1
|
Porter T, Kucheryavykh L. F10 Gene Expression and Ethnic Disparities Present in Papillary Thyroid Carcinoma. J Pers Med 2024; 14:524. [PMID: 38793106 PMCID: PMC11122589 DOI: 10.3390/jpm14050524] [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: 04/18/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Papillary thyroid carcinoma (PTC) presents a significant health concern, particularly among Hispanic women in the United States, who exhibit a disproportionately higher chance of developing an advanced disease when compared to the non-Hispanic population. Emerging evidence suggests coagulation factor X, encoded by the F10 gene, has a potential role in inhibiting cancer cell migration. However, comprehensive investigations into the differential expression patterns of F10 in Hispanic versus non-Hispanic females remain limited. RNA-sequencing data were acquired from the TCGA database for white female patients, 166 non-Hispanic and 25 Hispanic. A statistically significant (p < 0.05) 2.06-fold increase in F10 expression levels was detected in disease-free tumors compared to recurrent PTC tumors. Furthermore, an increase in F10 gene expression levels was also observed, corresponding to approximately a 1.74-fold increase in non-Hispanic patients compared to Hispanic patients. The probability of tumor recurrence was 1.82 times higher in the cohort with low expression of F10 compared to the high-expression cohort, correlating with the lower disease-free rates observed in the Hispanic patient cohort when compared to non-Hispanics. This finding underscores the relevance of ethnic disparities in molecular profiles for understanding cancer susceptibility. Identifying F10 as a potential prognostic biomarker highlights avenues for targeted interventions and contributes to improving diagnostic and treatment strategies for diverse patient populations.
Collapse
Affiliation(s)
- Tyrel Porter
- Department of Biochemistry, Universidad Central del Caribe, Bayamón, PR 00956, USA;
| | | |
Collapse
|
2
|
Mardani P, Koulaian S, Fouladi D, Rajaie Ramsheh FS, Amirian A, Shahriarirad S, Malekhosseini SA, Shahriarirad R. Demographic, clinical, and surgical features of patients undergoing thyroidectomy due to thyroid lesions in Southern Iran: A cross-sectional study. Health Sci Rep 2024; 7:e2012. [PMID: 38567186 PMCID: PMC10985224 DOI: 10.1002/hsr2.2012] [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: 09/03/2023] [Revised: 03/04/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Background and Aims The incidence of thyroid cancer has witnessed a significant global increase and stands as one of the most prevalent cancers in Iran. This surge is primarily attributed to the escalating incidence of papillary thyroid cancer (PTC), with overdiagnosis emerging as an equally noteworthy factor. Consequently, this study aims to ascertain the incidence of thyroid cancer, along with its clinical presentation, demographic characteristics, and surgical features in patients undergoing thyroid surgery. Methods This cross-sectional study involved the evaluation of patient files from referral centers in Shiraz spanning the years 2015-2020. Demographic and clinical information pertaining to thyroid cancer was extracted and subsequently analyzed using SPSS software. Results A total of 533 documented cases of thyroid cancer undergoing surgery revealed an annual rate of 89 cases in our location. The average age of the patients was 43.9 ± 13.4 years (ranging from 13 to 92), with females constituting 429 (83.5%) of the cases, and 278 (54.1%) being malignant. Conventional PTC emerged as the most prevalent pathology, accounting for 239 (45.0%) of the cases. Patients with thyromegaly exhibited significantly higher incidences of nonmalignant tumors (p = 0.01), while those with malignant tumors were notably younger than those with nonmalignant tumors (p = 0.001). Conclusion Our study revealed a progressive rise in the number of patients undergoing thyroidectomy over the years, with PTC constituting the majority of cases. Malignant cases were more frequently observed in younger patients, and in smaller lesion sizes, highlighting the importance of early screening and optimizing detection methods, especially in high-risk populations.
Collapse
Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Shiraz Transplant Research CenterShiraz University of Medical SciencesShirazIran
| | - Sepehr Koulaian
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Damoun Fouladi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | | | - Armin Amirian
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
| | | | | | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research CenterShiraz University of Medical ScienceShirazIran
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| |
Collapse
|
3
|
Díez JJ, Parente P, Durán-Poveda M. Surgical management of low-risk papillary thyroid cancer in real life in Spain: a nationwide survey of endocrine neck surgeons and endocrinologists. Endocrine 2024; 83:422-431. [PMID: 37592163 DOI: 10.1007/s12020-023-03488-3] [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: 05/28/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The extent of surgery in patients with papillary thyroid cancer (PTC) is a subject of ongoing debate. We aimed to explore the attitude of Spanish specialists (endocrinologists, surgeons, and otolaryngologists) in real life on the surgical management of low-risk PTC. METHODS We designed an anonymous, web-based survey to inquire information regarding the preferences of interviewees for hemithyroidectomy (Hem), total thyroidectomy (TT) and prophylactic central neck dissection (pCND) in one standard patient with PTC and six clinical variants. We differentiated between small (1.1-2.5 cm) and large (2.6-4.0 cm) tumors. RESULTS A total of 278 valid responses were received and divided into two groups: group END (n = 135) and group SUR (n = 143, 101 general surgeons and 42 otolaryngologists). The preference for Hem was low in the standard patient and similar between both groups (40.6 vs 49.0%, NS). This preference decreased for tumors measuring 2.6-4.0 cm, multifocal, with risk location, family history of thyroid cancer, or history of irradiation, and increased in patients older than 65 years or with comorbidity. Preference for pCND ranged from 12.6-71.1% in the group END and from 22.4-65.0% in the group SUR, with few differences between the two. In multivariate analysis, being a high-volume specialist was associated with a lower preference for Hem, while having private practice was associated with a more favorable opinion of Hem. CONCLUSION The real clinical practice of Spanish specialists is far from what is recommended by the clinical guidelines in patients with low-risk PTC, especially among high-volume professionals.
