Incidence of thyroid cancer in England by ethnic group, 2001-2007

Thyroid cancer in Ecuador: A genetic variants review and a cross-sectional population-based analysis before and after COVID-19 pandemic

Objectives

The purpose of this study is to describe the genetic variants present in the Ecuadorian population and the incidence and mortality patterns of thyroid cancer in Ecuador from 2016 to 2021.

Methods

The present research constitutes a nationwide cross-sectional study encompassing all reported cases of thyroid cancer (C-73) in Ecuador from 2016 to 2021. Incidence rates were calculated based on the annual population at risk, considering factors such as ethnicity, sex, age group, and the geographic location of the incidence. All data was collected from the Hospital Discharge Statistics and the Statistical Registry of General Deaths Databases.

Results

Between 2016 and 2021, a total of 20,297 hospital admissions and 921 deaths attributed to thyroid cancer were reported in Ecuador. The incidence of thyroid cancer remained relatively stable from 2016 to 2019. However, there was a notable decrease in 2020, followed by an increase in 2021. Notably, thyroid cancer prevalence rates were found to be higher in highlands regions. Moreover, two genetic variants, the BRAFV600E and KITL678F, have been identified in the Ecuadorian population. It is noteworthy that women exhibited a higher susceptibility to thyroid cancer, being five times more likely than men to develop this condition.

Conclusion

Ecuador exhibits one of the highest global incidences of thyroid cancer. Consequently, describing the genetic variants and epidemiological characteristics of thyroid cancer is imperative for enhancing healthcare access and formulating evidence-based public health policies. This research contributes towards a comprehensive understanding of thyroid cancer in the Ecuadorian context, aiming to improve targeted interventions and health outcomes.

Differences in cancer incidence by broad ethnic group in England, 2013-2017

BACKGROUND

Cancer incidence variation between population groups can inform public health and cancer services. Previous studies have shown cancer incidence rates vary by ethnic group in England. Since their publication, the completeness of ethnicity recording in cancer data has improved, and relevant inequalities (e.g. risk factor prevalence and healthcare access) may have changed.

METHODS

Age-standardised incidence rates were calculated for Asian, Black, Mixed/Multiple and White ethnic groups in England in 2013-2017, using almost 3 million diagnoses across 31 cancer sites. Rate ratios were calculated with the White ethnic group as reference. Sensitivity analyses used imputed ethnicity for cases with missing data and perturbed population estimates.

RESULTS

Incidence rates for most cancer sites and ethnic group and sex combinations were lower in non-White minority ethnic groups compared with the corresponding White group, with particularly low rate ratios (below 0.5) for melanoma skin cancer and some smoking-related cancers (lung, bladder and oesophageal cancers). Exceptions included prostate cancer (2.1 times higher in males of Black ethnicity), myeloma (2.7-3.0 times higher in people of Black ethnicity), several gastrointestinal cancers (1.1-1.9 times higher in people of Black ethnicity, 1.4-2.2 times higher in people of Asian ethnicity), Hodgkin lymphoma (1.1 times higher in males of Asian ethnicity, 1.3 times higher in males of Black ethnicity) and thyroid cancers (1.4 times higher in people of Asian ethnicity, 1.2 times higher in people of Black ethnicity). Sensitivity analyses did not materially alter these results (rate ratios changed by a maximum of 12 percentage points, the direction and significance of results were unchanged in all but two cancer site/sex/ethnic group combinations).

CONCLUSIONS

People of non-White minority ethnicity in England generally have lower cancer risk than the White population, though there are a number of notable exceptions. These results should galvanise efforts to better understand the reasons for this variation, and the possible impact on cancer services, patient experiences and outcomes.

Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups

More people in the UK are living with cancer than ever before. With an increasingly ethnically diverse population, greater emphasis must be placed on understanding factors influencing cancer outcomes. This review seeks to explore UK-specific variations in engagement with cancer services in minority ethnic groups and describe successful interventions. The authors wish to highlight that, despite improvement to engagement and education strategies, inequalities still persist and work to improve cancer outcomes across our communities still needs to be prioritised. There are many reasons why cancer healthcare inequities exist for minority communities, reported on a spectrum ranging from cultural beliefs and awareness, through to racism. Strategies that successfully enhanced engagement included language support; culturally-sensitive reminders; community-based health workers and targeted outreach. Focusing on the diverse city of Leicester the authors describe how healthcare providers, researchers and community champions have worked collectively, delivering targeted community-based strategies to improve awareness and access to cancer services.

Epidemiological, Clinical, Ultrasonographic and Cytological Characteristics of Thyroid Nodules in an Afro-Caribbean Population: A Series of 420 Patients

Simple Summary

This study describes the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and evaluates the value of cytology in the diagnosis of malignancy in an Afro-Caribbean population. Our results revealed that none of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in Afro-Caribbean populations. Bethesda system-based cytology revealed low sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results.

Abstract

The incidence of thyroid cancer is increasing worldwide. The aim of this study is to describe the epidemiological, clinical and ultrasound characteristics of malignancy in thyroid nodules and to evaluate the predictive value of the Bethesda system for thyroid cytology in the diagnosis of malignancy in an Afro-Caribbean population. We conducted a retrospective study in Martinique involving 420 patients with a diagnosis of thyroid nodules between 2011 and 2014. Of the 192/420 (45.7%) patients operated on for thyroid nodules, 9% had thyroid cancer. All patients with thyroid cancer were obese women with a mean age of 50 years. The final histological examination revealed papillary microcarcinomas in 61% of cases and papillary carcinomas in 39% of cases. Thyroid cytology alone had a low sensitivity (22.2%) and positive predictive value (15.4%) for the diagnosis of malignancy, with a good specificity (91.1%) and negative predictive value (94.2%). None of the standard ultrasound criteria of malignancy were significantly predictive of cancer, but hypoechogenicity and central vascularity were frequently found in malignant nodules. These epidemiological, clinical and ultrasound results could increase awareness and guide practitioners in their diagnostic approach and management of thyroid nodules in an Afro-Caribbean population. Bethesda system-based cytology revealed lower sensitivity in analyzing the risk of malignancy in this population. The high prevalence of papillary microcarcinomas may explain the inconclusive ultrasound and cytological results.

Trend dynamics of thyroid cancer incidence among China and the U.S. adult population from 1990 to 2017: a joinpoint and age-period-cohort analysis

BACKGROUND

Thyroid cancer (TC) is the most common malignant disease of the endocrine system. Based on the previously published reports, the incidence of TC has been increasing in the past 25 years, and the reason for the increase is not yet clear. The present study aims to reveal the long-term trends and age-period-cohort effects for the incidence of TC in China and the U.S. from 1990 to 2017.

METHODS

We examined the trends of TC incidence and the average annual percentage change (AAPC) of rate using the Joinpoint regression analysis in the two countries, for the different genders (men/women) in the Global Burden of Disease (GBD 2017). We further used an age-period-cohort model to analyze age-period-cohort effects on TC incidence.

RESULTS

The ASIR of China increased markedly with AAPC of 4.5% (95% confidence interval (CI): 4.0, 5.0%) and 1.8% (1.6, 2.0%) for men and women during 1990-2017. The ASIR of the U. S increased by 1.4% (1.0, 1.8%) and 1.3% (0.9, 1.7%) for men and women from 1990 to 2017.TC increased with the age and period. Aging was one of the most influential factors of TC in China. The age effect increased markedly in the U.S. compared with China. The period effect showed an increase in China while that tended to grow steadily during 1990-2017 in the U.S. The cohort effect peaked in 1963-1967 birth cohorts for men and women in China and declined consistently in the birth cohort in the U.S.

