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Barrio MJ, Pozdeyev N, Raeburn CD, McIntyre RC, Marshall CB, Haugen B, La Greca A. Pre-operative thyroglobulin measurement for thyroid cancer risk of recurrence and response to therapy. Am J Surg 2024:115818. [PMID: 39004566 DOI: 10.1016/j.amjsurg.2024.115818] [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: 04/16/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Thyroid cancer has an overall favorable prognosis, but no pre-operative biochemical marker has been shown to distinguish between low and high-risk disease or predict response to therapy. METHODS We retrospectively reviewed 162 patients that underwent thyroid surgery for thyroid cancer between 2006 and 2022 in whom a pre-operative thyroglobulin level (Tg) was measured. We subdivided patients into low, intermediate and high-risk thyroid cancer and based on their response to therapy per ATA guidelines. RESULTS We showed that as pre-operative Tg level increased, patients were more likely to have high-risk disease (p < 0.01). We found a linear association between the primary tumor size and high-risk histology with pre-operative Tg (p < 0.01). Pre-operative Tg level was significantly associated with response to therapy following initial surgical management. Specifically, as pre-operative Tg increases, patients were less likely to achieve an excellent response (p < 0.01). CONCLUSIONS Our retrospective analysis demonstrated that pre-operative Tg is significantly associated with ATA structural risk of recurrence and response to therapy and may have the potential to guide initial therapy and follow-up management.
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Affiliation(s)
- Martin Jose Barrio
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States; Department of Biomedical Informatics, University of Colorado School of Medicine, 1890 N. Revere Court, Mailstop F600, Aurora, CO, 80045, United States
| | - Christopher D Raeburn
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Robert C McIntyre
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, 12605 E. 16th Ave Aurora, CO, 80045, United States
| | - Bryan Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States
| | - Amanda La Greca
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States.
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2
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Cheng X, Fan Y, Ye W, Xu S, Wu J, Gao W, Bao J, Yu H, Zhang L. Preoperative Serum Thyroglobulin Levels Predict Radioiodine Therapy Outcome in Papillary Thyroid Microcarcinoma Patients. Horm Metab Res 2024; 56:498-503. [PMID: 38503312 DOI: 10.1055/a-2291-0340] [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: 03/21/2024]
Abstract
Our previous study showed that elevated preoperative thyroglobulin (pre-Tg) level predicted the risk of developing radioiodine refractory in PTC patients. In the present study, we aimed to evaluate the prognostic value of pre-Tg in papillary thyroid microcarcinoma (PTMC). After a specific inclusion and exclusion criteria were applied, a total of 788 PTMCs were enrolled from Jiangyuan Hospital affiliated to Jiangsu Institute of Nuclear Medicine between Jan 2015 and Dec 2019. Among them, 107 PTMCs were treated with radioiodine therapy (RAIT) and the response to therapy was grouped as excellent response (ER), and non-excellent response (NER: indeterminate response, IDR and biochemical incomplete response, BIR). Multivariable logistic regression was used to identify predictors for the response of RAIT in PTMCs. Higher pre-Tg levels were detected in PTMCs with RAIT as compared with PTMCs without RAIT (p=0.0018). Higher levels of pre-Tg were also found in patients with repeated RAIT as compared with patients with single RAIT (p<0.0001). Furthermore, pre-Tg level was higher in PTMC with IDR (n=16) and much higher in BIR (n=9) as compared with patients with ER (n=82, p=0.0003) after RAIT. Multivariate analysis showed that pre-Tg level over 16.79 ng/ml [OR: 6.55 (2.10-20.39), p=0.001] was the only independent predictor for NER in PTMC with RAIT. We found that high level of pre-Tg predicted a poor RAIT outcome in PTMC. Our finding explores a prospective way in identifying high-risk PTMCs with poor response to RAIT.
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Affiliation(s)
- Xian Cheng
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Yijun Fan
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Wanzhong Ye
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Shichen Xu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Jing Wu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Wenjing Gao
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Jiandong Bao
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Huixin Yu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
| | - Li Zhang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi
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3
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Kim M, Lee J, Hwang YB, Kang J, Ahn HY, Lee JK. Graves' orbitopathy development in thyroid cancer patients: a 16-year nationwide cohort study in South Korea. Eye (Lond) 2024:10.1038/s41433-024-03197-9. [PMID: 38942911 DOI: 10.1038/s41433-024-03197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 05/16/2024] [Accepted: 06/20/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES We aimed to investigate the prevalence, risk factors, and prognosis of Graves' orbitopathy (GO) in patients with thyroid cancer without a history of hyperthyroidism. SUBJECTS/METHODS This retrospective cohort study analysed a sample from the Korean National Health Insurance Service database, which included 1,137,861 subjects from 2002 through 2019. Patients diagnosed with thyroid cancer, without a history of hyperthyroidism, were identified according to the Korean Standard Classification of Disease codes. The study compared the type of surgery, dose of radioactive iodine (RAI), and daily average thyroid hormone dose between patients who developed GO after being diagnosed with thyroid cancer and those who did not develop GO. We analysed the course of GO and the type of treatment. RESULTS A total of 8499 cancer patients without a history of hyperthyroidism were identified, among whom 7836 underwent thyroidectomy. Of those who underwent thyroidectomy, 12 developed GO postoperatively. Among the 663 patients who did not undergo thyroidectomy, none developed GO. The prevalence of GO among thyroid cancer patients was 0.14%. The GO group received a significantly higher total RAI dose than the non-GO group (p = 0.036). There were no significant differences in sex, age, type of surgery, rate of RAI treatment, or average thyroid hormone dose between the two groups. One of the 12 patients who developed GO required intravenous steroids. CONCLUSIONS Although GO rarely develops in thyroid cancer patients without coexisting hyperthyroidism, the total RAI dose may increase its risk. Further research would help clarify GO's association with thyroid cancer.
