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Lei L, Hong Qing S, Wei L, Ma Mo Yang F, Xiao Xiang Y. The Combined Use of Fine-Needle Aspiration (FNA) and BRAF V600E Gene Testing: Can it Increase the Definitive Diagnosis Rate of Nodules Categorized as Bethesda III for Papillary Thyroid Carcinoma? Am Surg 2024:31348241265143. [PMID: 39047144 DOI: 10.1177/00031348241265143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This study aimed to analyze the malignant probability of thyroid nodules diagnosed as indeterminate cytology, including atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), and investigate the diagnostic value of combining BRAF V600E gene testing within this classification. METHODS We conducted a retrospective analysis of 126 patients who underwent fine-needle aspiration (FNA) examination of thyroid nodules and subsequent surgical treatment at Beijing Haidian Hospital between October 2021 and November 2022. Among them, there were 22 male and 104 female patients, aged between 18 and 75 years old. Surgical pathology results were considered the gold standard for diagnosing the nature of thyroid nodules, evaluating the malignant incidence of cytological results categorized as AUS/FLUS. Fisher's exact test and diagnostic test evaluation methods were used to analyze the discriminatory diagnostic efficacy of preoperative FNA combined with BRAF V600E gene testing for papillary thyroid carcinoma (PTC). Statistical analysis was performed using SPSS 22.0 software. RESULTS In PTC patients, the BRAF V600E gene mutation rate was 87.93% (102/116). Within the category of FNA results as AUS/FLUS, the proportion of PTC was 60.00% (15/25). The specificity, sensitivity, positive predictive value, and negative predictive value of the BRAF V600E gene mutation in diagnosing PTC within the AUS/FLUS category were 10/10, 6/15, 6/6, and 10/19, respectively. The BRAF V600E gene mutation significantly increased the detection rate of PTC in patients classified under this cytology (P = 0.028, <0.05). CONCLUSION Preoperative FNA combined with BRAF V600E gene mutation testing significantly enhances the malignant detection rate of thyroid nodules diagnosed cytologically as AUS/FLUS. This combined approach provides a potent tool to improve diagnostic accuracy in this indeterminate classification.
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Affiliation(s)
- Lu Lei
- Department of Breast and Thyroid Surgery, Beijing Haidian Hospital, Beijing, China
| | - Shang Hong Qing
- Department of Breast and Thyroid Surgery, Beijing Haidian Hospital, Beijing, China
| | - Li Wei
- Department of Breast and Thyroid Surgery, Beijing Haidian Hospital, Beijing, China
| | - Fu Ma Mo Yang
- Department of Breast and Thyroid Surgery, Beijing Haidian Hospital, Beijing, China
| | - Yao Xiao Xiang
- Department of Pathology, Beijing Haidian Hospital, Beijing, China
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Pałyga I, Rumian M, Kosel A, Albrzykowski M, Krawczyk P, Kalwat A, Gąsior-Perczak D, Walczyk A, Kuchareczko A, Kopczyński J, Chrapek M, Góźdź S, Kowalska A. The Frequency of Differentiated Thyroid Cancer Recurrence in 2302 Patients With Excellent Response to Primary Therapy. J Clin Endocrinol Metab 2024; 109:e569-e578. [PMID: 37768152 DOI: 10.1210/clinem/dgad571] [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] [Received: 06/01/2023] [Revised: 08/18/2023] [Accepted: 09/27/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT Discrepant data on the recurrence rate of differentiated thyroid cancer (DTC) are reported. OBJECTIVE To evaluate the frequency and risk factors of true recurrence in DTC patients with excellent responses (ExR) to initial therapy. METHODS A retrospective analysis of the 2302 consecutive DTC patients with ExR to primary therapy, treated during 24 years at single center. The percentage of recurrence and cumulative recurrence rate (CRR) were analyzed. Risk factors for recurrence for patients with papillary thyroid cancer (PTC) were investigated and methods for establishing a diagnosis of recurrence were evaluated. RESULTS Of DTC patients, 32 (1.4%) experienced recurrence. PTC patients with recurrence were more likely to have younger age (P = .0182), larger tumor size (P = .0013), lymph node metastases (P = .0013), incomplete resection (P = .0446), higher ATA risk (P = .0002), and had more frequently been treated with 131I (P = .0203). CRRs at 5, 10, 15, 20, and 24 years after surgery were 1.2%, 1.9%, 2.5%, 2.9%, and 2.9%, respectively. The CRRs according to histological type were highest for poorly differentiated thyroid cancer (PDTC), lower for oncocytic (OTC) and follicular thyroid cancer (FTC), and lowest for PTC. Most recurrences occurred within the first 5 years of observation. The most effective method for detecting local recurrence was ultrasonography with fine needle aspiration cytology, and for distant metastases, 18F-FDG PET. CONCLUSION True recurrence is rare in DTC patients. PTC patients with ExR to primary therapy and N0/Nx can be dismissed from oncological follow-up. Despite ExR to primary therapy, DTC patients with N1, and PDTC, OTC, FTC should remain under oncological follow-up.