CONCLUSION

From 1990 to 2017, due to ionizing radiation and over-diagnosis, age-standardized TC incidence rates in both genders rose in China and the U.S. The standardized incidence rate of women is higher than that of men. It is necessary to provide women with reasonable prevention and protection measures for TC. We need to apply for health services and screening to reduce ionizing radiation.

Epidemiologic, Clinical, Ultrasonographic, and Cytological Features of Thyroid Nodules in Predicting Malignancy Risk: A Retrospective Study of 442 French Afro-Caribbean Patients

OBJECTIVE

To evaluate epidemiologic, clinical, cytological, and ultrasonographic features of thyroid nodules in a sample French Afro-Caribbean population to determine if the standard criteria for predicting malignancy risk are applicable to this specific ethnic population. Methods and Design. This retrospectively designed study consisted of 442 patients who had consulted with the Endocrinology Department in Martinique (French overseas department) between 2007 and 2011. Of the 442 patients, 641 ultrasound-guided fine-needle aspirations (US-FNA) were performed by two experienced endocrinologists, and 212 patients underwent surgery. The geographical situation, age, gender of the patient, clinical and ultrasonographic features, TSH level, and US-FNA results were considered and cross-referenced with their pathology results.

RESULTS

The overall malignancy rate on final histopathology was 9% (women only), 80% of which were papillary cancer, and 20% were follicular cancer. Occult micropapillary carcinoma represented 35% of the papillary cancer. There was no significant difference in age, nodule localization, number of nodules, or thyroid function test between benign and malignant nodules. Contrary to the literature, we found only 12% incidentaloma in our series, while more than half of the nodules were discovered on palpation or as a clinical symptom. Hypoechogenicity in solid pattern nodules and nodules between 2 and 3 cm in size revealed a high diagnostic value in detecting malignancy. The corresponding rate of malignancy on Bethesda system histopathologic examination was as follows: 0% in undiagnosed (I), 0% benign (II) (micropapillary), 5% (FLUS)/atypia (III), 9% follicular neoplasm (IV), 33% suspected malignancy (V), and no malignant cytology (VI). These results show a different Bethesda system predictive value for this French Afro-Caribbean population.

CONCLUSION

Studies evaluating ethnic cancer disparities among patients with thyroid cancer are limited and do not specifically focus on the French Afro-Caribbean population. Despite rare thyroid incidentaloma, 35% of the papillary cancer cases were micropapillary carcinoma, and the incidence and standardized mortality rate in Martinique are lower than in metropolitan France. The malignant risk distribution of thyroid FNA Bethesda classification in this sample population differs from the standard risk, and it is necessary to take that into account in the decision to operate by associating it with echographic malignancy criteria.

Increasing Thyroid Cancer Incidence in Oman: A Joinpoint Trend Analysis

Objectives

We sought to investigate the epidemiology of thyroid cancer and its trends in Oman over a 20-year period.

Methods

We analyzed all cases of primary thyroid cancer reported to the Oman National Cancer Registry between 1996 and 2015. Age-standardized incidence rates (ASR) were calculated using the World Standard Population. Joinpoint regression was used to assess trends and obtain annual percentage changes (APC) in incidence rates with 95% confidence intervals (95% CI) and p-values at the alpha = 0.050 level. Gender-specific APC was used to project thyroid cancer incidence rates in Oman over the next 20 years. Population attributable fraction was calculated for obesity and current non-smoking.

Results

A total of 1285 cases of primary thyroid cancer cases were registered in Oman between 1996 and 2015, with a female to male ratio of 4:1. In men, the ASR was 2.0 per 100 000 while in females it was 7.6 per 100 000 (p < 0.010). Over 80.0% of thyroid tumors were of a papillary type and 19.0% follicular type. Statistically significant trends for thyroid cancer were detected in women from 2008–2015 (APC = 14.3%, 95% CI: 8.0–20.9, p < 0.010) and among both genders (APC = 16.7%, 95% CI: 4.9–29.9, p < 0.010). If current trends continue, thyroid cancer incidence will increase to 3.1, 16.6, and 11.8 per 100 000 by 2040 in men, women, and both genders, respectively. Nearly 10.0% of thyroid cancer can be prevented by controlling obesity in the Omani population.

