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Komatsuda H, Kono M, Wakisaka R, Sato R, Inoue T, Kumai T, Takahara M. Harnessing Immunity to Treat Advanced Thyroid Cancer. Vaccines (Basel) 2023; 12:45. [PMID: 38250858 PMCID: PMC10820966 DOI: 10.3390/vaccines12010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
The incidence of thyroid cancer (TC) has increased over the past 30 years. Although differentiated thyroid cancer (DTC) has a good prognosis in most patients undergoing total thyroidectomy followed by radioiodine therapy (RAI), 5-10% of patients develop metastasis. Anaplastic thyroid cancer (ATC) has a low survival rate and few effective treatments have been available to date. Recently, tyrosine kinase inhibitors (TKIs) have been successfully applied to RAI-resistant or non-responsive TC to suppress the disease. However, TC eventually develops resistance to TKIs. Immunotherapy is a promising treatment for TC, the majority of which is considered an immune-hot malignancy. Immune suppression by TC cells and immune-suppressing cells, including tumor-associated macrophages, myeloid-derived suppressor cells, and regulatory T cells, is complex and dynamic. Negative immune checkpoints, cytokines, vascular endothelial growth factors (VEGF), and indoleamine 2,3-dioxygenase 1 (IDO1) suppress antitumor T cells. Basic and translational advances in immune checkpoint inhibitors (ICIs), molecule-targeted therapy, tumor-specific immunotherapy, and their combinations have enabled us to overcome immune suppression and activate antitumor immune cells. This review summarizes current findings regarding the immune microenvironment, immunosuppression, immunological targets, and immunotherapy for TC and highlights the potential efficacy of immunotherapy.
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Affiliation(s)
- Hiroki Komatsuda
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan; (H.K.); (M.K.); (R.W.); (R.S.); (T.I.); (M.T.)
| | - Michihisa Kono
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan; (H.K.); (M.K.); (R.W.); (R.S.); (T.I.); (M.T.)
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Risa Wakisaka
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan; (H.K.); (M.K.); (R.W.); (R.S.); (T.I.); (M.T.)
| | - Ryosuke Sato
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan; (H.K.); (M.K.); (R.W.); (R.S.); (T.I.); (M.T.)
| | - Takahiro Inoue
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan; (H.K.); (M.K.); (R.W.); (R.S.); (T.I.); (M.T.)
| | - Takumi Kumai
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan; (H.K.); (M.K.); (R.W.); (R.S.); (T.I.); (M.T.)
- Department of Innovative Head & Neck Cancer Research and Treatment, Asahikawa Medical University, Asahikawa 078-8510, Japan
| | - Miki Takahara
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Asahikawa 078-8510, Japan; (H.K.); (M.K.); (R.W.); (R.S.); (T.I.); (M.T.)
- Department of Innovative Head & Neck Cancer Research and Treatment, Asahikawa Medical University, Asahikawa 078-8510, Japan
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2
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Issa PP, Omar M, Buti Y, Aboueisha M, Munshi R, Hussein M, Haidari M, Blair G, Issa CP, Shama M, Toraih E, Kandil E. Hashimoto's Thyroiditis: A Protective Factor against Recurrence in BRAF-Wild Type Differentiated Thyroid Carcinoma. Cancers (Basel) 2023; 15:cancers15082371. [PMID: 37190300 DOI: 10.3390/cancers15082371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
A recent work analyzing the concomitant factors BRAF mutation (risk factor) and Hashimoto's thyroiditis (HT) (protective factor) found that the presence of HT reduced lymph node metastasis in BRAF-mutated papillary thyroid carcinoma. Whether this notion is upheld with respect to disease recurrence and differentiated thyroid carcinoma (DTC), however, is unknown. We aimed to investigate the effect of underlying HT in DTC patients and its influence on recurrence with a specific emphasis in BRAF-mutated tumors. A total of 469 patients were included. Patients were stratified according to BRAF and HT status. Multivariate regression analysis was conducted to determine protective and risk factors of disease recurrence in patients with DTC. HT was associated with less-aggressive carcinomas including more frequent microcarcinomas (HT: 45.0% vs. no-HT: 34.0%, p = 0.02), less lymph node involvement (HT: 16.4% vs. no-HT: 