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Akbarian S, Sheikhtaheri A, Khorrami F, Ghahvechian H, Karimi N, Kashkouli MB. Implementation of thyroid eye disease registry in Iran: rationale and research protocol. Orphanet J Rare Dis 2024; 19:42. [PMID: 38321499 PMCID: PMC10845661 DOI: 10.1186/s13023-024-03053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/29/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND To describe the implementation of a registry system for patients with thyroid eye disease (TED) in Iran to obtain more information about its nature, prevalence, and annual incidence, as well as extend insight into the etiology, pathogenesis, and eventually make an accurate prognosis of different medical or surgical treatment methods. METHODS After receiving approval from the Disease Registry Committee of Iran University of Medical Sciences (IUMS) in 2019 and the Ministry of Health and Medical Education (MOHME) in 2020, the protocol was introduced in three consecutive phases at regional, provincial and national levels. The establishment of a registry committee in Rassoul Akram Hospital, one of the medical centers affiliated to IUMS, was the first step to organizing the registry project's main core. The steering committee included six subgroups of required subject fields. The members are experts in developing a guideline, providing a new dataset, drawing an outline for the next steps, and structuring user-friendly software through several panel discussion meetings. The data is collected from clinical and para-clinical/imaging findings, laboratory evaluations, and their selected treatment strategy, retrospectively and prospectively. RESULTS The purpose is to broaden our knowledge about the profile of TED; accordingly, data related to patients' demographics, thyroid gland disease (status, duration, treatments, and function tests), general medical and ocular history, along with visual/ocular exams resulting TED status are collected and recorded in a 2- language software. The web-based software system is accessible at https://orc.iums.ac.ir . To maintain data security, prioritized user access was defined for different members. Furthermore, diverse methods, such as employing trained staff and utilizing software validation rules, were implemented to control data quality in every step of data collection, entry, and registration. Medical records of retrospective subjects were also evaluated and entered after accuracy verification. CONCLUSION Iran's TED registry provides practitioners with comprehensive data on natural history and phenotype variations in clinical features and outcomes. It facilitates patient recruitment and, consequently, earlier diagnosis on a large scale which helps improve treatment and quality of life for patients.
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Affiliation(s)
- Shadi Akbarian
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran
| | - Abbas Sheikhtaheri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farid Khorrami
- Health Information Technology, Faculty of Paramedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hossein Ghahvechian
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran
| | - Nasser Karimi
- Skull Base Research Center, Eye Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Skull Base Research Center, Eye Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Rassoul Akram Hospital, Tehran, Tehran, 1465544814, Iran.
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2
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McDonald AM, Galgano SJ. Reply to P. Petranović Ovčariček et al. J Clin Oncol 2022; 40:3466-3467. [PMID: 35709426 DOI: 10.1200/jco.22.00753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Andrew M McDonald
- Andrew M. McDonald, MD, MS, University of Alabama at Birmingham, Department of Radiation Oncology, Birmingham, AL, University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship, Birmingham, AL; and Samuel J. Galgano, MD, University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, University of Alabama at Birmingham, Division of Molecular Imaging and Therapeutics, Birmingham, AL
| | - Samuel J Galgano
- Andrew M. McDonald, MD, MS, University of Alabama at Birmingham, Department of Radiation Oncology, Birmingham, AL, University of Alabama at Birmingham, Institute for Cancer Outcomes and Survivorship, Birmingham, AL; and Samuel J. Galgano, MD, University of Alabama at Birmingham, Department of Radiology, Birmingham, AL, University of Alabama at Birmingham, Division of Molecular Imaging and Therapeutics, Birmingham, AL
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3
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McDonald AM, Lindeman B, Bahl D. Radioactive Iodine: Recognizing the Need for Risk-Benefit Balance. J Clin Oncol 2022; 40:1396-1399. [PMID: 35298297 DOI: 10.1200/jco.22.00013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrew M McDonald
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Brenessa Lindeman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Deepti Bahl
- Division of Endocrinology, Diabetes, and Metabolism, University of Alabama at Birmingham, Birmingham, AL