Conclusions

Oman has had moderate incidence rates of thyroid cancer with an increasing trend among women. Since projections estimate that the rates of this disease will double in women over the next 20 years, health authorities should consider providing sufficient resources to manage this condition and establish prevention programs that address obesity as part of the strategy for the prevention and control of noncommunicable diseases.

Incidence of thyroid cancer in Puerto Rico and the US by racial/ethnic group, 2011-2015

BACKGROUND

Puerto Rico has the highest incidence rate of thyroid cancer (TC) in the Americas and the third highest rate worldwide. The purpose of this study was to compare the burden of TC between the population of PR and United States (US) non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB), and US Hispanics (USH) during the period 2011-2015.

METHODS

TC data for the period 2011-2015 was obtained from the Puerto Rico Central Cancer Registry (PRCCR) and the Surveillance Epidemiology and Ends Results Program (SEER) 18 Registries Research Data. TC was categorized in: papillary carcinoma (PTC), and other TC histologic types. Data was analyzed by sex, age groups, and histologic type. Racial/ethnic differences by sex, age, and histologic types were assessed using the Standardized Rate Ratio (SRR) and its 95% CI.

RESULTS

During the period 2011-2015 there were 5175 and 65,528 cases of TC diagnosed in PR and the US, respectively. The overall age-adjusted incidence rate of PTC was almost two-fold higher in PR than in the US (25.8/100,000 vs. 12.9/100,000). Among PR women, the incidence rate of PTC was 40.0/100,000 compared to 19.4/100,000 in US. PR women had 83% increased risk of being diagnosed with PTC than NHW women, a 2.25-fold increased risk than USH, and 3.45-fold increased risk than NHB women. For men, PR had 34% increased risk of being diagnosed with PTC than NHW men, 2.2-fold increased risk than USH men, and 3.2-fold higher risk than in NHB men.

CONCLUSION

Further research is needed to understand this disparity in the island. This research should address the extent of overdiagnosis in PR, the role of health insurance status and insurance type, characteristics of the healthcare delivery system as well as the role of patient and environmental factors.

Prognostic Impact of Direct 131I Therapy After Detection of Biochemical Recurrence in Intermediate or High-Risk Differentiated Thyroid Cancer: A Retrospective Cohort Study

Background: Patients treated for intermediate- or high-risk differentiated thyroid carcinoma (DTC) and Thyroglobulin (TG) elevation during follow-up, require a diagnostic whole-body scan (DWBS) and if positive, ¹³¹I treatment. This approach can lead to a delay in treatment and increased costs. The purpose of this study is to compare the oncologic outcomes associated to administration of direct therapy with ¹³¹I at first biochemical recurrence. Methods: Retrospective cohort study of patients with intermediate- or high-risk DTC treated with total thyroidectomy, ¹³¹I ablation and who developed TG elevation during follow-up, between January 2007 and December 2015. Cohort A included patients who underwent a DWBS with 5 mCi of ¹³¹I, and if negative an MRI and/or ¹⁸FDG PET-CT prior to the therapeutic dosage, and cohort B included those who only received a therapeutic dosage of ¹³¹I, without a DWBS or extensive image studies. Main outcomes were second recurrence (SR) and disease-free survival (DFS). The diagnostic accuracy of DWBS was analyzed. Results: Cohorts A and B had 74 and 41 patients, each. By multivariate analysis, age, differentiation grade, TN classification, ablation dose, and performed DWBS (odds ratio 55.1; 95% CI 11.3-269) were associated with SR (p < 0.0001); age, male gender, ablation dose and performed DWBS (hazard ratio 7.79; 95% CI 3.67-16.5) were independent factors associated with DFS (p < 0.0001). DWBS diagnostic accuracy was 36.48%. Conclusion: ¹³¹I treatment in patients with DTC biochemical recurrence and no DWBS or extensive image studies is associated with a significantly lower frequency of SR and an increased DFS. The diagnostic accuracy of DWBS is low, and its clinical efficiency should be defined in prospective phase III studies.

Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis

There is an increasing incidence of well-differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low-risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient-based and clinician-led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low-risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.

Childhood cancer incidence by ethnic group in England, 2001-2007: a descriptive epidemiological study

BACKGROUND

After the first year of life, cancers are the commonest cause of death in children. Incidence rates vary between ethnic groups, and recent advances in data linkage allow for a more accurate estimation of these variations. Identifying such differences may help identify potential risk or protective factors for certain childhood cancers. This study thus aims to ascertain whether such differences do indeed exist using nationwide data across seven years, as have previously been described in adult cancers.

METHODS

We obtained data for all cancer registrations for children (aged 0-14) in England from January 2001 to December 2007. Ethnicity (self-assigned) was established through record linkage to the Hospital Episodes Statistics database or cancer registry data. Cancers were classified morphologically according to the International Classification of Childhood Cancer into four groups - leukaemias; lymphomas; central nervous system; and other solid tumours. Age standardised incidence rates were estimated for each ethnic group, as well as incidence rate ratios comparing each individual ethnic group (Indian, Pakistani, Bangladeshi, Black African, Black Carribean, Chinese) to Whites, adjusting for sex, age and deprivation.

RESULTS

The majority of children in the study are UK born. Black children (RR = 1.18, 99% CI: 1.01-1.39), and amongst South Asians, Pakistani children (RR = 1.19, 99% CI: 1.02-1.39) appear to have an increased risk of all cancers. There is an increased risk of leukaemia in South Asians (RR = 1.31, 99% CI: 1.08-1.58), and of lymphoma in Black (RR = 1.72, 99% CI: 1.13-2.63) and South Asian children (RR = 1.51, 99% CI: 1.10-2.06). South Asians appear to have a decreased risk of CNS cancers (RR = 0.71, 99% CI: 0.54-0.95).

CONCLUSIONS

In the tradition of past migrant studies, such descriptive studies within ethnic minority groups permit a better understanding of disease incidence within the population, but also allow for the generation of hypotheses to begin to understand why such differences might exist. Though a major cause of mortality in this age group, childhood cancer remains a relatively rare disease; however, the methods used here have permitted the first nationwide estimation of childhood cancer by individual ethnic group.

The role of race in thyroid cancer: systematic review

BACKGROUND

The incidence of thyroid cancer is increasing. There is conflicting evidence as to why. However, studies suggest that it is not an apparent increase resulting from enhanced diagnostic practices, but a true increase with more affected patients. This study aimed to assess racial variation in thyroid cancer.

METHOD

A narrative systematic review of the literature was conducted.

RESULTS

Eight retrospective cohort studies were identified, comprising 611 777 adult patients. Variations exist between racial groups, which are also dependent on gender; white patients have a slightly higher male population when compared to their counterparts. Black and white patients have a higher proportion of follicular cancer. Hispanics were younger at the age of diagnosis. Outcomes are greatly affected by socioeconomic status.

CONCLUSION

This study identified many gaps in the way that these types of data are presented. A more concise manner of reporting, with individual-level risk factors, is recommended.

The impact of family history on non-medullary thyroid cancer

INTRODUCTION

Around 10% of patients with non-medullary thyroid cancer (NMTC) will have a positive family history for the disease. Although many will be sporadic, families where 3 first-degree relatives are affected can be considered to represent true familial non-medullary thyroid cancer (FNMTC). The genetic basis, impact on clinical and pathological features, and overall effect on prognosis are poorly understood.

