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Park J, An S, Bae JS, Kim K, Kim JS. Impact of Tumor Size on Prognosis in Differentiated Thyroid Cancer with Gross Extrathyroidal Extension to Strap Muscles: Redefining T3b. Cancers (Basel) 2024; 16:2577. [PMID: 39061216 PMCID: PMC11274482 DOI: 10.3390/cancers16142577] [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: 05/24/2024] [Revised: 07/10/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
The prognostic significance of tumor size in T3b differentiated thyroid cancer (DTC) remains debated and underexplored. This study aimed to examine the varying impact of T3b based on tumor size, analyzing disease-specific survival, disease-free survival, and overall survival. A retrospective review of 6282 DTC patients who underwent thyroid surgery at Seoul St. Mary's Hospital from September 2000 to December 2017 was conducted. T3b was classified into three subcategories, T3b-1 (≤2 cm), T3b-2 (2-4 cm), and T3b-3 (>4 cm), using the same size criteria for T1, T2, and T3a. T3b-1 showed no significant difference in disease specific survival compared to T1, and both disease-free and disease-specific survival curves were sequentially ranked as T1, T3b-1, T2, T3a, T3b-2, and T3b-3. The modified T category, reclassifying T3b-1 as T1, demonstrated superior staging performance compared to the classic T category (c-index: 0.8961 vs. 0.8959 and AUC: 0.8573 vs. 0.8518). Tumors measuring 2 cm or less within the T3b category may require downstaging, and a modified T category could improve the precision of prognostic staging compared to the current T category.
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Affiliation(s)
| | | | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.P.); (S.A.); (K.K.); (J.S.K.)
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Chen J, Zeng C, Jin J, Zhang P, Zhang Y, Zhang H, Li Y, Guan H. Overexpression of FHL1 suppresses papillary thyroid cancer proliferation and progression via inhibiting Wnt/β-catenin pathway. Endocrine 2024; 85:238-249. [PMID: 38191984 DOI: 10.1007/s12020-023-03675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The four and a half LIM domain protein 1 (FHL1) has been found to act as a tumor suppressor in several cancers. However, the clinical and functional significance, as well as underlying molecular mechanisms of FHL1 in papillary thyroid cancer (PTC) are largely unknown. METHODS Bioinformatics analyses, qRT-PCR and Western blotting were used to investigate the expression of FHL1 in PTC. Cell proliferation was measured using CCK8, Edu, colony formation, and flow cytometry assays. Cell migration and invasion were examined by wound healing and Transwell assays. qRT-PCR, Western blot, immunofluorescence and Top/Fop reporter assays were performed to assess the underlying mechanisms. RESULTS FHL1 expression was significantly downregulated in PTC. FHL1 downregulation negatively correlated with stage, T classification, and N classification of the patients. The downregulation of FHL1 is associated with poor prognosis. Overexpression of FHL1 inhibited PTC cells' proliferation, invasion, migration and Wnt/β-catenin pathway activity. LiCl partially restored the inhibitory effects of FHL1 on aggressive phenotypes and Wnt/β-catenin pathway activity of PTC cells. CONCLUSION FHL1 is downregulated in PTC and its expression is associated with better clinical outcomes for patients with the disease. FHL1 acts as a tumor suppressor via, at least partially, suppressing Wnt/β-catenin pathway.
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Affiliation(s)
- Junxin Chen
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chuimian Zeng
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jiewen Jin
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Pengyuan Zhang
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yilin Zhang
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hanrong Zhang
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanbing Li
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Hongyu Guan
- Department of Endocrinology and Diabetes Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Jin Q, Heng Y, Zhu X, Xu C, Cai W, Tao L. Patterns of cervical lymph node involvement in mono-focal papillary thyroid carcinoma patients with different capsular status: A multi-center analysis. Am J Otolaryngol 2024; 45:104265. [PMID: 38703608 DOI: 10.1016/j.amjoto.2024.104265] [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: 10/06/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The characteristics of cervical lymph node involvement in papillary thyroid carcinoma (PTC) patients with different degree of capsular invasion remains unclear, especially for those with mono-focal lesion who have traditionally been considered as low neck metastasis risk subgroup. STUDY DESIGN Retrospective cohort study. SETTING Three academic teaching hospital. METHODS A total of 1276 mono-focal PTC patients were retrospectively analyzed. RESULTS Mono-focal PTC patients with extrathyroidal extension (ETE) showed significantly higher central lymph node metastasis (CLNM) rate than those without. For patients with no gross ETE (gETE), those with minimal ETE (mETE) also showed more commonly CLNM than those with encapsulated lesions. However, the lateral lymph node metastasis (LLNM) rates of patients with mETE and encapsulated tumors were comparable, both lower than that of patients with gETE. Age ≥40, male, and MTD ≥0.5 cm were identified as independent risk factors of CLNM for those with encapsulated tumors and were enrolled for creating a prediction model. In terms of LLNM, only MTD ≥1.0 cm was confirmed as independent risk factors of LLNM for patients with positive gETE. CONCLUSIONS The presence and degree of ETE may have different effects on the risk of central and lateral lymph node metastasis. gETE demonstrates a strong correlation with both CLNM and LLNM while mETE is only associated with CLNM in mono-focal PTC patients. A comprehensive model is established in the aim of predicting neck involvement according to the capsular status and the corresponding stratified risk factors, which may aid clinical decision-making for the management of neck regions.
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Affiliation(s)
- Qiuyan Jin
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China
| | - Yu Heng
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China
| | - Xiaoke Zhu
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China
| | - Chengzhi Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of medicine, China.
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of medicine, China.
| | - Lei Tao
- ENT institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, China.
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Chiew YEW, Yang YT, Chi SY, Chan YC, Chang YH, Lim LS, Chen WC, Chen YN, Wu ST, Chou CK. Prognostic factors and treatment responses among patients with gross residual disease in differentiated thyroid cancer. J Chin Med Assoc 2024; 87:602-608. [PMID: 38625842 DOI: 10.1097/jcma.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Various postoperative staging systems were developed to assess the outcome of differentiated thyroid cancer from initial risk after surgery to dynamic changing prognosis during follow-up. The objective of our retrospective cohort study was to identify risk factors contributing to macroscopic positive surgical margin (R2 resection) and parameters in discriminating the treatment responses and prognosis among R2 patients. METHODS In total, 242 differentiated thyroid cancer patients with extrathyroidal extension who underwent a thyroidectomy at Kaohsiung Chang Gung Memorial Hospital between January 2013 and July 2018, were included. The patients were grouped according to the presence or absence of gross residual disease (R2). The R2 patients were further classified into two categories according to their treatment response into excellent and nonexcellent groups. The parameters and treatment outcomes were compared between these groups. RESULTS The mean follow-up time was 45.3 months. Two hundred seven (85.5%) patients had either surgery-free or microscopic margins (R0/R1), while 35 (14.5%) had R2 resection. In the R2 group (n = 35), 15 (42.9%) patients achieved an excellent response, while 20 (57.1%) achieved a nonexcellent response. Statistically significant differences were observed in the extent of neck dissection, TSH-Tg level, post-RAI Tg level, nodal status, and recurrence between the two groups. The Kaplan-Meier curves for 5-year local and distant recurrence-free survival of R0/R1 versus R2 patients were 90.0% versus 66.3%, and 98.4% versus 90.7%, respectively ( p < 0.001). Among the R2 patients, the excellent responders had a higher local recurrence-free survival than nonexcellent responders (93.3% vs. 45.1%, p = 0.008). CONCLUSION There are significant disparities in recurrence-free survival among R2 patients with different treatment responses. The nodal status of papillary thyroid cancer and thyroglobulin level after thyroidectomy and RAI were factors contributing to difference in their treatment responses.
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Affiliation(s)
- Yvonne Ee Wern Chiew
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Yi-Ting Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Shun-Yu Chi
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Yi-Chia Chan
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Yen-Hsiang Chang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Lay San Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Wen-Chieh Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Yung-Nien Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Shu-Ting Wu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Chen-Kai Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
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Jiang KC, Zhou DH, Luo DC. Microscopic extrathyroidal extension does not affect the prognosis of patients with papillary thyroid carcinoma: A propensity score matching analysis. Heliyon 2024; 10:e25280. [PMID: 38322895 PMCID: PMC10844248 DOI: 10.1016/j.heliyon.2024.e25280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
Background Extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC) can be divided into two categories based on different degrees of invasion: microscopic ETE (micro-ETE) and macroscopic ETE (macro-ETE). At present, there is a consensus that macro-ETE significantly affects PTC prognosis, while the prognostic significance of micro-ETE remains controversial. Methods The clinicopathological and follow-up data for PTC patients who underwent surgical treatment at the Hangzhou First People's Hospital between 2015 and 2018 were retrospectively analyzed. According to the degree of ETE, patients were divided into three groups: non-ETE, micro-ETE and macro-ETE. Cox regression analysis was performed to evaluate the effect of ETE on recurrence-free survival (RFS). The propensity score matching (PSM) method was used to reduce the interference of confounding factors, and Kaplan-Meier curves were utilized to compare the RFS. Results Both micro- and macro-ETE were associated with some aggressive tumor features, including tumor size, multifocality, and lymph node metastasis. Univariate and multivariate Cox regression analyses showed that macro-ETE was an independent risk factor for recurrence, while micro-ETE was not associated with recurrence. The K-M curves showed that RFS for micro-ETE and non-ETE were not statistically different before and after PSM, while RFS for macro-ETE was significantly shorter than that for non-ETE. Conclusion The presence of micro-ETE in PTC did not affect prognosis of patients, suggesting that its treatment should be consistent with the treatment for intrathyroidal tumors. The surgical method and the necessity for radioiodine therapy should be carefully evaluated to reduce overtreatment.
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Affiliation(s)
- Ke-cheng Jiang
- Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong-hui Zhou
- Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ding-cun Luo
- Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, China
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Marongiu A, Nuvoli S, De Vito A, Vargiu S, Spanu A, Madeddu G. Minimal Extrathyroid Extension (mETE) as the Only Risk Factor in Patients with Papillary Thyroid Carcinoma (PC): Its Clinical Impact on Recurrence and Outcome during Long-Term Follow-Up. Biomedicines 2024; 12:350. [PMID: 38397952 PMCID: PMC10886778 DOI: 10.3390/biomedicines12020350] [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: 01/04/2024] [Revised: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Minimal extrathyroid extension (mETE) effect on papillary thyroid carcinoma (PC) prognosis is still debated even more so now that this factor has been removed in the 8th AJCC Edition, supporting the hypothesis that mETE is not associated with aggressive tumors. We retrospectively enrolled 91 PC patients (Group 1) submitted to total thyroidectomy and radioiodine ablation. At the time of the primary tumor surgery, mETE was ascertained in all patients with no other risk factors, such as multifocality, vascular invasion, neck and distant metastases, and aggressive histological variants. As controls, 205 consecutive matched PC patients (Group 2) without mETE and the aforementioned risk factors were enrolled. During the follow-up (average 8 years), 16/91 (17.58%) Group 1 patients and 15/205 (7.32%) Group 2 patients developed metastases (p = 0.0078). Cox regression analysis showed an increased risk of metastases in patients with mETE (HR: 2.58 (95% CI 1.28-5.22) p = 0.008). Disease-free survival (DFS) was significantly lower in patients with mETE than in controls (p = 0.0059). The present study seems to demonstrate that mETE can be associated with an aggressive PC and can be considered, even alone without other risk factors, an independent factor of unfavorable DFS. Thus, by excluding mETE in the 8th AJCC Edition, patient care and management could be compromised.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Sonia Vargiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
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Beom Shin I, Hoon Koo D, Sik Bae D. Optimal Cutoff Values of the Contact Angle of Tumor on Sonography System for Predicting Extrathyroidal Extension of Papillary Thyroid Carcinoma by Tumor Location. Clin Med Insights Oncol 2023; 17:11795549231199918. [PMID: 37854360 PMCID: PMC10580720 DOI: 10.1177/11795549231199918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/07/2023] [Indexed: 10/20/2023] Open
Abstract
Background Extrathyroidal extension (ETE) significantly affects the treatment strategy for thyroid cancer. We present a new method to predict ETE of papillary thyroid carcinoma (PTC). methods We enrolled 1 481 patients with PTCs. The ETE was classified into minimal and gross ETE. Using the novel "contact angle of the tumor on sonography" (CATS) system, we calculated optimal cutoffs for predicting ETE according to tumor location and compared the diagnostic performance to that of previous methods. Results The optimal cutoff angles for predicting anterior minimal and gross ETE were 41.5° and 49.4°, respectively, while those for posterior ETE were 39.8° and 54.6°, respectively. The optimal cutoff angle predicting tracheal ETE was 88.0°. The diagnostic performance was comparable to that of previous methods. Conclusion The CATS method for predicting ETE is a valuable alternative.
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Affiliation(s)
- Ik Beom Shin
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Do Hoon Koo
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Dong Sik Bae
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, South Korea
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Shi W, Wang M, Dong L, Li F, He X, Li X, Sun D, Zheng X, Jia Q, Tan J, Zheng W, Li N, Xu K, Meng Z. Extrathyroidal extension or tumor size of primary lesion influences thyroid cancer outcomes. Nucl Med Commun 2023; 44:854-859. [PMID: 37440210 DOI: 10.1097/mnm.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
AIMS Extrathyroidal extension (ETE) is a determined factor of T3 and T4 stage of differentiated thyroid cancer (DTC) in American Joint Committee on Cancer. We aimed to compare clinical outcomes between different extent of ETE according to tumor size. METHODS Patients diagnosed with DTC were collected from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. They were categorized into two groups by presence of lymph node metastases (LNM) or distant metastases (DM): group A: no presence of LNM and DM, and group B: presence of LNM or DM. Each group was further divided into four groups according to tumor size: <1 cm, 1-2 cm, 2-4 cm, >4 cm. ETE was divided into three groups by the extent: no ETE, microscopic ETE, and macroscopic ETE. Kaplan-Meier method and log-rank test were used to analyze cancer-specific survival (CSS). RESULTS 91,975 patients were included. In groups A and B, for tumor size 1 cm, there was no significant difference in CSS between no ETE and microscopic ETE, while a significant difference was observed between no ETE and macroscopic ETE. For tumor size >1 cm, there were significant differences in CSS (both no ETE vs. micro ETE and no ETE vs. macro ETE). CONCLUSION We suggests that when tumor size is more than 1 cm, micro ETE is significantly associated with poorer outcome. T3 and T4 stages may take account into tumor size rather than merely based on the presence and extent of ETE. It may be prudent to revisit the omission of micro ETE in TNM staging.