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Affiliation(s)
- Minjeong Kim
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Yu Been Hwang
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Jinmo Kang
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Hwa Young Ahn
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
| | - Jeong Kyu Lee
- Department of Ophthalmology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
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Asa SL, Uccella S, Tischler A. The Unique Importance of Differentiation and Function in Endocrine Neoplasia. Endocr Pathol 2023; 34:382-392. [PMID: 37043101 DOI: 10.1007/s12022-023-09762-4] [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: 03/29/2023] [Indexed: 04/13/2023]
Abstract
The assessment of cell differentiation in endocrine neoplasms involves not only the identification of a cell's structure and expression of specific transcription factors which regulate that cell, but also the identification of hormones and/or enzymes involved in hormone synthesis. The importance of this functional characterization is emphasized by the fact that the hormones serve as biomarkers for clinical surveillance to identify persistence, recurrence, or progression of disease. Sometimes, unusual patterns of hormone expression lead to unexpected clinical signs and symptoms. Loss of differentiated hormone production can be a sign of dedifferentiation as a tumor becomes more aggressive. In addition to prognostic information, cell differentiation can be predictive, since differentiated endocrine cells express targets for therapy, such as the sodium iodide symporter in thyroid cancers and somatostatin receptors in neuroendocrine tumors. The salient features of differentiation in the three main types of endocrine cells can be used to determine prognosis and to tailor management of patients with endocrine neoplasms.
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Affiliation(s)
- Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Silvia Uccella
- Unit of Pathology, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Pathology, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Arthur Tischler
- Department of Pathology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 02111, USA
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Ntotsikas K, Lazarioti S, Daraki V, Drakos E, Tsakalomatis PN, Syntzanaki EK, Moustakis N, Marinis AI, Salapatas-Gkinis A, Xekouki P, Vakis A, Tsitsipanis C. Thyroglobulin as a Rapid and Cost-Effective Biomarker for Diagnosis of Thyroid Carcinoma Brain Metastasis: A Case Report of a Patient with Metastatic Hurthle Cell Thyroid Carcinoma. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e939025. [PMID: 37853680 PMCID: PMC10598507 DOI: 10.12659/ajcr.939025] [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: 11/21/2023] [Revised: 09/04/2023] [Accepted: 06/26/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Brain metastasis of papillary thyroid cancer (PTC) is rare. Treatment of these patients is challenging due to the lack of specific guidelines. Early diagnosis is accompanied by immediate treatment and less morbidity. Total resection of brain lesions may be unattainable when they include infiltration of eloquent areas. This report is of an 81-year-old man who had undergone total thyroidectomy for goiter in the past and presented with metastatic papillary thyroid carcinoma (PTC) to the neck after a gap of 16 years. After two years, the patient developed a solitary cystic brain PTC metastasis associated with raised thyroglobulin (Tg) inside the cystic lesion aspirated during brain surgery. CASE REPORT An 81-year-old male patient was admitted for a space-occupying brain lesion in the right frontal lobe. The patient's history included metastatic disease of PTC to the neck with cervical lymph node metastasis and local recurrence after surgery and radioactive iodine-131 treatment. The patient underwent craniotomy and removal of the lesion. The aspirated fluid was sent for cytological examination and measurement of Tg levels, which were interestingly high. Pathology of the brain lesion revealed infiltration of brain parenchyma from a metastatic lesion characterized by eosinophilic cells with irregular contours forming grooves, resulting in cytoplasmic pseudo-inclusions, an oncotic variant of PTC. CONCLUSIONS This report has shown that residual tissue may be present following total thyroidectomy and may be the origin of PTC with metastasis to the brain. The patient in this study suffered from a brain lesion that could be excised. However, aspiration of cystic compartments could provide a rapid diagnosis in patients with non-removable brain lesions.
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Affiliation(s)
- Konstantinos Ntotsikas
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Lazarioti
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Vasiliki Daraki
- Department of Endocrinology, University Hospital of Crete, Heraklion, Crete, Greece
| | - Elias Drakos
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Pathology, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | - Nikolaos Moustakis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | - Anastasios I. Marinis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Paraskevi Xekouki
- Department of Endocrinology, University Hospital of Crete, Heraklion, Crete, Greece
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Antonis Vakis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Tsitsipanis
- Department of Neurosurgery, University General Hospital of Heraklion, Heraklion, Crete, Greece
- School of Medicine, University of Crete, Heraklion, Crete, Greece
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Guo P, Wang X, Xia L, Shawureding N, Hu Z. Analysis of factors associated with the prognosis of papillary thyroid cancer and the construction of a survival model. Cancer Med 2022; 12:7868-7876. [PMID: 36560883 PMCID: PMC10134317 DOI: 10.1002/cam4.5555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the survival prediction value of lymph node ratio (LNR) and preoperative thyroglobulin (Tg) in the prognosis of thyroid papillary carcinoma (PTC). METHODS A total of 495 patients with PTC and lymph node metastasis treated at the Cancer Hospital of Xinjiang Medical University were selected for a retrospective study. The disease-free survival (DFS) of patients was the follow-up endpoint. DFS was calculated for all patients. The Cox proportional risk regression model and nomogram were used to predict the survival prognosis of PTC with lymph node metastasis by index. LNR and preoperative Tg level cutoff values were obtained using ROC curves. To express DFS, Kaplan-Meier survival curves were created. Using 3- and 5-year calibration curves and AUC values, the prognostic models' precision and discrimination were assessed. Clinical decision curve analysis was used to forecast clinical benefitability. Finally, the results were validated using internal cross-validation. RESULTS The cutoff values of LNR and preoperative Tg level were 0.295 and 50.24, respectively, and they were divided into two groups according to the cutoff values. Multifactorial Cox regression models showed that NLNM, LNR, and preoperative Tg level (all p < 0.05) were independent risk factors affecting the prognosis of PTC with lymph node metastasis. Kaplan-Meier curves showed higher DFS rates in the group with low NLNM (<10), LNR (<0.295), and preoperative Tg level (<50.24) groups. The 3-year and 5-year calibration curves showed good agreement. A ROC curve analysis was performed on the nomogram model, and its AUC values at 3 and 5 years were, respectively, 0.805 and 0.793. Clinical decision curves indicate good clinical benefit. Finally, internal cross-validation demonstrated the legitimacy of the prognostic model. CONCLUSION The LNR and preoperative Tg levels, in combination with other independent factors, were effective in predicting the survival prognosis for patients with PTC.