METHODS

A literature review identified articles which report on genetic, clinical, therapeutic and screening aspects of FNMTC. The results are presented to allow an understanding of the genetic basis and the impact on clinical-pathological features and prognosis in order to inform clinical decision making.

RESULTS

The genetic basis of FNMTC is unknown. Despite this, significant progress has been made in identifying potential susceptibility genes. The lack of a test for FNMTC has led to a clinical definition requiring a minimum of 3 first-degree relatives to be diagnosed with NMTC. Although some have shown an association with multi-centric disease, younger age and increased rates of extra-thyroidal extension and nodal metastases, these findings are not supported by all. The impact of FNMTC is unclear with all groups reporting good outcome, and some finding an association with more aggressive disease. The role of screening remains controversial.

CONCLUSION

FNMTC is rare but can be diagnosed clinically. Its impact on prognostic factors and the subsequent role in influencing management is debated. For those patients who present with otherwise low-risk differentiated thyroid cancer, FNMTC should be included in risk assessment when discussing therapeutic options.

Increasing thyroid cancer incidence in Queensland, Australia 1982-2008 - true increase or overdiagnosis?

BACKGROUND

Thyroid cancer incidence has been increasing worldwide. Some suggest greater ascertainment of indolent tumours is the only driver, but others suggest there has been a true increase. Increases in Australia appear to have been among the largest in the world, so we investigated incidence trends in the Australian state of Queensland to help understand reasons for the rise.

METHODS

Thyroid cancers diagnoses in Queensland 1982-2008 were ascertained from the Queensland Cancer Registry. We calculated age-standardized incidence rates (ASR) and used Poisson regression to estimate annual percentage change (APC) in thyroid cancer incidence by socio-demographic and tumour-related factors.

RESULTS

Thyroid cancer ASR in Queensland increased from 2·2 to 10·6/100 000 between 1982 and 2008 equating to an APC of 5·5% [95% confidence interval (CI) 4·7-6·4] in men and 6·1% (95% CI 5·5-6·6) in women. The rise was evident, and did not significantly differ, across socio-economic and remoteness-of-residence categories. The largest increase seen was in the papillary subtype in women (APC 7·9%, 95% CI 7·3-8·5). Incidence of localized and more advanced-stage cancers rose over time although the increase was greater for early-stage cancers.

CONCLUSION

There has been a marked increase in thyroid cancer incidence in Queensland. The increase is evident in men and women across all adult age groups, socio-economic strata and remoteness-of-residence categories as well as in localized and more advanced-stage cancers. Our results suggest 'overdiagnosis' may not entirely explain rising incidence. Contemporary aetiological data and individual-level information about diagnostic circumstances are required to further understand reasons for rising thyroid cancer incidence.

The changing epidemiology of thyroid cancer: why is incidence increasing?

PURPOSE OF REVIEW

Thyroid cancer incidence is increasing worldwide. Causes are highly debated.

RECENT FINDINGS

Thyroid cancer increase has been associated to socioeconomic status, better access to healthcare and rising use of thyroid imaging. Therefore, the rise could be apparent because of the useless identification of a large reservoir of subclinical papillary lesions that will never affect patient health (overdiagnosis).However, not all epidemiological and clinical data support this hypothesis. The increasing number of large tumors, the increasing thyroid cancer-related mortality in spite of earlier treatment and the changes in thyroid cancer molecular profile suggest a true increase. Recently increased and thyroid-specific environmental carcinogens could be responsible, such as radiation (mostly medical radiation), increased iodine intake and chronic lymphocytic thyroiditis and environmental pollutants such as nitrates, heavy metals and other compounds largely used in the industrialized society. Possible mechanisms await further investigation.

SUMMARY

The increased incidence of thyroid cancer is the likely result of two coexisting processes: increased detection (apparent increase) and increased number of cases (true increase) due to unrecognized thyroid-specific carcinogens.To identify causal factors and to differentiate stationary cancers from those that will progress are major urgent requirements for both clinical and scientific purposes.