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Ming J, Zhu JQ, Zhang H, Sun H, Wang J, Cheng RC, Xie L, Li XR, Tian W, Huang T. A multicenter, prospective study to observe the initial management of patients with differentiated thyroid cancer in China (DTCC study). BMC Endocr Disord 2021; 21:208. [PMID: 34670546 PMCID: PMC8529744 DOI: 10.1186/s12902-021-00871-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To assess the gaps between the initial management of patients with differentiated thyroid cancer (DTC) in real clinical practice and the recommendations of the 2012 Chinese DTC guidelines. METHODS This multicenter, prospective study was conducted at nine tertiary hospitals across China. Eligible patients were those having intermediate or high-risk DTC after first-time thyroidectomy. During 1 year of follow-up, comprehensive medical records were collected and summarized using descriptive statistics. RESULTS Of 2013 patients, 1874 (93.1%) underwent standard surgery according to the guidelines (including total lobectomy plus isthmusectomy and total/near total thyroidectomy), and 1993 (99.0%) underwent lymph node dissection; only 56 (2.8%) had postoperative complications. Overall, 982/2013 patients (48.8%) received radioactive iodine (RAI) therapy after thyroidectomy. Of all enrolled patients, 61.4% achieved the target serum thyroid-stimulating hormone level, with a median time to target of 234.0 days (95% CI: 222.0-252.0). At 1 year of follow-up, proportions of patients with excellent response, incomplete structural response, biochemical incomplete response, and indeterminate response were 34.6, 11.2, 6.6, and 47.5%, respectively; recurrence or metastasis occurred in 27 patients (1.3%). During the overall study period, 209 patients (10.4%) had at least one adverse event: 65.1% of cases were mild, 24.9% moderate, and 10.1% severe. CONCLUSIONS This was the first large-scale prospective study of how patients with DTC in China are treated in actual practice. Initial DTC management is generally safe and adheres to the 2012 Chinese guidelines but could be improved, and the level of guideline adherence did not produce the anticipated treatment response at 1 year of follow-up.
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Affiliation(s)
- Jie Ming
- Department of Breast & Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing-Qiang Zhu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hui Sun
- Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin, China
| | - Jun Wang
- Department of Head & Neck Surgery, The Tumor Hospital of Gansu Province, Lanzhou, China
| | - Ruo-Chuan Cheng
- Department of Thyroid Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lei Xie
- Department of Head & Neck Surgery, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xing-Rui Li
- Department of Breast & Thyroid Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Tao Huang
- Department of Breast & Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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5
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Kaliszewski K, Diakowska D, Rzeszutko M, Nowak Ł, Aporowicz M, Wojtczak B, Sutkowski K, Rudnicki J. Risk factors of papillary thyroid microcarcinoma that predispose patients to local recurrence. PLoS One 2020; 15:e0244930. [PMID: 33382852 PMCID: PMC7775061 DOI: 10.1371/journal.pone.0244930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/20/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, less aggressive treatment or even active surveillance of papillary thyroid microcarcinoma (PTMC) is widely accepted and recommended as a therapeutic management option. However, there are some concerns about these approaches. We investigated whether there are any demographic, clinical and ultrasound characteristics of PTMC patients that are easy to obtain and clinically available before surgery to help clinicians make proper therapeutic decisions. METHODS We performed a retrospective chart review of 5,021 patients with thyroid tumors surgically treated in one center in 2008-2018. Finally, 182 (3.62%) PTMC patients were selected (158 (86.8%) females and 24 (13.2%) males, mean age 48.8±15.4 years). We analyzed the disease-free survival (DFS) time of the PTMC patients according to demographic and histopathological parameters. Univariate and multivariate logistic regression analyses were used to assess the relationships of demographic, clinical and ultrasound characteristics with aggressive histopathological features. RESULTS Age ≥55 years, hypoechogenicity, microcalcifications, irregular tumor shape, smooth margins and high vascularity significantly increased the risk for minimal extrathyroidal extension (minETE), lymph node metastasis (LNM), and capsular and vascular invasion (p<0.0001). Multivariate logistic regression analysis demonstrated a statistically significant risk of LNM (OR = 5.98, 95% CI: 2.32-15.38, p = 0.0002) and trends toward significantly higher rates of minETE and capsular and vascular invasion (OR = 2.24, 95% CI: 0.97-5.19, p = 0.056) in patients ≥55 years than in their younger counterparts. The DFS time was significantly shorter in patients ≥55 years (p = 0.015), patients with minETE and capsular and vascular invasion (p = 0.001 for all), patients with tumor size >5 mm (p = 0.021), and patients with LNM (p = 0.002). CONCLUSIONS The absence of microcalcifications, irregular tumor shape, blunt margins, hypoechogenicity and high vascularity in PTMC patients below 55 years and with tumor diameters below 5 mm may allow clinicians to select individuals with a low risk of local recurrence so that they can receive less aggressive management.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Marta Rzeszutko
- Department of Pathomorphology, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Nowak
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Aporowicz
- Department of Surgery Didactics, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Takes RP, Halmos GB, Ridge JA, Bossi P, Merkx MAW, Rinaldo A, Sanabria A, Smeele LE, Mäkitie AA, Ferlito A. Value and Quality of Care in Head and Neck Oncology. Curr Oncol Rep 2020; 22:92. [PMID: 32651680 PMCID: PMC7351804 DOI: 10.1007/s11912-020-00952-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging. RECENT FINDINGS This monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention. Health care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value.