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Affiliation(s)
- Iwona Pałyga
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Maciej Rumian
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Alicja Kosel
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | | | - Paulina Krawczyk
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Agata Kalwat
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
| | - Danuta Gąsior-Perczak
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Agnieszka Walczyk
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Artur Kuchareczko
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Janusz Kopczyński
- Department of Pathology, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Magdalena Chrapek
- Department of Mathematics, Faculty of Natural Sciences, Jan Kochanowski University, Kielce 25-406, Poland
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Department of Clinical Oncology, Holycross Cancer Centre, Kielce 25-734, Poland
| | - Aldona Kowalska
- Collegium Medicum, Jan Kochanowski University, Kielce 25-317, Poland
- Endocrinology Clinic, Holycross Cancer Centre, Kielce 25-734, Poland
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Lin Y, Wu ZR, Shi YP, Ding M, Tang XY, He Y, Zhai B, Li P. Radiofrequency Ablation of Unifocal Papillary Thyroid Microcarcinoma With BRAF V600E Mutation. J Clin Endocrinol Metab 2023; 108:e1298-e1305. [PMID: 37220176 DOI: 10.1210/clinem/dgad269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Indexed: 05/25/2023]
Abstract
CONTEXT To date there is no study on the feasibility of radiofrequency ablation (RFA) for papillary thyroid microcarcinomas (PTMCs) with BRAF V600E mutation. OBJECTIVE This study was designed to evaluate the efficiency, safety, and prognosis of ultrasound (US)-guided percutaneous RFA for unifocal PTMCs with BRAF V600E mutation. MATERIALS AND METHODS Sixty patients with 60 unifocal BRAF V600E mutation-positive PTMCs who received US-guided RFA between January 2020 and December 2021 were retrospectively analyzed. The mean maximum PTMC tumor diameter was 5.8 ± 1.7 mm (range, 2.5-10.0 mm). All PTMCs were pathologically confirmed by fine needle aspiration or core needle biopsy, and BRAF V600E mutation was confirmed to be positive by real-time fluorescent quantitative polymerase chain reaction. Contrast-enhanced ultrasound (CEUS) was performed immediately after RFA to evaluate whether PTMCs were extendedly ablated. Ultrasound was performed 1, 3, 6, and 12 months after RFA and every 6 months thereafter to evaluate the changes in the ablation zone, local recurrence, and cervical lymph node metastasis (LNM). The complications were recorded and evaluated. RESULTS Extended ablation was achieved in all enrolled patients. The ablation zone sizes increased immediately after RFA compared with those of tumors before treatment. One month later, the ablation zone sizes were smaller than immediately after RFA. At the last follow-up assessment, 42 nodules (70.0%) completely disappeared and the ablation zones of 18 nodules (30.0%) showed fissure-like changes. No local recurrence or cervical LNM was detected. Voice change (1.7%) was the only major complication. CONCLUSION RFA is effective and safe in treating unifocal PTMCs with BRAF V600E mutation, especially when surgery is not feasible or refused by patients who are unwilling to continue active surveillance.
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Affiliation(s)
- Yan Lin
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Zhao-Rong Wu
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yao-Ping Shi
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Min Ding
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Xiao-Yin Tang
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Yi He
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
| | - Ping Li
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People's Republic of China
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Kılınc E, Gunes P, Doganer A. TROP2 is a Good Indicator for Infiltrative Nature of Carcinoma Rather than Diagnosing Malignancy in Thyroid. Indian J Otolaryngol Head Neck Surg 2022; 74:2560-2568. [PMID: 36452626 PMCID: PMC9702226 DOI: 10.1007/s12070-020-02275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/09/2020] [Indexed: 11/28/2022] Open
Abstract
TROP2 is a glycoprotein which is expressed in carcinomas rather than normal tissues and associated with poor prognosis. Immunohistohemical TROP2 staining was determined to be useful for diagnosing papillary thyroid carcinoma (PTC). In this study, we aimed to find out relationship between TROP-2 expression and the diagnosis of PTC, and clinico pathological parameters. This retrospective study was conducted on 270 cases (145 malignant and 124 benign). All histopathological parameters were re-evaluated blindly. We used 3 different scores for positivity for TROP2 expression (TES: Total estimation score, 5%, IRS:Immunoreactive score). Sensitivity was respectively according to TES, 5%and IRS; 55.5%, 54.1%, 51.4%. Specificity was 98.4% in all different scores. TROP2 positivity was correlated with older age in 5% score and TES. Absence of encapsulation, presence of infiltrating spreading, perineural invasion, extra thyroidal extension, tall cell and/or hobnail differentiation were associated with TROP2 expression in three different scores. Presence of lymphatic invasion was correlated with TROP2 positivity in 5% score and IRS. TROP2 expression was inversely proportional to follicular variant PTC and tumour size in 5% score. TROP-2 is a marker for aggressive behaviour rather than detecting malignancy, but if it stained and not malignant, it may also have potential for determining precursor lesion that demands further studies. Additionally, in 3 different scores, TES was most sensitive, but most variable that had correlation with TROP2 was seen at 5% score.
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Affiliation(s)
- E. Kılınc
- Pathology Department, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - P. Gunes
- Pathology Department, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - A. Doganer
- Biostatistics Department, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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Risk and Prognostic Factors for BRAFV600E Mutations in Papillary Thyroid Carcinoma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9959649. [PMID: 35647194 PMCID: PMC9132653 DOI: 10.1155/2022/9959649] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/20/2022] [Indexed: 12/29/2022]
Abstract
Background Over the past ten years, the incidence rate of papillary thyroid carcinoma (PTC) worldwide has been increasing rapidly year by year, with the incidence rate increasing 6% annually. PTC has become the malignant tumor with the highest growth rate in the world that fourteen PTC-related mutant genes have been identified. Whether the BRAFV600E mutation related to more aggressive clinicopathologic features and worse outcome in PTC remains variable and controversial. We aim to investigate the risk factors that may predict the BRAFV600E mutation potential of these lesions and new prevention strategies in PTC patients. Methods A total of 9,908 papillary thyroid carcinoma patients with average 74.6% BRAFV600E mutations were analyzed (RevMan 5.3 software) in this study. The PubMed, Embase, and ISI Web of Science databases were systematically searched for works published through December 15, 2021. Results The following variables were associated with an increased risk of BRAFV600E mutation in PTC patients: age ≥ 45 years (OR = 1.39, 95%CI = 1.21–1.60, p < 0.00001), male gender (OR = 1.13, 95%CI = 0.99–1.28, p = 0.06), multifocality (OR = 1.22, 95%CI = 1.07–1.40, p = 0.004), lymph node metastasis (OR = 1.33, 95%CI = 0.79–2.23, p = 0.28), extrathyroidal extension + (OR = 1.61, 95%CI = 1.06–2.44, p = 0.03), vascular invasion + (OR = 2.04, 95%CI = 1.32–3.15, p = 0.001), and tumor node metastasis stage (OR = 1.61, 95%CI = 1.38–1.88, p < 0.00001). In addition, tumor size (>1 cm) (OR = 0.51, 95%CI = 0.32–0.81, p = 0.005) and distant metastasis (OR = 0.69, 95%CI = 0.22–2.21, p = 0.54) had no association or risk with BRAFV600E mutation in PTC patients. Conclusion Our systematic review identified the following significant risk factors of BRAFV600E mutation in PTC patients: age (≥45 years), gender (male), multifocality, lymph node metastasis, vascular invasion, extrathyroidal extension, and advanced tumor node metastasis stage (stages III and IV). Tumor size (>1 cm) and distant metastasis do not appear to be correlated with BRAFV600E mutation in PTC patients.