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Affiliation(s)
- Peng Guo
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Xinhua Wang
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Luhua Xia
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Nadiremu Shawureding
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Zhiheng Hu
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
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Garo ML, Campennì A, Petranovic-Ovcaricek P, D’Aurizio F, Giovanella L. Evolution of thyroid cancer biomarkers: from laboratory test to patients’ clinical management. Clin Chem Lab Med 2022; 61:935-945. [PMID: 36370420 DOI: 10.1515/cclm-2022-1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022]
Abstract
Abstract
Over the past three decades, laboratory medicine has significantly evolved thanks to technological advances made possible by new materials and evidence. Clinicians’ ongoing requests for powerful, rapid, and minimally invasive tests has led manufacturers to develop rapid, accurate, and sensitive tests that can increase diagnostic accuracy and improve follow-up, bringing laboratory medicine ever closer to personalized medicine. The aim of this study was to critically review the main problems of the current Tg and CT biomarkers for the diagnosis/monitoring of DTC and MTC, respectively, and to identify the advantages and challenges of using the new laboratory biomarkers in the clinical management of patients with differentiated and medullary thyroid cancer. Insufficient harmonization of Tg and CT assays and lack of interchangeability of laboratory results and cutoff values pose challenges for comparability and standardization of procedures and methods. New diagnostic and monitoring approaches such as PCT or the Tg doubling time have proven to be effective. Close collaboration between clinicians and laboratory specialists remains essential to translate the advantages and limitations of current assays into appropriate clinical interpretation criteria. Over the years, the journal Clinical Chemistry and Laboratory Medicine (CCLM) has taken many steps to develop advanced research and technology in the diagnosis and monitoring of tumor cancer and to help clinicians translate it into clinical practice.
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Affiliation(s)
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging , University of Messina , Messina , Italy
| | - Petra Petranovic-Ovcaricek
- Department of Oncology and Nuclear Medicine , University Hospital Center Sestre Milosrdnice , Zagreb , Croatia
| | - Federica D’Aurizio
- Department of Laboratory Medicine , Institute of Clinical Pathology, Santa Maria della Misericordia University Hospital , Udine , Italy
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale , Bellinzona , Switzerland
- Clinic for Nuclear Medicine, University Hospital of Zürich , Zürich , Switzerland
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8
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Lin Y, Wang P, Chen Z, Peng R, Lai S, Li J, Kuang J, Wang L. The correlation between preoperative serum thyroglobulin and pathological features of thyroid follicular carcinoma.. [DOI: 10.21203/rs.3.rs-1965404/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Purpose: To explore more meaningful information for making individualized medical decisions for patients with follicular thyroid carcinoma (FTC), we investigated the correlations between pathological features of FTC and preoperative serum markers, including thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb), thyroid peroxidase antibodies (TPOAb), thyroid stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and fT3/fT4 ratio.Methods:We retrospectively analyzed 82 patients with FTC. Data collected included demographics (sex and age), pathological features (infiltration extent, tumor stage, presence of multifocal FTC, and presence of concomitant PTC), and preoperative serum markers (Tg, TgAb, TPOAb, TSH, fT3, fT4, and fT3/fT4 ratio). The correlations between preoperative serum markers and pathological features were analyzed.Results:72.0% patients were female. Mean age was 46.4±16.5 years. In univariate analysis, older age (≥55 years) was associated with non-minimally invasive (P=0.016), larger (>T2 category, P=0.006), and multifocal (P=0.034) FTC; elevated preoperative serum Tg level (≥500.00 ng/mL) was associated with non-minimally invasive (P=0.015) and larger (>T2 category, P=0.001) FTC; higher fT3/fT4 ratio (≥0.541) was associated with multifocal FTC (P=0.031). In multivariable analysis, Tg ≥500.00 ng/mL was an independent risk factor for non-minimally invasive FTC [P=0.015, OR=3.289 (1.260-8.583)] and for >T2 category FTC [P=0.001, OR=5.397 (1.963-14.840)]; older age [≥55 years, P=0.045, OR=4.756 (1.037-21.818)] and higher fT3\fT4 ratio [≥0.541, P=0.044, OR=4.626 (1.043-20.525)] was an independent risk factor multifocal FTC, respectively.Conclusions: Preoperative serum Tg was correlated with the local tumor extent and primary tumor diameter of FTC. Further research regarding the utility of preoperative serum Tg in FTC is still needed.