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Affiliation(s)
- Wanying Shi
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
| | - Miao Wang
- Department of Nuclear Medicine, Tianjin Medical University Second Hospital
| | - Liyan Dong
- Department of General Surgery, Tianjin Medical University General Hospital
| | - Fuxin Li
- Department of General Surgery, Tianjin Medical University General Hospital
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital
| | - Xue Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
| | - Danyang Sun
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
| | - Xiangqian Zheng
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
| | - Wei Zheng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
| | - Ning Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
| | - Ke Xu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital
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Zhang X, Peng W, Fan J, Luo R, Liu S, Du W, Luo C, Zheng J, Pan X, Ge H. Regulatory role of Chitinase 3-like 1 gene in papillary thyroid carcinoma proved by integration analyses of single-cell sequencing with cohort and experimental validations. Cancer Cell Int 2023; 23:145. [PMID: 37480002 PMCID: PMC10362555 DOI: 10.1186/s12935-023-02987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is one of the most common thyroid carcinomas. The gross extrathyroidal extension and extensive metastases of PTC lead to high rates of recurrence and poor clinical outcomes. However, the mechanisms underlying PTC development are poorly understood. In this study, using single-cell RNA sequencing, the transcriptome profiles of two PTC patients were addressed, including PTC1 with low malignancy and good prognosis and PTC2 with high malignancy and poor prognosis. We found that epithelial subcluster Epi02 was the most associated with the malignant development of PTC cells, with which the fold change of Chitinase 3-like 1 (CHI3L1) is on the top of the differentially expressed genes between PTC1 and PTC2 (P < 0.001). However CHI3L1 is rarely investigated in PTC as far. We then studied its role in PTC with a series of experiments. Firstly, qRT-PCR analysis of 14 PTC patients showed that the expression of CHI3L1 was positively correlated with malignancy. In addition, overexpression or silencing of CHI3L1 in TPC-1 cells, a PTC cell line, cultured in vitro showed that the proliferation, invasion, and metastasis of the cells were promoted or alleviated by CHI3L1. Further, immunohistochemistry analysis of 110 PTC cases revealed a significant relationship between CHI3L1 protein expression and PTC progression, especially the T (P < 0.001), N (P < 0.001), M stages (P = 0.007) and gross ETE (P < 0.001). Together, our results prove that CHI3L1 is a positive regulator of malignant development of PTC, and it promotes proliferation, invasion, and metastasis of PTC cells. Our study improves understanding of the molecular mechanisms underlying the progression of PTC and provides new insights for the clinical diagnosis and treatment of PTC.
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Affiliation(s)
- Xiaojun Zhang
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Wanwan Peng
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Southern Medical University, 510515, Guangzhou, China
| | - Jie Fan
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Shanting Liu
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Wei Du
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Chaochao Luo
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Southern Medical University, 510515, Guangzhou, China
| | - Jiawen Zheng
- Department of Molecular Pathology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Xinghua Pan
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Southern Medical University, 510515, Guangzhou, China.
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, 510515, Guangzhou, China.
- Department of Hepatobiliary Surgery II, Zhujiang Hospital, Southern Medical University, 510515, Guangzhou, China.
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, 450008, Zhengzhou, China.
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Qi Q, Huang X, Zhang Y, Cai S, Liu Z, Qiu T, Cui Z, Zhou A, Yuan X, Zhu W, Min X, Wu Y, Wang W, Zhang C, Xu P. Ultrasound image-based deep learning to assist in diagnosing gross extrathyroidal extension thyroid cancer: a retrospective multicenter study. EClinicalMedicine 2023; 58:101905. [PMID: 37007735 PMCID: PMC10050776 DOI: 10.1016/j.eclinm.2023.101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Background The presence of gross extrathyroidal extension (ETE) in thyroid cancer will affect the prognosis of patients, but imaging examination cannot provide a reliable diagnosis for it. This study was conducted to develop a deep learning (DL) model for localization and evaluation of thyroid cancer nodules in ultrasound images before surgery for the presence of gross ETE. Methods From January 2016 to December 2021 grayscale ultrasound images of 806 thyroid cancer nodules (4451 images) from 4 medical centers were retrospectively analyzed, including 517 no gross ETE nodules and 289 gross ETE nodules. 283 no gross ETE nodules and 158 gross ETE nodules were randomly selected from the internal dataset to form a training set and validation set (2914 images), and a multitask DL model was constructed for diagnosing gross ETE. In addition, the clinical model and the clinical and DL combined model were constructed. In the internal test set [974 images (139 no gross ETE nodules and 83 gross ETE nodules)] and the external test set [563 images (95 no gross ETE nodules and 48 gross ETE nodules)], the diagnostic performance of DL model was verified based on the pathological results. And then, compared the results with the diagnosis by 2 senior and 2 junior radiologists. Findings In the internal test set, DL model demonstrated the highest AUC (0.91; 95% CI: 0.87, 0.96), which was significantly higher than that of two senior radiologists [(AUC, 0.78; 95% CI: 0.71, 0.85; P < 0.001) and (AUC, 0.76; 95% CI: 0.70, 0.83; P < 0.001)] and two juniors radiologists [(AUC, 0.65; 95% CI: 0.58, 0.73; P < 0.001) and (AUC, 0.69; 95% CI: 0.62, 0.77; P < 0.001)]. DL model was significantly higher than clinical model [(AUC, 0.84; 95% CI: 0.79, 0.89; P = 0.019)], but there was no significant difference between DL model and clinical and DL combined model [(AUC, 0.94; 95% CI: 0.91, 0.97; P = 0.143)]. In the external test set, DL model also demonstrated the highest AUC (0.88, 95% CI: 0.81, 0.94), which was significantly higher than that of one of senior radiologists [(AUC, 0.75; 95% CI: 0.66, 0.84; P = 0.008) and (AUC, 0.81; 95% CI: 0.72, 0.89; P = 0.152)] and two junior radiologists [(AUC, 0.72; 95% CI: 0.62, 0.81; P = 0.002) and (AUC, 0.67; 95 CI: 0.57, 0.77; P < 0.001]. There was no significant difference between DL model and clinical model [(AUC, 0.85; 95% CI: 0.79, 0.91; P = 0.516)] and clinical + DL model [(AUC, 0.92; 95% CI: 0.87, 0.96; P = 0.093)]. Using DL model, the diagnostic ability of two junior radiologists was significantly improved. Interpretation The DL model based on ultrasound imaging is a simple and helpful tool for preoperative diagnosis of gross ETE thyroid cancer, and its diagnostic performance is equivalent to or even better than that of senior radiologists. Funding Jiangxi Provincial Natural Science Foundation (20224BAB216079), the Key Research and Development Program of Jiangxi Province (20181BBG70031), and the Interdisciplinary Innovation Fund of Natural Science, Nanchang University (9167-28220007-YB2110).
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Affiliation(s)
- Qi Qi
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xingzhi Huang
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yan Zhang
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, Shanghai, China
| | - Shuangting Cai
- Ultrasound Department, Jiujiang First People's Hospital, Jiujiang, Jiangxi, China
| | - Zhaoyou Liu
- Ultrasound Department, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Taorong Qiu
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, China
| | - Zihan Cui
- School of Information Engineering, Nanchang University, Nanchang, Jiangxi, China
| | - Aiyun Zhou
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xinchun Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wan Zhu
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiang Min
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yue Wu
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weijia Wang
- Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chunquan Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Corresponding author.
| | - Pan Xu
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Corresponding author.
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Wang B, Zhu CR, Fei Y, Liu H, Yao XM, Wu J. Prelaryngeal and/or pretracheal lymph node metastasis could help to identify papillary thyroid carcinoma with intermediate risk from unilateral lobe cT1-2N0 papillary thyroid carcinoma. Front Endocrinol (Lausanne) 2023; 14:1156664. [PMID: 37124749 PMCID: PMC10140489 DOI: 10.3389/fendo.2023.1156664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Objective The study aims to explore the possibility of prelaryngeal and/or pretracheal lymph node metastasis in identifying papillary thyroid carcinoma with more than 5 metastatic central lymph nodes from unilateral lobe cT1-2N0 papillary thyroid carcinoma. Methods A retrospective analysis was conducted on patients who underwent the initial thyroid surgery for unilateral lobe cT1-2N0 PTC in a single tertiary center between July 2018 to December 2022. Multivariable binary logistic regression analysis was used to identify risk factors for unilateral lobe cT1-2N0 papillary thyroid carcinoma with more than 5 metastatic central lymph nodes. Results A total of 737 patients were included in the study and 399 patients were confirmed to suffer from occult central lymph node metastasis. The larger size of the largest diameter of tumor (> 1cm; OR = 3.3, 95%CI 1.6 - 6.83; p = 0.001), pretracheal lymph node metastasis (OR = 5.91, 95%CI 2.73 - 12.77; p < 0.001), prelaryngeal lymph node metastasis (OR = 3.74, 95%CI 1.73 - 8.1; p = 0.001), ipsilateral paratracheal lymph node metastasis (OR = 12.22, 95%CI 3.43 - 43.48; p < 0.001), and contralateral paratracheal lymph node metastasis (OR = 7.68, 95%CI 3.86 - 15.3; p < 0.001) were confirmed to be risk factors for unilateral lobe cT1-2N0 PTC with more than 5 metastatic central lymph nodes. When more than two metastatic prelaryngeal and/or pretracheal lymph nodes occurred, the incidence of more than 5 metastatic central lymph nodes was 71.2%. Conclusion Prelaryngeal and/or pretracheal lymph node metastasis could help to identify papillary thyroid carcinoma with more than 5 metastatic central lymph nodes from unilateral lobe cT1-2N0 papillary thyroid carcinoma. When more than two metastatic pretracheal and/or prelaryngeal lymph nodes occurred, total thyroidectomy and ipsilateral central lymph node dissection should be performed and contralateral paratracheal lymph node dissection might be also necessary.
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Affiliation(s)
- Bin Wang
- Center of Breast and Thyroid Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Chun-Rong Zhu
- Department of Oncology Ward 2, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Yuan Fei
- Center of Breast and Thyroid Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Hong Liu
- Center of Breast and Thyroid Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Xin-Min Yao
- Center of Breast and Thyroid Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
| | - Jian Wu
- Center of Breast and Thyroid Surgery, Department of General Surgery, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
- *Correspondence: Jian Wu,
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Pan X, Li Q. Risk factor score for the prediction of central compartment lymph node metastasis in papillary thyroid carcinoma and its clinical significance. Front Surg 2022; 9:914696. [DOI: 10.3389/fsurg.2022.914696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/28/2022] [Indexed: 11/09/2022] Open
Abstract
ObjectiveTo establish the criteria for a risk factor score (RFS) for predicting the probability of central compartment lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) and to explore the clinical significance of the RFS.MethodsThe data of 412 patients with PTC who underwent surgical resection between May 2013 and July 2016 were retrospectively analysed and divided into two groups: a central LNM group and a non-central LNM group. In each group, the frequency of six risk factors was documented: sex, age, tumour size, extracapsular spread (ECS), tumour multifocality, and tumour location. The maximum likelihood method of discriminant analysis was adopted to calculate patient scores for the six risk indicators. In addition, the data of 104 patients with PTC admitted between July 2016 and December 2016 were prospectively analysed using this method and these six risk factors. A higher score represented one certain possibility that was the more appropriate for one patient.ResultsIn the retrospective group, the result was as follows: 129 patients with positive (+) lymph nodes in the central compartment and 168 patients with negative (−) lymph nodes in the central compartment, which was in line with the actual results. In the prospective group, there were 28 patients with positive lymph nodes in the central compartment and 48 patients with negative lymph nodes in the central compartment. The coincidence rates using the RFS were 71.9% for the retrospective group and 73.1% for the prospective group.ConclusionBy simple and quantitative analyses of the presence of central LNM, the RFS is of great significance when choosing surgical approaches and postoperative individual-based treatment plans, as well as when determining the prognosis of central compartment LNM in patients with PTC.
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Wijewardene A, Gill AJ, Gild M, Learoyd DL, Glover AR, Sywak M, Sidhu S, Roach P, Schembri G, Hoang J, Robinson B, Tacon L, Clifton-Bligh R. A Retrospective Cohort Study with Validation of Predictors of Differentiated Thyroid Cancer Outcomes. Thyroid 2022; 32:1201-1210. [PMID: 35620896 DOI: 10.1089/thy.2021.0563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: The goal of radioactive iodine (RAI) in differentiated thyroid cancer (DTC) is to treat metastasis and reduce recurrence risk. International guidelines provide broad risk stratification to aid treatment decisions, but a more nuanced approach to individualize care is warranted. We developed a predictive risk model for DTC. Methods: We performed a retrospective multivariable analysis of 899 patients who received RAI after thyroidectomy at a quaternary center in Australia between 2008 and 2016. Collected data included age, gender, histology, stimulated thyroglobulin (sTg), and 8th American Joint Committee Cancer (AJCC) staging. The ATA Modified Initial Risk (ATA) was calculated retrospectively. Recurrence was defined as clinically significant progression requiring either surgical intervention or administration of a second activity of RAI. Synchronous metastasis was defined as distant metastasis (i.e., outside of the neck) that was present at the time of diagnosis on structural imaging or initial post-iodine treatment scan. The features significantly associated with synchronous metastasis or recurrence were employed in the generation of a predictive risk model. A separate cohort of 393 patients who received RAI in 2017-2021 was used for validation. Results: On multivariate analysis, sTg ≥10 μg/L, extrathyroidal extension (ETE) and lymph node involvement predicted recurrence. Independent of ATA, patients with sTg ≥10 μg/L had a shorter disease-free survival (DFS) than those with sTg <10 μg/L (p < 0.001). The ETE stratified by four histological categories was significantly associated with worse DFS (p < 0.001). In a subset of patients, the presence of thyroglobulin antibody (TgAb) did not influence recurrence in patients with sTg <10 μg/L. On multivariate analysis, widespread ETE, sTg ≥10 μg/L, multifocal papillary thyroid cancer and follicular thyroid cancer were positively associated with synchronous metastasis. A predictive risk model was developed to estimate synchronous metastasis/recurrence risk and validated successfully in the second cohort. Conclusions: Our novel predictive risk model modifies and extends ATA stratification by including sTg and ETE, which we found to be independent predictors of both recurrence and synchronous metastasis in DTC.