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Liu L, Shi Y, Lai Q, Huang Y, Jiang X, Liu Q, Huang Y, Xia Y, Xu D, Jiang Z, Tu W. Construction of a Signature Model to Predict the Radioactive Iodine Response of Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2022; 13:865909. [PMID: 35634509 PMCID: PMC9132198 DOI: 10.3389/fendo.2022.865909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/28/2022] [Indexed: 12/04/2022] Open
Abstract
Papillary thyroid cancer (PTC) accounts for about 90% of thyroid cancer. There are approximately 20%-30% of PTC patients showing disease persistence/recurrence and resistance to radioactive iodine (RAI) treatment. For these PTC patients with RAI refractoriness, the prognosis is poor. In this study, we aimed to establish a comprehensive prognostic model covering multiple signatures to increase the predictive accuracy for progression-free survival (PFS) of PTC patients with RAI treatment. The expression profiles of mRNAs and miRNAs as well as the clinical information of PTC patients were extracted from TCGA and GEO databases. A series of bioinformatics methods were successfully applied to filtrate a two-RNA model (IPCEF1 and hsa-mir-486-5p) associated with the prognosis of RAI-therapy. Finally, the RNA-based risk score was calculated based on the Cox coefficient of the individual RNA, which achieved good performances by the time-dependent receiver operating characteristic (tROC) curve and PFS analyses. Furthermore, the predictive power of the nomogram, integrated with the risk score and clinical parameters (age at diagnosis and tumor stage), was assessed by tROC curves. Collectively, our study demonstrated high precision in predicting the RAI response of PTC patients.
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Affiliation(s)
- Lina Liu
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Yuhong Shi
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Qian Lai
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| | - Yuan Huang
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
| | - Xue Jiang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Qian Liu
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Ying Huang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Yuxiao Xia
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Dongkun Xu
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Zhiqiang Jiang
- Department of General Surgery, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Wenling Tu
- Department of Nuclear Medicine, the Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
- School of Bioscience and Technology, Chengdu Medical College, Chengdu, China
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Zhang WB, Deng WF, Mao L, He BL, Liu H, Chen J, Liu Y, Qi TY. Comparison of diagnostic value of SWE, FNA and BRAF gene detection in ACR TI-RADS 4 and 5 thyroid nodules. Clin Hemorheol Microcirc 2022; 81:13-21. [PMID: 35068450 DOI: 10.3233/ch-211280] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES: To compare the diagnostic value of shear wave elastography (SWE), fine needle aspiration (FNA) and BRAF gene detection (BRAFV600E gene mutation detection) in ACR TI-RADS 4 and 5 thyroid nodules. METHODS: SWE images, FNA cytological results and BRAF detection results of ACR TI-RADS 4 and 5 thyroid nodules confirmed by pathology were analyzed retrospectively. The receiver operating characteristic (ROC) curve was drawn to determine the best cutoff value of SWE Emax. In the combined diagnosis of SWE, FNA and BRAF, firstly, the nodules with BRAF gene mutation were included in the positive ones, secondly, the nodules with benign and malignant FNA were included in the FNA + SWE or FNA + SWE + BRAF negative and positive ones respectively, finally, for FNA uncertain nodules: those whose SWE Emax were less than or equal to the cutoff value were included in FNA + SWE or FNA + SWE + BRAF negative ones, and those whose SWE Emax were greater than the cutoff value were included in positive ones. The diagnostic efficacy of SWE, FNA, SWE + FNA, FNA + BRAF and their combination in ACR TI-RADS 4 and 5 thyroid nodules were compared. RESULTS: The ROC curve showed that the best cutoff value of SWE Emax was 40.9 kpa, and the area under ROC curve (AUC) was 0.842 (0.800∼0.885). The sensitivity, specificity and accuracy of SWE were 76.3% (270/354), 75.5% (80/106) and 76.1% (350/460), respectively. The sensitivity, specificity and accuracy of FNA were 58.2% (206/354), 88.7% (94/106) and 65.2(300/460), respectively. The sensitivity, specificity and accuracy of FNA + BRAF were 95.5% (338/354), 88.7% (94/106) and 93.9% (432/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA were 85.9% (304/354), 98.1% (104/106) and 88.7% (408/460), respectively. The sensitivity, specificity and accuracy of SWE + FNA + BRAF were 98.3% (348/354), 98.1% (104/106) and 98.3% (452/460), respectively. For the diagnostic accuracy, SWE + FNA + BRAF > FNA + BRAF > FNA + SWE > SWE > FNA, the difference was statistically significant (all P > 0.05). CONCLUSIONS: For ACR TI-RADS 4 and 5 thyroid nodules, SWE and FNA have high diagnostic efficiency. For the diagnostic accuracy, FNA + BRAF is better than FNA + SWE. FNA combination with BRAF gene detection further improves the diagnostic sensitivity and accuracy of FNA. The combined application of the three is the best.