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Affiliation(s)
| | | | - Zhijiang Chen
- Guangdong Academy of Medical Sciences: Guangdong Provincial People's Hospital
| | | | - Shuiqing Lai
- Guangdong Academy of Medical Sciences: Guangdong Provincial People's Hospital
| | | | - Jian Kuang
- Guangdong Academy of Medical Sciences: Guangdong Provincial People's Hospital
| | - Long Wang
- Guangdong Academy of Medical Sciences: Guangdong Provincial People's Hospital
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Cheng X, Xu S, Zhu Y, Wu J, Bao J, Yu H, Zhang L. Markedly elevated serum preoperative thyroglobulin predicts radioiodine-refractory thyroid cancer. Eur J Clin Invest 2022; 52:e13721. [PMID: 34855206 DOI: 10.1111/eci.13721] [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: 09/29/2021] [Revised: 11/11/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repeated radiotherapy brings limited benefits and significant side effects for differentiated thyroid cancer patients (DTC) with radioiodine refractory (RAIR). However, the prognostic role of preoperative thyroglobulin (pre-Tg) in predicting RAIR is unclear. METHODS In the present study, data were retrospectively reviewed from 5173 patients who underwent radiotherapy in the Jiangyuan Hospital from January 2006 to December 2020. RESULTS A total of 1,102 patients with or without repeated radiotherapy were compared (repeated vs. single radiotherapy; n = 199 vs. n = 903). Pre-Tg was significantly elevated in patients with repeated radiotherapy. After the classification of RAIR (non-RAIR, n = 786 vs. RAIR, n = 90), elevated pre-Tg was also correlated with RAIR after univariate and multivariate analyses. According to the receiver operating characteristic curve analysis, elevated pre-Tg well predicted RAIR (AUC = 0.76, CI: 0.71-0.82, p < 0.0001). To control the selection bias, the propensity score matching was used. Pre-Tg level was found to be an independent predictor of RAIR (p < 0.001, HR = 7.25, CI: 2.55-20.62). CONCLUSION Our results indicate that markedly elevated pre-Tg level can be served as an independent predictor of RAIR-DTC, which can guide a more precise treatment strategy and/or an active surveillance during surgery and follow-ups.
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Affiliation(s)
- Xian Cheng
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Shichen Xu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Yun Zhu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China.,Department of Pathology, Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Jing Wu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Jiandong Bao
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China.,Department of Endocrinology, Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Huixin Yu
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China
| | - Li Zhang
- NHC Key Laboratory of Nuclear Medicine, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, China.,Department of Radiopharmaceuticals, School of Pharmacy, Nanjing Medical University, Nanjing, China.,School of Life science and Technology, Southeast University, Nanjing, China
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10
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Chang Q, Zhang J, Wang Y, Li H, Du X, Zuo D, Yin D. Nomogram model based on preoperative serum thyroglobulin and clinical characteristics of papillary thyroid carcinoma to predict cervical lymph node metastasis. Front Endocrinol (Lausanne) 2022; 13:937049. [PMID: 35909521 PMCID: PMC9337858 DOI: 10.3389/fendo.2022.937049] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Preoperative evaluation of cervical lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) has been one of the serious clinical challenges. The present study aims at understanding the relationship between preoperative serum thyroglobulin (PS-Tg) and LNM and intends to establish nomogram models to predict cervical LNM. METHODS The data of 1,324 PTC patients were retrospectively collected and randomly divided into training cohort (n = 993) and validation cohort (n = 331). Univariate and multivariate logistic regression analyses were performed to determine the risk factors of central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). The nomogram models were constructed and further evaluated by 1,000 resampling bootstrap analyses. The receiver operating characteristic curve (ROC curve), calibration curve, and decision curve analysis (DCA) of the nomogram models were carried out for the training, validation, and external validation cohorts. RESULTS Analyses revealed that age, male, maximum tumor size >1 cm, PS-Tg ≥31.650 ng/ml, extrathyroidal extension (ETE), and multifocality were the significant risk factors for CLNM in PTC patients. Similarly, such factors as maximum tumor size >1 cm, PS-Tg ≥30.175 ng/ml, CLNM positive, ETE, and multifocality were significantly related to LLNM. Two nomogram models predicting the risk of CLNM and LLNM were established with a favorable C-index of 0.801 and 0.911, respectively. Both nomogram models demonstrated good calibration and clinical benefits in the training and validation cohorts. CONCLUSION PS-Tg level is an independent risk factor for both CLNM and LLNM. The nomogram based on PS-Tg and other clinical characteristics are effective for predicting cervical LNM in PTC patients.
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Affiliation(s)
- Qungang Chang
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou, China
| | - Jieming Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaqian Wang
- Department of Surgery, The First Affiliated Hospital of ZhengZhou University, Zhengzhou, China
| | - Hongqiang Li
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou, China
| | - Xin Du
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Daohong Zuo
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Detao Yin
- Department of Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Medicine Laboratory of Thyroid Cancer of Henan Province, Zhengzhou, China
- Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province, Zhengzhou, China
- *Correspondence: Detao Yin,
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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]
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12
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Li S, Ren C, Gong Y, Ye F, Tang Y, Xu J, Guo C, Huang J. The Role of Thyroglobulin in Preoperative and Postoperative Evaluation of Patients With Differentiated Thyroid Cancer. Front Endocrinol (Lausanne) 2022; 13:872527. [PMID: 35721746 PMCID: PMC9200986 DOI: 10.3389/fendo.2022.872527] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/29/2022] [Indexed: 12/02/2022] Open
Abstract
Thyroglobulin (Tg) is secreted by thyroid follicular cells and stored in the thyroid follicular lumen as a component of thyroid hormone. It is known that both benign and well-differentiated malignant thyroid tissue can secrete Tg. In recent years, growing lines of evidence have shown that Tg plays an important role in the diagnosis and metastasis of preoperative differentiated thyroid carcinoma (DTC). The levels of Tg, whether in the serum or in a fine-needle aspiration washout fluid, are usually viewed as an excellent indicator in the monitoring of postoperative DTC, including the guidance and evaluation of radioactive iodine ablation. Nevertheless, some factors limit the application of Tg, such as the method used to measure Tg and the presence of Tg antibodies. This review aimed to summarize the role of Tg in the preoperative and postoperative evaluation of patients with DTC, and the factors influencing Tg. This review could provide a reference for a more accurate application of Tg in patients with DTC.