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Affiliation(s)
- Ayanthi Wijewardene
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Anthony J Gill
- Faculty of Medicine, The University of Sydney, Sydney, Australia
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
| | - Matti Gild
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Diana L Learoyd
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
| | - Anthony Robert Glover
- Faculty of Medicine, The University of Sydney, Sydney, Australia
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Mark Sywak
- Faculty of Medicine, The University of Sydney, Sydney, Australia
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Stan Sidhu
- Faculty of Medicine, The University of Sydney, Sydney, Australia
- Department of Endocrine Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Paul Roach
- Faculty of Medicine, The University of Sydney, Sydney, Australia
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Geoffrey Schembri
- Faculty of Medicine, The University of Sydney, Sydney, Australia
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Jeremy Hoang
- Faculty of Medicine, The University of Sydney, Sydney, Australia
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Bruce Robinson
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Lyndal Tacon
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, The University of Sydney, Sydney, Australia
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Park J, Kang IK, Bae JS, Kim JS, Kim K. Clinical Significance of Tumor Size in Gross Extrathyroidal Extension to Strap Muscles (T3b) in Papillary Thyroid Carcinoma: Comparison with T2. Cancers (Basel) 2022; 14:cancers14194615. [PMID: 36230541 PMCID: PMC9563603 DOI: 10.3390/cancers14194615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of the present study was to compare the risk of recurrence between T2 and T3b papillary thyroid carcinoma (PTC) and the effect of tumor size on survival in T3b disease. A total of 634 patients with PTC who underwent thyroid surgery at a single center were retrospectively analyzed. Clinicopathological characteristics were compared according to the T category in the TNM staging system, with T3b divided into T3b-1 (tumor size, ≤2 cm) and T3b-2 (tumor size, 2–4 cm). Disease-free survival (DFS) and recurrence risk were compared between T2, T3b, T3b-1, and T3b-2. Tumor size was significantly larger in T2 than in T3b. A significant difference in recurrence was observed between T2 and T3b-2 but not between T2 and T3b-1. T3b-2 was identified as a significant risk factor for PTC recurrence. A significant difference in the DFS curve was observed between T2 and T3b-2. However, no significant differences in survival were observed between T2 and T3b or T3b-1. These results indicate that the prognostic impact of T3b may vary depending on tumor size. Further studies are required to determine the need for T classifications that account for tumor size and gETE invasion of the strap muscles.
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Affiliation(s)
| | | | | | | | - Kwangsoon Kim
- Correspondence: ; Tel.: +82-2-2258-6784; Fax: +82-2-2258-2138
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Jang A, Jin M, Kim WW, Jeon MJ, Sung TY, Song DE, Kim TY, Chung KW, Kim WB, Shong YK, Lee YM, Kim WG. Prognosis of Patients with 1-4 cm Papillary Thyroid Cancer Who Underwent Lobectomy: Focus on Gross Extrathyroidal Extension Invading Only the Strap Muscles. Ann Surg Oncol 2022; 29:7835-7842. [PMID: 35907995 DOI: 10.1245/s10434-022-12155-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study was designed to evaluate the prognostic implication of gross extrathyroidal extension (ETE) invading the strap muscles after thyroid lobectomy in patients with 1-4 cm papillary thyroid cancer (PTC). METHODS This retrospective cohort study included patients with 1-4 cm PTC who underwent thyroid lobectomy from 2005 to 2012. Overall, 595 patients were enrolled after excluding patients with aggressive variants of PTC, gross ETE into a major neck structure, and lateral cervical lymph node (LN) metastasis. We evaluated the risk factors for structural recurrence after lobectomy in 1-4 cm PTC. RESULTS Seventy-eight patients (13.1%) had gross ETE invading only the strap muscles. During the median follow-up period of 7.7 years, structural recurrence was confirmed in 35 patients (5.9%). The presence of gross ETE was an independent risk factor for structural recurrence (hazard ratio 2.54, 95% confidence interval 1.19-5.44; p = 0.016). Subgroup analysis of patients with gross ETE showed that 11 and 47 patients had low- and intermediate-risk LN metastasis, respectively. A significant difference in recurrence-free survival was observed according to the degree of cervical LN metastasis (p = 0.03). Those without LN metastasis or low-risk LNs had a 75% lower risk of recurrence when compared with those with both gross ETE and intermediate-risk LNs. CONCLUSION Gross ETE and intermediate-risk cervical LN metastasis were associated with a significantly high risk of recurrence after lobectomy in patients with 1-4 cm PTC. Completion thyroidectomy would be considered in this subgroup of patients but not in all patients with gross ETE invading only the strap muscles.
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Affiliation(s)
- Ahreum Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Meihua Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma. Cancers (Basel) 2022; 14:cancers14153677. [PMID: 35954338 PMCID: PMC9367408 DOI: 10.3390/cancers14153677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The lymph node ratio (LNR) is an emerging predictive marker for recurrence in papillary thyroid carcinoma (PTC). The purpose of this study was to investigate the association between LNR and disease-free survival (DFS) in patients with N1b PTC. Unlike that in the lateral or whole neck, LNR in the central compartment (CLNR) was found to have prognostic significance. The high-CLNR group (CLNR ≥ 0.7) had worse DFS and was 4.5 times more likely to experience recurrence in patients with N1b PTC. Abstract The lymph node ratio (LNR) indicates the number of metastatic lymph nodes (LNs) to the total number of LNs. The prognostic value of LNR in papillary thyroid carcinoma (PTC) and other solid tumors is known. This study aimed to investigate the relationship between LNR and disease-free survival (DFS) in patients with PTC with lateral LN metastases (N1b PTC). A total of 307 patients with N1b PTC who underwent total thyroidectomy and therapeutic central and lateral LN dissection were retrospectively analyzed. The DFS and recurrence risk in the patients with LNR, central-compartment LNR (CLNR), and lateral-compartment LNR (LLNR) were compared. The mean follow-up duration was 93.6 ± 19.9 months. Eleven (3.6%) patients experienced recurrence. Neither LNR nor LLNR affected the recurrence rate in our analysis (p = 0.058, p = 0.106, respectively). However, there was a significant difference in the recurrence rates between the patients with low and high CLNR (2.1% vs. 8.8%, p = 0.017). In the multivariate analysis, CLNR ≥ 0.7 and perineural invasion were independent predictors of tumor recurrence. High CLNR was associated with an increased risk of recurrence, and was shown to be a significant predictor of prognosis in patients with N1b PTC.
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Song RY, Kim HS, Kang KH. Minimal extrathyroidal extension is associated with lymph node metastasis in single papillary thyroid microcarcinoma: a retrospective analysis of 814 patients. World J Surg Oncol 2022; 20:170. [PMID: 35643530 PMCID: PMC9148524 DOI: 10.1186/s12957-022-02629-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Extrathyroidal extension (ETE) is considered a major prognostic factor in papillary thyroid carcinoma (PTC). Patients with gross ETE are at increased risk of recurrence and mortality. The importance of minimal ETE still remains controversial, especially in patients with papillary thyroid microcarcinoma (PTMC). The purpose of this study was to evaluate the association between ETE and lymph node (LN) metastasis in single PTMC.
Methods
A retrospective analysis was performed of 1994 patients underwent thyroidectomy for PTC between 2012 and 2016 in a single institution. Patients with combined thyroid carcinoma of other types and those who underwent completion thyroidectomy were excluded. After further exclusion of PTC larger than 1 cm and multifocal tumors, 814 patients with single PTMC were included in the study.
Results
72.9% patients had no ETE, 25.1% minimal ETE, and 2.1% gross ETE. ETE was associated with lymphatic invasion, perineural invasion, and vascular invasion. Patients with minimal and gross ETE were also more likely to have LN metastasis, including lateral neck metastasis, compared to those without ETE. In univariate analysis, LN metastasis was associated with male gender, conventional PTC, lymphatic invasion, perineural invasion, and ETE. In multivariate analysis, male gender (OR = 1.987; 95% CI 1.369–2.884), lymphatic invasion (OR = 4.389; 95% CI 1.522–12.658), perineural invasion (OR = 6.545; 95% CI 1.262–33.948), and minimal ETE (OR = 1.852; 95% CI 1.298–2.643) were found to be independent risk factors of LN metastasis.
Conclusions
Minimal ETE is associated with LN metastasis in single PTMC, compared to no ETE. Minimal ETE should be considered in the management of patients with single PTMC, whether surgical or during active surveillance.
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Prognostic Impact of Microscopic Extra-Thyroidal Extension (mETE) on Disease Free Survival in Patients with Papillary Thyroid Carcinoma (PTC). Cancers (Basel) 2022; 14:cancers14112591. [PMID: 35681573 PMCID: PMC9179642 DOI: 10.3390/cancers14112591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This study assessed the risk of reduced disease-free survival (DFS) and poor clinical outcome in patients with papillary thyroid carcinomas (PTC) with microscopic extra-thyroidal extension (mETE), as compared to PTC patients without mETE. Methods: Retrospective analysis of a prospective database of patients treated by total thyroidectomy and radioactive iodine (RAI) with a five-year follow-up and tumors < 40 mm. In total, 303 patients were analyzed: 30.7% presented tumors with mETE, and 69.3% without. mETE was defined as extra-thyroidal invasion without skeletal muscle involvement. The primary outcome, DFS, was defined as the interval between initial treatment and any subsequent PTC-related treatment. The second outcome was the clinical status at five years. Results: In univariate analyses, the five-year DFS was significantly lower for tumors with mETE (62.4% versus 88.1%, p < 0.001). In multivariate analysis, mETE and massive lymph node involvement (LNI) were independent prognostic factors, associated respectively with a hazard ratio of 2.55 (95% CI 1.48−4.40) and 8.94 (95% CI 4.92−16.26). mETE was significantly associated with a pejorative clinical outcome at five years, i.e., biochemical/indeterminate response and structural persistence (Respectively OR 1.83 (95% CI 0.83; 4.06) and OR 4.92 (95% CI 1.87; 12.97)). Conclusion: Our results suggest that mETE is an independent poor prognosis factor of reduced DFS and predictive of poor clinical outcome.
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Is Gross Extrathyroidal Extension to Strap Muscles (T3b) Only a Risk Factor for Recurrence in Papillary Thyroid Carcinoma? A Propensity Score Matching Study. Cancers (Basel) 2022; 14:cancers14102370. [PMID: 35625974 PMCID: PMC9139627 DOI: 10.3390/cancers14102370] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 12/22/2022] Open
Abstract
Simple Summary In papillary thyroid carcinoma (PTC), staging classification of gross and minimal extrathyroidal extension (ETE) has been recently modified in the eighth edition of the American Joint Commission on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system. In this study, we compared the clinicopathological characteristics and recurrence rates between minimal and gross ETE. No significant differences in the recurrence and disease-free survival rates were found between the two groups. Whether gross ETE invading strap muscles (T3b) only could be a risk factor for recurrence in PTC remains questionable. Abstract The presence of extrathyroidal extension (ETE) is associated with locoregional recurrence and distant metastases in papillary thyroid carcinoma (PTC). This study was designed to compare the recurrence risk between minimal ETE (mETE) and gross ETE (gETE) in patients with PTC using propensity score matching. In this study, 4452 patients with PTC who underwent thyroid surgery in a single center were retrospectively analyzed, and clinicopathological characteristics were compared according to the ETE status. Disease-free survival (DFS) and recurrence risk were compared between mETE and gETE after propensity score matching. The mean follow-up duration was 122.7 ± 22.5 months. In multivariate analysis, both mETE and gETE were not associated with recurrence risk before propensity score matching (p = 0.154 and p = 0.072, respectively). After propensity score matching, no significant difference in recurrence rates was observed between the two groups (p = 0.668). DFS of the gETE group did not significantly differ from that of the mETE group (log-rank p = 0.531). This study revealed that both mETE and gETE are not independent risk factors for the risk of recurrence in PTC. Our findings suggest that gETE invading strap muscles only might not be associated with worse oncological outcomes in PTC.