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Affiliation(s)
- Wei-Bing Zhang
- Department of Medical Ultrasound, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China
| | - Wen-Fang Deng
- Department of Surgery, Subei people’s Hospital of Jiangsu Province, Yangzhou, China
| | - Lun Mao
- Department of Medical Ultrasound, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China
| | - Bei-Li He
- Department of Medical Ultrasound, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China
| | - Hua Liu
- Department of Medical Ultrasound, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China
| | - Jian Chen
- Department of Medical Ultrasound, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China
| | - Yu Liu
- Department of Medical Ultrasound, Jiangsu Provincial Corps Hospital, Chinese People’s Armed Police Forces, Yangzhou, China
| | - Ting-Yue Qi
- Department of Ultrasound, Medical Imaging Center, Affiliated Hospital of Yangzhou University, Yangzhou, China
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Pérez-Fernández L, Sastre J, Zafón C, Oleaga A, Castelblanco E, Capel I, Galofré JC, Guadalix-Iglesias S, De la Vieja A, Riesco-Eizaguirre G. Validation of dynamic risk stratification and impact of BRAF in risk assessment of thyroid cancer, a nation-wide multicenter study. Front Endocrinol (Lausanne) 2022; 13:1071775. [PMID: 36714606 PMCID: PMC9880445 DOI: 10.3389/fendo.2022.1071775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The dynamic risk stratification (DRS) is a relatively new system in thyroid cancer that considers the response to primary treatment to improve the initial risk of recurrence. We wanted to validate DRS system in a nationwide multicenter study and explore if the incorporation of BRAFV600E into DRS helps to better categorize and predict outcomes. MATERIALS AND METHODS Retrospective study of 685 patients from seven centers between 1991 and 2016, with a mean age of 48 years and a median follow-up time of 45 months (range 23-77). The overall BRAFV600E prevalence was 53.4%. We classified patients into four categories based on DRS ('excellent', 'indeterminate', 'biochemical incomplete', and 'structural incomplete' response). Cox regression was used to calculate adjusted hazard ratios (AHR) and proportions of variance explained (PVEs). RESULTS We found 21.6% recurrences and 2.3% cancer-related deaths. The proportion of patients that developed recurrence in excellent, indeterminate, biochemical incomplete and structural incomplete response to therapy was 1.8%, 54%, 91.7% and 96.2% respectively. Considering the outcome at the end of the follow up, patients showed no evidence of disease (NED) in 98.2, 52, 33.3 and 25.6% respectively. Patients in the structural incomplete category were the only who died (17.7%). Because they have similar outcomes in terms of NED and survival, we integrated the indeterminate and biochemical incomplete response into one unique category creating the 3-tiered DRS system. The PVEs of the AJCC/TNM staging, ATA risk classification, 4-tiered DRS, and 3-tiered DRS to predict recurrence at five years were 21%, 25%, 57% and 59% respectively. BRAFV600E was significantly associated with biochemical incomplete response (71.1 vs 28.9%) (HR 2.43; 95% CI, 1.21 to 5.23; p=0.016), but not with structural incomplete response or distant metastases. BRAF status slightly changes the AHR values of the DRS categories but is not useful for different risk grouping. CONCLUSIONS This is the first multicenter study to validate the 4-tiered DRS system. Our results also show that the 3-tiered DRS system, by integrating indeterminate and biochemical incomplete response into one unique category, may simplify response to therapy keeping the system accurate. BRAF status does not provide any additional benefit to DRS.
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Affiliation(s)
| | - Julia Sastre
- Department of Endocrinology, Hospital Universitario de Toledo, Toledo, Spain
| | - Carles Zafón
- Diabetes and Metabolism Research Unit (VHIR) and Department of Endocrinology, Hospital Vall d’Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Amelia Oleaga
- Department of Endocrinology and Nutrition, Basurto University Hospital, Bilbao, Spain
| | - Esmeralda Castelblanco
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, IRBLLEIDA, Lleida, Spain
| | - Ismael Capel
- Endocrinology Department, Parc Taulí Sabadell University Hospital, Sabadell Barcelona, Spain
| | - Juan C. Galofré
- Department of Endocrinology, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Antonio De la Vieja
- Endocrine Tumor Unit (UFIEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Ciber de Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Garcilaso Riesco-Eizaguirre
- Ciber de Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitario de Móstoles, Madrid, Spain
- Endocrinology Molecular Group, Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
- *Correspondence: Garcilaso Riesco-Eizaguirre,
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Lim ST, Jeon YW, Gwak H, Bae JS, Suh YJ. Nomogram for the Prediction of Biochemical Incomplete Response in Papillary Thyroid Cancer Patients. Cancer Manag Res 2021; 13:5641-5650. [PMID: 34285584 PMCID: PMC8286100 DOI: 10.2147/cmar.s320993] [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: 05/19/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To develop a nomogram for predicting biochemical incomplete response (BIR) in the dynamic risk stratification (DRS) of papillary thyroid carcinoma (PTC) patients without structural recurrence, and to investigate its validity. Patients and Methods Overall, 1705 (1005 and 700 in the training and validation cohorts, respectively) PTC patients treated with total thyroidectomy without structural recurrence were included. multivariate logistic regression analyses were performed to determine the significant predictors of BIR in the training cohort. A nomogram was subsequently constructed for BIR risk prediction. Assessments for the predictive accuracy, discrimination, and calibration of the nomogram were performed. Subsequently, internal and external validations were conducted. Results In the multivariate analysis, age, sex, lymph node metastasis site, extrathyroidal extension, and lymphovascular invasion showed significant predictive value; using these predictive factors and tumor size, a nomogram for BIR risk prediction was constructed. In the training cohort, the nomogram showed good predictive performance and discrimination in the receiver operating characteristic (ROC) curve analysis, with an area under the curve (AUC) of 0.765. In internal validation, the bootstrap-corrected AUC was 0.76. The calibration plot showed good agreement between the predicted and actual observation. The Hosmer-Lemeshow (HL) test did not suggest a lack of fit (p=0.1613). In the external validation, the AUC was 0.828 in the ROC curve analysis; the calibration plot showed good quality, and the HL test did not suggest a lack of fit (p=0.2161). Conclusion The constructed nomogram may effectively predict the risk of BIR in DRS in PTC patients without structural recurrence. Level of Evidence Level 4.
