to therapy, and disease status was assessed. Men with PTC showed some adverse clinicopathological features more often than women, including angioinvasion, lymph node metastases, and tumor size > 40 mm. There were sex-related disparities with respect to response to initial therapy and final follow-up. Male sex is associated with some unfavorable clinicopathological features of PTC, which may affect response to initial therapy or final disease status. In our study, modification of the ATA system by including male sex as a risk factor does not enhance its value. Thus, further studies are needed to assess whether males require treatment modalities or oncological follow-up protocols that are different from those of females.
Collapse
Affiliation(s)
- Aleksandra Gajowiec
- ESKULAP Student Scientific Organization, Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.C.); (K.F.); (A.S.)
- Correspondence: ; Tel.: +48-663-961-210
| | - Anna Chromik
- ESKULAP Student Scientific Organization, Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.C.); (K.F.); (A.S.)
| | - Kinga Furga
- ESKULAP Student Scientific Organization, Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.C.); (K.F.); (A.S.)
| | - Alicja Skuza
- ESKULAP Student Scientific Organization, Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.C.); (K.F.); (A.S.)
| | - Danuta Gąsior-Perczak
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (D.G.-P.); (A.W.); (I.P.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Agnieszka Walczyk
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (D.G.-P.); (A.W.); (I.P.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Iwona Pałyga
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (D.G.-P.); (A.W.); (I.P.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Tomasz Trybek
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Estera Mikina
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Monika Szymonek
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Klaudia Gadawska-Juszczyk
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Artur Kuchareczko
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Agnieszka Suligowska
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| | - Jarosław Jaskulski
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (D.G.-P.); (A.W.); (I.P.); (J.J.); (P.O.); (S.G.); (A.K.)
| | - Paweł Orłowski
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (D.G.-P.); (A.W.); (I.P.); (J.J.); (P.O.); (S.G.); (A.K.)
| | - Magdalena Chrapek
- Faculty of Natural Sciences, Jan Kochanowski University, 25-406 Kielce, Poland;
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (D.G.-P.); (A.W.); (I.P.); (J.J.); (P.O.); (S.G.); (A.K.)
- Clinical Oncology, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland
| | - Aldona Kowalska
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (D.G.-P.); (A.W.); (I.P.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Centre, S. Artwińskiego Str. 3, 25-734 Kielce, Poland; (T.T.); (E.M.); (M.S.); (K.G.-J.); (A.K.); (A.S.)
| |
Collapse
|
45
|
Díaz-Soto G, Torres Torres B, López JJ, García S, Álvarez Quiñones M, de Luis D. Incidence and dynamic risk stratification in differentiated thyroid cancer in a high-resolution clinic, 2002-2017. ENDOCRINOL DIAB NUTR 2021; 68:S2530-0164(21)00050-1. [PMID: 33745679 DOI: 10.1016/j.endinu.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/02/2020] [Accepted: 10/21/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We evaluated the incidence, progression and the dynamic risk stratification in differentiated thyroid cancer (DTC) under follow-up in a high-resolution clinic (HRC). METHODS This was a retrospective observational study on incident cases in the tumor registry from 2002 to 2017 and their evolution under follow-up in HRC. RESULTS A total of 444 patients (78.5% women, 52.1±14.9 mean years old) were DTC diagnosed from 2002 to 2017. The incidence rate of DTC increased from 5.2 to 25.7x105 habitants/year in women and from 2.3 to 7.1x105 habitants/year in men (P<0.0001). This increased incidence was not associated with an increment in the incidental papillary microcarcinoma diagnosed (from 29.4% to 32%). In those patients undergoing follow-up at the HRC (84% papillary carcinomas), 65.7% were classified as being at a low risk of recurrence compared to 14.5% at high risk. Of those, 88.8% classified as making an excellent response at diagnosis remained disease-free at the final follow-up visit. However, those patients with an indeterminate or structurally incomplete response at diagnosis evolved to an excellent response in 55.8% and 42.9% of the cases, respectively, compared to 14.8% of those with a biochemically incomplete response (P<0.001) CONCLUSIONS: The increased incidence of DTC is similar to results published previously in other countries. Dynamic risk stratification systems adequately classify DTC patients and assess diagnostic and treatment procedures, especially in low-risk subgroups.