26.1%, p = 0.02), and less disease recurrence (HT: 2.9% vs. no-HT: 11.9%, p = 0.002). BRAF mutation was also significantly associated with higher rates of lymph node involvement (BRAF-mutant: 41.9% vs. BRAF-wild type: 14.6%, p < 0.001) and almost two times the rate of recurrence (BRAF-mutant: 14.9% vs. BRAF-wild type: 6.5%, p = 0.004). Underlying HT was the only protective factor determined, reducing the odds of developing recurrence by 70% (HR: 0.30, 95%CI: 0.11-0.88). In the BRAF-wild type cohort, regression analysis continued to determine HT as a protective factor (p = 0.03). However, in the BRAF-mutant cohort, HT was no longer an independent protective factor (p = 0.20) against recurrence. Sub-group regression analysis, including PTC patients, similarly found HT as a protective factor only in BRAF-wild type patients (p = 0.039) and not BRAF-mutant (p = 0.627). The presence of underlying HT is associated with less aggressive tumors and is an independent protective factor against DTC recurrence, reducing the risk by 70%. HT remains a protective factor in BRAF-wild type carcinoma, but not in patients with BRAF-mutant carcinoma. HT may potentially be considered as a parameter which enhances American Thyroid Association patient risk stratification.
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Affiliation(s)
- Peter P Issa
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Yusef Buti
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Aboueisha
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Ruhul Munshi
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad Hussein
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Muhib Haidari
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Graham Blair
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Chad P Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Mohamed Shama
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman Toraih
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Emad Kandil
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Turchini J, Sioson L, Clarkson A, Sheen A, Delbridge L, Glover A, Sywak M, Sidhu S, Gill AJ. The Presence of Typical "BRAFV600E-Like" Atypia in Papillary Thyroid Carcinoma is Highly Specific for the Presence of the BRAFV600E Mutation. Endocr Pathol 2023; 34:112-118. [PMID: 36709221 DOI: 10.1007/s12022-022-09747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/29/2023]
Abstract
Papillary thyroid carcinomas (PTCs) are driven by a variety of molecular abnormalities including BRAF, RAS, ALK, RET, and NTRK alterations. PTCs driven by the BRAFV600E mutation, or tumours which demonstrate a similar gene expression profile to PTCs driven by this mutation, have been reported to demonstrate specific morphological features sometimes termed "BRAFV600E-like" atypia. BRAFV600E-like atypia is characterised by a well-developed papillary architecture, infiltrative growth, marked nuclear clearing, prominent intranuclear pseudoinclusions, abundant eosinophilic cytoplasm, and scattered psammoma bodies. We sought to investigate the sensitivity and specificity of these morphological features for the presence of BRAFV600E mutation in PTCs as determined by mutation specific immunohistochemistry. An unselected cohort of 495 PTCs was reviewed by a single pathologist and categorised into three groups: typical BRAFV600E-like atypia (145 cases, 29%), possible BRAFV600E-like atypia (166 cases, 33%) and little/no BRAFV600E-like atypia (184 cases, 37%). The specificity and sensitivity of typical BRAFV600E-like atypia for the BRAFV600E mutation was 97.2% and 44.3%, respectively. When typical and possible BRAFV600E-like atypia were analysed together, the specificity was 70.6% and the sensitivity was 81.7%. In the morphologically little/no BRAFV600E-like atypia group, 58 cases (31.5%) had a BRAFV600E mutation. We conclude that typical BRAFV600E-like atypia is highly specific for the presence of the BRAFV600E mutation; however, the absence of BRAFV600E-like atypia does not exclude this mutation.
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Affiliation(s)
- John Turchini
- Anatomical Pathology, Douglass Hanly Moir Pathology, 14 Giffnock Avenue, Macquarie Park, NSW, 2113, Australia.
- Discipline of Pathology, Macquarie Medical School, Macquarie University, Macquarie Park, NSW, 2109, Australia.
- Sydney Medical School, The University of Sydney, Sydney, 2006, Australia.