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Affiliation(s)
- Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek Hospital, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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7
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Choi JY, Bae IE, Kim HS, Yoon SG, Yi JW, Yu HW, Kim SJ, Chai YJ, Lee KE, Youn YK. Comparative study of bilateral axillo-breast approach endoscopic and robotic thyroidectomy: propensity score matching analysis of large multi-institutional data. Ann Surg Treat Res 2020; 98:307-314. [PMID: 32528910 PMCID: PMC7263885 DOI: 10.4174/astr.2020.98.6.307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this study was to compare the large multi-institutional data of surgical outcomes of bilateral axillo-breast approach (BABA) robotic (RT) and endoscopic thyroidectomy (ET) and to evaluate the merits of robotic thyroidectomy. Methods From 2004 to 2015, 1,029 patients underwent BABA ET, and from 2008 to 2015, 2003 patients underwent BABA RT in 3 large volume centers in Korea. Two groups were retrospectively compared in terms of clinicopathologic characteristics, complications, surgical completeness, and long-term outcomes using propensity score matching analysis. Results Both groups had similar demographic characteristics including age, sex, tumor size, pathologic stage, and hospital stay after matching. Each group had similar rate of transient hypoparathyroidism, however, ET showed significantly higher rate of permanent hypoparathyroidism (ET 5.2% vs. RT 2.3%, P = 0.05), and transient vocal cord palsy (ET 14.4% vs. RT 9.1%, P = 0.006). Total operation time was longer in the ET group irrespective of surgical extents, including lobectomy (P = 0.016), total thyroidectomy (P = 0.031), and total thyroidectomy with central lymph node dissection (P = 0.019). The rate of patients with off-Tg under 1.0 ng/mL after 1st ablation was significantly higher in RT than ET group (ET 64.6% vs. RT 92.7%, P < 0.001). In long-term follow-up of cancer patients, 1.4% experienced recurrence after ET (10 cases), while 0.3% cases experienced recurrence after RT (5 cases) (P < 0.001). Conclusion Both ET and RT can be safe and effective methods to treat thyroid diseases. However, the application of robotic system may help to overcome the limitations of the instruments and surgeon's skills.
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Affiliation(s)
- June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - In Eui Bae
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Hyun Soo Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gab Yoon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Yi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jun Chai
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Yeo-Kyu Youn Thyroid Clinic, St. Peter's Hospital, Seoul, Korea
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Liu Y, Wang Y, Zhao K, Li D, Chen Z, Jiang R, Wang X, He X. Lymph node metastasis in young and middle-aged papillary thyroid carcinoma patients: a SEER-based cohort study. BMC Cancer 2020; 20:181. [PMID: 32131769 PMCID: PMC7057480 DOI: 10.1186/s12885-020-6675-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) occurs frequently in young papillary thyroid carcinoma (PTC) patients, though the mortality rates are low. We aimed to analyze the relationship between age at diagnosis and LNM in PTC at a population level to elucidate the clinical behavior of PTC. METHODS Data of adult patients with surgically treated PTC and follicular thyroid carcinoma (FTC) were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015) to investigate the relationship between age and clinical characteristics by curve estimation. The adjusted odds ratio of age and LNM rate were determined. RESULTS A total of 50,347 PTC (48,166) and FTC (2181) (median age: 45 and 50 years, respectively) patients met the inclusion criteria; 44.5% of those with PTC (21,428) had LNM. Rank-sum test analysis indicated differences in distribution of age in LNM-positive and LNM-negative PTC. The relationship between age, tumor size and LNM showed a quadratic curve in PTC. The mean tumor diameter and LNM rate correlated linearly with age in 18-59-year-old patients. LNM rate decreased with age (R2 = 0.932, P < .0001), especially women (R2 = 0.951, P < .0001). CONCLUSION In young and middle-aged PTC patients, LNM may resolve spontaneously with delayed diagnosis and management. Active surveillance of low-risk PTC is justified.