Collapse
Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Pablo Parente
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Durán-Poveda
- Department of General Surgery, King Juan Carlos University Hospital, Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences King Juan Carlos University, Madrid, Spain
| |
Collapse
|
4
|
Bach K, Ansari P, Ansari H, Mott NM, Elfenbein DM, Underwood H, Pitt SC. Health-Related Quality of Life in Patients with Low-Risk Differentiated Thyroid Cancer: A Systematic Review Examining the Extent of Thyroidectomy. Thyroid 2024; 34:14-25. [PMID: 37861284 PMCID: PMC10818048 DOI: 10.1089/thy.2023.0328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: Total thyroidectomy (TT) and hemithyroidectomy (HT) are acceptable surgical options for the treatment of low-risk differentiated thyroid cancer (DTC). While previous data suggest similar disease-free and disease-specific survival regardless of initial surgical treatment, the effect of the extent of surgery on health-related quality of life (HRQOL) is less clear. This systematic review aimed to examine HRQOL in low-risk DTC survivors after TT compared with HT. Methods: A search of PubMed, CINAHL, Cochrane, PsycINFO, and Scopus databases was conducted to identify studies published between January 1, 2011, and December 31, 2022, that assessed HRQOL predominantly in patients with low-risk DTC who underwent open thyroid surgery. Covidence™ software was used to apply the inclusion criteria, and a validated instrument was used to assess study quality. Results: Sixteen of the 1402 identified studies were included: 5 prospective and 11 retrospective cohort studies. The majority of included studies were of good quality (n = 14) and were from Asia and the Middle East (n = 11). Overall, six studies concluded that HT led to a better HRQOL than TT, two concluded that HT only resulted in better HRQOL compared with TT with central neck dissection (CND), and two concluded HT resulted in better short-term HRQOL that dissipated by 6 months postoperatively. The HRQOL domains found across all studies to be most consistently improved after HT included physical health, psychological/emotional, and social function. Factors found to be associated with HRQOL in more than one study included age, stage, and marital status. Conclusion: Differences in HRQOL after HT and TT tended to favor HT particularly when measured <6 months after surgery or when compared with TT with CND. Additional prospective and ideally randomized data are needed to fully determine the impact of the extent of surgery on HRQOL in patients with low-risk thyroid cancer.
Collapse
Affiliation(s)
- Kathy Bach
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Palvishey Ansari
- CMH-Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | | | - Nicole M. Mott
- Department of Surgery, University of Colorado, Denver, Colorado, USA
| | - Dawn M. Elfenbein
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Hunter Underwood
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan C. Pitt
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
5
|
Chen H, Liu Y, Huang D, Zhang X, She L. Total thyroidectomy versus unilateral lobectomy for unilateral multifocal papillary thyroid carcinoma: systematic review and meta‑analysis. Updates Surg 2024; 76:33-41. [PMID: 38127193 DOI: 10.1007/s13304-023-01726-x] [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: 08/11/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
The optimal surgical procedure(s) for unilateral multifocal papillary thyroid carcinomas is currently controversial. As such, the present study aimed to compare the efficacies of total thyroidectomy and lobectomy in patients with unilateral multifocal papillary thyroid carcinoma. A literature search of the PubMed/Medline, Embase, Web of Science, Cochrane Library, Wan Fang, and Zhi Wang databases for relevant studies, published from inception to October 31, 2022, was performed. Two researchers independently extracted data from the included studies. Lymph node metastasis, vocal fold paralysis, parathyroid injury, postoperative recurrence, and disease-free survival were evaluated. The meta-analysis included 7 studies comprising 1540 patients, of whom 496 and 1044 underwent lobectomy and total thyroidectomy, respectively. Compared with lobectomy, total thyroidectomy resulted in more vocal cord paralysis (odds ratio [OR] 0.35 [95% confidence interval (CI) 0.13 to 0.96]; P = 0.04) and parathyroid injury (OR 0.11 [95% CI 0.03-0.39]; P = 0.001) but with better disease-free survival (OR 0.21 [95% CI 0.09-0.49]; P = 0.000), although vocal cord paralysis and parathyroid injury, in large part, resolved within 1 year after surgery. In addition, there was no difference in postoperative lymph nodes metastasis (OR 0.74 [95% CI 0.13-4.21]; P = 0.737) and postoperative recurrence (OR 2.37 [95% CI 0.42-13.38]; P = 0.33). Excluding studies that deviated from the general trend, total thyroidectomy was beneficial in reducing recurrence. Compared with lobectomy, total thyroidectomy was beneficial in reducing recurrence and disease-free survival and may be considered a more optimal approach for unilateral multifocal papillary thyroid carcinoma.
Collapse
Affiliation(s)
- Huihong Chen
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Yong Liu
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Donghai Huang
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
| | - Xin Zhang
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital), 87 Xiangya Road, Changsha, Hunan, People's Republic of China
| | - Li She
- Department of Otolaryngology-Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, People's Republic of China.
- Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, Hunan, People's Republic of China.
- Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People's Republic of China.
| |
Collapse
|
6
|
Mansy I, Elsenosy AM, Hassan EM, Zakria M. A Clinical Audit of Thyroid Hormonal Replacement After Total Thyroidectomy. Cureus 2023; 15:e50374. [PMID: 38116025 PMCID: PMC10730255 DOI: 10.7759/cureus.50374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
Background Thyroid hormone replacement (THR) in athyreotic patients post-thyroidectomy due to thyroid cancer might seem like a straightforward clinical issue to address. To investigate the impact of THR on enhancing thyroid-stimulating hormone (TSH) levels, we conducted a clinical audit, tailoring the dosage based on patient weight and aligning with the standards outlined by the National Institute for Health and Care Excellence and the American Thyroid Association guidelines. Methodology This retrospective and prospective audit analyzed outpatient clinic records for hormone replacement therapy (HRT) post-total thyroidectomy. Retrospective data from March to May 2022 were collected, followed by prospective data after interventions adjusting HRT based on patient weight to digitize clinic notes. The second phase involved changes for 20 scheduled thyroidectomy patients among the total 37 included in the study. Results The thyroid profiles of both groups in the initial and subsequent cycles, treated with adjusted doses of THR, exhibited normal levels of thyroid hormones and calcium. No substantial differences were observed between the groups. On multivariate logistic regression analysis, we found that older age, male sex, body mass index, and preoperative TSH level were the only significant predictors of the need for hormonal therapy. Conclusions Optimal dose of THR after total thyroidectomy had a positive effect on TSH levels in hypothyroidism patients. Hence, THR should be prescribed according to patient weight based on standards and guidelines.
Collapse
Affiliation(s)
- Islam Mansy
- General Surgery and Surgical Oncology, Maadi Armed Forces Medical Complex, Cairo, EGY
| | | | - Eslam M Hassan
- Trauma and Orthopaedics, Poole General Hospital, Poole, GBR
| | | |
Collapse
|
7
|
Rathod R, Panda NK, Bakshi J, Nayak G, Ramavat A. Hemithyroidectomy in Papillary Thyroid Cancers: A Prospective, Single Institutional Surgical Audit and Contemplating on the Clinical Implications of 2015 American Thyroid Association Guidelines. Indian J Otolaryngol Head Neck Surg 2023; 75:508-516. [PMID: 37275097 PMCID: PMC10234917 DOI: 10.1007/s12070-022-03312-w] [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: 02/22/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) contributes to 88% of thyroid malignancies and its extent of surgical management has been a topic of debate in the past 2 decades. American thyroid association (ATA) recommendations have been periodically updated for its robust and evidence-based management. We present our experience in implementing 2015 ATA guidelines, assessment of surgical outcomes of hemithyroidectomy in PTC ≤ 4 cm and contemplating on the potential clinical implications of 2015 ATA guidelines. A prospective study in a cohort of Bethesda class V and VI PTC with nodule ≤ 4 cm who underwent Hemithyroidectomy between 2012 and 2020. Data on thyroid nodule evaluation, management, histopathology and follow up were used for risk stratification. Of 37 patients, 27 (72.9%) were low risk and 10 (37%) were intermediate risk ATA group. 4 (40%) intermediate risk patients had structural incomplete response and underwent completion thyroidectomy. 1 (2.7%) out of 4 completion surgery patients required adjuvant radio-ablation iodine (RAI) and 3 patients were under surveillance. Overall, 2 (5.4%) of 37 patients, 1 each from low and intermediate groups were given remnant RAI in view of aggressive histology, old age and unwillingness for a completion surgery. During follow up of 4.94 ± 2.4 years, 35 (94.5%) showed excellent response and 2 (5.4%) showed biochemical incomplete response. The difference in RFS between two groups was statistically significant with p < 0.001. Thyroid preserving surgery combined with real time risk stratification seems appropriate for low and intermediate risk PTC ≤ 4 cm.
Collapse
Affiliation(s)
- Ramya Rathod
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Naresh K. Panda
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Jaimanti Bakshi
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Gyanaranjan Nayak
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Anurag Ramavat
- Department of Otolaryngology, Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012 India
| |
Collapse
|
8
|
Krajewska J, Kukulska A, Samborski K, Czarniecka A, Jarzab B. Lobo-isthmectomy in the management of differentiated thyroid cancer. Thyroid Res 2023; 16:4. [PMID: 36775829 PMCID: PMC9923929 DOI: 10.1186/s13044-022-00145-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/21/2022] [Indexed: 02/14/2023] Open
Abstract
We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones.The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015.Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma.This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions.
Collapse
Affiliation(s)
- Jolanta Krajewska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102, Gliwice, Poland.