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia.
| | - Loretta Sioson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
| | - Adele Clarkson
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
- Department of Anatomical Pathology, Royal North Shore Hospital, NSW Health Pathology, St Leonards, NSW, 2065, Australia
| | - Amy Sheen
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
| | - Leigh Delbridge
- Sydney Medical School, The University of Sydney, Sydney, 2006, Australia
- Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Anthony Glover
- Sydney Medical School, The University of Sydney, Sydney, 2006, Australia
- Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Mark Sywak
- Sydney Medical School, The University of Sydney, Sydney, 2006, Australia
- Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Stan Sidhu
- Sydney Medical School, The University of Sydney, Sydney, 2006, Australia
- Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Anthony J Gill
- Sydney Medical School, The University of Sydney, Sydney, 2006, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, 2065, Australia
- Department of Anatomical Pathology, Royal North Shore Hospital, NSW Health Pathology, St Leonards, NSW, 2065, Australia
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4
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Zhang MN, Liang XY, Li MT, Zhi XY, Yan QY, Zhu H, Xie J. Current status and temporal trend of disease burden of thyroid cancer in China from 1990 to 2019. Asia Pac J Clin Oncol 2023; 19:196-205. [PMID: 35692103 DOI: 10.1111/ajco.13800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/22/2022] [Accepted: 05/07/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Thyroid cancer has been an increasingly high-profile public health issue. Comprehensive assessment for its disease burden seems particularly important for understanding health priorities and hinting high-risk populations. METHODS We estimated the age-sex-specific thyroid cancer burden and its temporal trend in China from 1990 to 2019 by following the general methods from the global burden of disease (GBDs) 2019 Study. And Joinpoint regression model, the Cox-Stuart trend test, and Cochran-Armitage test were applied for the analysis of temporal and age trend. The Mantel-Haenszel statistical method was used to compare the gender difference. RESULTS From 1990 to 2019, the age-standardized incidence rate of thyroid cancer in China has almost doubled to 2.05 per 100,000. Although the mortality rate and DALY rate kept leveling off, they presented a downtrend among females, while an upward trend in males. While the average annual percentage changes of those metrics all became deline since 2010 than the previous years. With age advancing, the rates of incidence, mortality, and DALYs for both sexes all presented linear fashion increases, which was particularly typical among males. CONCLUSION Given the serious trend and gender-age heterogeneity of Chinese thyroid cancer burden, male gender and advanced age may be related to poor prognosis of thyroid cancer, and strengthening primary prevention and exploring the underlying risk factors should be among the top priorities.
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Affiliation(s)
- Meng-Ni Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Xiao-Yu Liang
- Tianjin Medical University General Hospital, Tianjin, China
| | - Mao-Ting Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Xin-Yue Zhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Qiu-Yu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Hong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
| | - Juan Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.,Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China
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Valerio L, Maino F, Castagna MG, Pacini F. Radioiodine therapy in the different stages of differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 2023; 37:101703. [PMID: 36151009 DOI: 10.1016/j.beem.2022.101703] [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] [Indexed: 11/02/2022]
Abstract
Differentiated thyroid cancer is the most frequent type of thyroid cancer with an increasing incidence in the last decades. The initial management is represented by surgical treatment followed by radioactive iodine therapy that includes remnant ablation, adjuvant treatment or treatment of metastatic disease. Radioactive iodine treatment is performed only in selected cases based on the risk of recurrence and mortality during follow up, according to American Joint Committee on Cancer Union for international Cancer Control Tumor, Node, Metastasis (AJCC/TNM) staging system and the 2015 American Thyroid Association (ATA) risk stratification system. This article will review the key factors to consider when planning radioactive iodine therapy in differentiated thyroid cancer patients after surgery and during follow up.
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Affiliation(s)
- Laura Valerio
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
| | - Furio Pacini
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy - Viale Bracci 16, 53100, Siena, Italy.