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Affiliation(s)
| | - Chutong Ren
- *Correspondence: Jiangsheng Huang, ; Chutong Ren,
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13
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Noel JE, Thatipamala P, Hung KS, Chen J, Shi RZ, Orloff LA. Pre-Operative Anti-Thyroid Antibodies in Differentiated Thyroid Cancer. Endocr Pract 2021; 27:1114-1118. [PMID: 34217894 DOI: 10.1016/j.eprac.2021.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the significance of anti-thyroglobulin and anti-thyroid peroxidase antibody levels in locoregional metastatic disease in patients with well-differentiated thyroid cancer. METHODS Included patients underwent initial treatment for well-differentiated thyroid cancer at our institution between 2014 and 2018. The following variables were collected: age, sex, pre-operative thyroid stimulating hormone (TSH), thyroglobulin (Tg), anti-thyroglobulin antibody (TgAb), anti-thyroid peroxidase antibody (TPOAb); extent of surgery; T-stage; N-stage; extrathyroidal extension (ETE), extranodal extension (ENE), lymphovascular invasion (LVI), and multifocal disease. The relationships between pre-operative TPOAb, TgAb, Tg, and TSH and disease status were analyzed. RESULTS 405 patients were included in the study. 66.4% were female. Mean age was 52 years. Elevated TgAb was associated with the presence of lymph node metastases (LNM) in both the central and lateral neck (p<0.01), with stronger correlation with N1b compared with N1a disease (p=0.03). Presence of ETE was inversely associated with TgAb titer (p=0.03). TPOAb was associated with lower T- stage, fewer LNM, and lower likelihood of ETE (p=0.04, p=0.04, p=0.02). In multivariable analysis, TgAb≥40 IU/mL was an independently predictive factor of higher N-stage (p<0.01 for N0 v. N1 and p=0.01 for N1a v. N1b), and for ENE (p<0.01). TPOAb≥60 IU/mL was associated with lower T-stage (p=0.04 for T< 3) and absence of ETE (p=0.01). CONCLUSIONS Elevated pre-operative TgAb was an independent predictor of nodal metastases and ENE, while elevated TPOAb was associated with a lower pathologic T and N stage. Pre-operative anti-thyroid antibody titers may be useful to inform disease extent and features.
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Affiliation(s)
- Julia E Noel
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305.
| | - Priyanka Thatipamala
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305
| | - Kay S Hung
- Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305
| | - Julie Chen
- Division of Endocrinology, Gerontology, and Metabolism, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Run-Zhang Shi
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 93405
| | - Lisa A Orloff
- Department of Otolaryngology Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA 94305
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Zhao H, Zhu X, Luo Y, Liu S, Wu W, Zhang L, Zhu J. LINC01816 promotes the migration, invasion and epithelial‑mesenchymal transition of thyroid carcinoma cells by sponging miR‑34c‑5p and regulating CRABP2 expression levels. Oncol Rep 2021; 45:81. [PMID: 33786631 PMCID: PMC8025121 DOI: 10.3892/or.2021.8032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 02/01/2021] [Indexed: 02/05/2023] Open
Abstract
Thyroid carcinoma (THCA) is a common type of endocrine system cancer and its current clinical treatment method is surgical resection. Long non-coding RNAs (lncRNAs) have been revealed to serve important roles in a variety of complex human diseases. Therefore, determining the association between lncRNAs and diseases may provide novel insight into disease-related lncRNAs, with the aim of improving disease treatments and diagnoses. Long intergenic non-protein coding RNA 1816 (LINC01816) was identified to be associated with the survival of patients with colorectal cancer using the IDHI-MIRW method. The present study aimed to investigate the role and molecular mechanism of LINC01816 in THCA. Analysis of datasets from The Cancer Genome Atlas database revealed that the upregulation of LINC01816 expression levels was associated with a variety of cancer types. Reverse transcription-quantitative PCR analysis demonstrated that compared with the normal thyroid tissues, the expression levels of LINC01816 were upregulated in THCA tissues. The results of wound healing and Transwell assays, and western blotting demonstrated that the overexpression of LINC01816 could strengthen the invasive and migratory abilities of THCA cells and enhance epithelial-mesenchymal transition progression. Analysis using the starBase website and dual-luciferase reporter assays identified that microRNA (miR)-34c-5p was a target of LINC01816. The overexpression of miR-34c-5p could inhibit the invasive and migratory abilities of THCA cells, in addition to inhibiting the cellular retinoic acid binding protein 2 (CRABP2) overexpression-induced effects on invasion, migration and EMT processes. In conclusion, the findings of the present study indicated that LINC01816 may be capable of sponging miR-34c-5p to upregulate CRABP2 expression levels, which subsequently promoted the invasion, migration and EMT of THCA cells. Therefore, targeting the LINC01816/miR-34c-5p/CRABP2 pathway may be an effective therapeutic approach for patients with THCA.