| | - Aleksandra Kukulska
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland ,Radiotherapy Department, M.Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Konrad Samborski
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland
| | - Agnieszka Czarniecka
- Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Wybrzeze AK 15, 44-102 Gliwice, Poland
| |
Collapse
|
9
|
Choi JH, Lee JK, Kim W, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. Response to Letter to the Editor from Yang et al.: "Prevalence of Postoperatively Detected High-risk Features in 2- to 4-cm Papillary Thyroid Cancers". J Clin Endocrinol Metab 2023; 108:e198-e199. [PMID: 36611244 DOI: 10.1210/clinem/dgac754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
- Department of Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 1468 Madison Ave, New York, NY 10029, USA
| | - Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea
- Department of Surgery, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, Korea
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Korea
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, Korea
| |
Collapse
|
10
|
Yang S, Tan M, Gao F, Xu X. Letter to the Editor from Yang et al.: "Prevalence of Postoperatively Detected High-risk Features in 2- to 4-cm Papillary Thyroid Cancers". J Clin Endocrinol Metab 2023; 108:e197. [PMID: 36592380 DOI: 10.1210/clinem/dgac753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Shijie Yang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meijuan Tan
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Gao
- Feng Gao, Department of General Surgery, Hebei Petrochina Central Hospital, Langfang, Hebei, China
| | - Xiequn Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
11
|
Dralle H, Weber F, Machens A, Brandenburg T, Schmid KW, Führer-Sakel D. [Hemithyroidectomy or total thyroidectomy for low-risk papillary thyroid cancer? : Surgical criteria for primary and secondary choice of treatment in an interdisciplinary treatment concept]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:79-92. [PMID: 36121448 DOI: 10.1007/s00104-022-01726-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/21/2023]
Abstract
The increase in small intrathyroid papillary thyroid cancer (PTC) observed worldwide over the past two decades, with no increase in cancer-specific mortality, has challenged the previous concept of total thyroidectomy as a one-size-fits-all panacea. After exclusion of papillary microcarcinomas, a systematic review of 20 clinical studies published since 2002, which compared hemithyroidectomy (HT) to total thyroidectomy (TT), found comparable long-term oncological outcomes for low-risk papillary thyroid cancer (LRPTC) 1-4 cm in diameter, whereas postoperative complication rates were markedly lower for HT. To refine individual treatment plans, HT should be combined with ipsilateral central lymph node dissection and intraoperative frozen section analysis for staging. Based on recent evidence from studies and in consideration of individual risk factors, patients with LRPTC can be offered the concept of HT as an alternative to the standard TT. A prerequisite for the treatment selection and decision is a comprehensive patient clarification of the possible advantages and disadvantages of both approaches.
Collapse
Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - F Weber
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - A Machens
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Brandenburg
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - K W Schmid
- Institut für Pathologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Führer-Sakel
- Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| |
Collapse
|
12
|
Díez JJ. Continuing controversies on the extent of surgery in papillary thyroid carcinoma. Gland Surg 2023; 12:11-15. [PMID: 36761484 PMCID: PMC9906101 DOI: 10.21037/gs-22-693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Juan J. Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain;,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
13
|
Angell TE, Kwon DI. Finding the Balance on Extent of Initial Thyroidectomy for Low-Risk Papillary Thyroid Carcinoma. J Clin Endocrinol Metab 2022; 108:e7-e8. [PMID: 36137000 DOI: 10.1210/clinem/dgac557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Trevor E Angell
- Division of Endocrinology and Diabetes, Keck School of Medicine, University of Southern California, Los Angeles 90033, CA, USA
| | - Daniel I Kwon
- Department of Otolaryngology, Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90033, CA, USA
| |
Collapse
|
14
|
Cheon YI, Shin SC, Lee M, Sung ES, Lee JC, Kim M, Kim BH, Kim IJ, Lee BJ. Survey of Korean head and neck surgeons and endocrinologists for the surgical extent of 1.5 and 2.5 cm papillary thyroid carcinoma. Gland Surg 2022; 11:1744-1753. [PMID: 36518800 PMCID: PMC9742055 DOI: 10.21037/gs-22-326] [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: 05/27/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
Background The surgical extent of 1-4 cm papillary thyroid carcinoma (PTC) is controversial. We aimed to determine the current trend in the extent of thyroidectomy and prophylactic central neck dissection (pCND) for 1.5 and 2.5 cm PTC, which are the most clinically controversial sizes. Methods The questionnaire was sent to 342 Korean Society of Head and Neck Surgery and 160 one branch of Korean Endocrine Society members from June to July 2021 by e-mail. A questionnaire included extent of thyroidectomy [hemithyroidectomy (Hemi) vs. total thyroidectomy (TT)] and pCND according to the tumor location and degree of extrathyroidal extension (ETE) at 1.5 or 2.5 cm PTC. We compared the proportion of respondents' preference for each scenario. Results Fifty-seven of 342 surgeons and twenty-seven of 160 endocrinologists responded to the questionnaire. At 1.5 and 2.5 cm PTC without ETE, both groups preferred Hemi, and there was no difference between the groups. When 1.5 or 2.5 cm PTC with anterior minimal ETE was suspected, the preference for Hemi by endocrinologists was significantly lower than that by surgeons (P<0.05). When anterior and posterior gross ETE were suspected, TT was preferred in both groups. When anterior gross ETE was suspected, the preference for Hemi by endocrinologists was significantly lower than that by surgeons (P<0.05). There was no difference between the groups in the posterior gross ETE. Surgeons preferred Hemi and endocrinologists preferred TT for a 1.5 cm PTC located in the isthmus. The pCND showed a similar pattern in both groups according to the size and location of the tumor and the degree of ETE. The proportion of Hemi did not differ between high-experience and low-experience endocrinologists. Also, there was no significant difference in preference for surgical extent between low-volume and high-volume surgeons. Conclusions TT was frequently preferred in tumors with a large size or gross ETE, and pCND was frequently preferred in cases of suspected gross ETE. This study shows as the extent of thyroid surgery may differ between endocrinologists and surgeons and this could be confusing to patient and affect the patient outcomes. Therefore, multidisciplinary approach considering the extent of surgery for thyroid cancer is recommended.