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TERT Promoter and BRAF V600E Mutations in Papillary Thyroid Cancer: A Single-Institution Experience in Korea. Cancers (Basel) 2022; 14:cancers14194928. [PMID: 36230856 PMCID: PMC9563418 DOI: 10.3390/cancers14194928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary TERT promoter mutation has recently emerged as a promising prognostic biomarker for aggressive papillary thyroid cancer (PTC), along with BRAF B600E mutation. The prevalence of the TERT promoter mutations has been reported as relatively uncommon in Asian countries. We report on a prospective study of the TERT promoter and BRAF V600E mutation in the largest number of subjects with PTC in Korea. We assume that our specific clinical settings and the favorable healthcare environment in Korea led to several distinct findings: the lowest prevalence of TERT promoter mutation ever reported, multifocal gene mutations in bilateral PTCs, and more early-stage papillary microcarcinomas included in this study. This study indicates that relevant evaluation and treatment strategies should be investigated continuously based on different circumstances. Abstract Telomerase reverse transcriptase (TERT) promoter mutation has been investigated for its clinical and prognostic significance in aggressive papillary thyroid cancer (PTC). In this study, we aimed to assess the prevalence, clinicopathologic features, and treatment outcomes of TERT mutation-positive PTCs along with the common BRAF V600E mutation. We performed mutational analyses for BRAF and the TERT promoter in thyroid cancer patients who had undergone surgery at our institution since 2019. We reviewed and analyzed 7797 patients with PTC in this study. The prevalence of BRAF V600E and TERT promoter mutations was 84.0% and 1.1%, respectively. Multifocal gene mutations in bilateral PTCs were identified. TERT promoter mutations were associated with older age, larger tumor size, tumor multifocality, tumor variants, advanced stages, more adjuvant radioactive iodine treatment (RAI), higher stimulated serum thyroglobulin level before RAI, and more uptakes in the regions outside the surgical field on a post-RAI whole-body scan. The coexistence of BRAF V600E and TERT promoter mutations exacerbated all clinicopathologic characteristics. The frequency of TERT promoter mutations was the lowest in this study, compared to previous studies. TERT promoter mutations consistently correlated with aggressive PTCs, and the synergistic effect of both mutations was evident. Specific clinical settings in our institution and in Korea may have led to these distinctive results. Prospective multicenter studies with longer follow-up periods are required to establish valuable oncologic outcomes.
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Rashid FA, Bhat GH, Khan MS, Tabassum S, Bhat MH. Variations in MAP kinase gladiators and risk of differentiated thyroid carcinoma. Mol Clin Oncol 2022; 16:45. [PMID: 35003743 PMCID: PMC8739702 DOI: 10.3892/mco.2021.2478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/27/2021] [Indexed: 12/02/2022] Open
Abstract
Thyroid carcinoma (TC) accounts for ~2.1% of newly diagnosed cancer cases. Mutations in KRAS, HRAS, NRAS and BRAF are primary participants in the development and progression of various types of malignancy, including differentiated TC (DTC). Therefore, the present prospective cohort study aimed to screen patients with DTC for variations in RAS gene family and BRAF gene. Exon 1 and 2 of KRAS, HRAS, NRAS and exon 15 of BRAF gene were screened for hotspot mutations in 72 thyroid tumor and adjacent normal tissue samples using di-deoxy Sanger sequencing. HRAS T81C mutation was found in 21% (15 of 72) of DTC tissue samples, therefore this mutation was investigated in blood samples from patients with DTC and controls as a genetic polymorphism. In addition, HRAS T81C genotypes were determined in 180 patients with DTC and 220 healthy controls by performing restriction fragment length polymorphism. BRAFV600E mutation was confined to classical variant of papillary thyoid cancer (CPTC; 44.4%) and was significantly associated with multifocality and lymph node (LN) metastasis. No mutation was found in exons 1 and 2 of KRAS and NRAS and exon 2 of HRAS genes, however, mutation was detected in exon 1 of HRAS gene (codon 27) at nucleotide position 81 in 21% (15 of 72) of DTC tumor tissue samples. Furthermore, HRAS T81C single nucleotide polymorphism was significantly associated with the risk of DTC with variant genotypes more frequently detected in cases compared with controls (P≤0.05). Moreover, frequency of variant genotypes (TC+CC) was significantly higher among DTC cases with no history of smoking, males, greater age, multifocality and LN metatasis compared with healthy controls (P<0.05). BRAFV600E mutation was primarily present in CPTC and associated with an aggressive tumor phenotype but mutations in RAS gene family were not present in patients with DTC. HRAS T81C polymorphism may be involved in the etiopathogenesis of DTC in a Pakistani cohort. Furthermore, testing for the BRAFV600E mutation may be useful for selecting initial therapy and follow-up monitoring.