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Affiliation(s)
- Hongyuan Zhao
- Department of Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Xiaofeng Zhu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 510515, P.R. China
| | - Yi Luo
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 510515, P.R. China
| | - Shengshan Liu
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 510515, P.R. China
| | - Wenshuang Wu
- Department of Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Lingyun Zhang
- Department of Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
| | - Jingqiang Zhu
- Department of Thyroid and Parathyroid Surgery Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610000, P.R. China
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Diagnostic Algorithm for Metastatic Lymph Nodes of Differentiated Thyroid Carcinoma. Cancers (Basel) 2021; 13:cancers13061338. [PMID: 33809585 PMCID: PMC8000218 DOI: 10.3390/cancers13061338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Fine-needle aspiration cytology (FNAC) with measurement of thyroglobulin concentrations obtained through aspiration (FNA-Tg) is routinely used for the diagnosis of metastatic lymph nodes (LNs) from differentiated thyroid carcinomas. However, some areas of uncertainty remain, including the optimal FNA-Tg cutoff and its interpretation based on ultrasound (US) features. In this study, we evaluated the appropriate strategies for interpreting FNAC and FNA-Tg results based on the sonographic features of LNs. We confirmed that the malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg was sufficiently high to be diagnosed as metastasis, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and US features of LNs, for diagnosing metastatic LNs of differentiated thyroid carcinomas. Abstract We aimed to evaluate appropriate strategies for interpreting fine-needle aspiration cytology (FNAC) and thyroglobulin concentrations obtained through aspiration (FNA-Tg) results based on the sonographic features of lymph nodes (LNs). Consecutive patients who underwent ultrasound-guided FNAC and FNA-Tg for metastatic LNs from differentiated thyroid carcinomas (DTCs) from January 2014 to December 2018 were reviewed retrospectively. LNs were categorized sonographically as suspicious, indeterminate, or benign. The optimal FNA-Tg cutoff for metastatic LNs was evaluated preoperatively, after lobectomy, and after total thyroidectomy. The diagnostic performances of FNA-Tg, FNAC, and their combination were analyzed based on the sonographic features of LNs. The malignancy rates of LNs were analyzed based on the sonographic features, FNAC, and FNA-Tg results. Of the 1543 LNs analyzed, 528 were benign, whereas 1015 were malignant. FNA-Tg increased the sensitivity and accuracy of FNAC for LNs. The malignancy rate of LNs found to be malignant by FNAC or elevated FNA-Tg ranged from 82% to 100%, regardless of the sonographic features. The malignancy rate of LNs with indeterminate or benign FNAC findings and low FNA-Tg were stratified according to their sonographic features. We propose a diagnostic algorithm, based on combined FNAC, FNA-Tg, and ultrasound features of LNs, for diagnosing metastatic LNs of DTCs.
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De la Vieja A, Riesco-Eizaguirre G. Radio-Iodide Treatment: From Molecular Aspects to the Clinical View. Cancers (Basel) 2021; 13:cancers13050995. [PMID: 33673669 PMCID: PMC7957486 DOI: 10.3390/cancers13050995] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary This year marks the 80th commemoration of the first time that radio-iodide treatment (RAI) was used. RAI is one of the most effective targeted internal radiation anticancer therapies ever devised and it has been used for many decades, however, a thorough understanding of the underlying molecular mechanisms involved could greatly improve the success of this therapy. This is an in-depth innovative review focusing on the molecular mechanisms underlying radio-iodide therapy in thyroid cancer and how the alteration of these mechanisms affects the results in the clinic. Abstract Thyroid radio-iodide therapy (RAI) is one of the oldest known and used targeted therapies. In thyroid cancer, it has been used for more than eight decades and is still being used to improve thyroid tumor treatment to eliminate remnants after thyroid surgery, and tumor metastases. Knowledge at the molecular level of the genes/proteins involved in the process has led to improvements in therapy, both from the point of view of when, how much, and how to use the therapy according to tumor type. The effectiveness of this therapy has spread into other types of targeted therapies, and this has made sodium/iodide symporter (NIS) one of the favorite theragnostic tools. Here we focus on describing the molecular mechanisms involved in radio-iodide therapy and how the alteration of these mechanisms in thyroid tumor progression affects the diagnosis and results of therapy in the clinic. We analyze basic questions when facing treatment, such as: (1) how the incorporation of radioiodine in normal, tumor, and metastatic thyroid cells occurs and how it is regulated; (2) the pros and cons of thyroid hormonal deprivation vs. recombinant human Thyroid Stimulating Hormone (rhTSH) in radioiodine residence time, treatment efficacy, thyroglobulin levels and organification, and its influence on diagnostic imaging tests and metastasis treatment; and (3) the effect of stunning and the possible causes. We discuss the possible incorporation of massive sequencing data into clinical practice, and we conclude with a socioeconomical and clinical vision of the above aspects.
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Affiliation(s)
- Antonio De la Vieja
- Endocrine Tumors Unit (Unidad Funcional de Investigación en Enfermedades Endocrinas (UFIEC), Instituto de Salud Carlos III (ISCIII), Majadahonda, 28220 Madrid, Spain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain;
- Correspondence: ; Tel.: +34-918223270
| | - Garcilaso Riesco-Eizaguirre
- Departamento de Endocrinología y Nutrición, Hospital Universitario de Móstoles, 28935 Madrid, Spain
- Molecular Endocrinology Group, Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
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Chesover AD, Vali R, Hemmati SH, Wasserman JD. Lung Metastasis in Children with Differentiated Thyroid Cancer: Factors Associated with Diagnosis and Outcomes of Therapy. Thyroid 2021; 31:50-60. [PMID: 32517539 DOI: 10.1089/thy.2020.0002] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Lung metastasis from differentiated thyroid cancer (DTC) in children and young adults (CAYA) is estimated at 25%, which is 3-4 times higher than in adults. Lung metastases may respond to radioactive iodine (RAI) therapy and overall survival is excellent. Associations with lung metastasis include lateral lymph node (LN) disease although CAYA data are limited. We investigated factors associated with lung metastasis in children and adolescents and described their presentation and outcome. Methods: A retrospective review of medical records from 1998 to 2017 in patients aged <18 years treated at a tertiary pediatric center was carried out. Data on age, clinical features at diagnosis, histology, biochemistry, imaging, RAI therapy, and outcome were collected. Results: Patients treated for DTC totaled 98 and 19 of 98 (19%) patients had lung metastasis; 17 of 19 (89%) patients were identified within 6 months from thyroidectomy. Patients with lung metastasis were younger (p < 0.001)-40% <13 years old had lung metastasis-and had a larger primary tumor diameter (p = 0.01). Absence of LN disease had negative predictive values ≥90% (p < 0.02). Patients with lung metastasis had a higher postoperative thyrotropin-stimulated thyroglobulin (Tg) (p < 0.001), ≥2 ng/mL in 10 of 11 (91%) patients, and 100% had an elevated preoperative Tg (>60 ng/mL). Post-therapy whole body scan (WBS) identified most metastasis (13 of 17 patients), which were mostly diffuse (11 of 19 patients). Discordant findings were found between WBS and computed tomography (CT) at diagnosis (2 patients), WBS and CT during surveillance (3 patients), and diagnostic and post-therapy WBS (2 patients). Final outcome was "excellent" in 3 of 19 (16%) patients, "biochemically persistent" in 1 of 19 (5%) patients, "structurally persistent" in 13 of 19 (68%) patients-including 1 death-and indeterminate in 2 of 19 (11%) patients. Postoperative Tg correlated with response to therapy. Lung metastasis pattern and RAI cumulative activity were not predictive of response to therapy. Conclusions: Lung metastases are mostly observed at diagnosis of DTC and higher suspicion should be maintained in CAYA who are younger, have LN disease, and have elevated postoperative Tg. Preoperative Tg shows promise as another predictive marker, but limited sample size precludes generalization. "Excellent" response to therapy is uncommon-multiple RAI courses do not necessarily improve outcome-response appears unrelated to RAI activity or metastasis pattern.
