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Li X, Ding Z, Tong Y. Identification of SUMOylation-related biomarkers in papillary thyroid carcinoma. Cancer Cell Int 2024; 24:149. [PMID: 38671425 PMCID: PMC11055338 DOI: 10.1186/s12935-024-03323-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Small ubiquitin-like modifier (SUMO) modification is increasingly recognized as critical in tumorigenesis and progression. This study identifies biomarkers linked to SUMOylation in papillary thyroid carcinoma (PTC), aiming to advance therapeutic and prognostic strategies. METHODS Employing PTC datasets and SUMO related genes (SRGs), we utilized univariate Cox regression for prognosis-related SRGs, conducted differential expression analyses, and integrated findings to pinpoint candidate genes. These genes underwent further validation through survival, gene set enrichment, immune infiltration, and drug sensitivity analyses, including external validation via quantitative RT-qPCR. In our final step, we conducted immunohistochemical staining on tumor samples from PTC patients at our center and integrated this with their clinical data to validate BMP8A's effectiveness in predicting recurrence in PTC. RESULTS Three biomarkers-BMP8A, RGS8, and SERPIND1-emerged as significant. Gene Set Enrichment Analysis (GSEA) showed their involvement in immune-related pathways, with differential immune infiltration patterns and drug response correlations observed, underscoring their potential for targeted therapy. Lastly, we validated the efficacy of BMP8A in predicting the recurrence of PTC in patients using clinical and pathological data from our center. CONCLUSION The study identifies BMP8A, RGS8, and SERPIND1 as key biomarkers associated with SUMOylation in PTC. Their linkage to immune response and drug sensitivity highlights their importance as targets for therapeutic intervention and prognosis in PTC research.
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Affiliation(s)
- Xiang Li
- Department of General Surgery, The Affiliated Hospital of Jiujiang University, Jiujiang, China
| | - Zigang Ding
- Department of General Surgery, The Affiliated Hospital of Jiujiang University, Jiujiang, China
| | - Yun Tong
- Department of Pain, The Affiliated Hospital of Jiujiang University, No. 57 East Xunyang Road, Jiujiang, 332000, Jiangxi, China.
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Ling D, Liu A, Sun J, Wang Y, Wang L, Song X, Zhao X. Integration of IDPC Clustering Analysis and Interpretable Machine Learning for Survival Risk Prediction of Patients with ESCC. Interdiscip Sci 2023:10.1007/s12539-023-00569-9. [PMID: 37248421 DOI: 10.1007/s12539-023-00569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
Precise forecasting of survival risk plays a pivotal role in comprehending and predicting the prognosis of patients afflicted with esophageal squamous cell carcinoma (ESCC). The existing methods have the problems of insufficient fitting ability and poor interpretability. To address this issue, this work proposes a novel interpretable survival risk prediction method for ESCC patients based on extreme gradient boosting improved by whale optimization algorithm (WOA-XGBoost) and shapley additive explanations (SHAP). Given the imbalanced nature of the data set, the adaptive synthetic sampling (ADASYN) is first used to generate the samples with high survival risk. Then, an improved clustering by fast search and find of density peaks (IDPC) algorithm based on cosine distance and K nearest neighbors is used to cluster the patients. Next, the prediction model for each cluster is obtained by WOA-XGBoost and the constructed model is visualized with SHAP to uncover the factors hidden in the structured model and improve the interpretability of the black-box model. Finally, the effectiveness of the proposed scheme is demonstrated by analyzing the data collected from the First Affiliated Hospital of Zhengzhou University. The results of the analysis reveal that the proposed methodology exhibits superior performance, as indicated by the area under the receiver operating characteristic curve (AUROC) of 0.918 and accuracy of 0.881.
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Affiliation(s)
- Dan Ling
- Henan Key Lab of Information-Based Electrical Appliances, Zhengzhou University of Light Industry, Zhengzhou, 450002, China
| | - Anhao Liu
- Henan Key Lab of Information-Based Electrical Appliances, Zhengzhou University of Light Industry, Zhengzhou, 450002, China
| | - Junwei Sun
- Henan Key Lab of Information-Based Electrical Appliances, Zhengzhou University of Light Industry, Zhengzhou, 450002, China
| | - Yanfeng Wang
- Henan Key Lab of Information-Based Electrical Appliances, Zhengzhou University of Light Industry, Zhengzhou, 450002, China.