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Affiliation(s)
- Faiza A Rashid
- Department of Biological Sciences, International Islamic University, Islamabad 1243, Pakistan
| | - Ghulam Hassan Bhat
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh and Super Speciality Hospital, Srinagar, Jammu and Kashmir 190010, India
| | - Mosin S Khan
- Department of Biochemistry, Government Medical College and Associated Shri Maharaja Hari Singh and Super Speciality Hospital, Srinagar, Jammu and Kashmir 190010, India
| | - Sobia Tabassum
- Department of Biological Sciences, International Islamic University, Islamabad 1243, Pakistan
| | - Mohammad Hayat Bhat
- Department of Endocrinology, Government Medical College and Associated Shri Maharaja Hari Singh and Super Speciality Hospital, Srinagar, Jammu and Kashmir 190010, India
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Póvoa AA, Teixeira E, Bella-Cueto MR, Batista R, Pestana A, Melo M, Alves T, Pinto M, Sobrinho-Simões M, Maciel J, Soares P. Genetic Determinants for Prediction of Outcome of Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2021; 13:2048. [PMID: 33922635 PMCID: PMC8122921 DOI: 10.3390/cancers13092048] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) usually presents an excellent prognosis, but some patients present with aggressive metastatic disease. BRAF, RAS, and TERT promoter (TERTp) genes are altered in PTC, and their impact on patient outcomes remains controversial. We aimed to determine the role of genetic alterations in PTC patient outcomes (recurrent/persistent disease, structural disease, and disease-specific mortality (DSM)). The series included 241 PTC patients submitted to surgery, between 2002-2015, in a single hospital. DNA was extracted from tissue samples of 287 lesions (primary tumors and metastases). Molecular alterations were detected by Sanger sequencing. Primary tumors presented 143 BRAF, 16 TERTp, and 13 RAS mutations. Isolated TERTpmut showed increased risk of structural disease (HR = 7.0, p < 0.001) and DSM (HR = 10.1, p = 0.001). Combined genotypes, BRAFwt/TERTpmut (HR = 6.8, p = 0.003), BRAFmut/TERTpmut (HR = 3.2, p = 0.056) and BRAFmut/TERTpwt (HR = 2.2, p = 0.023) showed increased risk of recurrent/persistent disease. Patients with tumors BRAFwt/TERTpmut (HR = 24.2, p < 0.001) and BRAFmut/TERTpmut (HR = 11.5, p = 0.002) showed increased risk of structural disease. DSM was significantly increased in patients with TERTpmut regardless of BRAF status (BRAFmut/TERTpmut, log-rank p < 0.001; BRAFwt/TERTpmut, log-rank p < 0.001). Our results indicate that molecular markers may have a role in predicting PTC patients' outcome. BRAFmut/TERTpwt tumors were prone to associate with local aggressiveness (recurrent/persistent disease), whereas TERTpmut tumors were predisposed to recurrent structural disease and DSM.