Sorafenib in the treatment of thyroid cancer

Sorafenib has been evaluated in several Phase II and III studies in patients with locally advanced/metastatic radioactive iodine-refractory differentiated thyroid carcinomas (DTCs), reporting partial responses, stabilization of the disease and improvement of progression-free survival. Best responses were observed in lung metastases and minimal responses in bone lesions. On the basis of these studies, sorafenib was approved for the treatment of metastatic DTC in November 2013. Few studies suggested that reduction of thyroglobulin levels, or of average standardized uptake value at the fluorodeoxyglucose-PET, could be helpful for the identification of responding patients; but further studies are needed to confirm these results. Tumor genetic marker levels did not have any prognostic or predictive role in DTC patients.The most common adverse events observed included skin toxicity and gastrointestinal and constitutional symptoms. Encouraging results have also been observed in patients with medullary thyroid cancer. Many studies are ongoing to evaluate the long-term efficacy and tolerability of sorafenib in DTC patients.

Long-Term Follow-Up of the Therapeutic Outcomes for Papillary Thyroid Carcinoma With Distant Metastasis

Papillary thyroid carcinoma (PTC) patients with distant metastasis (DM) have variable clinical courses and therapeutic outcomes. Survival time after diagnosis of DM may be several months to years. Long-term follow-up is necessary to determine prognostic factors for survival in PTC with DM. The purpose of this study was to investigate the clinical features and therapeutic outcomes of PTC with DM after 10 years of follow-up. The study population consisted of 70 patients who underwent initial thyroidectomy before 2004 and had DM beyond the locoregional neck area. Of these 70 patients, 40 patients were diagnosed with DM before or within 9 months after initial thyroidectomy in first radioactive iodide (I) whole-body scintigraphy (group A), and 30 patients were diagnosed with DM during the follow-up period (group B). Patients with DM underwent 3.7 to 7.4 GBq I therapy every 6 to 12 months. After a mean follow-up period of 10.1 ± 0.9 years, the disease-specific mortality and remission rates were 70.0% (49/70) and 10% (7/70), respectively. The survival rates for patients in groups A and B were 72.5% and 96.7% at 1 year, 47.5% and 90.0% at 5 years, 40.0% and 70.0% at 10 years, 36.4% and 41.1% at 15 years, and 35.0% and 8.0% at 20 years, respectively. The percentage of male and older patients and patients with larger tumor size was higher in the mortality group than in the survival group, whereas the percentage of patients with I avid metastatic lesions (first DM) was lower in the mortality group. The percentage of patients with secondary primary cancers was higher in group B than in group A. In the multiple regression analysis, age and male gender were independently associated with disease-specific mortality. In conclusion, after a mean follow-up of 10.1 years, the disease-specific mortality rate for PTC with DM was 70.0%. Older patients and male PTC patients with DM need more aggressive treatment. The timing of DM diagnosis did not influence disease-specific mortality.

Over ten years of single-institution experience in percutaneous image-guided treatment of bone metastases from differentiated thyroid cancer

OBJECTIVE

Percutaneous image-guided treatments (PIGT) are performed by interventional radiologists with a minimally invasive approach. Currently, very little published data on their outcomes are available and conclusions regarding their application are cautious. The aim of the present study was to review our experience in PIGT of bone metastases from thyroid cancer.

MATERIALS AND METHODS

Institutional databases were reviewed to identify patients with differentiated thyroid cancer and bone metastases who received PIGT between October 2001 and April 2014. Complications, local evolution of the treated lesions, and overall survival (OS) were investigated.

RESULTS

Twenty-five patients (12 male, 13 female) underwent 49 PIGT sessions consisting of cementoplasty (77.5%), cryoablation (14.3%) or radiofrequency ablation (8.2%). Most of the treated lesions (50/54, 92.6%) were symptomatic at the time of PIGT. Median follow-up after PIGT was 4.6 years. Local complete remission rate was 55.6%. Two complications (one major and one minor) were noted, but none of these were consistent with fractures or nervous system injuries. OS after PIGT was 71.6%, 66.8% and 60.1% at 1, 2 and 3 years, respectively. A difference in survival was observed between patients with metastatic bone involvement only at the time of first PIGT compared to those with multi-organ involvement (P = 0.03).