Collapse
Affiliation(s)
- Yong-Il Cheon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Minhyung Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Eui-Suk Sung
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin-Choon Lee
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - In Ju Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
15
|
Choi JH, Lee JK, Kim W, Yu HW, Kim SJ, Chai YJ, Choi JY, Lee KE. Prevalence of Postoperatively Detected High-risk Features in 2- to 4-cm Papillary Thyroid Cancers. J Clin Endocrinol Metab 2022; 107:e4124-e4131. [PMID: 35914522 DOI: 10.1210/clinem/dgac457] [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] [Received: 04/06/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The 2015 American Thyroid Association guidelines proposed thyroid lobectomy as an acceptable option for 1- to 4-cm papillary thyroid cancers (PTC) without extrathyroidal extension (ETE) or lymph node (LN) metastasis. However, high-risk features are often detected postoperatively, even in tumors that are considered low risk on preoperative workup. A continued evaluation is necessary to determine the optimal treatment strategies. OBJECTIVE We examined the frequency of preoperatively and postoperatively detected high-risk features in 2- to 4-cm PTCs to assess the appropriate surgical extent. METHODS All patients who underwent a thyroid surgery between 2015 and 2020 with a final diagnosis of 2- to 4-cm PTC were selected. Demographics, preoperative findings, perioperative course, and surgical pathology were retrospectively analyzed. RESULTS Of the entire study cohort (N = 424), 244 (57.5%) patients had at least 1 of the following high-risk features: gross ETE (18.6%), distant metastasis (1.2%), >3 LN involvement with extranodal extension (24.8%), any LN > 3 cm (0.5%), positive margin (13.2%), TERT mutation (2.6%), vascular invasion (10.8%), cN1 disease (28.5%), and > 5 LN involvement (30.4%). Two hundred patients had neither ETE nor LN metastasis on preoperative imaging, but 62/200 (31.0%) were found to have at least 1 of the aforementioned high-risk features on final pathology. Preoperative imaging had sensitivities of 75.9% and 44.4% for detecting gross ETE and LN metastasis, respectively. CONCLUSION A significant portion of patients with 2- to 4-cm PTCs, including those who preoperatively met the criteria for lobectomy, were found to have high-risk features on final pathology. Careful patient selection and appropriate counseling are necessary when considering lobectomy for tumors greater than 2 cm.
Collapse
Affiliation(s)
- Jee-Hye Choi
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
- Department of Surgery, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, NY 10029, USA
| | - Ja Kyung Lee
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
- Department of Surgery, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
- Department of Surgery, Seoul National University Boramae Medical Center, Dongjak-gu, Seoul 07061, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul 03080, Korea
- Department of Surgery, Seoul National University Hospital, Jongno-gu, Seoul 03080, Korea
| |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
Hsiao V, Light TJ, Adil AA, Tao M, Chiu AS, Hitchcock M, Arroyo N, Fernandes-Taylor S, Francis DO. Complication Rates of Total Thyroidectomy vs Hemithyroidectomy for Treatment of Papillary Thyroid Microcarcinoma: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2022; 148:531-539. [PMID: 35511129 PMCID: PMC9073663 DOI: 10.1001/jamaoto.2022.0621] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Importance Papillary thyroid microcarcinomas (PTMCs) have been associated with increased thyroid cancer incidence in recent decades. Total thyroidectomy (TT) has historically been the primary treatment, but current guidelines recommend hemithyroidectomy (HT) for select low-risk cancers; however, the risk-benefit ratio of the 2 operations is incompletely characterized. Objective To compare surgical complication rates between TT and HT for PTMC treatment. Data Sources SCOPUS, Medline via the PubMed interface, and the Cochrane Central Register of Controlled Trials (CENTRAL); through January 1, 2021, with no starting date restriction. Terms related to papillary thyroid carcinoma and its treatment were used for article retrieval. This meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline and was written according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal. Study Selection Original investigations of adults reporting primary surgical treatment outcomes in PTMC and at least 1 complication of interest were included. Articles evaluating only secondary operations or non-open surgical approaches were excluded. Study selection, data extraction, and risk of bias assessment were performed by 2 independent reviewers and conflicts resolved by a senior reviewer. Data Extraction and Synthesis Pooled effect estimates were calculated using a random-effects inverse-variance weighting model. Main Outcomes and Measures Cancer recurrence and site, mortality (all-cause and disease-specific), vocal fold paralysis, hypoparathyroidism, and hemorrhage/hematoma. Risk of bias was assessed using the McMaster Quality Assessment Scale of Harms scale. Results In this systematic review and meta-analysis, 17 studies were analyzed and included 1416 patients undergoing HT and 2411 patients undergoing TT (HT: pooled mean [SD] age, 47.0 [10.0] years; 1139 [84.6%] were female; and TT: pooled mean [SD] age, 48.8 [10.0] years; 1671 [77.4%] were female). Patients undergoing HT had significantly lower risk of temporary vocal fold paralysis compared with patients undergoing TT (3.3% vs 4.5%) (weighted risk ratio [RR], 0.4; 95% CI, 0.2-0.7), temporary hypoparathyroidism (2.2% vs 21.3%) (weighted RR, 0.1; 95% CI, 0.0-0.4), and permanent hypoparathyroidism (0% vs 1.8%) (weighted RR, 0.2; 95% CI, 0.0-0.8). Contralateral lobe malignant neoplasm recurrence was 2.3% in the HT group, while no such events occurred in the TT group. Hemithyroidectomy was associated with a higher overall recurrence rate (3.8% vs 1.0%) (weighted RR, 2.6; 95% CI, 1.3-5.4), but there was no difference in recurrence in the thyroid bed or neck. Conclusions and Relevance The results of this systematic review and meta-analysis help characterize current knowledge of the risk-benefit ratio of HT vs TT for treatment of PTMC and provide data that may have utility for patient counseling surrounding treatment decisions.