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Affiliation(s)
- Antónia Afonso Póvoa
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Vila Nova de Gaia, Portugal;
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Elisabete Teixeira
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Maria Rosa Bella-Cueto
- Department of Pathology, Parc Taulí Sabadell Hospital Universitari—Institut d’Investigació i Innovació Parc Taulí—I3PT—Universitat Autònoma de Barcelona, 08208 Barcelona, Spain;
| | - Rui Batista
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Ana Pestana
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Miguel Melo
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Department of Endocrinology, Centro Hospitalar Universitário de Coimbra,3000-075 Coimbra, Portugal
| | - Thalita Alves
- Laboratório de Endocrinologia Molecular e Translacional—Departamento de Medicina, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil;
| | - Mafalda Pinto
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
| | - Manuel Sobrinho-Simões
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
| | - Jorge Maciel
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Vila Nova de Gaia, Portugal;
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4200-253 Porto, Portugal
| | - Paula Soares
- IPATIMUP—Instituto de Patologia e Imunologia Molecular da Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (R.B.); (A.P.); (M.M.); (M.P.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
- Departament of Pathology, Faculdade de Medicina da Universidade do Porto, 4200-319, Porto, Portugal
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9
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Jin M, Song DE, Ahn J, Song E, Lee YM, Sung TY, Kim TY, Kim WB, Shong YK, Jeon MJ, Kim WG. Genetic Profiles of Aggressive Variants of Papillary Thyroid Carcinomas. Cancers (Basel) 2021; 13:cancers13040892. [PMID: 33672707 PMCID: PMC7924361 DOI: 10.3390/cancers13040892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Aggressive variants of papillary thyroid carcinoma (PTC) are associated with unfavorable clinical outcomes. However, limited data exist on the genetic profile of these variants of PTC. We performed targeted next-generation sequencing in 36 tissue samples from patients with aggressive variants of PTC. Aggressive variants of PTC had a higher prevalence of the BRAF mutation and a lower prevalence of RAS mutation than other types of thyroid cancer. The prevalence of mutations in the TERT promoter, TP53, and genes encoding histone methyl transferases (HMTs), switch/sucrose non-fermenting (SWI/SNF) chromatin remodeling complex, and the phosphoinositide 3-kinase/protein kinase B (PKB/AKT)/mammalian target of the rapamycin (PI3K/AKT/mTOR) pathway was between the range of PTCs and poorly differentiated/anaplastic carcinoma from The Cancer Genome Atlas (TCGA) and the Memorial Sloan Kettering Cancer Center (MSKCC) data. Abstract Aggressive variants of papillary thyroid carcinoma (PTC) have been described with increasing frequency and are associated with unfavorable clinical outcomes. However, limited data exist on the comprehensive genetic profile of these variants. We performed targeted next-generation sequencing in 36 patients with aggressive variants of PTC and compared it to PTC from The Cancer Genome Atlas (TCGA) project and poorly differentiated thyroid cancers (PDTCs)/anaplastic thyroid cancers (ATCs) from the Memorial Sloan Kettering Cancer Center (MSKCC). BRAF mutation was the most prevalent (89%) in aggressive variants of PTC compared to that in other thyroid cancers. RAS mutation was identified in one patient (3%), which was less frequent than in others. TERT promoter mutation (17%) ranged between that of PTCs (9%) and PDTCs (40%). Tumor suppressor genes, ZFHX3, TP53, and CHEK2, were mutated in 14%, 3%, and 6% of aggressive variants of PTC, respectively. The mutation rate of TP53 (3%) was significantly higher than that of PTCs (0.7%) and lower than that of ATCs (73%). Mutations in three functional groups, histone methyl transferases, SWI/SNF chromatin remodeling complex, and the PI3K/AKT/mTOR pathway, were present in 11%, 14%, and 11% of samples, respectively. In conclusion, aggressive variants of PTC had higher BRAF and lower NRAS mutation prevalence than other thyroid cancers. The prevalence of mutations in the TERT promoter, TP53, and genes encoding three functional groups ranged between that of PTCs and PDTCs/ATCs.
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Affiliation(s)
- Meihua Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (M.J.); (J.A.); (T.Y.K.); (W.B.K.); (Y.K.S.)
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea;
| | - Jonghwa Ahn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (M.J.); (J.A.); (T.Y.K.); (W.B.K.); (Y.K.S.)
| | - Eyun Song
- Division of Endocrinology and Metablosim, Department of Internal Medicine, Korea University College of Medicine and School of Medicine, Seoul 08308, Korea;
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (Y.-M.L.); (T.-Y.S.)
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (Y.-M.L.); (T.-Y.S.)
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (M.J.); (J.A.); (T.Y.K.); (W.B.K.); (Y.K.S.)
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (M.J.); (J.A.); (T.Y.K.); (W.B.K.); (Y.K.S.)
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (M.J.); (J.A.); (T.Y.K.); (W.B.K.); (Y.K.S.)