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Affiliation(s)
- Yuanchao Liu
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Yizeng Wang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Ke Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Dongyang Li
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Zuoyu Chen
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Ruoyu Jiang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Xiaoning Wang
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, 154 Anshan Road Heping District, Tianjin, 300052, China.
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Moon JH, Steinhubl SR. Digital Medicine in Thyroidology: A New Era of Managing Thyroid Disease. Endocrinol Metab (Seoul) 2019; 34:124-131. [PMID: 31257740 PMCID: PMC6599900 DOI: 10.3803/enm.2019.34.2.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/23/2019] [Accepted: 05/27/2019] [Indexed: 01/28/2023] Open
Abstract
Digital medicine has the capacity to affect all aspects of medicine, including disease prediction, prevention, diagnosis, treatment, and post-treatment management. In the field of thyroidology, researchers are also investigating potential applications of digital technology for the thyroid disease. Recent studies using artificial intelligence (AI)/machine learning (ML) have reported reasonable performance for the classification of thyroid nodules based on ultrasonographic (US) images. AI/ML-based methods have also shown good diagnostic accuracy for distinguishing between benign and malignant thyroid lesions based on cytopathologic findings. Assistance from AI/ML methods could overcome the limitations of conventional thyroid US and fine-needle aspiration cytology. A web-based database has been developed for thyroid cancer care. In addition to its role as a nationwide registry of thyroid cancer, it is expected to serve as a clinical platform to facilitate better thyroid cancer care and as a research platform providing comprehensive disease-specific big data. Evidence has been found that biosignal monitoring with wearable devices may predict thyroid dysfunction. This real-world thyroid function monitoring could aid in the management and early detection of thyroid dysfunction. In the thyroidology field, research involving the range of digital medicine technologies and their clinical applications is expected to be even more active in the future.
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Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Steven R Steinhubl
- Department of Molecular Medicine, Scripps Research Translational Institute, La Jolla, CA, USA.
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Ioannou LJ, Serpell J, Dean J, Bendinelli C, Gough J, Lisewski D, Miller JA, Meyer-Rochow W, Sidhu S, Topliss D, Walters D, Zalcberg J, Ahern S. Development of a binational thyroid cancer clinical quality registry: a protocol paper. BMJ Open 2019; 9:e023723. [PMID: 30782713 PMCID: PMC6352782 DOI: 10.1136/bmjopen-2018-023723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The occurrence of thyroid cancer is increasing throughout the developed world and since the 1990s has become the fastest increasing malignancy. In 2014, a total of 2693 Australians and 302 New Zealanders were diagnosed with thyroid cancer, with this number projected to rise to 3650 in 2018. The purpose of this protocol is to establish a binational population-based clinical quality registry with the aim of monitoring and improving the quality of care provided to patients diagnosed with thyroid cancer in Australia and New Zealand. METHODS AND ANALYSIS The Australian and New Zealand Thyroid Cancer Registry (ANZTCR) aims to capture clinical data for all patients over the age of 16 years with thyroid cancer, confirmed by histopathology report, who have been diagnosed, assessed or treated at a contributing hospital. A multidisciplinary steering committee was formed which, with operational support from Monash University, established the ANZTCR in early 2017. The pilot phase of the registry is currently operating in Victoria, New South Wales, Queensland, Western Australia and South Australia, with over 20 sites expected to come on board across Australia in 2018. A modified Delphi process was undertaken to determine the clinical quality indicators to be reported by the registry, and a minimum data set was developed comprising information regarding thyroid cancer diagnosis, pathology, surgery and 90-day follow-up. FUTURE PLANS The establishment of the ANZTCR provides the opportunity for Australia and New Zealand to further understand current practice in the treatment of thyroid cancer and identify variation in outcomes. The engagement of endocrine surgeons in supporting this initiative is crucial. While the pilot registry has a focus on early clinical outcomes, it is anticipated that future collection of longer term outcome data particularly for patients with poor prognostic disease will add significant further value to the registry.