| | - Lidong Wang
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Xin Song
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
| | - Xueke Zhao
- State Key Laboratory of Esophageal Cancer Prevention and Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, China
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van Velsen EFS, Peeters RP, Stegenga MT, van Kemenade FJ, van Ginhoven TM, van Balkum M, Verburg FA, Visser WE. Evaluating Disease Specific Survival Prediction of Risk Stratification and TNM Systems in Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2022; 108:e267-e274. [PMID: 36508298 DOI: 10.1210/clinem/dgac721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many countries have national guidelines for the management of differentiated thyroid cancer (DTC), including a risk stratification system to predict recurrence of disease. Studies whether these guidelines could also have relevance, beyond their original design, in predicting survival are lacking. Additionally, no studies evaluated these international guidelines in the same population, nor compared them to the TNM system. Therefore, we investigated the prognostic value of six stratification systems employed by ten International guidelines, and the TNM system with respect to predicting disease specific survival (DSS). METHODS We retrospectively studied adult patients with DTC from a Dutch university hospital. Patients were classified using the risk classification described in the British, Dutch, French, Italian, Polish, Spanish, European Society of Medical Oncology, European Thyroid Association, and 2009 and 2015 American Thyroid Association (ATA) guidelines, and the latest TNM system. DSS was analyzed using the Kaplan-Meier method, and the statistical model performance using the C-index, AIC, BIC and PVE. RESULTS We included 857 patients with DTC (79% PTC, 21% FTC). Median follow-up was 9 years, and 67 (7.8%) died due to DTC. The Dutch guideline had the worst statistical model performance, while the 2009 ATA/2014 British guideline had the best. However, the (adapted) TNM system outperformed all stratification systems. CONCLUSIONS In a European population of patients with DTC, out of ten International guidelines employing six risk of recurrence stratification systems and one mortality based stratification system, our optimized age-adjusted TNM system (8th edition) outperformed all other systems.
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Affiliation(s)
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine
| | - Merel T Stegenga
- Academic Center for Thyroid Diseases, Department of Internal Medicine
| | | | - Tessa M van Ginhoven
- Erasmus MC Cancer Institute, Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands
| | - Mathé van Balkum
- Academic Center for Thyroid Diseases, Department of Internal Medicine
| | - Frederik A Verburg
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 CE, Rotterdam, The Netherlands
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine
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Sun JH, Li YR, Chang KH, Liou MJ, Lin SF, Tsai SS, Yu MC, Hsueh C, Chen ST. Evaluation of recurrence risk in patients with papillary thyroid cancer through tumor-node-metastasis staging: A single-center observational study in Taiwan. Biomed J 2022; 45:923-930. [PMID: 34808423 PMCID: PMC9795347 DOI: 10.1016/j.bj.2021.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/08/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Many patients with papillary thyroid cancer (PTC) demonstrate satisfactory outcomes. However, 8%-28% of patients with PTC show tumor recurrence, which may affect prognosis. Therefore, identifying factors associated with tumor recurrence in patients with PTC may be helpful to refine therapeutic strategies. METHODS To identify factors associated with PTC recurrence, we retrospectively reviewed demographic features (sex and age), operation method, image character, serum thyroglobulin (Tg), accumulated radioactive iodine (I-131) therapeutic dose, I-131 uptake, and metastases at diagnosis in 829 patients with PTC. Patients were grouped into early (stage I and II; n = 698) and advanced (stage III and IV; n = 131) tumor-node-metastasis (TNM) stages. Recurrence rate, mortality rate, risk factors of recurrence, recurrent free survival and overall survival curve were compared between two groups. RESULTS Patients in the early stage demonstrated a lower recurrence rate (7.2%) than did those in the advanced stage (28.2%, p < 0.05). The mortality rate of patients with recurrence in the advanced stage was higher than that of those in the early stage (51.4% vs. 12.0%). The major impact factors on tumor recurrence in early TNM stage were distant metastasis and lymph node metastasis, while in advanced TNM stage were distant metastasis, male gender, total thyroidectomy with limited lymph node dissection, and a high serum Tg level. CONCLUSIONS Strategies to monitor tumor recurrence might be refined according to the TNM stages of PTC patients.