CONCLUSIONS

Patients with bone metastases from differentiated thyroid cancer may benefit from PIGT. Although patients are usually referred for PIGT due to their symptomatic status, a more relevant "curative" role may exist for PIGT. Further prospective studies are needed to confirm this perception.

Time trends and age-period-cohort analyses on incidence rates of thyroid cancer in Shanghai and Hong Kong

Background

Increasing incidence rates of thyroid cancer have been noted worldwide, while the underlying reasons remain unclear.

Methods

Using data from population-based cancer registries, we examined the time trends of thyroid cancer incidence in two largest cities in China, Shanghai and Hong Kong, during the periods 1973–2009 and 1983–2011, respectively. We further performed age-period-cohort analyses to address the possible underlying reasons for the observed temporal trends.

Results

We observed continuous increases in the incidence rates of thyroid cancer in Shanghai and Hong Kong, since the 1980s, in addition to higher incidence rates in the 1970s in both sexes in Shanghai. The age-standardized incidence rate of thyroid cancer increased by 3.1% [95% confidence interval (CI): 1.0%, 5.1%] and 3.8% (95% CI: 1.9%, 5.7%) per year on average, respectively, in Shanghai men and women during the period 1973–2009, while it increased by 2.2% (95% CI: 1.5%, 2.8%) and 2.7% (1.6%, 3.8%) per year on average, respectively, in Hong Kong men and women during the period 1983–2011. We observed global changes in trends across all age groups in similar ways, in addition to varied trends across different generations (birth cohorts).

Conclusions

The increased incidence rates of thyroid cancer in these two Chinese populations during recent decades may be contributable to a combination of the introduction of more sensitive diagnostic techniques and the increasing prevalence of environmental exposures in the populations.

Genetic variants associated with serum thyroid stimulating hormone (TSH) levels in European Americans and African Americans from the eMERGE Network

Thyroid stimulating hormone (TSH) hormone levels are normally tightly regulated within an individual; thus, relatively small variations may indicate thyroid disease. Genome-wide association studies (GWAS) have identified variants in PDE8B and FOXE1 that are associated with TSH levels. However, prior studies lacked racial/ethnic diversity, limiting the generalization of these findings to individuals of non-European ethnicities. The Electronic Medical Records and Genomics (eMERGE) Network is a collaboration across institutions with biobanks linked to electronic medical records (EMRs). The eMERGE Network uses EMR-derived phenotypes to perform GWAS in diverse populations for a variety of phenotypes. In this report, we identified serum TSH levels from 4,501 European American and 351 African American euthyroid individuals in the eMERGE Network with existing GWAS data. Tests of association were performed using linear regression and adjusted for age, sex, body mass index (BMI), and principal components, assuming an additive genetic model. Our results replicate the known association of PDE8B with serum TSH levels in European Americans (rs2046045 p = 1.85×10⁻¹⁷, β = 0.09). FOXE1 variants, associated with hypothyroidism, were not genome-wide significant (rs10759944: p = 1.08×10⁻⁶, β = −0.05). No SNPs reached genome-wide significance in African Americans. However, multiple known associations with TSH levels in European ancestry were nominally significant in African Americans, including PDE8B (rs2046045 p = 0.03, β = −0.09), VEGFA (rs11755845 p = 0.01, β = −0.13), and NFIA (rs334699 p = 1.50×10⁻³, β = −0.17). We found little evidence that SNPs previously associated with other thyroid-related disorders were associated with serum TSH levels in this study. These results support the previously reported association between PDE8B and serum TSH levels in European Americans and emphasize the need for additional genetic studies in more diverse populations.