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Affiliation(s)
- Seung Taek Lim
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ye Won Jeon
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hongki Gwak
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ja Seong Bae
- Division of Thyroid Surgical Oncology, Department of Surgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young Jin Suh
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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10
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Zhu J, Li X, Zhang S, Liu J, Yao X, Zhao Q, Kou B, Han P, Wang X, Bai Y, Zheng Z, Xu C. Taraxasterol inhibits TGF-β1-induced epithelial-to-mesenchymal transition in papillary thyroid cancer cells through regulating the Wnt/β-catenin signaling. Hum Exp Toxicol 2021; 40:S87-S95. [PMID: 34219514 DOI: 10.1177/09603271211023792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Taraxasterol (TAR) is a kind of active compound extracted from dandelion and its molecular structure resembles steroid hormones. Recently, TAR has been reported to show an anti-tumor activity. However, the specific role of TAR in papillary thyroid cancer (PTC) has not been clarified. In this study, we investigated the effect of TAR on PTC cell migration, invasion and epithelial-to-mesenchymal transition (EMT) induced by TGF-β1. PTC cells were exposed to TGF-β1 (5 ng/mL) and then treated with different concentrations of TAR. We found that TAR showed no obvious cytotoxicity below 10 μg/mL but notably reduced migration and invasion of TGF-β1-treated PTC cells. Moreover, TAR treatment decreased MMP-2 and MMP-9 levels, and obviously affected the expression of EMT markers. We also observed that Wnt3a and β-catenin levels were significantly increased in TGF-β1-treated PTC cells while TAR inhibited these effects in a concentration-dependent manner. Additionally, activation of the Wnt pathway by LiCl attenuated the suppressive effect of TAR on TGF-β1-induced migration, invasion and EMT in PTC cells. Taken together, we highlighted that TAR could significantly suppress TGF-β1-regulated migration and invasion by reversing the EMT process via the Wnt/β-catenin pathway, suggesting that TAR may be a potential anti-cancer agent for PTC treatment.
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Affiliation(s)
- J Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of General Surgery, Shaanxi Tumor Hospital, Xi'an, China
| | - X Li
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - S Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - J Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - X Yao
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Q Zhao
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - B Kou
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - P Han
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - X Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Y Bai
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Z Zheng
- The Third Ward of Department of General Surgery, Rizhao People's Hospital, Rizhao, China
| | - C Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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11
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Soares P, Póvoa AA, Melo M, Vinagre J, Máximo V, Eloy C, Cameselle-Teijeiro JM, Sobrinho-Simões M. Molecular Pathology of Non-familial Follicular Epithelial-Derived Thyroid Cancer in Adults: From RAS/BRAF-like Tumor Designations to Molecular Risk Stratification. Endocr Pathol 2021; 32:44-62. [PMID: 33651322 DOI: 10.1007/s12022-021-09666-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2021] [Indexed: 12/24/2022]
Abstract
This review addresses the impact of molecular alterations on the diagnosis and prognosis of differentiated thyroid carcinoma (DTC), including papillary, follicular, and well-differentiated carcinoma NOS, as well as oncocytic neoplasms. The molecular characterization of DTC is based upon the well-established dichotomy of BRAF-like and RAS-like designations, together with a remaining third group, less homogeneous, composed of non-BRAF-/non-RAS-like tumors. The role of BRAF V600E mutation in risk stratification is discussed in the clinico-pathological context, namely, staging and invasive features of classic papillary thyroid carcinoma (PTC) and histopathological variants carrying an excellent prognosis (microPTC) or a guarded prognosis, including the aggressive variants tall cell and hobnail cell PTCs. In follicular patterned tumors, namely, follicular thyroid carcinoma (FTC), with or without oncocytic features, the most prevalent molecular alteration are RAS mutations that do not carry prognostic significance. The only genetic alteration that has been proven to play a role in risk stratification of PTC and FTC is TERT promoter (TERTp) mutation.
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Affiliation(s)
- Paula Soares
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal.
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal.
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal.
| | - Antónia Afonso Póvoa
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4400-129, Vila Nova de Gaia, Portugal
| | - Miguel Melo
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar Universitário de Coimbra, 3004-561, Coimbra, Portugal
| | - João Vinagre
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
| | - Valdemar Máximo
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
| | - Catarina Eloy
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
| | - José Manuel Cameselle-Teijeiro
- Department of Pathology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Galician Healthcare Service (SERGAS), University of Santiago de Compostela, 15706, Santiago de Compostela, Spain
| | - Manuel Sobrinho-Simões
- i3S - Instituto de Investigação E Inovação Em Saúde, Universidade Do Porto, 4200-135, Porto, Portugal
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4250-475, Porto, Portugal
- Faculdade de Medicina da Universidade Do Porto, 4200-139, Porto, Portugal
- Centro Hospitalar E Universitário São João, 4200-139, Porto, Portugal
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12
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Gąsior-Perczak D, Kowalik A, Gruszczyński K, Walczyk A, Siołek M, Pałyga I, Trepka S, Mikina E, Trybek T, Kopczyński J, Suligowska A, Ślusarczyk R, Gonet A, Jaskulski J, Orłowski P, Chrapek M, Góźdź S, Kowalska A. Incidence of the CHEK2 Germline Mutation and Its Impact on Clinicopathological Features, Treatment Responses, and Disease Course in Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2021; 13:cancers13030470. [PMID: 33530461 PMCID: PMC7865996 DOI: 10.3390/cancers13030470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 01/23/2023] Open
Abstract
Simple Summary The aim of our study was to evaluate whether the CHEK2 mutation was a predictor of poorer clinical course in patients with papillary thyroid cancer. The study included 1547 patients from a single center in Poland, in whom the presence and variant of the CHEK2 mutation were determined. Two hundred and forty patients were found to carry this mutation. We found significant association of the CHEK2 truncating variant with vascular invasion and intermediate or high initial risk of recurrence/persistence, whereas this relationship was not found in case of the missense CHEK2 variant. Neither the truncating nor the missense mutations were associated with worse primary treatment response and outcome of the disease. Abstract The CHEK2 gene is involved in the repair of damaged DNA. CHEK2 germline mutations impair this repair mechanism, causing genomic instability and increasing the risk of various cancers, including papillary thyroid carcinoma (PTC). Here, we asked whether CHEK2 germline mutations predict a worse clinical course for PTC. The study included 1547 unselected PTC patients (1358 women and 189 men) treated at a single center. The relationship between mutation status and clinicopathological characteristics, treatment responses, and disease outcome was assessed. CHEK2 mutations were found in 240 (15.5%) of patients. A CHEK2 I157T missense mutation was found in 12.3%, and CHEK2 truncating mutations (IVS2 + 1G > A, del5395, 1100delC) were found in 2.8%. The truncating mutations were more common in women (p = 0.038), and were associated with vascular invasion (OR, 6.91; p < 0.0001) and intermediate or high initial risk (OR, 1.92; p = 0.0481) in multivariate analysis. No significant differences in these parameters were observed in patients with the I157T missense mutation. In conclusion, the CHEK2 truncating mutations were associated with vascular invasion and with intermediate and high initial risk of recurrence/persistence. Neither the truncating nor the missense mutations were associated with worse primary treatment response and outcome of the disease.