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Affiliation(s)
- Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yan-Rong Li
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kuo-Hsuan Chang
- Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Miaw-Jene Liou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Fu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Sung-Sheng Tsai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,Corresponding author. Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
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Mao Y, Huang Y, Xu L, Liang J, Lin W, Huang H, Li L, Wen J, Chen G. Surgical Methods and Social Factors Are Associated With Long-Term Survival in Follicular Thyroid Carcinoma: Construction and Validation of a Prognostic Model Based on Machine Learning Algorithms. Front Oncol 2022; 12:816427. [PMID: 35800057 PMCID: PMC9253987 DOI: 10.3389/fonc.2022.816427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/19/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study aimed to establish and verify an effective machine learning (ML) model to predict the prognosis of follicular thyroid cancer (FTC), and compare it with the eighth edition of the American Joint Committee on Cancer (AJCC) model.MethodsKaplan-Meier method and Cox regression model were used to analyze the risk factors of cancer-specific survival (CSS). Propensity-score matching (PSM) was used to adjust the confounding factors of different surgeries. Nine different ML algorithms,including eXtreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LightGBM), Random Forests (RF), Logistic Regression (LR), Adaptive Boosting (AdaBoost), Gaussian Naive Bayes (GaussianNB), K-Nearest Neighbor (KNN), Support Vector Machine (SVM) and Multi-Layer Perceptron (MLP),were used to build prognostic models of FTC.10-fold cross-validation and SHapley Additive exPlanations were used to train and visualize the optimal ML model.The AJCC model was built by multivariate Cox regression and visualized through nomogram. The performance of the XGBoost model and AJCC model was mainly assessed using the area under the receiver operating characteristic (AUROC).ResultsMultivariate Cox regression showed that age, surgical methods, marital status, T classification, N classification and M classification were independent risk factors of CSS. Among different surgeries, the prognosis of one-sided thyroid lobectomy plus isthmectomy (LO plus IO) was the best, followed by total thyroidectomy (hazard ratios: One-sided thyroid LO plus IO, 0.086[95% confidence interval (CI),0.025-0.290], P<0.001; total thyroidectomy (TT), 0.490[95%CI,0.295-0.814], P=0.006). PSM analysis proved that one-sided thyroid LO plus IO, TT, and partial thyroidectomy had no significant differences in long-term prognosis. Our study also revealed that married patients had better prognosis than single, widowed and separated patients (hazard ratios: single, 1.686[95%CI,1.146-2.479], P=0.008; widowed, 1.671[95%CI,1.163-2.402], P=0.006; separated, 4.306[95%CI,2.039-9.093], P<0.001). Among different ML algorithms, the XGBoost model had the best performance, followed by Gaussian NB, RF, LR, MLP, LightGBM, AdaBoost, KNN and SVM. In predicting FTC prognosis, the predictive performance of the XGBoost model was relatively better than the AJCC model (AUROC: 0.886 vs. 0.814).ConclusionFor high-risk groups, effective surgical methods and well marital status can improve the prognosis of FTC. Compared with the traditional AJCC model, the XGBoost model has relatively better prediction accuracy and clinical usage.
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Affiliation(s)
- Yaqian Mao
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yanling Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Lizhen Xu
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jixing Liang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Wei Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Huibin Huang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Liantao Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Junping Wen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Gang Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Analysis, Fujian Academy of Medical, Fuzhou, China
- *Correspondence: Gang Chen,
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Dhanani R, Faisal M, Akram M, Shakeel O, Zahid MT, Hassan A, Hussain R. Differentiated Thyroid Carcinoma: Distant Metastasis as an Unusual Sole Initial Manifestation. Turk Arch Otorhinolaryngol 2021; 59:188-192. [PMID: 34713003 PMCID: PMC8527540 DOI: 10.4274/tao.2021.2021-2-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/25/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: The objective of this study was to identify the characteristic features of patients with distant metastasis as the only manifestation of well-differentiated thyroid cancers and to analyze the treatment outcomes Methods: A retrospective review of all patients with well-differentiated thyroid cancers and distant metastasis as the sole initial presentation was carried out. Data regarding age, gender, tumor histology, site, symptoms, and treatment outcomes were collected. Results: There were 10 patients who presented with distant metastasis as the only presentation. The mean age was 56.1 years. Eight (80%) patients had osseous metastasis, one (10%) had pulmonary and one (10%) had both. Follicular thyroid carcinoma was more common and seen in six (60%) patients. Seven (77.8%) out of nine patients had demised within five years of initial presentation. Conclusion: Distant metastases without a neck lump as the initial presentation of well-differentiated thyroid cancers are extremely rare. No specific guidelines are available to manage such patients due to lack of relevant data in the literature.