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Harries V, McGill M, Yuan A, Wang LY, Tuttle RM, Shaha AR, Shah JP, Wong RJ, Patel SG, Ganly I. Does macroscopic extrathyroidal extension to the strap muscles alone affect survival in papillary thyroid carcinoma? Surgery 2022; 171:1341-1347. [PMID: 34600743 PMCID: PMC8960478 DOI: 10.1016/j.surg.2021.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Macroscopic extrathyroidal extension to structures adjacent to the thyroid gland is one of the most important predictors of survival in papillary thyroid carcinoma. However, the prognostic significance of macroscopic extrathyroidal extension to strap muscles alone is unknown. The aim of this study is to determine the impact on survival in patients with macroscopic extrathyroidal extension to strap muscles alone compared to those with no macroscopic extrathyroidal extension and macroscopic extrathyroidal extension involving other adjacent structures. METHODS After institutional review board approval, adult papillary thyroid carcinoma patients were identified from an institutional database of 6,259 patients undergoing initial surgery for well-differentiated thyroid carcinoma from 1986 to 2015. Patients were classified as having no macroscopic extrathyroidal extension, macroscopic extrathyroidal extension to strap muscles alone, or macroscopic extrathyroidal extension to other adjacent structures. Disease-specific survival was calculated using the Kaplan-Meier method and groups were compared using the log-rank test. A P value < .05 was considered statistically significant and significant factors were used in a Cox proportional hazard model to predict disease-specific survival. RESULTS There were 5,880 patients included in the analysis; 5,485 patients (93.3%) in the no macroscopic extrathyroidal extension group, 179 (3.0%) in the macroscopic extrathyroidal extension to strap muscles alone group and 216 (3.7%) in the macroscopic extrathyroidal extension involving other adjacent structures group. With a median follow-up of 64 months, the estimated 10-year disease-specific survival for patients with no macroscopic extrathyroidal extension, macroscopic extrathyroidal extension to strap muscles alone, and macroscopic extrathyroidal extension involving other adjacent structures were 98.9%, 95.7%, and 83.7%, respectively (P < .0001). In the ≥55-year-old cohort, the estimated 10-year disease-specific survival for patients with no macroscopic extrathyroidal extension, macroscopic extrathyroidal extension to strap muscles alone, and macroscopic extrathyroidal extension involving other adjacent structures were 97.6%, 89.3%, and 68.1%, respectively (P <.0001). After controlling for pathological nodal stage and distant metastasis stage, extent of extrathyroidal extension remained an independent predictor of disease-specific survival; patients with macroscopic extrathyroidal extension to strap muscles alone had a 3.3-fold increased likelihood of a disease-specific death compared to no macroscopic extrathyroidal extension patients (hazard ratio 3.294; 95% confidence interval 1.076-10.086, P < .0368). CONCLUSION In our study, patients aged ≥55 years with papillary thyroid carcinoma and macroscopic extrathyroidal extension to strap muscles alone appear to have an increased likelihood of a disease-specific death compared to patients with no macroscopic extrathyroidal extension.
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Affiliation(s)
- Victoria Harries
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marlena McGill
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Avery Yuan
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Laura Y Wang
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - R Michael Tuttle
- Department of Medicine, Endocrine Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Snehal G Patel
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
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Zhang RJ, Chen YL, Deng X, Yang H. Carbon Nanoparticles for Thyroidectomy and Central Lymph Node Dissection for Thyroid Cancer. Am Surg 2022:31348221086780. [PMID: 35387525 DOI: 10.1177/00031348221086780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate whether the application of carbon nanoparticles (CNs) in total or near-total thyroidectomy combined with central lymph node dissection (CLND) for thyroid cancer (TC) is beneficial to lymph node dissection, parathyroid, and recurrent laryngeal nerve (RLN) protection. METHODS Relevant literatures were systematically searched on PubMed, EMBASE, and Cochrane Library Databases until March 31, 2021. All analyses were performed using Revman Manager 5.3 software. The main results were the number of central lymph nodes, the number of central metastatic lymph nodes, accidental parathyroidectomy, postoperative hypoparathyroidism, postoperative hypocalcemia, and postoperative transient RLN paralysis. RESULTS This meta-analysis identified 4 randomized controlled trials and 8 non-randomized controlled trials comprising 1870 patients. Compared with the control, the use of CNs was helpful to dissect more central lymph nodes (weighted mean difference [WMD]: 3.55, 95% confidence interval [CI]: 2.12-4.98, P < .00001) and central metastatic lymph nodes (WMD: 1.69, 95% CI:1.31-2.08, P < .00001), lower rate of accidental parathyroidectomy (odds ratio [OR]: .33, 95% CI: .23-.47, P < .00001), lower rate of both postoperative transient hypoparathyroidism (OR: .40, 95% CI: .31-.51, P < .00001), and transient hypocalcemia (OR: .37, 95% CI: .27-.51, P < .00001). However, there were no statistical difference between the groups for postoperative permanent hypoparathyroidism (OR: .29, 95% CI: .06-1.28, P = .10), postoperative permanent hypocalcemia (OR: .94, 95% CI: .10-9.16, P = .96), and postoperative transient RLN paralysis (OR: .66, 95% CI: .40-1.12, P = .12). CONCLUSIONS The application of CNs in total or near-total thyroidectomy combined with CLND for TC can better dissect the central lymph nodes and protect parathyroid glands (PGs) and their function.
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Affiliation(s)
- Rong-Jia Zhang
- Department of Thyroid Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yu-Lu Chen
- Department of Cardiovascular Medicine, Shifang People's Hospital, Deyang, China
| | - Xian Deng
- Department of Thyroid Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hui Yang
- Department of Thyroid Surgery, 556508The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Dell’Aquila M, Tralongo P, De Ruggieri G, Curatolo M, Revelli L, Lombardi CP, Pontecorvi A, Fadda G, Larocca LM, Raffaelli M, Pantanowitz L, Rossi ED. Does Locally Advanced Thyroid Cancer Have Different Features? Results from a Single Academic Center. J Pers Med 2022; 12:221. [PMID: 35207709 PMCID: PMC8879437 DOI: 10.3390/jpm12020221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/28/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite the fact that the majority of thyroid cancers are indolent, 15% of patients with well-differentiated carcinoma including papillary thyroid carcinoma (PTC) present with locally advanced thyroid cancer (LATC) at diagnosis. The current study analyzes a cohort of patients with LATC focusing on their risk for local recurrence, distant metastases, and overall survival. MATERIALS AND METHODS From January 2010 to December 2020, 65 patients with LATC were retrieved, including 42 cases with preoperative cytological samples. BRAFV600E and TERT mutations were performed on both cytology and histopathology specimens in this cohort. RESULTS Among the 65 cases, 42 (65%) were women. The median age was 60.1 years. Histological diagnoses included 25 (38.4%) with classic PTC and 30 (46.1%) aggressive variants of PTC, mostly tall cell variant (17 cases, 26.1%). Multifocality was seen in 33 cases (50.8%). All patients had nodal metastases. The most common site of extrathyroidal extension was the recurrent laryngeal nerve (69.2%). Staging revealed 21 cases were stage I, none were stage II, 33 were stage III, and 7 were stage IVa and 4 stage IVb. No differences were found between well and poorly/undifferentiated thyroid cancers. CONCLUSION These data suggest that locally advanced thyroid cancers, including variants of PTC, exhibit a more aggressive biological course and should accordingly be more assertively managed.
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Affiliation(s)
- Marco Dell’Aquila
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Giuseppe De Ruggieri
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Mariangela Curatolo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Luca Revelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Alfredo Pontecorvi
- Division of Endocrinology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy;
| | - Guido Fadda
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Luigi Maria Larocca
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
| | - Marco Raffaelli
- Division of Endocrine Surgery, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (G.D.R.); (L.R.); (C.P.L.); (M.R.)
| | - Liron Pantanowitz
- Department of Pathology& Clinical Labs, University of Michigan, Ann Arbor, MI 48103, USA;
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, 00168 Rome, Italy; (M.D.); (P.T.); (M.C.); (G.F.); (L.M.L.)
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Shen W, Pan XJ, Li QH. Utility and significance of clinical risk factor scoring model in predicting central compartment lymph node metastasis (CLNM) in patients with papillary thyroid cancer (PTC). Pak J Med Sci 2022; 38:214-218. [PMID: 35035428 PMCID: PMC8713228 DOI: 10.12669/pjms.38.1.4450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/21/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To establish and discuss the significance of a clinical risk factor scoring model in predicting central compartment lymph node metastasis (CLNM) (level VI) in patients with papillary thyroid cancer (PTC). Methods A retrospective analysis was performed on 412 patients who underwent surgical treatment for PTC who were admitted to the Second Hospital of Hebei Medical University between July 2016 and May 2017, with the patients being divided into a CLNM group and a non-metastasis (NM) group. Risk factors such as sex, age, tumor diameter, capsular invasion, multifocality, and tumor location were recorded for scoring via maximum likelihood estimation (MLE)-based discriminant analysis. The scoring model was used for prospective analysis of CLNM in another 104 patients. Besides, the discriminant function that was developed using the risk factors based on the retrospective data derived from the 412 patients was evaluated by plugging the retrospective data in for specified variables, with a higher score indicating a greater risk of developing CLNM. Clinical diagnosis of CLNM was based on postoperative paraffin section pathology, which was adopted as the criterion to assess discriminative accuracy in the prospective and retrospective groups. Results The discriminative accuracy of the scoring model was 71.8% in the retrospective group and 72.2% in the prospective group. Conclusions The scoring model enables simplified, quantitative analysis of CLNM in PTC patients. The scoring model has clinical significance in that it provides a basis for the choice of operation, personalized postoperative treatment, and prognosis of PTC.
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Affiliation(s)
- Wei Shen
- Wei Shen, Department of Thyroid and Breast Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Xiao-Jia Pan
- Xiao-jia Pan, Department of Thyroid and Breast Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Qing-Huai Li
- Qing-huai Li, Department of Thyroid and Breast Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
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Pacini F, Fuhrer D, Elisei R, Handkiewicz-Junak D, Leboulleux S, Luster M, Schlumberger M, Smit JW. 2022 ETA Consensus Statement: What are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer? Eur Thyroid J 2022; 11:e210046. [PMID: 34981741 PMCID: PMC9142814 DOI: 10.1530/etj-21-0046] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/04/2021] [Indexed: 11/08/2022] Open
Abstract
Modern use of post-operative radioactive iodine (RAI) treatment for differentiated thyroid cancer (DTC) should be implemented in line with patients' risk stratification. Although beneficial effects of radioiodine are undisputed in high-risk patients, controversy remains in intermediate-risk and some low-risk patients. Since the last consensus on post-surgical use of RAI in DTC patients, new retrospective data and results of prospective randomized trials have been published, which have allowed the development of a new European Thyroid Association (ETA) statement for the indications of post-surgical RAI therapy in DTC. Questions about which patients are candidates for RAI therapy, which activities of RAI can be used, and which modalities of pre-treatment patient preparation should be used are addressed in the present guidelines.
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Affiliation(s)
- Furio Pacini
- Section of Endocrinology, University of Siena, Siena, Italy
- Correspondence should be addressed to F Pacini:
| | - Dagmar Fuhrer
- Department of Endocrinology, Diabetes and Metabolism, West German Cancer Centre (WTZ), University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Rossella Elisei
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Sophie Leboulleux
- Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France
| | - Markus Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Martin Schlumberger
- Gustave Roussy Cancer Campus and University Paris-Saclay, Villejuif, Cedex, France
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Parvathareddy SK, Siraj AK, Qadri Z, DeVera F, Siddiqui K, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Microscopic Extrathyroidal Extension Results in Increased Rate of Tumor Recurrence and Is an Independent Predictor of Patient’s Outcome in Middle Eastern Papillary Thyroid Carcinoma. Front Oncol 2021; 11:724432. [PMID: 34926245 PMCID: PMC8671701 DOI: 10.3389/fonc.2021.724432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background Papillary Thyroid Cancer (PTC) is the most common endocrine malignancy, with recurrence rate as high as 30%. A great deal of controversy surrounds the significance of microscopic extrathyroidal extension (m-ETE) as a prognostic factor. The most recent edition (8th) of American Joint Committee on Cancer (AJCC) staging system has removed m-ETE from the definition of pT3, which suggests that m-ETE may lack prognostic impact in PTC patients. Moreover, data about m-ETE prevalence and clinical impact on Middle Eastern PTC remains unknown. We therefore investigate the prevalence of m-ETE and its clinico-pathological correlation and prognostic impact in Middle Eastern PTC. We also compared the AJCC 7th and 8th staging systems and their prognostic performance. Methods PTCs from 1430 consecutive adult (> 18 years) patients from single tertiary care hospital were included in this study. A retrospective analysis of PTC patients’ survival and recurrence were compared between AJCC 8th and AJCC 7th staging systems using Proportion of Variation Explained (PVE) and Harrell’s C-index. Results Median follow up of the study cohort was 9.3 years. 31.2% (446/1430) of patients had m-ETE. In the overall cohort, m-ETE was associated with multiple adverse features such as older age (p < 0.0001), male sex (p = 0.0245), tall cell variant (p < 0.0001), bilateral tumors (p < 0.0001), multifocality (p < 0.0001), lymphovascular invasion (p < 0.0001), lymph node metastasis (p < 0.0001), distant metastasis (p = 0.0166), tumor recurrence (p < 0.0001), radioactive iodine refractoriness (p < 0.0001), BRAF mutation (p < 0.0001) and reduced recurrence-free survival (RFS; HR = 1.75; 95% CI = 1.30 – 2.35; p < 0.0001) irrespective of tumor size. Of the 611 patients with T3 disease based on AJCC 7th edition, 359 (58.8%) were down-staged in AJCC 8th edition classification. Overall, the prognostic performance of AJCC 8th edition was inferior to AJCC 7th on the basis of lower PVE (3.04% vs. 3.73%) and lower C-index (0.40 vs. 0.48). Conclusions In Middle Eastern PTC, m-ETE is significantly associated with compromised survival and acts as an independent predictor of RFS. Given these findings, m-ETE should be included in the thyroid cancer treatment guidelines.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zeeshan Qadri
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Felisa DeVera
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology-Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- *Correspondence: Khawla S. Al-Kuraya,
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Forleo R, Grani G, Alfò M, Zilioli V, Giubbini R, Zatelli MC, Gagliardi I, Piovesan A, Ragni A, Morelli S, Puxeddu E, Pagano L, Deandrea M, Ceresini G, Torlontano M, Puligheddu B, Antonelli A, Centanni M, Fugazzola L, Spiazzi G, Monti S, Rossetto R, Monzani F, Tallini G, Crescenzi A, Sparano C, Bruno R, Repaci A, Tumino D, Pezzullo L, Lombardi CP, Ferraro Petrillo U, Filetti S, Durante C, Castagna MG. Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4). Thyroid 2021; 31:1814-1821. [PMID: 34541894 DOI: 10.1089/thy.2021.0248] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aims of this study were to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE. Methods: We reviewed all records in the Italian Thyroid Cancer Observatory database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines. Results: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p = 0.65), tumor size >2 cm (OR 1.45, p = 0.34), aggressive PTC histology (OR 0.55, p = 0.15), and age at diagnosis (OR 0.90, p = 0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a >2 cm tumor was significantly associated with a worse outcome (OR 5.27 [95% confidence interval], p = 0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and nontreated patients (p = 0.24). Conclusions: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease.