Collapse
Affiliation(s)
- Gonzalo Díaz-Soto
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, España; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, España.
| | - Beatriz Torres Torres
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, España; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, España
| | - Juan José López
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, España; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, España
| | - Susana García
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, España; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, España
| | - María Álvarez Quiñones
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Valladolid, Valladolid, España
| | - Daniel de Luis
- Servicio de Endocrinología y Nutrición, Hospital Clínico Universitario Valladolid, Valladolid, España; Centro de Investigación de Endocrinología y Nutrición FAc Medicina Uva, Valladolid, España
| |
Collapse
|
46
|
Park JH, Moon GS, Nam KT, Yoon JH. Optimal Timing of Initiating Dynamic Risk Stratification During the Early Postoperative Period in Patients with Differentiated Thyroid Carcinoma After Thyroidectomy and Radioactive Iodine Remnant Ablation. Ann Surg Oncol 2021; 28:6580-6589. [PMID: 33677764 DOI: 10.1245/s10434-021-09721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study investigated the optimal timing to initiate assessment of the response to initial therapy during the early postoperative period in patients with differentiated thyroid carcinoma (DTC) using dynamic risk stratification (DRS). METHODS This historical cohort study included 510 patients with DTC who underwent a total thyroidectomy followed by radioactive iodine (RAI) remnant ablation. DRS for these patients was categorized into subgroups according to the time into the follow-up period at which the response to initial therapy was assessed. The ability of each DRS subgroup to predict the long-term structural recurrence of cancer was compared using the proportion of variance explained (PVE) from logistic regression models. RESULTS The median follow-up period was 108 months. Structural recurrence occurred in 7.6% of patients (n = 39/510). The PVE for long-term structural recurrence was higher among DRS subgroups (28.8-34.19%) compared with the American Joint Committee on Cancer/Union for International Cancer Control tumor-node-metastasis staging system (both the 7th and 8th editions; 4.01% and 6.13%, respectively) and the American Thyroid Association initial risk estimate (4.59%). Among the DRS subgroups, DRS assessed between 2 and 3 years after the initial surgery was associated with the highest PVE (34.19%). CONCLUSIONS The first assessment of DRS optimally predicts long-term structural recurrence in patients with DTC who underwent a total thyroidectomy and subsequent RAI remnant ablation at that 2- to 3-year postoperative period.
Collapse
Affiliation(s)
- Jae Hyun Park
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Gil Seong Moon
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Kyung Tae Nam
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong Ho Yoon
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea.
| |
Collapse
|
47
|
Machine learning-based prediction model using clinico-pathologic factors for papillary thyroid carcinoma recurrence. Sci Rep 2021; 11:4948. [PMID: 33654166 PMCID: PMC7925610 DOI: 10.1038/s41598-021-84504-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/15/2021] [Indexed: 01/18/2023] Open
Abstract
This study analyzed the prognostic significance of clinico-pathologic factors, including the number of metastatic lymph nodes (LNs) and lymph node ratio (LNR), in patients with papillary thyroid carcinoma (PTC), and attempted to construct a disease recurrence prediction model using machine learning techniques. We retrospectively analyzed clinico-pathologic data from 1040 patients diagnosed with PTC between 2003 and 2009. We analyzed clinico-pathologic factors related to recurrence through logistic regression analysis. Among the factors that we included, only sex and tumor size were significantly correlated with disease recurrence. Parameters such as age, sex, tumor size, tumor multiplicity, ETE, ENE, pT, pN, ipsilateral central LN metastasis, contralateral central LNs metastasis, number of metastatic LNs, and LNR were input for construction of a machine learning prediction model. The performance of five machine learning models related to recurrence prediction was compared based on accuracy. The Decision Tree model showed the best accuracy at 95%, and the lightGBM and stacking model together showed 93% accuracy. Among those factors mentioned above, LNR and contralateral LN metastasis were used as important features in all machine learning prediction models. We confirmed that all machine learning prediction models showed an accuracy of 90% or more for predicting disease recurrence in PTC. LNR and contralateral LN metastasis were used as important features for constructing a robust machine learning prediction model. In the future, we have a plan to perform large-scale multicenter clinical studies to improve the performance of our prediction models and verify their clinical effectiveness.
Collapse
|
48
|
Lee JY, Baek JH, Ha EJ, Sung JY, Shin JH, Kim JH, Lee MK, Jung SL, Lee YH, Ahn HS, Yoon JH, Choi YJ, Park JS, Lee YJ, Choi M, Na DG. 2020 Imaging Guidelines for Thyroid Nodules and Differentiated Thyroid Cancer: Korean Society of Thyroid Radiology. Korean J Radiol 2021; 22:840-860. [PMID: 33660459 PMCID: PMC8076832 DOI: 10.3348/kjr.2020.0578] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a key role in the diagnosis and characterization of thyroid diseases, and the information provided by imaging studies is essential for management planning. A referral guideline for imaging studies may help physicians make reasonable decisions and minimize the number of unnecessary examinations. The Korean Society of Thyroid Radiology (KSThR) developed imaging guidelines for thyroid nodules and differentiated thyroid cancer using an adaptation process through a collaboration between the National Evidence-based Healthcare Collaborating Agency and the working group of KSThR, which is composed of radiologists specializing in thyroid imaging. When evidence is either insufficient or equivocal, expert opinion may supplement the available evidence for recommending imaging. Therefore, we suggest rating the appropriateness of imaging for specific clinical situations in this guideline.