Collapse
Affiliation(s)
- Vivian Hsiao
- Department of Surgery, University of Wisconsin-Madison, Madison
| | - Tyler J. Light
- Department of Surgery, University of Wisconsin-Madison, Madison,Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison
| | | | - Michael Tao
- Department of Otolaryngology, State University of New York, Syracuse, New York
| | - Alexander S. Chiu
- Department of Surgery, University of Wisconsin-Madison, Madison,Department of Surgery, Division of Endocrine Surgery, University of Wisconsin-Madison, Madison
| | - Mary Hitchcock
- Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison
| | - Natalia Arroyo
- Department of Surgery, University of Wisconsin-Madison, Madison,Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison
| | - Sara Fernandes-Taylor
- Department of Surgery, University of Wisconsin-Madison, Madison,Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison
| | - David O. Francis
- Department of Surgery, University of Wisconsin-Madison, Madison,Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison,Division of Otolaryngology, University of Wisconsin-Madison, Madison
| |
Collapse
|
18
|
Circ_100395 impedes malignancy and glycolysis in papillary thyroid cancer: involvement of PI3K/AKT/mTOR signaling pathway. Immunol Lett 2022; 246:10-17. [DOI: 10.1016/j.imlet.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/02/2022] [Accepted: 04/16/2022] [Indexed: 11/23/2022]
|
19
|
Fenton ME, Wade SA, Pirrili BN, Balogh ZJ, Rowe CW, Bendinelli C. Variability in Thyroid Cancer Multidisciplinary Team Meeting Recommendations Is Not Explained by Standard Variables: Outcomes of a Single Centre Review. J Clin Med 2021; 10:4150. [PMID: 34575260 PMCID: PMC8470818 DOI: 10.3390/jcm10184150] [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] [Received: 08/17/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Multidisciplinary team (MDT) meetings are the mainstay of the decision-making process for patients presenting with complex clinical problems such as papillary thyroid carcinoma (PTC). Adherence to guidelines by MDTs has been extensively investigated; however, scarce evidence exists on MDT performance and variability where guidelines are less prescriptive. We evaluated the consistency of MDT management recommendations for T1 and T2 PTC patients and explored key variables that may influence therapeutic decision making. A retrospective review of the prospective database of all T1 and T2 PTC patients discussed by the MDT was conducted between January 2016 and May 2021. Univariate analysis (with Bonferroni correction significance calculated at p < 0.006) was performed to establish clinical variables linked to completion thyroidectomy and Radioactive iodine (RAI) recommendations. Of 468 patients presented at thyroid MDT, 144 pT1 PTC and 118 pT2 PTC met the selection criteria. Only 18% (n = 12) of pT1 PTC patients initially managed with hemithyroidectomy were recommended completion thyroidectomy. Mean tumour diameter was the only variable differing between groups (p = 0.003). pT2 patients were recommended completion thyroidectomy in 66% (n = 16) of instances. No measured variable explained the difference in recommendation. pT1 patients initially managed with total thyroidectomy were not recommended RAI in 71% (n = 55) of cases with T1a status (p = 0.001) and diameter (p = 0.001) as statistically different variables. For pT2 patients, 60% (n = 41) were recommended RAI post-total thyroidectomy, with no differences observed among groups. The majority of MDT recommendations were concordant for patients with similar measurable characteristics. Discordant recommendations for a small group of patients were not explained by measured variables and may have been accounted for by individual patient factors. Further research into the MDT decision-making process is warranted.
Collapse
Affiliation(s)
- Mark E. Fenton
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
| | - Sarah A. Wade
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
| | - Bibi N. Pirrili
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
| | - Zsolt J. Balogh
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Christopher W. Rowe
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Endocrinology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Cino Bendinelli
- Department of General Surgery, John Hunter Hospital, Newcastle, NSW 2305, Australia; (M.E.F.); (S.A.W.); (C.B.)
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia; (B.N.P.); (C.W.R.)
- Department of Traumatology, John Hunter Hospital, Newcastle, NSW 2305, Australia
| |
Collapse
|
20
|
Merten MM, Foster T, Lyden M, Henry M, Regina Castro M. Favorable Early Outcomes With Thyroid Lobectomy for Low-Risk Papillary Thyroid Cancer: The Mayo Clinic Experience. Am Surg 2021; 87:1374-1378. [PMID: 34468234 DOI: 10.1177/00031348211038557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Until 2015, standard of care for low-risk papillary thyroid cancer (PTC) >1 cm was a total or near-total thyroidectomy. Despite changes in guidelines and surgical management of low-risk PTC since 2015, little data are available regarding the effect on the need for additional surgery or risk for development of lymph node metastases. Our aim was to determine outcomes in patients who underwent initial thyroid lobectomy for low-risk PTC at a high-volume tertiary care institution. METHODS Retrospective review of patients ≥18 years old with biopsy proven low-risk PTC 1-4 cm who underwent partial thyroidectomy (eg, lobectomy/isthmusectomy) at Mayo Clinic, Rochester, MN, between March 2016 and June 30, 2019. RESULTS From 1481 thyroidectomies performed during study period, 940 contained PTC on final pathology. Of these, 87 (of 123) patients who had an initial thyroid lobectomy met inclusion criteria. Five (6%) of these patients proceeded to completion thyroidectomy (CT), with 3 requiring CT and radioactive iodine in the first postoperative year and 2 undergoing only CT in the second postoperative year. No postoperative complications were reported. No patient in this cohort required additional surgery or treatment for newly discovered lymph node metastases during the follow-up period. 43 (of 72, 60%) patients not on thyroxine therapy preoperatively were started on thyroxine therapy postoperatively. CONCLUSIONS Early outcomes for those undergoing thyroid lobectomy for low-risk PTC at our institution have been favorable. These results support the 2015 American Thyroid Association guidelines to offer lobectomy for those with low-risk PTC 1-4 cm.