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Affiliation(s)
- Raffaella Forleo
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
| | - Giorgio Grani
- Department of Translational and Precision Medicine, and Sapienza University of Rome, Rome, Italy
| | - Marco Alfò
- Department of Statistical Sciences, Sapienza University of Rome, Rome, Italy
| | - Valentina Zilioli
- Chair and Nuclear Medicine Unit, University and Spedali Civili Hospital, Brescia, Italy
| | - Raffaele Giubbini
- Chair and Nuclear Medicine Unit, University and Spedali Civili Hospital, Brescia, Italy
| | - Maria Chiara Zatelli
- Department of Medical Sciences, Unit of Endocrinology, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Department of Medical Sciences, Unit of Endocrinology, University of Ferrara, Ferrara, Italy
| | - Alessandro Piovesan
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Alberto Ragni
- Division of Oncological Endocrinology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Silvia Morelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Efisio Puxeddu
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Loredana Pagano
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Maurilio Deandrea
- UO Endocrinologia, Diabetologia e Malattie del metabolismo, AO Ordine Mauriziano Torino, Torino, Italy
| | - Graziano Ceresini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Massimo Torlontano
- Department of Medical Sciences, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Barbara Puligheddu
- SCDU Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Laura Fugazzola
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Spiazzi
- Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Monti
- Department of Endocrinology and Diabetes, Azienda Ospedaliero-Universitaria Sant'Andrea, Sapienza University of Rome, Roma, Italy
| | - Ruth Rossetto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Tallini
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Anna Crescenzi
- Pathology Unit, University Hospital Campus Bio-Medico, Rome, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Rocco Bruno
- Endocrinology Unit, Tinchi Hospital, Matera, Italy
| | - Andrea Repaci
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Dario Tumino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Luciano Pezzullo
- Struttura Complessa Chirurgia Oncologica della Tiroide, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Naples, Italy
| | - Celestino Pio Lombardi
- Division of Endocrine Surgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
| | | | - Sebastiano Filetti
- Department of Translational and Precision Medicine, and Sapienza University of Rome, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, and Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical, and Neurological Sciences, University of Siena, Siena, Italy
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Predictive Factors of Recurrence of Papillary Thyroid Microcarcinomas: Analysis of 2,538 Patients. Int Arch Otorhinolaryngol 2021; 25:e585-e593. [PMID: 34737832 PMCID: PMC8558954 DOI: 10.1055/s-0040-1722253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction
The incidence of papillary thyroid microcarcinoma (PTMC) has increased, and its treatment remains controversial.
Objective
To identify the clinical and pathological factors predictive of tumor recurrence.
Methods
We retrospectively analyzed 2,538 consecutive patients treated for PTMC, most submitted to total thyroidectomy (98%) followed by radioactive iodine (RAI) ablation (51.7%) at a cancer center from 1996 to 2015. The patients were stratified according to the American Thyroid Association (ATA) risk categories (low, intermediate, or high), and the clinicopathological features were evaluated by multivariate Cox regression analysis to identify independent prognostic factors for recurrence.
Results
After a mean follow-up of 58 months (range: 3 to 236.5 months), tumor recurrence was diagnosed in 63 (2.5%) patients, mostly in the lymph nodes. Distant metastasis occurred in 2 (0.1%) patients. There were no cancer-related deaths. The multivariate analysis showed that age < 55 years (
p
= 0.049; hazard ratio [HR]: 2.54; 95% confidence interval [95%CI]: 0.95 to 0.99), multifocality (
p
= 0.032; HR: 1.76; 95%CI: 1.05 to 2.96), and the presence of lymph-node metastasis (
p
< 0.001; HR: 3.69; 95%CI: 2.07–6.57) were independent risk factors for recurrence. Recurrence was observed in 29 (1.5%) out of 1,940 low-risk patients, 32 (5.4%) out of 590 intermediate-risk patients, and in 2 (25%) out of 8 high-risk patients.
Conclusions
The prognosis of PTMC is excellent, favoring a conservative treatment for most patients. Age < 55 years, multifocality, and node metastasis at diagnosis, as well the ATA staging system effectively predict the risk of recurrence. The presence of these risk factors can help identify patients who should be considered for more aggressive management and more frequent follow-up.
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Weber M, Binse I, Oebbecke K, Brandenburg T, Herrmann K, Theurer S, Weber F, Ehrlich AK, Schmid KW, Führer-Sakel D, Vardarli I, Fendler WP, Gilman E, Görges R. Analysis of risk factors and prognosis in differentiated thyroid cancer with focus on minimal extrathyroidal extension. BMC Endocr Disord 2021; 21:161. [PMID: 34376175 PMCID: PMC8353758 DOI: 10.1186/s12902-021-00826-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 07/19/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS In contrast to all prior AJCC/TNM classifications for differentiated thyroid cancer (DTC) the 8th edition does not take minimal extrathyroidal extension (M-ETE) into consideration for local tumor staging. We therefore aimed to retrospectively assess the specific impact of M-ETE on the outcome of M-ETE patients treated in our clinic. METHODS DTC patients with M-ETE and a follow-up time of ≥ 5 years were included and matched with an identical number of patients without M-ETE, but with equal histopathological tumor subtype and size. The frequency of initially metastatic disease among groups was compared using Fisher's exact test, the recurrence rate by virtue of log-rank test. Fisher's exact test and multivariate analysis were used to account for the presence of confounding risk factors. RESULTS One hundred sixty patients (80 matching pairs) were eligible. With other confounding risk factors being equal, the prevalence of N1-/M1-disease at initial diagnosis was comparable among groups (M-ETE: 42.5 %; no M-ETE: 32.5 %; p = 0.25). No differences with regard to the recurrence rate were shown. However, M-ETE patients were treated with external beam radiation therapy more often (16.3 % vs. 1.3 %; p = 0.004) and received higher median cumulative activities of 131I (10.0 vs. 8.0 GBq; p < 0.001). DISCUSSION Although having played a pivotal role for local tumor staging of DTC for decades M-ETE did not increase the risk for metastases at initial diagnosis and the recurrence rate in our cohort. Patients with M-ETE had undergone intensified treatment, which entails a possible confounding factor that warrants further investigation in randomized controlled trials.
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Affiliation(s)
- Manuel Weber
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany.
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany.
| | - Ina Binse
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
| | - Karin Oebbecke
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
| | - Tim Brandenburg
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
| | - Sarah Theurer
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Frank Weber
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
- Department of Surgery, Section Endocrine Surgery, Essen University Hospital, Essen, Germany
| | - Ann-Kathrin Ehrlich
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
- Department of Surgery, Section Endocrine Surgery, Essen University Hospital, Essen, Germany
| | - Kurt Werner Schmid
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
- Department of Endocrinology, Diabetes and Metabolism, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Irfan Vardarli
- Department of Medicine I, Klinikum Vest GmbH, Knappschaftskrankenhaus Recklinghausen, Academic Teaching Hospital, Ruhr-University Bochum, Recklinghausen, Germany
| | | | - Elena Gilman
- Gilman Biometrics, Elena Gilman, Leipziger Strasse 18, 50858, Köln, Germany
| | - Rainer Görges
- Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany
- University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital, Hufelandstraße 55, 45147, Essen, Germany
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Dobrescu R, Picu C, Caragheorgheopol A, Manda D, Ioachim D, Goldstein A, Badiu C. Serum Matrix metalloproteinase-9 (MMP-9) can help identify patients with papillary thyroid cancer at high risk of persistent disease: Value and limitations of a potential marker of neoplasia. Cancer Biomark 2021; 29:337-346. [PMID: 32716342 DOI: 10.3233/cbm-190609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Matrix metalloproteinase-9 (MMP-9) is an important mediator of invasion and metastasis in neoplasia. In thyroid cancer expression levels correlate with aggressiveness but data on peripheral MMP-9 levels are less definitive. OBJECTIVE Prospective study evaluating serum MMP-9 in the diagnosis and prognosis of papillary thyroid cancer. METHODS Serum samples of MMP-9 were drawn before surgery in 185 consecutively enrolled patients with nodular thyroid disease, stratified on pathology as benign disease (N= 88) and papillary thyroid cancer (N= 97). Serum MMP-9 was measured by an immunometric assay. RESULTS MMP-9 levels were not different between benign vs malignant pathology (p= 0.3). In papillary thyroid cancer there was no significant difference in MMP-9 levels between histologies, TNM stage and invasive/non-invasive cancers. High-risk patients with multiple features of aggressiveness had significantly higher MMP-9 levels compared to low-intermediate risk patients (767.5 ± 269.2 ng/ml vs 563.7 ± 228.4 ng/ml, p= 0.019). A cut-off of 806 ng/ml distinguished high from low-intermediate risk patients with a sensitivity of 60% and a specificity of 87.36%, p= 0.018. In patients with available follow-up data (N= 78), MMP-9 was higher in patients who required ⩾ 2 doses of 131I therapy (p= 0.009) and in those with biochemical evidence of persistent disease/who required additional therapy to achieve disease-free status (p= 0.017). CONCLUSION Serum MMP-9 is not useful in the diagnosis of PTC, but preliminary data shows that high pre-surgical serum MMP-9 levels may identify patients at higher risk of persistent disease who require intensive treatment. Large volume prospective studies are required to confirm this observation.
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Affiliation(s)
- Ruxandra Dobrescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Catalina Picu
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania.,Faculty of Biology, University of Bucharest, Bucharest, Romania
| | | | - Dana Manda
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Dumitru Ioachim
- "CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Andrei Goldstein
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
| | - Corin Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"CI Parhon" National Institute of Endocrinology, Bucharest, Romania
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30
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Abičić I, Prpić T, Bogović V, Milanković SG, Mihalj H, Včeva A, Zubčić Ž, Šestak A, Rezo M. Characteristics of Malignant Thyroid Tumors: A Retrospective Study on 320 Patients. Acta Clin Croat 2021; 59:108-114. [PMID: 34219892 PMCID: PMC8212610 DOI: 10.20471/acc.2020.59.s1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Papillary thyroid cancer accounts for 80-85% of diagnosed thyroid cancers, while follicular, medullary, and anaplastic cancers are diagnosed significantly less frequently. This study aimed to show the characteristics of malignant thyroid tumors. In this retrospective study, we analyzed data from 320 patients who underwent thyroid surgery from January 2018 to December 2019. We recorded and statistically analyzed basic demographic data, data of the cytological and pathohistological findings, and tumor characteristics (size, multifocality, extrathyroidal and lymphovascular invasion). Thyroid cancer was diagnosed in 95 patients. The incidence of thyroid cancer was higher in women than in men, but without a significant difference (p=0.46). There was a significant difference between preoperative cytological findings and definitive pathohistological diagnosis (p=0.001). There was no significant difference between genders in tumor size, extrathyroidal and lymphovascular invasion, and multifocality. There were significantly more thyroid cancers with a lymphovascular invasion that were less than 2 cm in size (p=0.04). In our opinion, it is important to emphasize the value of early diagnostics and analysis of the malignant tumor characteristics that are major prognostic factors for survival in patients with thyroid cancer.
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Affiliation(s)
- Ivan Abičić
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Tin Prpić
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Vjeran Bogović
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Stjepan Grga Milanković
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Hrvoje Mihalj
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Andrijana Včeva
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Željko Zubčić
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Anamarija Šestak
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
| | - Matej Rezo
- 1Department of Otorhinolaryngology and Maxillofacial Surgery, Osijek Medical Faculty, J.J. Strossmayer Osijek University, J. Huttlera 4, Osijek, Croatia; 2Department of Otorhinolaryngology and Head and Neck Surgery, Osijek Clinical Hospital Centre, J. Huttlera 4, Osijek, Croatia; 3Department of Otorhinolaryngology, Vukovar General Hospital, Županijska ul. 35, Vukovar, Croatia
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Wang L, Yun C, Huang F, Xiao J, Ju Y, Cheng F, Zhang W, Jia H. Preablative Stimulated Thyroglobulin and Thyroglobulin Reduction Index as Decision-Making Markers for Second Radioactive Iodine Therapy in Patients with Structural Incomplete Response. Cancer Manag Res 2021; 13:5351-5360. [PMID: 34262343 PMCID: PMC8275041 DOI: 10.2147/cmar.s314621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to evaluate the value of preablative stimulated thyroglobulin (presTg) and thyroglobulin reduction index (TRI) to predict the different responses to second radioactive iodine (RAI) therapy in differentiated thyroid cancer (DTC) patients with structural incomplete response (SIR). Patients and Methods A single-center retrospective study analyzed the different clinical outcomes after second RAI therapy in 206 patients with SIR. PresTg1 and presTg2 were measured before first and second RAI management and TRI was the reduction index of presTg1 and presTg2. Cut-off values of presTg and TRI were obtained using receiver operating characteristic analysis. The univariate logistic regression analysis was performed to confirm these parameters as prognostic factors to predict different responses to second RAI therapy. Results Only ATA risk stratification, the post-therapy whole-body scanning (Rx-WBS) findings, presTg1, presTg2, TRI, were different in patients with SIR. After second RAI therapy, 28.2% (58/206) of patients with SIR initially were reclassified as excellent response (ER). PresTg1 <6.6 ng/mL, presTg2 <1.2ng/mL, and TRI >74.2% were excellent indications to predict ER from non-ER after second RAI treatment. PresTg1 >14.9 ng/mL, presTg2 >1.8ng/mL and TRI <66.5% were well markers to predict poor outcome (SIR). High risk and distant metastases could still be considered as risk factors. Conclusion DTC patients with SIR could benefit through second RAI treatment. PresTg before each RAI therapy and TRI could be considered as effective decision-making markers for second RAI therapy and as predictive indications for clinical outcomes.