Collapse
Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Eun Ju Ha
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Jin Yong Sung
- Department of Radiology and Thyroid Center, Daerim St. Mary's Hospital, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyoung Lee
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - So Lyung Jung
- Department of Radiology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hen Lee
- Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hye Shin Ahn
- Department of Radiology and Thyroid Center, Chungang University Hospital, Chungang University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jeong Seon Park
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Miyoung Choi
- Division for Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Dong Gyu Na
- Department of Radiology, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung, Korea
| | | |
Collapse
|
49
|
Díez JJ, Alcázar V, Iglesias P, Romero-Lluch A, Sastre J, Corral BP, Zafón C, Galofré JC, Pamplona MJ. Thyroid lobectomy in patients with differentiated thyroid cancer: an analysis of the clinical outcomes in a nationwide multicenter study. Gland Surg 2021; 10:678-689. [PMID: 33708550 DOI: 10.21037/gs-20-712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Total thyroidectomy is the standard initial surgery for differentiated thyroid carcinoma (DTC), but the extent of the thyroidectomy remains controversial. Thyroid lobectomy (TL) has been widely used in eastern countries; however, its use has not been generalized in western countries, including Spain. Our aims were to analyse the clinical outcome of a multicentre nation-wide cohort of DTC patients treated by TL and to assess the proportion of patients who required completion of the thyroidectomy and who presented disease recurrence. Methods We retrospectively analyzed patients who underwent TL for DTC and were followed-up for ≥12 months. We collected demographic, clinical, and histopathological data. Dynamic risk stratification (DRS) was performed at 12 months and at last visit. Results One hundred and sixty-four patients (128 women, mean age 50.8 years, median follow-up 45.4 months) from 9 hospitals were included. There were 158 cases of papillary and 6 of follicular thyroid carcinoma (FTC). Remission of the disease (excellent response) was shown in 71.6% of the patients at 12 months and in 74.4% at the end of follow-up. At that time, there were 34 patients (20.7%) with indeterminate response, 6 (3.7%) with biochemical incomplete response, and 2 (1.2%) with structural incomplete response. Completion of the thyroidectomy was necessary in 8 patients (4.9%), but only 3 of them (1.8%) had disease recurrence. Conclusions These results, obtained in real clinical practice, suggest that TL is a safe operative option for selected patients with DTC and that the intensity of the treatment must be tailored according to the presurgical tumor-associated risk, in line with a personalized medicine.
Collapse
Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain
| | - Victoria Alcázar
- Department of Endocrinology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain
| | - Ana Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Julia Sastre
- Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Begoña Pérez Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | - Carles Zafón
- Department of Endocrinology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan Carlos Galofré
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain
| | | |
Collapse
|
50
|
Stewart LA, Kuo JH. Advancements in the treatment of differentiated thyroid cancer. Ther Adv Endocrinol Metab 2021; 12:20420188211000251. [PMID: 33796254 PMCID: PMC7975487 DOI: 10.1177/20420188211000251] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
Derived from follicular epithelial cells, differentiated thyroid cancer (DTC) accounts for the majority of thyroid malignancies. The threefold increase in DTC incidence over the last three decades has been largely attributed to advancements in detection of papillary thyroid microcarcinomas. Efforts to address the issue of overtreatment have notably included the reclassification of encapsulated follicular variant papillary thyroid cancers (EFVPTC) to non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). In the last 5 years, the overall management approach for this relatively indolent cancer has become less aggressive. Although surgery and radioiodine ablation remain the mainstay of DTC therapy, the role of active surveillance is being explored. Furthermore, the most recent American Thyroid Association (ATA) guidelines offer flexibility between lobectomy and total thyroidectomy for thyroid nodules between 1 cm and 4 cm in the absence of extrathyroidal extension or nodal disease. As our understanding of the natural history and molecular underpinnings of DTC evolves, so might our approach to managing low-risk patients, obviating the need for invasive intervention. Simultaneously, advances in interventional and systemic therapies have greatly expanded treatment options for high-risk surgical candidates and patients with widespread disease, and continue to be areas of active investigation. Continued research efforts are essential to improve our ability to offer effective individualized therapy to patients at all disease stages and to reduce the incidence of recurrent and progressive disease.
Collapse
Affiliation(s)
- Latoya A. Stewart
- Columbia University Vagelos College of
Physicians and Surgeons, New York, NY, USA
| | | |
Collapse
|