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Affiliation(s)
- Danuta Gąsior-Perczak
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (E.M.); (T.T.); (A.S.)
- Correspondence:
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (A.K.); (K.G.)
- Division of Medical Biology, Institute of Biology Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland
| | - Krzysztof Gruszczyński
- Department of Molecular Diagnostics, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (A.K.); (K.G.)
| | - Agnieszka Walczyk
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (E.M.); (T.T.); (A.S.)
| | - Monika Siołek
- Genetic Clinic, Holycross Cancer Center, 25-734 Kielce, Poland;
| | - Iwona Pałyga
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (E.M.); (T.T.); (A.S.)
| | - Sławomir Trepka
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
- Department of Surgical Oncology, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland
| | - Estera Mikina
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (E.M.); (T.T.); (A.S.)
| | - Tomasz Trybek
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (E.M.); (T.T.); (A.S.)
| | - Janusz Kopczyński
- Surgical Pathology, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland;
| | - Agnieszka Suligowska
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (E.M.); (T.T.); (A.S.)
| | - Rafał Ślusarczyk
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
| | - Agnieszka Gonet
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
| | - Jarosław Jaskulski
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
| | - Paweł Orłowski
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
| | - Magdalena Chrapek
- Faculty of Natural Sciences, Jan Kochanowski University, 25-406 Kielce, Poland;
| | - Stanisław Góźdź
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
- Clinical Oncology, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland
| | - Aldona Kowalska
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (A.W.); (I.P.); (S.T.); (R.Ś.); (A.G.); (J.J.); (P.O.); (S.G.); (A.K.)
- Endocrinology Clinic, Holycross Cancer Center, Artwińskiego 3, 25-734 Kielce, Poland; (E.M.); (T.T.); (A.S.)
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Ma H, Wang R, Fang J, Zhong Q, Chen X, Hou L, Feng L, Chen X, Huang Z, Zhao H. A meta-analysis evaluating the relationship between B-type Raf kinase mutation and cervical lymphatic metastasis in papillary thyroid cancer. Medicine (Baltimore) 2020; 99:e18917. [PMID: 32000400 PMCID: PMC7004699 DOI: 10.1097/md.0000000000018917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND B-type Raf kinase (BRAF) mutation is proved to be a critical predictive factor in papillary thyroid cancer (PTC) with aggressive characteristics. However, the association between BRAF mutation and cervical lymphatic metastasis in PTC is controversial. METHODS We searched papers on the study of BRAF mutation and cervical lymphatic metastasis in PTC patients through PubMed, Web of Science, Embase, and Cochranelibrary. The BRAF (+) cases, BRAF (-) cases, and cervical lymphphatic metastatic cases in both BRAF (+) and BRAF (-) groups were collected. After Quality assessment, statistical Analysis (funnel plot and Harbord evaluation, Random-effect model, heterogeneity, subgroup analysis, sensitivity analysis, and metacum analysis) were done by the Review Manager (RevMan) 5.3 and stata14 statistical software. RESULTS There were 78 cross-section studies which met our inclusion criteria. And all of them had no selection bias, publication bias, or any other bias. A significant association existed between BRAF mutation and cervical lymph node metastasis (LNM) (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.44-1.84; P < .05). Overall, 46 studies were conducted among East Asians. Twenty four articles had provided the data of central lymph node metastasis (CLNM), 11 articles with the data of lateral lymph node metastasis (LLNM), and classic/conventional PTC (CPTC) was analyzed in 10 studies. Subgroup analyses were performed based on ethnicity, metastatic site, and subtype of PTC. Significant association between BRAF (+) mutation and cervical LNM were indicated in East Asians (OR = 1.73; 95% CI: 1.49-2.02; P < .05), in non-East Asians (OR = 1.57; 95% CI: 1.26-1.96; P < .05), and in CLNM (OR = 1.80; 95% CI: 1.56-2.07; P < .05). While no significant association was found in LLNM (OR = 1.37; 95% CI: 0.76-2.48; P = .29 > .05) and in CPTC (OR = 1.32; 95% CI: 0.97-1.80; P = .08 > .05). We did not find any other major changes when sensitivity analysis was performed. The metacum analysis showed no significant association existed before 2012. While a significant association began to exist between BRAF mutation and LNM from 2012, and this association became stable from 2017. CONCLUSIONS We consider that a significant association exists between BRAF mutation and cervical LNM. Further meta-analysis on subgroup may reveal some valuable factors between BRAF gene mutation and LNM. And we do not recommend that BRAF (+) as the biomarker for LNM in PTC.