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Affiliation(s)
- Liane J Ioannou
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
- Endocrine Surgery Unit, Monash University, Melbourne, Victoria, Australia
| | - Joanne Dean
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cino Bendinelli
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Jenny Gough
- Breast and Endocrine Surgery, The Wesley Hospital, Queensland, Australia
| | - Dean Lisewski
- Department of General Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Julie A Miller
- Endocrine Surgery Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Stan Sidhu
- Endocrine Surgery Unit, University of Sydney, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Duncan Topliss
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | - David Walters
- Breast and Endocrine Surgical Unit, University of Adelaide, The Queen Elizabeth Hospital, Sydney, New South Wales, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Kiplagat K, Griffin MJ, Baik F, Minkowitz AD, Urken ML. Thyroid Care Collaborative: an electronic health record facilitating multidisciplinary management of thyroid cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2018. [DOI: 10.2217/ije-2017-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Kimberly Kiplagat
- Thyroid, Head & Neck Cancer (THANC) Foundation, New York, NY 10003, USA
| | - Martha J Griffin
- Thyroid, Head & Neck Cancer (THANC) Foundation, New York, NY 10003, USA
| | - Fred Baik
- Thyroid, Head & Neck Cancer (THANC) Foundation, New York, NY 10003, USA
- Department of Otolaryngology – Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY 10003, USA
- Department of Otolaryngology – Head & Neck Surgery, Icahn School of Medicine, New York, NY 10029, USA
| | | | - Mark L Urken
- Thyroid, Head & Neck Cancer (THANC) Foundation, New York, NY 10003, USA
- Department of Otolaryngology – Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY 10003, USA
- Department of Otolaryngology – Head & Neck Surgery, Icahn School of Medicine, New York, NY 10029, USA
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12
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Hoque DME, Kumari V, Hoque M, Ruseckaite R, Romero L, Evans SM. Impact of clinical registries on quality of patient care and clinical outcomes: A systematic review. PLoS One 2017; 12:e0183667. [PMID: 28886607 PMCID: PMC5591016 DOI: 10.1371/journal.pone.0183667] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 08/08/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical quality registries (CQRs) are playing an increasingly important role in improving health outcomes and reducing health care costs. CQRs are established with the purpose of monitoring quality of care, providing feedback, benchmarking performance, describing pattern of treatment, reducing variation and as a tool for conducting research. OBJECTIVES To synthesise the impact of clinical quality registries (CQRs) as an 'intervention' on (I) mortality/survival; (II) measures of outcome that reflect a process or outcome of health care; (III) health care utilisation; and (IV) healthcare-related costs. METHODS The following electronic databases were searched: MEDLINE, EMBASE, CENTRAL, CINAHL and Google Scholar. In addition, a review of the grey literature and a reference check of citations and reference lists within articles was undertaken to identify relevant studies in English covering the period January 1980 to December 2016. The PRISMA-P methodology, checklist and standard search strategy using pre-defined inclusion and exclusion criteria and structured data extraction tools were used. Data on study design and methods, participant characteristics attributes of included registries and impact of the registry on outcome measures and/or processes of care were extracted. RESULTS We identified 30102 abstracts from which 75 full text articles were assessed and finally 17 articles were selected for synthesis. Out of 17 studies, six focused on diabetes care, two on cardiac diseases, two on lung diseases and others on organ transplantations, rheumatoid arthritis, ulcer healing, surgical complications and kidney disease. The majority of studies were "before after" design (#11) followed by cohort design (#2), randomised controlled trial (#2), experimental non randomised study and one cross sectional comparison. The measures of impact of registries were multifarious and included change in processes of care, quality of care, treatment outcomes, adherence to guidelines and survival. Sixteen of 17 studies demonstrated positive findings in their outcomes after implementation of the registry. CONCLUSIONS Despite the large number of published articles using data derived from CQRs, few have rigorously evaluated the impact of the registry as an intervention on improving health outcomes. Those that have evaluated this impact have mostly found a positive impact on healthcare processes and outcomes. TRIAL REGISTRATION PROSPERO CRD42015017319.