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Affiliation(s)
- Lihua Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Canhua Yun
- Department of Nuclear Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
| | - Fengyan Huang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Juan Xiao
- Center of Evidence-Based Medicine, Institute of Medical Sciences, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
| | - Yanli Ju
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Fang Cheng
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Wei Zhang
- Department of Nuclear Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
| | - Hongying Jia
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, People's Republic of China.,Center of Evidence-Based Medicine, Institute of Medical Sciences, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250033, People's Republic of China
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Wijewardene A, Gild M, Nylén C, Schembri G, Roach P, Hoang J, Aniss A, Glover A, Sywak M, Sidhu S, Learoyd D, Robinson B, Tacon L, Clifton-Bligh R. Change in Practice of Radioactive Iodine Administration in Differentiated Thyroid Cancer: A Single-Centre Experience. Eur Thyroid J 2021; 10:408-415. [PMID: 34540711 PMCID: PMC8406251 DOI: 10.1159/000516358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Our study aimed to analyse temporal trends in radioactive iodine (RAI) treatment for thyroid cancer over the past decade; to analyse key factors associated with clinical decisions in RAI dosing; and to confirm lower activities of RAI for low-risk patients were not associated with an increased risk of recurrence. METHODS Retrospective analysis of 1,323 patients who received RAI at a quaternary centre in Australia between 2008 and 2018 was performed. Prospectively collected data included age, gender, histology, and American Joint Committee on Cancer stage (7th ed). American Thyroid Association risk was calculated retrospectively. RESULTS The median activities of RAI administered to low-risk patients decreased from 3.85 GBq (104 mCi) in 2008-2016 to 2.0 GBq (54 mCi) in 2017-2018. The principal driver of this change was an increased use of 1 GBq (27 mCi) from 1.3% of prescriptions in 2008-2011 to 18.5% in 2017-2018. In patients assigned as low risk per ATA stratification, lower activities of 1 GBq or 2 GBq (27 mCi or 54 mCi) were not associated with an increased risk of recurrence. In patients assigned to intermediate- or high-risk categories who received RAI as adjuvant therapy, there was no difference in risk of recurrence between 4 GBq (108 mCi) and 6 GBq (162 mCi). CONCLUSIONS Our data demonstrate an evolution of RAI activities consistent with translation of ATA guidelines into clinical practice. Use of lower RAI activities was not associated with an increase in recurrence in low-risk thyroid cancer patients. Our data also suggest lower RAI activities may be as efficacious for adjuvant therapy in intermediate- and high-risk patients.
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Affiliation(s)
- Ayanthi Wijewardene
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- *Correspondence to: Ayanthi Wijewardene,
| | - Matti Gild
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Carolina Nylén
- Endocrine Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Geoffrey Schembri
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Nuclear Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Paul Roach
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Nuclear Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jeremy Hoang
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Nuclear Medicine Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Ahmad Aniss
- Endocrine Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Anthony Glover
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Endocrine Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Mark Sywak
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Endocrine Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Stan Sidhu
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Endocrine Surgery Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Diana Learoyd
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Bruce Robinson
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Tacon
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
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Wang W, Kong L, Guo H, Chen X. Prevalence and predictor for malignancy of contralateral thyroid nodules in patients with unilateral PTMC: a systematic review and meta-analysis. Endocr Connect 2021; 10:656-666. [PMID: 34010153 PMCID: PMC8240708 DOI: 10.1530/ec-21-0164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND The presence of clinically negative nodules on the contralateral lobe is common in patients with unilateral papillary thyroid microcarcinoma (PTMC). The appropriate operational strategies of contralateral thyroid nodules remain controversial. In this study, we analyzed clinical features that could be predictors for malignancy of contralateral thyroid nodules coexisting with diagnosed unilateral PTMC. METHODS The literatures published from January 2000 to December 2019 were searched in PubMed, Cochrane Library, Embase, Web of Science, CNKI, and Wan Fang database. Odds ratio (OR) with 95% CI was used to describe categorical variables. Heterogeneity among studies was examined by the Q test and I2 test; potential publication bias was detected by Harbord test and 'trim and fill' method. RESULTS In this meta-analysis, 2541 studies were searched and 8 studies were finally included. The results showed that the rate of carcinoma in contralateral nodules was 23% (OR = 0.23, 95% CI = 0.18-0.29). The pooled data indicated that contralateral malignancy was not associated with age, gender, primary lesion size, ipsilateral central lymph node metastasis and multifocality of contralateral lesion. The following variables have correlations with an increased risk of contralateral malignancy: multifocality of primary carcinomas (OR = 3.93, 95% CI = 2.70-5.73, P < 0.0001), capsular invasion (OR = 1.61, 95% CI = 1.10-2.36, P = 0.01), and Hashimoto's thyroiditis (OR = 1.57, 95% CI = 1.13-2.20, P = 0.008). CONCLUSIONS Based on our meta-analysis, the rate at which contralateral malignancies are preoperatively misdiagnosed as benign is 23%. The risk factors for contralateral malignancy in unilateral PTMC patients with contralateral clinical negative nodules include multifocality of primary carcinomas, capsular invasion, and Hashimoto's thyroiditis.
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Affiliation(s)
- Weidi Wang
- Department of Emergency, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Lingjun Kong
- Department of Thyroid and Breast, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Hongkun Guo
- Department of Emergency, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiangjin Chen
- Department of Thyroid and Breast, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Correspondence should be addressed to X Chen:
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Kersting D, Seifert R, Kessler L, Herrmann K, Theurer S, Brandenburg T, Dralle H, Weber F, Umutlu L, Führer-Sakel D, Görges R, Rischpler C, Weber M. Predictive Factors for RAI-Refractory Disease and Short Overall Survival in PDTC. Cancers (Basel) 2021; 13:cancers13071728. [PMID: 33917322 PMCID: PMC8038667 DOI: 10.3390/cancers13071728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The clinical phenotype of poorly differentiated thyroid cancer (PDTC) can vary substantially. We aim to evaluate risk factors for radioiodine refractory (RAI-R) disease and reduced overall survival (OS). METHODS We retrospectively screened our institutional database for PDTC patients. For the assessment of RAI-R disease, we included patients who underwent dual imaging with 18F-FDG-PET and 124I-PET/131I scintigraphy that met the internal standard of care. We tested primary size, extrathyroidal extension (ETE), and age >55 years as risk factors for RAI-R disease at initial diagnosis and during the disease course using uni- and multivariate analyses. We tested metabolic tumor volume (MTV), total lesion glycolysis (TLG) on 18F-FDG-PET, and the progression of stimulated thyroglobulin within 4-6 months of initial radioiodine therapy as prognostic markers for OS. RESULTS Size of primary >40 mm and ETE were significant predictors of RAI-R disease in the course of disease in univariate (81% vs. 27%, p = 0.001; 89% vs. 33%, p < 0.001) and multivariate analyses. Primary tumor size was an excellent predictor of RAI-R disease (AUC = 0.90). TLG/MTV > upper quartile and early thyroglobulin progression were significantly associated with shorter median OS (29.0 months vs. 56.9 months, p < 0.05; 57.8 months vs. not reached p < 0.005, respectively). DISCUSSION PDTC patients, especially those with additional risk factors, should be assessed for RAI-R disease at initial diagnosis and in the course of disease, allowing for early implementation of multimodal treatment. Primary tumor size >40 mm, ETE, and age >55 are significant risk factors for RAI-R disease. High MTV/TLG is a significant risk factor for premature death and can help identify patients requiring intervention.
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Affiliation(s)
- David Kersting
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Lukas Kessler
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Sarah Theurer
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Tim Brandenburg
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (T.B.); (D.F.-S.)
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.D.); (F.W.)
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (H.D.); (F.W.)
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Dagmar Führer-Sakel
- Department of Endocrinology and Metabolism, Division of Laboratory Research, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (T.B.); (D.F.-S.)
| | - Rainer Görges
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany; (D.K.); (R.S.); (L.K.); (K.H.); (R.G.); (C.R.)
- Correspondence: ; Tel.: +49-201-723-2032; Fax: +49-201-723-5658
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Ghossein R, Barletta JA, Bullock M, Johnson SJ, Kakudo K, Lam AK, Moonim MT, Poller DN, Tallini G, Tuttle RM, Xu B, Gill AJ. Data set for reporting carcinoma of the thyroid: recommendations from the International Collaboration on Cancer Reporting. Hum Pathol 2021; 110:62-72. [PMID: 32920035 PMCID: PMC7943644 DOI: 10.1016/j.humpath.2020.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/29/2022]
Abstract
Thyroid cancer therapy is increasingly tailored to patients' risk of recurrence and death, placing renewed importance on pathologic parameters. The International Collaboration on Cancer Reporting (ICCR), an organization promoting evidence-based, internationally agreed-upon standardized pathology data sets, is the ideal conduit for the development of a pathology reporting protocol aimed at improving the care of patients with thyroid carcinomas. An international expert panel reviewed each element of thyroid pathology reporting. Recommendations were made based on the most recent literature and expert opinion.The data set uses the most recent World Health Organization (WHO) classification for the purpose of a more clinically and prognostically relevant nomenclature. One example is the restriction of the term minimally invasive follicular carcinoma to tumors with capsular invasion only. It reinforces the already established criteria for blood vessel invasion adopted by the most recent WHO classification and Armed Forces Institute of Pathology fascicle. It emphasizes the importance of the extent of blood vessel invasion and extrathyroid extension to better stratify patients for appropriate therapy. It is the first data set that requires pathologists to use the more recently recognized prognostically powerful parameters of mitotic activity and tumor necrosis. It highlights the importance of assessing nodal disease volume in predicting the risk of recurrence.The ICCR thyroid data set provides the tools to generate a report that will guide patient treatment in a more rational manner aiming to prevent the undertreatment of threatening malignancies and spare patients with indolent tumors the morbidity of unnecessary therapy. We recommend its routine use internationally for reporting thyroid carcinoma histology.
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Affiliation(s)
- Ronald Ghossein
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA.
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Martin Bullock
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, B3H 4R2 Canada
| | - Sarah J Johnson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, NE1 4LP, UK
| | - Kennichi Kakudo
- Department of Pathology and Thyroid Disease Centre, Izumi City General Hospital, Izumi, 594-0073, Japan
| | - Alfred K Lam
- Department of Pathology, School of Medicine, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Mufaddal T Moonim
- Department of Histopathology, Guy's & St. Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - David N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK
| | - Giovanni Tallini
- Department of Pathology, University of Bologna Medical Center, 40138, Bologna, Italy
| | - R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Bin Xu
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Anthony J Gill
- University of Sydney, Sydney, New South Wales, 2006, Australia; Cancer Diagnosis and Pathology Group Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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Kunjumohamed FP, Al Rawahi A, Al Busaidi NB, Al Musalhi HN. Disease-free Survival of Patients with Differentiated Thyroid Cancer: A Study from a Tertiary Center in Oman. Oman Med J 2021; 36:e246. [PMID: 33854795 PMCID: PMC8039634 DOI: 10.5001/omj.2021.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives As with global trends, the prevalence of differentiated thyroid cancer (DTC) has increased in recent years in Oman. However, to the best of our knowledge, no local studies have yet been published evaluating the prognosis of DTC cases in Oman. This study aimed to assess disease-free survival (DFS) and prognostic factors related to DTC among Omani patients attending a tertiary care center. Methods This retrospective, observational cohort study was conducted between January 2006 and May 2016 at the National Diabetes and Endocrine Center in Oman. Data related to DFS and prognostic factors were obtained from the electronic medical records of all ≥ 18-year-old patients diagnosed with DTC during the study period. Results A total of 346 DTC cases were identified. Overall, 82.7% of patients were disease-free at their last follow-up appointment. Univariate analysis indicated that various tumor characteristics including histological subtype (i.e., papillary carcinoma, Hurthle cell cancer, and minimally invasive follicular thyroid carcinoma), lymph node status, number of lymph node metastases, distant metastasis status, and TNM status (primary tumor (T), regional lymph node (N), distant metastasis (M) stage) were strong prognostic factors for DFS (p < 0.050). According to multivariate regression analysis, lymph node status, extrathyroidal extension, and angiovascular invasion were independent predictors of DFS (p < 0.050). Conclusions The overall prognosis of DTC among Omani patients was excellent. Treatment and follow-up strategies for patients with DTC should be tailored based on the individual’s risk factor profile.
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Xiang J, Wang Z, Sun W, Zhang H. The new T3b category has clinical significance? SEER-based study. Clin Endocrinol (Oxf) 2021; 94:449-459. [PMID: 32745252 DOI: 10.1111/cen.14305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE As per the eighth edition of the American Joint Committee on Cancer (AJCC) staging system for differentiated thyroid carcinoma (DTC), minimal extrathyroidal extension (mETE) has been removed. Instead, gross ETE (gETE) invading only strap muscles has been designated as a new T3b category. Our objective was to investigate the impact of the T3b category on survival in order to establish its prognostic value in DTC. DESIGN In this retrospective study, we included patients who had undergone thyroidectomy between 2004 and 2012. Data from the Surveillance, Epidemiology and End Results (SEER) database were examined. METHODS We used the Kaplan-Meier method and log-rank test to analyse overall survival (OS) and cancer-specific survival (CSS). The effect of potential predictors associated with survival were estimated using the Cox regression model. To minimize selection bias, propensity-score matching (PSM) was performed. RESULTS A total of 63 315 patients were included in our study. During the average follow-up duration of nearly 78 months, significant differences were observed in cancer-specific survival among patients with no ETE, mETE, gETE invading only strap muscles (T3b) and gETE invading perithyroidal structures other than strap muscles (T4) (P < .05). In univariable and multivariate analysis, both mETE and T3b exhibited significant poorer CSS compared with no ETE. After adjusting for patient features with PSM, it was confirmed that T3b was associated with worse CSS compared with no ETE and mETE. CONCLUSIONS Both mETE and gETE are independent factors for DTC, implying that the new T3b category is worthy of reference for medical workers. Furthermore, mETE was significantly associated with poorer outcome. Our conclusion may provide support for the modification of the TNM staging system in the future.