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Affiliation(s)
- Hongzhi Ma
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Ru Wang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Jugao Fang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Qi Zhong
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Xiao Chen
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Lizhen Hou
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Ling Feng
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Xiaohong Chen
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Zhigang Huang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Huanhu Zhao
- School of Pharmacy, Minzu University of China, China
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14
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Coexisting Germline CHEK2 and Somatic BRAFV600E Mutations in Papillary Thyroid Cancer and Their Association with Clinicopathological Features and Disease Course. Cancers (Basel) 2019; 11:cancers11111744. [PMID: 31703344 PMCID: PMC6896084 DOI: 10.3390/cancers11111744] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 11/01/2019] [Accepted: 11/05/2019] [Indexed: 01/26/2023] Open
Abstract
BRAFV600E is the most common somatic mutation in papillary thyroid carcinoma (PTC) and the majority of evidence indicates that it is associated with an aggressive clinical course. Germline mutations of the CHEK2 gene impair the DNA damage repair process and increase the risk of PTC. Coexistence of both mutations is expected to be associated with poorer clinical course. We evaluated the prevalence of concomitant CHEK2 and BRAFV600E mutations and their associations with clinicopathological features, treatment response, and disease course in PTC patients. The study included 427 unselected PTC patients (377 women and 50 men) from one center. Relationships among clinicopathological features, mutation status, treatment response, and disease outcomes were assessed. Mean follow-up was 10 years. CHEK2 mutations were detected in 15.2% and BRAFV600E mutations in 64.2% patients. Neither mutation was present in 31.4% cases and both BRAFV600E and CHEK2 mutations coexisted in 10.8% patients. No significant differences in clinicopathological features, initial risk, treatment response, or disease outcome were detected among these patient groups. CHEK2 mutations were significantly associated with older age, while BRAFV600E was significantly associated with older age and extrathyroidal extension. The coexistence of both mutations was not associated with more aggressive clinicopathological features of PTC, poorer treatment response, or disease outcome.
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15
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Trybek T, Walczyk A, Gąsior-Perczak D, Pałyga I, Mikina E, Kowalik A, Hińcza K, Kopczyński J, Chrapek M, Góźdź S, Kowalska A. Impact of BRAF V600E and TERT Promoter Mutations on Response to Therapy in Papillary Thyroid Cancer. Endocrinology 2019; 160:2328-2338. [PMID: 31305897 DOI: 10.1210/en.2019-00315] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/08/2019] [Indexed: 11/19/2022]
Abstract
In this study, we examined the relationship between coexisting BRAF V600E and TERT promoter mutations in papillary thyroid cancer (PTC) and response to therapy. PTC cases (n = 568) with known BRAF and TERT status, diagnosed from 2000 to 2012 and actively monitored at one institution, were reviewed retrospectively. Associations between BRAF V600E and TERT promoter mutations and clinicopathological features, Tumor-Node-Metastasis stage, initial risk, response to therapy, follow-up, and final disease outcome were assessed according to American Thyroid Association 2015 criteria and the American Joint Committee on Cancer/Tumor-Node-Metastasis (8th edition) staging system. Median follow-up was 120 months. TERT promoter mutations (any type) were detected in 13.5% (77/568) of PTC cases with known BRAF status. The C228T and C250T TERT hotspot mutations were found in 54 (9.5%) and 23 (4%) patients, respectively, and 22 other TERT promoter alterations were identified. Coexisting BRAF V600E and TERT hotspot promoter mutations were detected in 9.5% (54/568) of patients, and significantly associated with older patient age (P = 0.001), gross extrathyroidal extension (P = 0.003), tumor stage pT3-4 (P = 0.005), stage II to IV (P = 0.019), intermediate or high initial risk (P = 0.003), worse than excellent response to primary therapy (P = 0.045), recurrence (P = 0.015), and final outcome of no remission (P = 0.014). We conclude that coexisting BRAF V600E and TERT mutations in patients with PTC are associated with poor initial prognostic factors and clinical course and may be useful for predicting a worse response to therapy, recurrence, and poorer outcome than in patients without the above mutations.
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Affiliation(s)
- Tomasz Trybek
- Endocrinology Clinic, Holycross Cancer Center, Kielce, Poland
| | | | | | - Iwona Pałyga
- Endocrinology Clinic, Holycross Cancer Center, Kielce, Poland
| | - Estera Mikina
- Endocrinology Clinic, Holycross Cancer Center, Kielce, Poland
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Center, Kielce, Poland
| | - Kinga Hińcza
- Department of Molecular Diagnostics, Holycross Cancer Center, Kielce, Poland
| | - Janusz Kopczyński
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | - Magdalena Chrapek
- Department of Probability Theory and Statistics Institute of Mathematics, Faculty of Mathematics and Natural Sciences, Jan Kochanowski University, Kielce, Poland
| | - Stanisław Góźdź
- Oncology Clinic, Holycross Cancer Center, Kielce, Poland
- The Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology Clinic, Holycross Cancer Center, Kielce, Poland
- The Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
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16
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Walczyk A, Kopczyński J, Gąsior-Perczak D, Pałyga I, Kowalik A, Chrapek M, Hejnold M, Góźdź S, Kowalska A. Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System (eighth edition). Clin Endocrinol (Oxf) 2019; 91:331-339. [PMID: 30525210 DOI: 10.1111/cen.13910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Poorly differentiated thyroid cancer (PDTC) is a rare, but aggressive thyroid cancer (TC) and a main cause of death from non-anaplastic follicular cell-derived TC. Assessing the risk of PDTC-related death and the risk of recurrence is important for clinicians. The recent American Thyroid Association (ATA) 2015 guidelines and the updated 8th edition of the American Joint Committee on Cancer/Tumor-Node-Metastasis (AJCC/TNM) staging system should support clinicians in the management approach to PDTC patients. PATIENTS Forty-six consecutive PDTC patients treated in a single oncologic centre, 2000-2017. MEASUREMENTS Retrospective analysis of TNM stage, initial risk, response-to-therapy categories, follow-up and final disease status incorporating the ATA 2015 criteria and the 8th AJCC/TNM staging system. Disease-specific survival (DSS) using the Kaplan-Meier method. RESULTS Of the 46 PDTC 21 (45.6%) were ATA high risk (HR), 22 (47.8%), 17 (37%) and seven (15.2%) were TNM stages I, II, and III-IV, respectively. During a median follow-up of 55.5 months, two (4.3%) patients were recurrent, 18 (39.1%) died of PDTC. The 5-/10-year DSS were 65/57%, respectively. According to the AJCC/TNM, the 5-/10-year DSS of I, II, and III-IV stage were 83/83%; 77/55%, and 0/0%, respectively. According to the 2015 ATA initial risk, the 5-/10-year DSS were 91/72% for ATA intermediate risk and 38/38% for ATA HR patients. CONCLUSIONS In PDTC patients, the updated AJCC/TNM staging system accurately predicts a high risk of death in stage III-IV, whereas it seems to be inadequate for predicting a very low or low risk of death expected for differentiated TC in stage I-II. The ATA initial HR may be also used to predict a high risk of PDTC-related death.