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Affiliation(s)
- Dewan Md Emdadul Hoque
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
- Maternal and Child Health Division, International Centre for Diarrhoeal Diseases Research in Bangladesh, Dhaka, Bangladesh
| | - Varuni Kumari
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Masuma Hoque
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred Centre, Melbourne, Victoria, Australia
| | - Sue M. Evans
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
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13
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Osorio M, Moubayed SP, Su H, Urken ML. Systematic review of site distribution of bone metastases in differentiated thyroid cancer. Head Neck 2017; 39:812-818. [DOI: 10.1002/hed.24655] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Marcela Osorio
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Sami P. Moubayed
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
| | - Henry Su
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
| | - Mark L. Urken
- Thyroid, Head and Neck Cancer (THANC) Foundation; New York New York
- Department of Otolaryngology - Head and Neck Surgery; Mount Sinai Beth Israel; New York New York
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14
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Likhterov I, Osorio M, Moubayed SP, Hernandez-Prera JC, Rhodes R, Urken ML. The Ethical Implications of the Reclassification of Noninvasive Follicular Variant Papillary Thyroid Carcinoma. Thyroid 2016; 26:1167-72. [PMID: 27480127 DOI: 10.1089/thy.2016.0212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Several studies have highlighted the lack of consensus in the diagnosis of follicular variant of papillary thyroid carcinoma (FVPTC). An international multidisciplinary panel to address the controversy was assembled at the annual meeting of the Endocrine Pathology Society in March of 2015, leading to the recent publication reclassifying encapsulated (or noninvasive) FVPTC (EFVPTC) as a benign neoplasm. Does this change in histologic taxonomy warrant a change in clinical practice, and how should it affect those who have been given this diagnosis in the past? We consider the financial and psychological impact of this reclassification and discuss the ethical, legal, and practical issues involved with sharing this information with the patients who are affected. SUMMARY The total direct and indirect cost of thyroid cancer surveillance in patients is significant. High levels of clinically relevant distress affect up to 43% of patients with papillary thyroid carcinoma, as estimated by the Distress Thermometer developed by the National Comprehensive Cancer Network for detecting distress in cancer patients. Although there are currently no legal opinions that establish a precedent for recontacting patients whose clinical status is altered by a change in nomenclature, the prudent course would be to attend to the requirements of medical ethics. CONCLUSION Informing patients with a previous diagnosis of EFVPTC that the disease has been reclassified as benign is expected to have a dramatic effect on their surveillance needs and to alleviate the psychological impact of living with a diagnosis of cancer. It is important to re-evaluate the pathologic slides of those patients at risk to ensure that the invasive nature of the tumor is comprehensively evaluated before notifying a patient of a change in diagnosis. The availability of the entire tumor for evaluation of the capsule may prove to be a challenge for a portion of the population at risk. We believe that it is the clinician's professional duty to make a sincere and reasonable effort to convey the information to the affected patients. We also believe that the cost savings with respect to the need for additional surgery, radioactive iodine, and rigorous surveillance associated with a misinterpretation of the biology of the diagnosis of EFVPTC in less experienced hands will likely more than offset the cost incurred in histologic review and patient notification.
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Affiliation(s)
- Ilya Likhterov
- 1 Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| | - Marcela Osorio
- 2 Thyroid, Head and Neck Cancer (THANC) Foundation , New York, New York
| | - Sami P Moubayed
- 1 Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
| | | | - Rosamond Rhodes
- 4 Icahn School of Medicine at Mount Sinai New York , New York
| | - Mark L Urken
- 1 Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Beth Israel , New York, New York
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15
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Sponziello M, Rosignolo F, Celano M, Maggisano V, Pecce V, De Rose RF, Lombardo GE, Durante C, Filetti S, Damante G, Russo D, Bulotta S. Fibronectin-1 expression is increased in aggressive thyroid cancer and favors the migration and invasion of cancer cells. Mol Cell Endocrinol 2016; 431:123-32. [PMID: 27173027 DOI: 10.1016/j.mce.2016.05.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/19/2022]
Abstract
In this study we analyzed the expression levels of markers of epithelial-to-mesenchymal transition (EMT) in several papillary thyroid carcinomas (PTCs) and the relation with tumor genotypes and clinicopathological characteristics. The role of fibronectin-1 (FN1) was investigated by analyzing the effects of FN1 silencing in two human thyroid cancer cell lines. Most of EMT markers were significantly over-expressed in a group of 36 PTCs. In particular, FN1 mRNA levels were higher in tumor vs non-tumor tissue (117.3, p < 0.001) and also in aggressive and BRAF(V600E) samples. Similar results were observed (and confirmed at the protein level) when FN1 expression was analyzed in a validation group of 50 PTCs and six lymph node (LN) metastases. Silencing of FN1 in TPC-1 and BCPAP thyroid cancer cells significantly reduced proliferation, adhesion, migration, and invasion in both cell lines. Collectively, our data indicate that FN1 overexpression is an important determinant of thyroid cancer aggressiveness.