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Affiliation(s)
- Alexander D Chesover
- Divisions of Endocrinology, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Reza Vali
- Divisions of Nuclear Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Seyed Hamid Hemmati
- Divisions of Nuclear Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Jonathan D Wasserman
- Divisions of Endocrinology, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
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Wang W, Chang J, Jia B, Liu J. The Blood Biomarkers of Thyroid Cancer. Cancer Manag Res 2020; 12:5431-5438. [PMID: 32753960 PMCID: PMC7351621 DOI: 10.2147/cmar.s261170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/20/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction With the gradual increase in the incidence of thyroid cancer, people’s attention to thyroid cancer has also gradually increased. Although the prognosis of thyroid cancer is rather mild compared to other cancers, it will still bring a heavy psychological burden on people who have been diagnosed. At present, the diagnosis of thyroid cancer mainly depends on ultrasound and percutaneous fine needle aspiration (pFNA). Due to the unsatisfactory accuracy of the diagnosis methods we use now, there are still some thyroid nodules that cannot be clearly diagnosed before surgery. Methods In this article, we have searched for relevant research on blood markers of thyroid cancer in the past five years and categoried them into four groups. Discussion Though we have not found a biomarker which can diagnose thyroid cancer both sensitively and specifically, we do found many substances that are related to it, and have the potential to recognize it and help the diagnosis. And perhaps combined models can do it better.
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Affiliation(s)
- Weiran Wang
- First Hospital of Shanxi Medical University, General Surgery Department, Taiyuan, Shanxi, People's Republic of China
| | - Jingtao Chang
- First Hospital of Shanxi Medical University, General Surgery Department, Taiyuan, Shanxi, People's Republic of China
| | - Baosong Jia
- First Hospital of Shanxi Medical University, General Surgery Department, Taiyuan, Shanxi, People's Republic of China
| | - Jing Liu
- First Hospital of Shanxi Medical University, General Surgery Department, Taiyuan, Shanxi, People's Republic of China
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Kim H, Park SY, Choe JH, Kim JS, Hahn SY, Kim SW, Chung JH, Jung J, Kim TH. Preoperative Serum Thyroglobulin and Its Correlation with the Burden and Extent of Differentiated Thyroid Cancer. Cancers (Basel) 2020; 12:cancers12030625. [PMID: 32182688 PMCID: PMC7139752 DOI: 10.3390/cancers12030625] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
Lymph node metastasis (LNM) in differentiated thyroid cancer (DTC) is usually detected with preoperative ultrasonography; however, this has limited sensitivity for small metastases, and there is currently no predictive biomarker that can help to inform the extent of surgery required. We evaluated whether preoperative serum thyroglobulin levels can predict tumor burden and extent. We retrospectively reviewed the clinical records of 4029 DTC cases diagnosed and treated at a Samsung Medical Center between 1994 and 2016. We reviewed primary tumor size, number and location of LNM, and presence of distant metastases to reveal relationships between tumor burden and extent and preoperative serum thyroglobulin levels. We found a linear association between increasing preoperative thyroglobulin levels, the size of the primary tumor, and the number of LNM (r = 0.34, p < 0.001, r = 0.20, p < 0.001, respectively). Tumor extent also increased with each decile of increasing preoperative thyroglobulin level (r = 0.18, p < 0.001). Preoperative thyroglobulin levels of 13.15 ng/mL, 30.05 ng/mL, and 62.9 ng/mL were associated with the presence of ipsilateral lateral LNM, contralateral lateral LNM, and distant metastasis, respectively. Our results suggest that preoperative measurement of serum thyroglobulin may help to predict LNM and help to tailor surgery.
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Affiliation(s)
- Hosu Kim
- Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon 51472, Korea;
| | - So Young Park
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.Y.P.); (S.W.K.); (J.H.C.)
| | - Jun-Ho Choe
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.K.)
| | - Jee Soo Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.K.)
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.Y.P.); (S.W.K.); (J.H.C.)
| | - Jae Hoon Chung
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.Y.P.); (S.W.K.); (J.H.C.)
| | - Jaehoon Jung
- Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon 51472, Korea;
- Correspondence: (J.J.); (T.H.K.); Tel.: +82-55-214-3740 (J.J.); +82-2-3410-6049 (T.H.K.); Fax: +82-55-214-3250 (J.J.); +82-2-3410-6983 (T.H.K.)
| | - Tae Hyuk Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (S.Y.P.); (S.W.K.); (J.H.C.)
- Correspondence: (J.J.); (T.H.K.); Tel.: +82-55-214-3740 (J.J.); +82-2-3410-6049 (T.H.K.); Fax: +82-55-214-3250 (J.J.); +82-2-3410-6983 (T.H.K.)