Collapse
Affiliation(s)
| | - Trenton Foster
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Melanie Lyden
- Department of Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - Michael Henry
- Department of Anatomic Pathology, 6915Mayo Clinic, Rochester, MN, United States
| | - M Regina Castro
- Division of Endocrinology, 6915Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
21
|
Di Filippo L, Giugliano G, Tagliabue M, Gandini S, Sileo F, Allora A, Grosso E, Proh M, Basso V, Scaglione D, Manzoni MF, Ansarin M. Total thyroidectomy versus lobectomy: surgical approach to T1-T2 papillary thyroid cancer. ACTA ACUST UNITED AC 2021; 40:254-261. [PMID: 33100336 PMCID: PMC7586194 DOI: 10.14639/0392-100x-n0608] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/09/2020] [Indexed: 01/14/2023]
Abstract
The incidence of papillary thyroid carcinoma, which accounts for 80-90% of all thyroid cancers, has recently been increasing. The current study aimed to compare the oncological and functional outcomes of total thyroidectomy (TT) and thyroid lobectomy (TL). To this end, a retrospective single-centre cohort study involving a tertiary care institution was conducted. Data regarding demographics, clinicopathology and postoperative complications from 586 patients with papillary thyroid cancer treated in a single institution were collected. Cox proportional-hazards models were utilised to determine differences in outcomes stratified according to propensity score. Our data suggested no significant difference in the risk for locoregional recurrence or distant metastasis between TL and TT among patients with pT1-2 pN0 papillary carcinoma. TT plays an important role in improving prognosis among patients with metastatic lymph nodes in the central neck compartment (pN1a) (p = 0.001). Moreover, TT had significantly higher rates of postoperative hypocalcaemia and recurrent laryngeal nerve paralysis compared to TL (p < 0.001 and p = 0.02, respectively).
Collapse
Affiliation(s)
- Luigi Di Filippo
- Departments of General Medicine and Endocrine Tumor Unit, San Raffaele Scientific Institute, IRCCS, Milano, Italy
| | - Gioacchino Giugliano
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Federica Sileo
- Departments of General Medicine and Endocrine Tumor Unit, San Raffaele Scientific Institute, IRCCS, Milano, Italy
| | - Agnese Allora
- Departments of General Medicine and Endocrine Tumor Unit, San Raffaele Scientific Institute, IRCCS, Milano, Italy
| | - Enrica Grosso
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Proh
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Veronica Basso
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Donatella Scaglione
- Division of Data Manager, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - Marco Federico Manzoni
- Departments of General Medicine and Endocrine Tumor Unit, San Raffaele Scientific Institute, IRCCS, Milano, Italy.,Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Co-last authors M.F. Manzoni and M. Ansarin share co-last authorship
| | - Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology, IRCCS, Milan, Italy.,Co-last authors M.F. Manzoni and M. Ansarin share co-last authorship
| |
Collapse
|
22
|
Song Q, Gao H, Ren L, Tian X, Lan Y, Yan L, Luo Y. Radiofrequency ablation versus total thyroidectomy in patients with papillary thyroid microcarcinoma located in the isthmus: a retrospective cohort study. Int J Hyperthermia 2021; 38:708-714. [PMID: 33899651 DOI: 10.1080/02656736.2021.1916625] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This retrospective study aimed to examine the benefits and complications of radiofrequency ablation (RFA) in patients with papillary thyroid microcarcinoma (PTMC) in the isthmus. METHODS This retrospective study included patients with PTMC in the isthmus and treated at the Chinese People's Liberation Army hospital from 05/2014 to 05/2018. The patients were divided into the RFA and total thyroidectomy (TT) groups. The outcomes were operation-related complications, rate of recurrence, metastasis rate, and thyroid carcinoma-specific questionnaire of quality of life (THYCA-QOL). RESULTS Among 218 patients, 115 patients underwent RFA, and 103 underwent TT. The rates of disappearance of the ablation zone at 1, 3, 6, 12, and 18 months after RFA were 0.8% (1/115), 10.4% (12/115), 51.3% (59/115), 90.4% (104/115), and 100% (115/115), respectively. Surgical time, blood loss, hospital stays, and treatment costs were higher with TT than with RFA (all p < 0.001). The final THYCA-QOL score of the RFA group was significantly higher than in the TT group (p < 0.001). Minor pain at the operation site was seen in all patients in the RFA group. No distant metastasis was detected in all patients, but one patient in the RFA group had a recurrence after 6 months. The final THYCA-QOL score of the RFA group was significantly lower than in the TT group (p < 0.001). CONCLUSION These results suggest that RFA for PTMC in the isthmus had similar outcomes than TT. It will have to be confirmed in future studies.