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Affiliation(s)
- Marialuisa Sponziello
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Francesca Rosignolo
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Marilena Celano
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, 88100, Catanzaro, Italy
| | - Valentina Maggisano
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, 88100, Catanzaro, Italy
| | - Valeria Pecce
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, 00161, Rome, Italy
| | | | | | - Cosimo Durante
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Sebastiano Filetti
- Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Giuseppe Damante
- Institute of Medical Genetics, "S. Maria della Misericordia" University Hospital, 33100, Udine, Italy
| | - Diego Russo
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, 88100, Catanzaro, Italy.
| | - Stefania Bulotta
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, 88100, Catanzaro, Italy
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16
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Lubitz CC, Sosa JA. The changing landscape of papillary thyroid cancer: Epidemiology, management, and the implications for patients. Cancer 2016; 122:3754-3759. [DOI: 10.1002/cncr.30201] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/01/2016] [Accepted: 06/20/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Carrie C. Lubitz
- Department of Surgery; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
- Institute for Technology Assessment, Massachusetts General Hospital; Boston Massachusetts
| | - Julie A. Sosa
- Departments of Surgery and Medicine; Duke Cancer Institute, and Duke Clinical Research Institute, Duke University School of Medicine; Durham NC
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17
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Nixon IJ, Wang LY, Migliacci JC, Eskander A, Campbell MJ, Aniss A, Morris L, Vaisman F, Corbo R, Momesso D, Vaisman M, Carvalho A, Learoyd D, Leslie WD, Nason RW, Kuk D, Wreesmann V, Morris L, Palmer FL, Ganly I, Patel SG, Singh B, Tuttle RM, Shaha AR, Gönen M, Pathak KA, Shen WT, Sywak M, Kowalski L, Freeman J, Perrier N, Shah JP. An International Multi-Institutional Validation of Age 55 Years as a Cutoff for Risk Stratification in the AJCC/UICC Staging System for Well-Differentiated Thyroid Cancer. Thyroid 2016; 26:373-80. [PMID: 26914539 PMCID: PMC4790212 DOI: 10.1089/thy.2015.0315] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions. METHODS A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model. RESULTS Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7%, 97.3%, 96.6%, and 76.3%, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5%, 94.7%, 94.1%, and 67.6%, respectively. The change resulted in 12% of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6%. The change resulted in an increase in CPE from 0.90 to 0.92. CONCLUSIONS A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12% of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.
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Affiliation(s)
- Iain J Nixon
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Laura Y Wang
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Jocelyn C Migliacci
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Antoine Eskander
- 2 Department of Otolaryngology, Mount Sinai Hospital , Toronto, Canada
| | - Michael J Campbell
- 3 Department of Surgery, University of California , Davis Medical Center, Sacramento, California
| | - Ahmad Aniss
- 4 Department of Endocrine Surgery, Endocrine Surgical Unit, University of Sydney , Sydney, Australia
| | - Lilah Morris
- 5 Department of Endocrine Surgery, MD Anderson , Houston, Texas
| | - Fernanda Vaisman
- 6 Department of Endocrinology, Endocrine Service, Instituto Nacional do Cancer , Rio de Janeiro, Brazil
| | - Rossana Corbo
- 6 Department of Endocrinology, Endocrine Service, Instituto Nacional do Cancer , Rio de Janeiro, Brazil
| | - Denise Momesso
- 7 Department of Endocrinology, Endocrinology Service, Faculdade de Medicina-Universidade Federal do Rio de Janeiro , Rio de Janeiro, Brazil
| | - Mario Vaisman
- 7 Department of Endocrinology, Endocrinology Service, Faculdade de Medicina-Universidade Federal do Rio de Janeiro , Rio de Janeiro, Brazil
| | - Andre Carvalho
- 8 Department of Head and Neck Surgery, Barretos Cancer Hospital , Barretos, Brazil
| | - Diana Learoyd
- 4 Department of Endocrine Surgery, Endocrine Surgical Unit, University of Sydney , Sydney, Australia
| | - William D Leslie
- 9 Department of Surgery, Head and Neck Surgical Oncology and Nuclear Medicine, Cancer Care Manitoba and University of Manitoba , Winnipeg, Canada
| | - Richard W Nason
- 9 Department of Surgery, Head and Neck Surgical Oncology and Nuclear Medicine, Cancer Care Manitoba and University of Manitoba , Winnipeg, Canada
| | - Deborah Kuk
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Volkert Wreesmann
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Luc Morris
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Frank L Palmer
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Ian Ganly
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Snehal G Patel
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Bhuvanesh Singh
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - R Michael Tuttle
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Ashok R Shaha
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Mithat Gönen
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