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Affiliation(s)
- Jingzhe Xiang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Zhihong Wang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
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Ruiz Pardo J, Ríos Zambudio A, Rodríguez González JM, Paredes Quiles M, Soriano Giménez V, Oviedo Ramírez MI, Hernández Martínez AM, Parrilla Paricio P. Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment? Rev Clin Esp 2021; 221:131-138. [PMID: 32216965 DOI: 10.1016/j.rce.2019.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/20/2019] [Accepted: 12/08/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS We observed PTMC with mETE in 11.2% (n=18) of patients. On the multivariate analysis, mETE was associated with age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8mm (OR: 5.913; 95% CL: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p = .034). CONCLUSIONS The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.
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Affiliation(s)
- J Ruiz Pardo
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - A Ríos Zambudio
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España
| | - J M Rodríguez González
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España
| | - M Paredes Quiles
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - V Soriano Giménez
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - M I Oviedo Ramírez
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - A M Hernández Martínez
- Servicio de Endocrinología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - P Parrilla Paricio
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España
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Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment? Rev Clin Esp 2021; 221:131-138. [PMID: 33998460 DOI: 10.1016/j.rceng.2019.12.012] [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: 10/02/2019] [Accepted: 12/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). Over the mean follow-up period of 119.8 ± 65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ± 5.6 vs. 97.4 ± 10.3 months; p = .034). CONCLUSIONS The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.
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Sanabria A, Kowalski LP, Nixon IJ, Simo R. Microscopic positive surgical margins in thyroid carcinoma: a proposal for thyroid oncology teams. Langenbecks Arch Surg 2021; 406:563-569. [PMID: 33555410 DOI: 10.1007/s00423-021-02095-y] [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: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE In the case of well-differentiated thyroid cancer, the importance of microscopic margin status remains controversial. We discuss the relevance of the effect of microscopic positive surgical margins in the early stages of differentiated thyroid cancer. METHODS A comprehensive literature search and review of available evidence in English literature was undertaken. RESULTS A previous meta-analysis did not find an association between microscopic positive surgical margins and local recurrence. Heterogeneity of definitions and differences between microscopic surgical margins and extrathyroid extension are discussed. Impact on clinical decision-making is explored. CONCLUSION The finding of microscopic positive surgical margins in a patient with a thyroid tumor without intraoperative evidence of macroscopic invasion to adjacent structures, with complete resection made by the surgeon and without pathological report of extrathyroid extension, does not have a worse prognostic effect. We present a classification of surgical margins that may help thyroid oncology teams to tailor further management in patients with thyroid cancer.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello, Cra. 51d #62-29, Medellín, Colombia.
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School and Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Iain J Nixon
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, University of Edinburgh, Edinburgh, UK
| | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Thyroid Oncology Unit Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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Lechner MG, Bernardo AC, Lampe A, Praw SS, Tam SH, Angell TE. Changes in Stage Distribution and Disease-Specific Survival in Differentiated Thyroid Cancer with Transition to American Joint Committee on Cancer 8th Edition: A Systematic Review and Meta-Analysis. Oncologist 2021; 26:e251-e260. [PMID: 32864832 PMCID: PMC7873343 DOI: 10.1634/theoncologist.2020-0306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recent revision significantly changed the American Joint Committee on Cancer (AJCC) staging criteria for differentiated thyroid cancer (DTC). To quantitatively evaluate resulting changes in patient stage distribution and the associated disease-specific survival (DSS) incorporating diverse populations, we performed a meta-analysis of studies comparing the AJCC 7th edition (AJCC-7) with 8th edition (AJCC-8) staging for DTC. MATERIALS AND METHODS After PROSPERO registration (#CRD42019123657), publications in English reporting DSS of DTC with AJCC-7 and AJCC-8 from inception to June 2019 were identified by search of MEDLINE and PubMed. Random-effects meta-analyses were conducted to compare differences in survival between AJCC-7 and AJCC-8. Pooled hazard ratios, 10-year DSS, and corresponding interval estimates were calculated for AJCC subgroups. Differences in survival between editions were assessed using subgroup analysis with nonoverlapping confidence intervals indicating statistical significance. RESULTS Final analysis included six studies with 10,850 subjects and median follow-up from 55 to 148 months. Use of AJCC-8 shifted classification to earlier stages: stage I, from 60% to 81%; stage II, from 5% to 13%; stage III, from 21% to 2%; stage IV, from 10% to 3%. Ten-year DSS was significantly lower in AJCC-8 versus AJCC-7 in patients with stage II (88.6%, 95% confidence interval [CI] 82.7-94.6% vs. 98.1%, 95% CI 96.6-99.6%, respectively) and stage III disease (70.5%, 95% CI 59.1-83.9% vs. 96.8%, 95% CI 94.1-99.64%, respectively). CONCLUSION Meta-analysis of revised AJCC staging for DTC, incorporating diverse populations, demonstrates redistribution of patients toward earlier clinical stages and better stratification of disease-specific mortality risk, specifically among patients now classified with stage II and III disease. IMPLICATIONS FOR PRACTICE This study provides updated estimates of disease-specific survival for patients with differentiated thyroid cancer determined by the American Joint Committee on Cancer staging system that are generalizable to broader populations and support improved stratification using the recently revised criteria.
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Affiliation(s)
- Melissa G. Lechner
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine, University of California Los AngelesLos AngelesCaliforniaUSA
| | - Angeli C. Bernardo
- Department of Preventative Medicine, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Southern California Clinical and Translational Science InstituteLos AngelesCaliforniaUSA
| | - Alyssa Lampe
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Stephanie Smooke Praw
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine, University of California Los AngelesLos AngelesCaliforniaUSA
| | - Samantha H. Tam
- Department of Otolaryngology, Henry Ford Health SystemDetroitMichiganUSA
| | - Trevor E. Angell
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Zhang X, Chen W, Fang Q, Fan J, Feng L, Guo L, Liu S, Ge H, Du W. Lateral Lymph Node Metastases in T1a Papillary Thyroid Carcinoma: Stratification by Tumor Location and Size. Front Endocrinol (Lausanne) 2021; 12:716082. [PMID: 34335480 PMCID: PMC8320373 DOI: 10.3389/fendo.2021.716082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/25/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To analyze the incidence and risk factors for lateral lymph node metastases (LNMs) in T1a papillary thyroid carcinoma (PTC) with a focus on tumor location and size. MATERIALS AND METHODS The incidence of lateral LNM in 345 cases of T1a PTC was retrospectively analyzed. Univariate and multivariate analyses were performed to assess the relationships between lateral LNM and clinicopathological characteristics. RESULTS The incidence of skip metastasis to lateral LNM in T1a PTC located in the upper lobe was 12.1% (8/66). Logistic regression analysis indicated tumor size >5 mm (OR = 5.04, 95% CI = 1.79 to 14.18, P = 0.002), upper lobe location (OR = 7.68, 95% CI = 3.05-19.34, P < 0.001) and the number of central neck LNM (<2: OR = 24.79, 95% CI = 8.23-74.60, P < 0.001; ≥2: OR = 4.99, 95% CI = 1.95-12.73, P < 0.001) were independently associated with lateral LNM. Comparing the lateral and central LNM stratification based on tumor location revealed that both the incidences of lateral (33.3%) and central (30.3%) LNM of T1a PTC located in the upper lobe were higher than those of T1a PTC located in the middle and lower lobes. Of T1a PTC located in the upper lobe, the incidence of lateral LNM was 33.3% (22/66), which was higher than that [30.3% (20/66)] of central LNM. This finding is reversed in all T1a PTC cases and T1a PTC cases with tumor located in the middle and lower lobes. CONCLUSION A particularly high likelihood of lateral LNM was observed in T1a PTC patients with tumor located in the upper lobe of the thyroid gland, especially the tumor >5 mm in size, which could be considered a risk factor for lateral LNM in the clinical management of T1a PTC.
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Affiliation(s)
- Xiaojun Zhang
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Wenkuan Chen
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Jie Fan
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Lu Feng
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Lanwei Guo
- Office for Cancer Control and Research, Henan Cancer Hospital, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Shanting Liu
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
- *Correspondence: Wei Du, ; Hong Ge,
| | - Wei Du
- Department of Head Neck and Thyroid Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan, China
- *Correspondence: Wei Du, ; Hong Ge,
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Han DY, Sohn YM, Seo M, Yun SJ, Park WS, Jeon SH, Cho YH. Shear-wave elastography in thyroid ultrasound: Can be a predictor of extrathyroidal extension and cervical lymph node metastasis in papillary thyroid carcinoma? Medicine (Baltimore) 2020; 99:e23654. [PMID: 33350745 PMCID: PMC7769340 DOI: 10.1097/md.0000000000023654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/19/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT This study aimed to investigate whether extrathyroidal extension (ETE) and cervical lymph node metastasis (LNM) can be predicted using elasticity parameters of shear-wave elastography (SWE) combined with B-mode ultrasound (US) of papillary thyroid carcinomas (PTCs).We retrospectively reviewed 111 patients who underwent preoperative SWE evaluation among PTC patients from July 1, 2016 to June 20, 2018. Patients were divided into 2 groups based on the presence or absence of ETE based on pathology reports. Univariate and multivariate analyses of clinical and radiologic features including B-mode US features, US patterns, and SWE parameters were performed. These analyses were repeated in LNM positive and negative groups. The diagnostic performance of SWE parameters were also evaluated.Of the 111 patients, 33 had ETE, 78 did not have ETE, 44 had LNM, and 67 did not have LNM. A taller-than-wide shape and T3 stage on US were associated with ETE. Female sex, total thyroidectomy, and T3 stage on US were associated with LNM. When B-mode US and SWE were combined, there was no improvement in diagnostic performance.Combination of SWE and B-mode US findings is not useful for predicting ETE and LNM status in PTC patients.
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Affiliation(s)
- Dong Yoon Han
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul
| | - Yu-Mee Sohn
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul
| | - Mirinae Seo
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul
| | - Seong Jong Yun
- Department of Radiology, G SAM Hospital, 591 Gunpo-ro, Gunpo-si, Gyeonggi-do
| | - Won Seo Park
- Department of Surgery, Kyung Hee University Hospital, College of Medicine, Kyung Hee University
| | - Seok Ho Jeon
- Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart General Hospital, 259 Wangsan-ro, Dongdaemun-gu, Seoul, South Korea
| | - Yong Hyun Cho
- Department of Anesthesiology and Pain Medicine, Seoul Sacred Heart General Hospital, 259 Wangsan-ro, Dongdaemun-gu, Seoul, South Korea
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Anda Apiñániz E, Zafon C, Ruiz Rey I, Perdomo C, Pineda J, Alcalde J, García Goñi M, Galofré JC. The extent of surgery for low-risk 1-4 cm papillary thyroid carcinoma: a catch-22 situation. A retrospective analysis of 497 patients based on the 2015 ATA Guidelines recommendation 35. Endocrine 2020; 70:538-543. [PMID: 32507966 DOI: 10.1007/s12020-020-02371-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/27/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The adequate extent of surgery for 1-4 cm low-risk papillary thyroid carcinoma (PTC) is unclear. Our objective was to analyze the applicability of the 2015 ATA Guidelines recommendation 35B (R35) for the management low-risk PTC. METHODS This multicentre study included patients with low-risk PTC who had undergone total thyroidectomy (TT). Retrospectively we selected those who met the R35 criteria for the performance of a thyroid lobectomy (TL). The aim was to identify the proportion of low-risk PTC patients treated using TT who would have required reintervention had they had a TL in accordance with R35. RESULTS We identified 497 patients (400 female; 80.5%). Median tumor size (mm): 21.2 (11-40). A tumor size ≥2 cm was found in 252 (50.7%). Most of them, 320 (64.4%), were in Stage I (AJCC 7th Edition). Following R35, 286 (57.5%) would have needed TT. Thus, they would have required a second surgery had they undergone TL. The indications for reintervention would have included lymph node involvement (35%), extrathyroidal extension (22.9%), aggressive subtype (8%), or vascular invasion (22.5%). No presurgical clinical data predict TT. CONCLUSIONS The appropriate management of low-risk PTC is unclear. Adherence to ATA R35 could lead to a huge increase in reinterventions when a TL is performed, though the need for them would be questionable. In our sample, more than half of patients (57.5%) who may undergo a TL for a seemingly low-risk PTC would have required a second operation to satisfy international guidelines, until better preoperative diagnostic tools become available.
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Affiliation(s)
- Emma Anda Apiñániz
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA (Instituto de investigación en la Salud de Navarra), Pamplona, Spain
- SEEN (Sociedad Española de Endocrinología y Nutrición) Thyroid Task-Force, Pamplona, Spain
| | - Carles Zafon
- SEEN (Sociedad Española de Endocrinología y Nutrición) Thyroid Task-Force, Pamplona, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Irati Ruiz Rey
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain
| | - Carolina Perdomo
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain
| | - Javier Pineda
- Department of Endocrinology and Nutrition, Complejo Hospitalario de Navarra, Pamplona, Spain
- IdiSNA (Instituto de investigación en la Salud de Navarra), Pamplona, Spain
| | - Juan Alcalde
- Department of Otorhinolaryngology, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain
| | - Marta García Goñi
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain
| | - Juan C Galofré
- IdiSNA (Instituto de investigación en la Salud de Navarra), Pamplona, Spain.