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Affiliation(s)
- Agnieszka Walczyk
- Department of Endocrinology, Holycross Cancer Center, Kielce, Poland
| | - Janusz Kopczyński
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | | | - Iwona Pałyga
- Department of Endocrinology, Holycross Cancer Center, Kielce, Poland
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Center, Kielce, Poland
| | - Magdalena Chrapek
- Faculty of Mathematics and Natural Sciences, Department of Probability Theory and Statistics Institute of Mathematics, Jan Kochanowski University, Kielce, Poland
| | - Maria Hejnold
- Department of Surgical Pathology, Holycross Cancer Center, Kielce, Poland
| | - Stanisław Góźdź
- Department of Clinical Oncology, Holycross Cancer Center, Kielce, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Department of Endocrinology, Holycross Cancer Center, Kielce, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
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Gąsior-Perczak D, Pałyga I, Szymonek M, Kowalik A, Walczyk A, Kopczyński J, Lizis-Kolus K, Trybek T, Mikina E, Szyska-Skrobot D, Gadawska-Juszczyk K, Hurej S, Szczodry A, Słuszniak A, Słuszniak J, Mężyk R, Góźdź S, Kowalska A. The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer. PLoS One 2018; 13:e0204668. [PMID: 30273371 PMCID: PMC6166948 DOI: 10.1371/journal.pone.0204668] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/12/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Obesity is a serious health problem worldwide, particularly in developed countries. It is a risk factor for many diseases, including thyroid cancer. The relationship between obesity and prognostic factors of thyroid cancer is unclear. Aims We sought to ascertain the relationship between body mass index (BMI) and clinicopathological features increasing the risk of poor clinical course, treatment response, and clinical outcome in patients with differentiated thyroid cancer (DTC). Subjects & methods The study included 1181 patients with DTC (88% women and 12% men) treated at a single center from 2000 to 2016. BMI before surgery and aggressive clinicopathological features, according to the American Thyroid Initial Risk stratification system, were analyzed. The relationship between BMI and initial risk, treatment response, and final status of the disease was evaluated, incorporating the revised 2015 American Thyroid Association guidelines and the 8th edition of the American Joint Committee on Cancer/Tumor-Node-Metastasis (AJCC/TNM) staging system. Patients were stratified according to the World Health Organization classification of BMI. Statistical analysis was performed using univariate and multivariate logistic regression analysis. Results Median follow-up was 7.7 years (1–16 years). There were no significant associations between BMI and extrathyroidal extension (microscopic and gross), cervical lymph node metastasis, or distant metastasis in univariate and multivariate analyses. BMI did not affect initial risk, treatment response or disease outcome. Obesity was more prevalent in men (p = 0.035) and in patients ≥55 years old (p = 0.001). There was no statistically significant relationship between BMI and more advanced TNM stage in patients ≤55 years old (stage I vs. stage II) (p = 0.266) or in patients >55 years old (stage I–II vs. III–IV) (p = 0.877). Conclusions Obesity is not associated with more aggressive clinicopathological features of thyroid cancer. Obesity is not a risk factor for progression to more advanced stages of disease, nor is it a prognostic factor for poorer treatment response and clinical outcome.
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Affiliation(s)
| | - Iwona Pałyga
- Endocrinology Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Monika Szymonek
- Endocrinology Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Artur Kowalik
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | | | - Janusz Kopczyński
- Department of Surgical Pathology, Holycross Cancer Centre, Kielce, Poland
| | | | - Tomasz Trybek
- Endocrinology Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Estera Mikina
- Endocrinology Clinic, Holycross Cancer Centre, Kielce, Poland
| | | | | | - Stefan Hurej
- Endocrinology Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Artur Szczodry
- Endocrinology Clinic, Holycross Cancer Centre, Kielce, Poland
| | - Anna Słuszniak
- Laboratory of Tumor Markers, Holycross Cancer Centre, Kielce, Poland
| | - Janusz Słuszniak
- Department of Surgical Oncology, Holycross Cancer Centre, Kielce, Poland
| | - Ryszard Mężyk
- Cancer Epidemiology, Holycross Cancer Centre, Kielce, Poland
| | - Stanisław Góźdź
- Oncology Clinic, Holycross Cancer Centre, Kielce, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Aldona Kowalska
- Endocrinology Clinic, Holycross Cancer Centre, Kielce, Poland
- Faculty of Health Sciences, Jan Kochanowski University, Kielce, Poland
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18
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Shaterian A, Bota D, Leis A. Expression of the BRAF L597Q mutation in sporadic neurofibromas of the upper extremity. Exp Mol Pathol 2017; 103:276-278. [DOI: 10.1016/j.yexmp.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/18/2017] [Indexed: 12/21/2022]
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