| | - K Alok Pathak
- 9 Department of Surgery, Head and Neck Surgical Oncology and Nuclear Medicine, Cancer Care Manitoba and University of Manitoba , Winnipeg, Canada
| | - Wen T Shen
- 10 Department of Endocrine Surgery, University of California , San Francisco, San Francisco, California
| | - Mark Sywak
- 4 Department of Endocrine Surgery, Endocrine Surgical Unit, University of Sydney , Sydney, Australia
| | - Luis Kowalski
- 11 Department of Head and Neck Surgery, ACCamargo Cancer Center , São Paulo, Brazil
| | - Jeremy Freeman
- 2 Department of Otolaryngology, Mount Sinai Hospital , Toronto, Canada
| | - Nancy Perrier
- 5 Department of Endocrine Surgery, MD Anderson , Houston, Texas
| | - Jatin P Shah
- 1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York
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Pearce EN, Lee SL, Weiss R, Magner J, Garber JR, Campion FX, Leung AM. Unique obstacles to establishing thyroid cancer registries. J Clin Transl Endocrinol 2016; 3:12-13. [PMID: 29159122 PMCID: PMC5680439 DOI: 10.1016/j.jcte.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Stephanie L Lee
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA, USA
| | - Richard Weiss
- Medical Affairs, Genzyme Corporation, a Sanofi company, Cambridge, MA, USA
| | - James Magner
- Medical Affairs, Genzyme Corporation, a Sanofi company, Cambridge, MA, USA
| | - Jeffrey R Garber
- Endocrine Division, Harvard Vanguard Medical Associates, Boston, MA, USA
| | - F X Campion
- Department of Population Medicine, Harvard Medical School, Boston, MA, USA
| | - Angela M Leung
- Division of Endocrinology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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19
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Haser GC, Tuttle RM, Su HK, Alon EE, Bergman D, Bernet V, Brett E, Cobin R, Dewey EH, Doherty G, Dos Reis LL, Harris J, Klopper J, Lee SL, Levine RA, Lepore SJ, Likhterov I, Lupo MA, Machac J, Mechanick JI, Mehra S, Milas M, Orloff LA, Randolph G, Revenson TA, Roberts KJ, Ross DS, Rowe ME, Smallridge RC, Terris D, Tufano RP, Urken ML. ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM. Endocr Pract 2016; 22:602-11. [PMID: 26799628 DOI: 10.4158/ep151065.ra] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. METHODS We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. RESULTS Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. CONCLUSION With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.
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Zafon C, Puig-Domingo M, Biarnés J, Halperin I, Bella MR, Castells I, González C, Megía A, Santos L, García-Pascual L, Reverter JL, Pizarro E, Mauricio D. A descriptive study of the characteristics of differentiated thyroid cancer in Catalonia during the period 1998-2012. The CECaT registry. ACTA ACUST UNITED AC 2015; 62:264-9. [PMID: 25979187 DOI: 10.1016/j.endonu.2015.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 02/19/2015] [Accepted: 03/09/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The consortium for the study of thyroid cancer (CECaT), including 20 hospitals and one research institute, was recently created in Catalonia (Spain). One of the first initiatives of the group was to perform a descriptive analysis of the characteristics of patients with differentiated thyroid carcinoma (DTC). PATIENTS AND METHODS The cohort included 1,855 patients from 11 hospitals treated over a period of 15 years (1998-2012). RESULTS In this series, 1.470 (79.2%) patients were women. Mean age was 47.7 (15.7) years old. Age was significantly higher in male than in female patients, 49.3 (15) versus 47.3 (15.8); p=0.02. Papillary thyroid carcinoma accounted for 88.9% of cases. Mean tumor size was 21.5 (16) mm, and was significantly lower in females than in males, 20.1 (14.5) mm and 26.6 (20.3) mm respectively (p<0.001). After a follow-up period of 5.5 (3.7) years, information was available for 1,355 patient, of whom 1065 (78.6%) were free of disease, 239 (17.6%) had no tumor persistence, and 51 (3.8) % had died. The risk of persistent or recurrent disease was significantly associated to older age at diagnosis, male gender, larger tumor size, lymph node metastases at surgery, no signs of thyroiditis in the remaining thyroid tissue, and presence of vascular and/or extraglandular invasion. CONCLUSIONS Patient characteristics analyzed are similar to those reported in other parts of the world.
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Affiliation(s)
- Carles Zafon
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España.
| | - Manel Puig-Domingo
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Josefina Biarnés
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Irene Halperin
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Maria Rosa Bella
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Ignasi Castells
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Cintia González
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Ana Megía
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Lola Santos
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Luís García-Pascual
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Jordi Lluís Reverter
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Eduarda Pizarro
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
| | - Dídac Mauricio
- Servicio de Endocrinología y Nutrición, Hospital General Universitari Vall d'Hebron, Barcelona, España
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