Collapse
Affiliation(s)
- Qing Song
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China.,Department of Ultrasound, Seventh Medical Center, General Hospital of Chinese PLA, Beijing, China
| | - Hanjing Gao
- Department of Ultrasound, Second Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Ling Ren
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Xiaoqi Tian
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Yu Lan
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Lin Yan
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center of General Hospital of Chinese PLA, Beijing, China
| |
Collapse
|
23
|
Huang F, Wang L, Jia H. Research trends for papillary thyroid carcinoma from 2010 to 2019: A systematic review and bibliometrics analysis. Medicine (Baltimore) 2021; 100:e26100. [PMID: 34032748 PMCID: PMC8154384 DOI: 10.1097/md.0000000000026100] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thyroid carcinoma comprises the fastest rising incidence of carcinomas over the past decade. Papillary thyroid carcinoma (PTC) is the most predominant type of thyroid carcinoma. This study aimed to assess the research trends in the field of PTC. METHODS Publications from January 2010 to December 2019 were retrieved from the Web of Science Core Collection database using Thompson Reuters. Searching strategies were determined according to Medical Subject Heading terms. Different kinds of bibliometrics software, such as HistCite and VOSviewer, and online bibliometrics analysis platforms were utilized to evaluate and visualize the results. RESULTS A total of 8102 publications across 93 countries were identified, with the annual number of publications showing an increasing trend. The United States, China, and South Korea showed their dominant position in PTC publication outputs, H-index, total citations, and international collaborations. Thyroid was the most productive journal. Akira Miyauchi published the most articles, and the most productive institution was Yonsei University. The hotspots keywords proliferation, invasion and metastasis, diagnoses and prognoses, therapeutic resistance, recurrence, and microcarcinomas appeared earlier and were sustained over the last 3 years. CONCLUSIONS This bibliometric study provides a comprehensive analysis delineating the scientific productivity, collaboration, and research hotspots within the PTC field, which will be very helpful when focusing on the direction of research over the next few years.
Collapse
Affiliation(s)
- Fengyan Huang
- Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012
| | - Lihua Wang
- Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012
| | - Hongying Jia
- Epidemiology and Health Statistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong 250012
- The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Dajie, Jinan, Shandong 250033, PR China
| |
Collapse
|
24
|
Chatchomchuan W, Thewjitcharoen Y, Karndumri K, Porramatikul S, Krittiyawong S, Wanothayaroj E, Vongterapak S, Butadej S, Veerasomboonsin V, Kanchanapitak A, Rajatanavin R, Himathongkam T. Recurrence Factors and Characteristic Trends of Papillary Thyroid Cancer over Three Decades. Int J Endocrinol 2021; 2021:9989757. [PMID: 34054949 PMCID: PMC8131146 DOI: 10.1155/2021/9989757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prevalence of thyroid cancer is rising worldwide. Although thyroid cancer has a favorable prognosis, up to 20% of patients experienced recurrent disease during the follow-up period. The present study aimed to examine the trend of incidence and factors associated with recurrence and outcomes of papillary thyroid cancer (PTC) in Thai patients over the last 30 years. METHODS We reviewed the clinical data of all patients with PTC who were treated between 1987 and 2019 at Theptarin Hospital. Clinical characteristics, epidemic trend, factors associated with the persistence/recurrence of the disease, overall disease-specific survival rate, and overall disease-free survival rate were analysed. RESULTS A total of 235 patients with PTC who were registered between 1987 and 2019 were reviewed. The mean age was 42.5 ± 14.3 years, with a mean follow-up of 9.5 years. Papillary thyroid microcarcinoma (PTMC) was consistently increased and accounted for 21.4% (50/235) of total cases. The American Thyroid Association (ATA) risk stratification was high in 24% of all PTMCs in the last decade, and 16.0% of these patients experienced local recurrence during the follow-up period. Coexistence with Hashimoto's thyroiditis (HT) was found in one-fifth of the patients with PTC and was correlated with a low recurrence rate (HR: 0.16, P=0.013). Only age ≥55 years associated with the persistence/recurrence of the disease. The overall disease-free survival and disease-specific survival rates were 77.4% and 98.3%, respectively. CONCLUSIONS The prognosis of PTC is generally considered favorable. However, approximately one-fourth of patients with PTMC demonstrated more aggressive clinical behavior, particularly in the last decade of the study. Coexistence of HT contributed to a better prognosis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Siriwan Butadej
- Diabetes and Thyroid Center, Theptarin Hospital, Bangkok, Thailand
| | | | | | | | | |
Collapse
|
25
|
Colombo C, Giancola N, Fugazzola L. Personalized treatment for differentiated thyroid cancer: current data and new perspectives. Minerva Endocrinol (Torino) 2020; 46:62-89. [PMID: 33213119 DOI: 10.23736/s2724-6507.20.03342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
More conservative and personalized treatment options have been developed in recent years to face the rising diagnosis of low-risk differentiated thyroid carcinoma (DTC). The present review describes the change towards a more risk-adapted management either in the treatment or in the follow-up of DTC. Particular attention is given to the innovations introduced by the latest guidelines for low-risk tumors, starting from the most appropriate extension of surgery up to the postoperative management. The emerging role of active surveillance for low-risk microcarcinoma is discussed, as well as the development of percutaneous strategies in the setting of malignant thyroid disease. The recent use of approved new systemic target therapies for advanced radioiodine refractory thyroid cancer is reported, together with the description of new compounds in trial. Finally, we provide some considerations to improve the risk evaluation in a presurgical setting, especially related to the rising role of genetics, to enable better risk-based cancer management and personalized treatment choices.
Collapse
Affiliation(s)
- Carla Colombo
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy - .,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy -
| | - Noemi Giancola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|