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Lei S, Wang D, Ge J, Liu H, Zhao D, Li G, Ding Z. Single-center study of familial papillary thyroid cancer in China: surgical considerations. World J Surg Oncol 2015; 13:115. [PMID: 25889362 PMCID: PMC4374499 DOI: 10.1186/s12957-015-0519-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/23/2015] [Indexed: 11/25/2022] Open
Abstract
Background Whether familial papillary thyroid cancer (FPTC) is more aggressive than sporadic counterpart remains elusive, and the optimal clinical approach for FPTC is yet to be established. In this study, we investigated familial occurrence of PTC in China and reviewed our experience of its surgical treatment. Methods The clinical records of 248 consecutive patients with an established diagnosis of PTC who were admitted to Nanfang Hospital for thyroidectomy between January 2011 and June 2013 were analyzed in this study. Patients included 66 males and 182 females, aged 11 to 76 years. Results Twenty-two patients (8.9%) with a positive family history were confirmed. Patients with FPTC had a predilection for female subjects and tended to be younger than other patients, but the difference was not significant (P = 0.0514 and P = 0.168). They were more likely to present large tumors (P = 0.0024), multifocality (familial vs. sporadic: 54.50% vs. 26.50%; P < 0.006), local invasion (81.8% vs. 23.9%; P < 0.001), and malignant lymph nodes (63.6% vs. 33.6%; P = 0.005). Univariate and multivariate analyses identified that a positive family history was an independent risk factor for local invasion (OR: 5.683; 95% CI: 2.056 to 15.707; P = 0.001), malignant lymph nodes (OR: 3.005; 95% CI: 1.046 to 8.630; P = 0.041) in FPTC patients. Kaplan-Meier survival curves revealed that an aggressive surgical strategy was associated with a better relapse-free survival than conventional one (P = 0.032). Conclusions FPTC is more likely to possess aggressive features than sporadic counterparts. Thus, screening of at-risk families is essential to aid in earlier recognition. An aggressive surgical strategy appeared to be the more effective therapy. However, sufficient detailed interrogation and long-term follow-up of the patients and their family are necessary for providing individualized recommendations for clinical management.
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Affiliation(s)
- Shangtong Lei
- Department of General Surgery, Nanfang Hospital, No, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Da Wang
- Department of General Surgery, Nanfang Hospital, No, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Junna Ge
- Department of General Surgery, Nanfang Hospital, No, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, No, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Donghui Zhao
- Department of General Surgery, Nanfang Hospital, No, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, No, 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China. .,Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
| | - Zihai Ding
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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Pitoia F, Cross G, Salvai ME, Abelleira E, Niepomniszcze H. Patients with familial non-medullary thyroid cancer have an outcome similar to that of patients with sporadic papillary thyroid tumors. ACTA ACUST UNITED AC 2011; 55:219-23. [PMID: 21655871 DOI: 10.1590/s0004-27302011000300007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/07/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether familial non-medullary thyroid cancer (FNMTC) is more aggressive than sporadic thyroid cancer. SUBJECTS AND METHODS We compared the clinical behavior and outcome of 16 subjects with FNMTC from 7 unrelated kindred with those observed in 160 subjects with sporadic PTC (SPTC) from our database. RESULTS The only different baseline characteristics observed between both groups were: bilateral malignancy, 38% vs. 24%, respectively (p = 0.03), and lymph node metastasis, 56.2% vs. 39%, respectively (p = 0.01). Considering the outcome, in the FNMTC, 9 (56.2%) patients were rendered free of disease, one patient died from thyroid cancer (6%), and 6/16 (37.5%) had persistent disease. In the SPTC Group, 87 (54%) patients were considered free of disease, 11 (7%) died due to PTC, and 62 (38%) had persistent disease (p = ns). CONCLUSIONS Despite the higher incidence of lymph node metastasis in FNMTC patients this situation seemed not to alter the compared outcome.
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Affiliation(s)
- Fabián Pitoia
- Division of Endocrinology, Hospital de Clinicas, University of Buenos Aires, Argentina.
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Khan A, Smellie J, Nutting C, Harrington K, Newbold K. Familial nonmedullary thyroid cancer: a review of the genetics. Thyroid 2010; 20:795-801. [PMID: 20465534 DOI: 10.1089/thy.2009.0216] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Thyroid cancer, the commonest of endocrine malignancies, continues to increase in incidence with over 19,000 new cases diagnosed in the European Union per year. Although nonmedullary thyroid cancer (NMTC) is mostly sporadic, evidence for a familial form, which is not associated with other Mendelian cancer syndromes (e.g., familial adenomatous polyposis and Cowden's syndrome), is well documented and thought to cause more aggressive disease. Just over a decade ago, the search for a genetic susceptibility locus for familial NMTC (FNMTC) began. This review details the genetic studies conducted thus far in the search for potential genes for FNMTC. DESIGN An electronic PubMed search was performed from the English literature for genetics of FNMTC and genetics of familial papillary thyroid carcinoma (subdivision of FNMTC). The references from the selected papers were reviewed to identify further studies not found in the original search criteria. MAIN OUTCOME Six potential regions for harboring an FNMTC gene have been identified: MNG1 (14q32), TCO (19p13.2), fPTC/PRN (1q21), NMTC1 (2q21), FTEN (8p23.1-p22), and the telomere-telomerase complex. Important genes reported to have been excluded are RET, TRK, MET, APC, PTEN, and TSHR. CONCLUSION The genetics of FNMTC is an exciting field in medical research that has the potential to permit individualized management of thyroid cancer. Studies thus far have been on small family groups using varying criteria for the diagnosis of FNMTC. Results have been contradictory and further large-scale genetic studies utilizing emerging molecular screening tests are warranted to elucidate the underlying genetic basis of FNMTC.
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Affiliation(s)
- Ayesha Khan
- Department of Endocrine Surgery, Chelsea and Westminster NHS Trust, London, United Kingdom.
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Santos RB, Melo TGD, Assumpção LVM. [Familial nommedullary thyroid cancer]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2007; 51:769-73. [PMID: 17891240 DOI: 10.1590/s0004-27302007000500014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/09/2007] [Indexed: 11/21/2022]
Abstract
Nonmedullary thyroid carcinoma, originating from thyroid epithelial cells, is the most frequent thyroid malignant neoplasia. Since 1955, there has been increasing evidence that this cancer may have a familial predisposition. It is now established that around 4.2% of all nonmedullary thyroid carcinomas occurs on the background of familial predisposition. These cases are often more aggressive, due to early onset, multifocality and a higher percentual of recurrences. An autossomal dominant inheritance pattern appears likely in most families, although the exact genes responsible for this syndrome have not yet been identified. Patients affected by this cancer should be treated with total thyroidectomy routinely and, in most cases, lymph node dissection, followed by iodine ablation and TSH suppressive therapy with levothyroxine. Some authors also recommend that first-degree relatives of patients with nonmedullary thyroid cancer (especially women) should be submitted to neck ultrasound for thyroid cancer screening, aiming early diagnosis for better treatment results.
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Affiliation(s)
- Roberto Bernardo Santos
- Serviço de Endocrinologia, Centro de Ciências da Vida, Departamento de Clínica Médica, Pontifícia Universidade Católica de Campinas, SP, Brazil.
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