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Affiliation(s)
- Rahim Dhanani
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Mahir Akram
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Osama Shakeel
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muhammad Toqeer Zahid
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Aamna Hassan
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
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Risk factors for posttreatment recurrence in patients with intermediate-risk papillary thyroid carcinoma. Am J Surg 2020; 220:642-647. [PMID: 32035626 DOI: 10.1016/j.amjsurg.2020.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/18/2020] [Accepted: 01/26/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is generally associated with favorable outcomes; however, intermediate-risk requires further evaluation. We therefore examined risk factors for posttreatment recurrence in patients with intermediate-risk PTC. METHODS This study involved 1782 patients who underwent thyroidectomy for intermediate-risk PTC. Univariate and multivariate Cox proportional hazard regression analyses were used to identify the significant factors predictive of posttreatment recurrence-free survival (RFS). RESULTS Of intermediate-risk factors, univariate analyses showed that clinical and pathological cervical lymph node (LN) positivity (cN1 and pN1), aggressive histology, and multifocality with microscopic extrathyroidal extension were significantly associated with RFS outcomes (all P < 0.05). In multivariate analyses, cN1, >5 pN1, and posttreatment radioactive iodine (RAI)-avid metastatic foci of intermediate risk remained the independent factors predictive of RFS (all P < 0.05). The combination of any three or more of these intermediate-risk factors appeared to increase the posttreatment recurrence rate. CONCLUSION Clinical nodal positivity, the number of positive LNs, and the presence of RAI-avid metastatic foci in the ATA intermediate-risk category might independently decrease RFS in patients with intermediate-risk PTC.
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Low-Dose Radioactive Iodine Ablation Is Sufficient in Patients With Small Papillary Thyroid Cancer Having Minor Extrathyroidal Extension and Central Lymph Node Metastasis (T3 N1a). Clin Nucl Med 2018; 42:842-846. [PMID: 28832376 DOI: 10.1097/rlu.0000000000001812] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of low-dose radioactive iodine (RAI) ablation in patients with small papillary thyroid cancer (PTC) exhibiting microscopic extrathyroidal extension (mETE) and central lymph node (CLN) metastasis. METHODS Among patients who underwent RAI ablation between March 2007 and February 2014, those who had small PTCs (≤2 cm), as well as mETE and CLN metastasis (T3 N1a M0), were enrolled. Response to ablation and long-term outcomes were assessed and compared according to the administered RAI dose. Factors associated with unsuccessful ablation were also determined. RESULTS A total of 180 patients were included in the study. Eighty-eight patients had been treated with 1110 MBq (low-dose group) and 92 with 2960 MBq (high-dose group) of RAI. There were no significant differences in the responses to ablation (P = 0.810) and long-term outcomes (P = 0.663) between both groups. Among all patients enrolled, 13 did not achieve successful ablation at long-term follow-up. Logistic regression found that a high ratio of metastatic nodes was a significant factor for predicting unsuccessful ablation. CONCLUSIONS Low-dose RAI ablation did not produce significantly different responses or long-term outcomes in patients with small PTCs exhibiting mETE and CLN metastasis. These findings suggest that low-dose ablation may be sufficient in this specific group of intermediate-risk patients, although careful selection is required for patients with a high ratio of metastatic nodes.
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Jeon MJ, Kim WG, Kim TH, Kim HK, Kim BH, Yi HS, Kim ES, Kim H, Kim YN, Kim EH, Kim TY, Kim SW, Kang HC, Chung JH, Shong YK, Kim WB. Disease-Specific Mortality of Differentiated Thyroid Cancer Patients in Korea: A Multicenter Cohort Study. Endocrinol Metab (Seoul) 2017; 32:434-441. [PMID: 29199400 PMCID: PMC5744729 DOI: 10.3803/enm.2017.32.4.434] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/19/2017] [Accepted: 09/15/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known regarding disease-specific mortality of differentiated thyroid cancer (DTC) patients and its risk factors in Korea. METHODS We retrospectively reviewed a large multi-center cohort of thyroid cancer from six Korean hospitals and included 8,058 DTC patients who underwent initial surgery between 1996 and 2005. RESULTS Mean age of patients at diagnosis was 46.2±12.3 years; 87% were females. Most patients had papillary thyroid cancer (PTC; 97%) and underwent total thyroidectomy (85%). Mean size of the primary tumor was 1.6±1.0 cm. Approximately 40% of patients had cervical lymph node (LN) metastases and 1.3% had synchronous distant metastases. During 11.3 years of follow-up, 150 disease-specific mortalities (1.9%) occurred; the 10-year disease-specific survival (DSS) rate was 98%. According to the year of diagnosis, the number of disease-specific mortality was not different. However, the rate of disease-specific mortality decreased during the study period (from 7.7% to 0.7%). Older age (≥45 years) at diagnosis, male, follicular thyroid cancer (FTC) versus PTC, larger tumor size (>2 cm), presence of extrathyroidal extension (ETE), lateral cervical LN metastasis, distant metastasis and tumor node metastasis (TNM) stage were independent risk factors of disease-specific mortality of DTC patients. CONCLUSION The rate of disease-specific mortality of Korean DTC patients was 1.9%; the 10-year DSS rate was 98% during 1996 to 2005. Older age at diagnosis, male, FTC, larger tumor size, presence of ETE, lateral cervical LN metastasis, distant metastasis, and TNM stages were significant risk factors of disease-specific mortality of Korean DTC patients.