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20
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Huang Z, Song M, Wang S, Huang J, Shi H, Huang Y, Yin Y, Liu Y, Wu Z. Preoperative serum thyroglobulin is a risk factor of skip metastasis in papillary thyroid carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:389. [PMID: 32355833 PMCID: PMC7186689 DOI: 10.21037/atm.2019.10.92] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lymph node metastasis of papillary thyroid carcinoma (PTC) was a significant risk factor of local recurrence and distant metastasis, and our study aimed to identify predictive factors of skip metastasis in PTC, helping surgeons to build a strategy when facing patients in N1b stage with clinical central lymph node-negative. METHODS A total of 304 patients who underwent total thyroidectomy with central and lateral lymph node dissection and were diagnosed PTC with lateral lymph node metastasis (LLNM) in the Department of General Surgery at Guangdong Provincial People's Hospital were enrolled. We collected clinicopathological characteristics and analyzed their correlation with skip metastasis by univariate and multivariate analysis. RESULTS The incidence of skip metastasis in PTC was 14.8%. Univariate analysis showed that age, tumor diameter, primary tumor location, and preoperative serum thyroglobulin (Tg) were risk factors. Age (P=0.049, OR =3.418), primary tumor location (P<0.001, OR =7.279), and Tg (P=0.038, OR =9.412) were independent predictors in PTC by multivariate analysis. CONCLUSIONS Skip metastasis of PTC was significantly associated with preoperative serum Tg ≤77 ng/mL, tumor diameter ≤10 mm, age ≥55, and tumor located in the upper lobe. It is the first time to demonstrate that Tg is associated with skip metastasis of PTC.
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Affiliation(s)
- Ziyang Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Muye Song
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Shujie Wang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Jianhao Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Hongyan Shi
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yijie Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ying Yin
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yongchen Liu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zeyu Wu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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21
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Kim H, Park SY, Jung J, Kim JH, Hahn SY, Shin JH, Oh YL, Chung MK, Kim HI, Kim SW, Chung JH, Kim TH. Improved survival after early detection of asymptomatic distant metastasis in patients with thyroid cancer. Sci Rep 2019; 9:18745. [PMID: 31822753 PMCID: PMC6904730 DOI: 10.1038/s41598-019-55370-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/27/2019] [Indexed: 12/12/2022] Open
Abstract
The incidence of thyroid cancer (TC) has been increasing in many countries and concerns about overdiagnosis are also widely shared. However, early detection may be helpful in some high-risk TC patients, such as those with initial distant metastasis. We conducted this study to evaluate the usefulness of early detection in TC patients with initial distant metastasis. We retrospectively reviewed the clinical data of 13,249 TC patients, and found 127 patients with initial distant metastasis. Enrolled patients were divided into two groups according to the diagnostic periods; before and after 2004, when the early detection of TC by ultrasonography began in earnest in Korea. Patients were also divided into two groups according to the presence of symptoms. Prior to 2004, 33 patients (1.7% of TC patients) were diagnosed with TC with initial distant metastasis and 16 (48.5%) of them died. After 2004, 94 patients (0.8% of TC patients) were diagnosed with TC with initial distant metastasis and 29 (30.9%) of them died. Prior to 2004, the disease-specific death rates were similar between the asymptomatic and symptomatic groups (46.2% vs. 50.0%, P = 0.566). Conversely, after 2004, the asymptomatic group showed a significantly lower disease-specific death rate as compared with that of the symptomatic groups (17.2% vs. 60.0%; P < 0.001). Early detection had a significant positive impact on survival outcomes only after 2004, especially in asymptomatic TC patients with initial distant metastasis.
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Affiliation(s)
- Hosu Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - So Young Park
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaehoon Jung
- Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jung-Han Kim
- Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Hahn
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye In Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Tae Hyuk Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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22
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Liu Z, Chen S, Huang Y, Hu D, Zeng W, Wang M, Zhou W, Chen D, Feng H, Wei W, Zhang C, Zhou L, Guo L. Synergic effects of histology subtype, tumor size, and lymph node metastasis on distant metastasis in differentiated thyroid cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:533. [PMID: 31807515 DOI: 10.21037/atm.2019.09.137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Detection of distant metastasis (DM) is important in differentiated thyroid cancer (DTC). This study aimed to investigate the synergic effects of histology subtype, tumor size, and lymph node metastasis (LNM) status on the occurrence of DM in DTC. Methods We collected data of 96,788 patients with DTC. Univariate and multivariate analyses were conducted to identify the risk factors of DM. Relative excess risk of synergic effect, attributable proportion of synergic effect, and synergy index were then calculated to assess synergic effects. Further, Kaplan-Meier method using the log-rank test and receiver operating characteristic (ROC) curves were utilized. Results Age at diagnosis (P<0.001), sex (P<0.001), race (P<0.01), tumor size (P<0.001), N stage (P < 0.001), histology subtype (P<0.001), and extrathyroidal extension (P<0.001) were risk factors for DM in both univariate and multivariate analyses. We also found a significant additive synergic effect between histology subtype and LNM, and between tumor size and LNM on DM in the DTC patients. In addition, patients with follicular thyroid cancer and N1 stage had the sharpest decline in cancer-specific survival curves (P<0.001) and all-cause survival curves (P<0.001) compared to patients with other combinations of histology subtype and N stage. Similar results were obtained in patients with larger tumors (≥10 mm) and N1 stage. The areas under the curve of histology subtype, tumor size, and LNM status were 0.569, 0.744, and 0.681, respectively. Conclusions Age at diagnosis, sex, race, tumor size, N stage, histology subtype, and extrathyroidal extension are risk factors for DM in DTC patients. LNM has a synergic effect with either follicular thyroid histology or larger tumor size for higher risk of DM which is important for diagnosing DM.
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Affiliation(s)
- Zeming Liu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Sichao Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yihui Huang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Di Hu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Min Wang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wei Zhou
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Danyang Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Haifeng Feng
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wei Wei
- Department of Pediatrics, St John Hospital and Medical Center, Detroit, MI, USA
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Ling Zhou
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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