- SEEN (Sociedad Española de Endocrinología y Nutrición) Thyroid Task-Force, Pamplona, Spain.
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra. University of Navarra, Pamplona, Spain.
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Effects of the Minimal Extrathyroidal Extension on Early Response Rates after (Adjuvant) Initial Radioactive Iodine Therapy in PTC Patients. Cancers (Basel) 2020; 12:cancers12113357. [PMID: 33202736 PMCID: PMC7696574 DOI: 10.3390/cancers12113357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The aim of our retrospective study was to evaluate the impact of minimal extrathyroidal extension on early response rate after (adjuvant) initial radioactive iodine therapy in patients with papillary thyroid cancer (PTC). We found that response rates after radioactive iodine (RAI) therapy in PTC patients were achieved irrespective of minimal extrathyroidal extension (mETE). Nonetheless, the risk of lymph node metastases involvement was significantly higher in the mETE patient group. Abstract Background: Extrathyroidal extension of differentiated thyroid cancer is a poor outcome factor but seems to be less significant in minimal extrathyroidal extension (mETE). However, the impact of mETE on response rate after (adjuvant) initial radioactive iodine (RAI) therapy remains unclear. We therefore compared response rates of patients with classical and follicular variants of papillary thyroid cancer (PTC) according to the updated eighth tumor-node-metastasis (TNM) classification to a control group. Methods: 455 patients with T3 (primary tumor > 4 cm) PTC according to the seventh classification who underwent total thyroidectomy followed by RAI therapy were screened. Patients formerly classified as T3 PTC solely due to mETE were reclassified into patients with T1 (primary tumor ≤ 2 cm) or T2 (primary tumor > 2 cm but ≤ 4 cm) +mETE and compared to a control group of T1/T2 −mETE PTC patients. Results: 138/455 patients were reclassified as T1/2 +mETE and compared to 317/455 T1/T2 −mETE control patients. At initial presentation, +mETE patients showed significantly higher rates of cervical lymph node metastases (p-value 0.001). Response rates were comparable in both groups (p-value n.s.). N1a/N1b-stage (Hazard ratio, HR 0.716; 95% CI 0.536–0.956, p-value 0.024) was identified as an independent prognostic factor for lower response rates. Conclusion: Response rates after RAI therapy were comparable in PTC patients irrespective of mETE but with higher rates of lymph node metastases.
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Abe I, Lam AKY. Anaplastic thyroid carcinoma: Updates on WHO classification, clinicopathological features and staging. Histol Histopathol 2020; 36:239-248. [PMID: 33170501 DOI: 10.14670/hh-18-277] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Anaplastic thyroid carcinoma is an uncommon carcinoma representing 1 to 4% of all thyroid cancers. The carcinoma is most common in females of the eight decades. It is a locally advanced cancer with frequent infiltration of surrounding organs, blood vessels and skin of neck. Paraneoplastic manifestations could occur. Approximately half of the patients with anaplastic thyroid carcinoma had distant metastasis with lung and brain as the most frequent sites of metastasis. The median survival of patients with anaplastic thyroid carcinoma reported was from 1 to 6 months. The terminology of the cancer in World Health Organization is "anaplastic thyroid carcinoma" rather than "undifferentiated thyroid carcinoma". In the latest American Joint Committee on Cancer (AJCC) TNM staging system for anaplastic thyroid carcinoma, there are updates on T and N categories. To conclude, updated knowledge of clinicopathological features, classification, pathological staging will improve our understanding of the cancer and will help in the management of the patients with this aggressive cancer.
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Affiliation(s)
- Ichiro Abe
- Cancer Molecular Pathology, School of Medicine and Destistry, Gold Coast campus, Griffith University, gold Coast, Australia.,Department of Endocrinology and Diabetes Mellitus, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan
| | - Alfred King-Yin Lam
- Cancer Molecular Pathology, School of Medicine and Destistry, Gold Coast campus, Griffith University, Gold Coast, Australia.
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Zhang L, Liu J, Wang P, Xue S, Li J, Chen G. Impact of Gross Strap Muscle Invasion on Outcome of Differentiated Thyroid Cancer: Systematic Review and Meta-Analysis. Front Oncol 2020; 10:1687. [PMID: 33102203 PMCID: PMC7546766 DOI: 10.3389/fonc.2020.01687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Gross strap muscle invasion (gSMI) in patients with differentiated thyroid cancer (DTC) was defined as high-risk recurrent group in the 2015 American Thyroid Association guidelines. However, controversy persists because several studies suggested gSMI had little effect on disease outcome. Herein, a systematic review and meta-analysis was conducted to investigate impact of gSMI on outcome of DTC. Methods: A systematic search of electronic databases (PubMed, EMBASE, Cochrane Library, and MEDLINE) for studies published until February 2020 was performed. Case-control studies and randomized controlled trials that studied the impact of gSMI on outcome of DTC were included. Results: Six studies (all retrospective studies) involving 13,639 patients met final inclusion criteria. Compared with no extrathyroidal extension (ETE), patients with gSMI were associated with increased risk of recurrence (P = 0.0004, OR, 1.46; 95% CI: 1.18-1.80) and lymph node metastasis (LNM) (P < 0.00001, OR 4.19; 95% CI: 2.53-6.96). For mortality (P = 0.34, OR 1.47; 95% CI: 0.67-3.25), 10 year disease-specific survival (P = 0.80, OR 0.91; 95% CI: 0.44-1.88), and distant metastasis (DM) (P = 0.21, OR 2.94; 95% CI: 0.54-15.93), there was no significant difference between gSMI and no ETE group. In contrast with maximal ETE(extension of the primary tumor to the trachea, esophagus, recurrent laryngeal nerve, larynx, subcutaneous soft tissue, skin, internal jugular vein, or carotid artery), patients with gSMI were associated with decreased risk of recurrence (P < 0.0001, OR, 0.58; 95% CI: 0.44-0.76), mortality (P = 0.0003, OR 0.20; 95% CI: 0.08-0.48), LNM (P = 0.0003, OR 0.64; 95% CI: 0.50-0.81), and DM (P = 0.0009, OR 0.28; 95% CI: 0.13-0.59). Conclusions : DTC patients with gSMI had a higher risk of recurrence and LNM than those without ETE. However, in contrast with maximal ETE, a much better prognosis was observed in DTC patients with only gSMI.
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Affiliation(s)
- Li Zhang
- Department of Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Jia Liu
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Peisong Wang
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Shuai Xue
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jie Li
- Department of Geriatric, The First Hospital of Jilin University, Changchun, China
| | - Guang Chen
- Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun, China
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Bortz MD, Kuchta K, Winchester DJ, Prinz RA, Moo-Young TA. Extrathyroidal extension predicts negative clinical outcomes in papillary thyroid cancer. Surgery 2020; 169:2-6. [PMID: 32682508 DOI: 10.1016/j.surg.2020.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The eighth edition American Joint Committee on Cancer tumor-node-metastasis staging for well-differentiated thyroid cancers, no longer considers "minimal" extrathyroidal extension for tumor staging. This change prompted us to examine the effect of extrathyroidal extension on patient outcomes. METHODS Patients (n = 177,497) in the 2016 National Cancer Database with classic papillary thyroid cancer were evaluated to determine the effect of extrathyroidal extension on overall survival and risk for nodal and distant metastases. Kaplan-Meier curves with the log-rank test were used to evaluate survival differences. Multivariable Cox and logistic regression analyses included relevant clinicopathologic variables (e.g. age, sex, race, and Charlson Comorbidity Index). RESULTS Patients with "minimal" extrathyroidal extension had worse survival versus patients with no extrathyroidal extension (10-year survival 89.3% vs 93.1%, hazard ratio 1.23; 95% confidence interval, 1.13-1.35; P < .001). Any extrathyroidal extension was associated with higher risks for lymph node (odds ratio 2.78; 95% confidence interval, 2.69-2.87) and distant metastasis (odds ratio 3.5; 95% confidence interval, 3.05-4.04). These associations persisted when comparing "micro" (extension into the thyroid capsule) versus none for nodal risk (odds ratio 1.25; 95% confidence interval, 1.18-1.33) and distant metastasis (OR 1.52; 95% confidence interval, 1.11-2.09). CONCLUSION All levels of extrathyroidal extension, including microscopic, were associated with increased risk for nodal and distant metastasis. Both minimal and macroscopic extrathyroidal extension were also associated with decreased overall survival. Such findings have the potential to affect the clinical decision making for patients diagnosed with papillary thyroid cancer.
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Affiliation(s)
- Michael D Bortz
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | | | - Richard A Prinz
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL
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Kim K, Kim JK, Lee CR, Kang SW, Lee J, Jeong JJ, Nam KH, Chung WY. Comparison of long-term prognosis for differentiated thyroid cancer according to the 7th and 8th editions of the AJCC/UICC TNM staging system. Ther Adv Endocrinol Metab 2020; 11:2042018820921019. [PMID: 32489582 PMCID: PMC7238312 DOI: 10.1177/2042018820921019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor-node-metastasis (TNM) staging system was released with major revisions. The purpose of this retrospective study was to investigate differences between the 7th and 8th editions of the AJCC/UICC TNM staging system and to compare the predictability of prognosis between the two staging systems with patients who underwent thyroidectomy for differentiated thyroid cancer (DTC) at a single institution. METHODS A total of 3238 patients underwent thyroid operation from January 2002 to December 2006 at Yonsei University Hospital (Seoul, Korea), of which 2294 with complete clinical data and sustained follow up were enrolled. Clinicopathologic features and TNM staging by applying the 7th and 8th editions of the AJCC/UICC were analyzed retrospectively by the complete review of medical charts and pathology reports of patients. Mean follow-up duration was 132.9 ± 27.9 months. RESULTS A significant number of T3 patients were downstaged to T1 (838, 36.5%) and T2 (122, 5.3%). After applying the 8th edition of the AJCC/UICC TNM staging system, the number of stage I patients increased significantly from 1434 (62.5%) to 2058 (89.7%), whereas numbers of stage III and IV patients decreased significantly from 644 (28.1%) to 33 (1.4%) and from 199 (8.7%) to 17 (0.7%), respectively. According to Kaplan-Meier survival analyses and values of the Harrell's c-index and integrated area under the curve (iAUC), the 8th edition has significantly better predictive performance for disease-free survival (DFS) and disease-specific survival (DSS) than the 7th edition. CONCLUSIONS A significant population was downstaged after applying the 8th edition of the AJCC/UICC TNM staging system, and the 8th edition provided significantly better accuracy in predicting DFS and DSS in patients with DTC.
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Affiliation(s)
- Kwangsoon Kim
- Department of Surgery, College of Medicine, The
Catholic University of Korea, Seoul, Korea
| | - Jin Kyong Kim
- Department of Surgery, Yonsei University College
of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Yonsei University College
of Medicine, Seoul, 03722, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College
of Medicine, Seoul, 03722, Korea
| | - Jandee Lee
- Department of Surgery, Yonsei University College
of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei University College
of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College
of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College
of Medicine, Seoul, Korea
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Mao J, Zhang Q, Zhang H, Zheng K, Wang R, Wang G. Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:265. [PMID: 32477264 PMCID: PMC7242632 DOI: 10.3389/fendo.2020.00265] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose: To explore the risk factors that may predict the lymph node metastasis potential of these lesions and new prevention strategies in papillary thyroid carcinoma patients. Materials and Methods: In total, 9,369 papillary thyroid carcinoma patients with 37.17% lymph node metastasis were analyzed (Revman 5.3 software) in this study. The PubMed and Embase databases were used for searching works systematically that were published through to January 22, 2020. Results: Several factors were related to the increased risk of lymph node metastasis in patients with papillary thyroid carcinoma: age <45 years (pooled OR = 1.52, 95% CI = 1.14-2.01, p <0.00001); gender = male (pooled OR = 1.68, 95% CI = 1.51-1.87, p <0.00001); multifocality (pooled OR = 2.05, 95% CI = 1.45-2.89, p <0.0001); tumor size ≥1.0 cm (pooled OR = 3.53, 95% CI = 2.62-4.76, p <0.00001); tumor location at the upper pole 1/3 (pooled OR =1.46, 95% CI = 1.04-2.04, p = 0.03); capsular invasion + (pooled OR = 3.48, 95% CI = 1.69-7.54, p = 0.002); and extrathyroidal extension + (pooled OR = 2.03, 95% CI= 1.78-2.31, p <0.00001). However, tumor bilaterality (pooled OR = 0.85, 95% CI = 0.54-1.34, p = 0.49) and Hashimoto's thyroditis (pooled OR = 1.08, 95% CI = 0.79-1.49, p = 0.62) showed no correlation with lymph node metastasis in papillary thyroid carcinoma patients. Conclusion: The systematic review and meta-analysis defined several significant risk factors of lymph node metastasis in papillary thyroid cancer patients: age (<45 years), gender (male), multifocality, tumor size (>1 cm), tumor location (1/3 upper), capsular invasion, and extra thyroidal extension. Bilateral tumors and Hashimoto's thyroiditis were unrelated to lymph node metastasis in patients with papillary thyroid cancer.
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Affiliation(s)
- Jingxin Mao
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
- College of Pharmaceutical Sciences, Southwest University, Chongqing, China
| | - Qinghai Zhang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
- College of Food Science, Guizhou Medical University, Guiyang, China
| | - Haiyan Zhang
- Institute of Deep-Sea Science and Engineering, Chinese Academy of Science, Sanya, China
| | - Ke Zheng
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Wang
- Department of Pharmacology, College of Pharmacy, Guilin Medical University, Guilin, China
| | - Guoze Wang
- School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang, China
- College of Food Science, Guizhou Medical University, Guiyang, China
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