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Affiliation(s)
- Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyon Seung Yi
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Eun Sook Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hosu Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Endocrinology, Department of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Young Nam Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Heui Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Association of tumor size and focality with recurrence/persistence in papillary thyroid cancer patients treated with total thyroidectomy along with radioactive-iodine ablation and TSH suppression. Updates Surg 2017; 70:121-127. [PMID: 28550398 DOI: 10.1007/s13304-017-0465-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/07/2017] [Indexed: 01/26/2023]
Abstract
Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was <1 cm; (unifocal n = 16 and multifocal PTMC n = 23). The primary endpoint is recurrence and tumor free survival in each of the four groups. Secondary endpoint is an assessment of a benefit of completion total thyroidectomy in terms of assignment of true focal status to an individual's PTC. The median follow-up was 4.1 years. Upon completion thyroidectomy, the tumor focality changed to multifocal in 31.4% of macro-PTC and 60% of micro-PTMC. Multifocality was an independent risk factor for recurrence, OR 2.41 for macro (CI 1.14-5.11), and 3.48 for micro-multifocal PTMC (CI 1.19-10.2). Disease free survival patterns on Kaplan-Meier's plots were alike for micro- and macro-unifocal groups, and similarly stayed comparable among the two multifocal groups. Our analysis showed that tumor multifocality rather than size is the significant factor determining prognosis; hence, total thyroidectomy is indicated for an optimal assessment of true focality in micro-PTC.
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Hassan A, Riaz S, Bashir H, Nawaz MK, Hussain R. Can the American Thyroid Association Risk of Recurrence Predict Radioiodine Refractory Disease in Differentiated Thyroid Cancer? Eur Thyroid J 2016; 5:261-267. [PMID: 28101491 PMCID: PMC5216185 DOI: 10.1159/000448920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/29/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare the TNM staging system and the American Thyroid Association (ATA) recurrence risk classification in predicting radioiodine refractory disease (RRD) in differentiated thyroid cancer (DTC) and to analyze the correlation of stimulated thyroglobulin (Tg) levels and rate of Tg elevation with the standardized uptake value on 18F-fludeoxyglucose (FDG) PET/CT scan. METHODS RRD was indicated through the retrospective analysis of consecutive 18F-FDG PET/CT scans in DTC with stimulated Tg >10 ng/ml and negative 131I NaI whole-body scans (WBS). Tg elevation velocity was compared to the likelihood of a positive scan. The ATA recurrence risk and TNM staging system were compared to see which of them better predicted the subsequent development of RRD. RESULTS Fifty-eight of 636 subjects developed RRD: 52 papillary and 6 follicular thyroid cancer. The median time between diagnosis and a negative WBS was 24 months (range 12-240). RRD developed in 11 low-risk, 32 intermediate-risk and 15 high-risk patients. A better response to therapy was seen in the low-risk versus the intermediate- and high-risk groups. 18F-FDG PET/CT scans had a diagnostic accuracy of 94.8%, sensitivity of 97.7%, specificity of 85.7%, positive predictive value of 95.6% and negative predictive value of 92%. There was no correlation between the Tg level or rate of rise and a positive scan. Overall, PET-CT upstaged 18 (31%) cases, leading to a change in management in 20 (35%) cases. CONCLUSION The TNM and ATA staging systems show no significant difference in predicting the development of RRD. RRD is less likely in stage I, II and low-risk patients. There is no correlation between the level or rate of Tg rise and a positive 18F-FDG PET/CT scan.
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Affiliation(s)
- Aamna Hassan
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
- *Dr. Aamna Hassan, MBBS, MD, CCD, Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and, Research Centre, 7-A, Block R-3, Johar Town, Lahore 54000 (Pakistan), E-Mail
| | - Saima Riaz
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Humayun Bashir
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - M. Khalid Nawaz
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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