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (M.J.); (J.A.); (T.Y.K.); (W.B.K.); (Y.K.S.)
- Correspondence: (M.J.J.); (W.G.K.); Tel.: +82-230-101-317 (M.J.J.); +82-230-105-883 (W.G.K.)
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (M.J.); (J.A.); (T.Y.K.); (W.B.K.); (Y.K.S.)
- Correspondence: (M.J.J.); (W.G.K.); Tel.: +82-230-101-317 (M.J.J.); +82-230-105-883 (W.G.K.)
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10
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Rashid FA, Munkhdelger J, Fukuoka J, Bychkov A. Prevalence of BRAFV600E mutation in Asian series of papillary thyroid carcinoma-a contemporary systematic review. Gland Surg 2020; 9:1878-1900. [PMID: 33224863 PMCID: PMC7667088 DOI: 10.21037/gs-20-430] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/04/2020] [Indexed: 12/30/2022]
Abstract
Papillary thyroid carcinoma (PTC), the most common malignancy of the endocrine system, is frequently driven by BRAFV600E mutation, which was reported in 35-60% cases in Western series. Numerous studies have recently emerged from Asian countries and regions; however sufficient summary is lacking to date. BRAF mutation serves as a diagnostic and prognostic tool in thyroid cancer, therefore establishing a rate of BRAF on the national scale could be of practical significance. We performed systematic reviews of available literature to investigate the prevalence of BRAF mutation in series of PTC from various Asian countries and regions. Out of the total 3,966 reports identified via initial screening, 138 studies encompassing over 40,000 PTCs were included for the final analysis. A vast majority (90.2%) of PTCs with known BRAF status were from East Asia, including China, South Korea, and Japan, with BRAF mutation rates of 71.2%, 75.5%, and 70.6%, respectively. Less abundant Indian and Saudi Arabian series found 45.6% and 46.3% prevalence of BRAFV600E in PTC, respectively. Much limited evidence was available from Thailand, Iran, Kazakhstan, Taiwan, Singapore, Indonesia, Hong Kong, Philippines, Vietnam, Iraq, and Myanmar. No relevant publications were found from other highly populated countries, such as Pakistan, Bangladesh, and Malaysia. After grouping by geographic region, we found that the highest rate of BRAFV600E was reported in the PTC series from East Asia (76.4%). Much lower rate (45-48%) was seen in PTC cohorts from South Asia, Central Asia, and the Middle East while the Southeast Asian series were in between (57%). Further subgroup analysis revealed that studies employing fresh frozen tissue and fine-needle aspirates showed higher rates of BRAF compared to those used formalin-fixed paraffin-embedded tissues. We found that the PTC series enrolled patients' cohorts after 2010 demonstrated a higher rate of BRAF compared to the earlier series. Finally, pediatric PTCs had lower BRAF prevalence compared to the baseline rate for the country. In conclusion, despite considerable among and within countries heterogeneity, the Asian PTC series showed a higher prevalence of BRAFV600E mutation than that in Western series. Causes of geographic heterogeneity, whether genuine (etiology, genetics) or methodology-related should be further investigated.
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Affiliation(s)
- Faiza Abdul Rashid
- Department of Biological Sciences, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad, Pakistan
| | | | - Junya Fukuoka
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrey Bychkov
- Department of Pathology, Kameda Medical Center, Kamogawa, Chiba, Japan
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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11
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Hernando J, Ros J, Arroyo A, Capdevila J. Clinical and Translational Challenges in Thyroid Cancer. Curr Med Chem 2020; 27:4806-4822. [PMID: 32056516 DOI: 10.2174/0929867327666200214125712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 01/15/2023]
Abstract
Thyroid cancer is the most common endocrine malignancy and it accounts for 1% of all newly diagnosed tumors. Approximately 10% of patients with differentiated thyroid carcinomas (DTC) and 30% with medullary thyroid carcinoma (MTC) could not be cured with locoregional treatment and could develop metastatic disease. In addition, one of the most aggressive solid tumors can arise from the thyroid gland, the anaplastic thyroid carcinoma, with a median overall survival of less than 6 months. Currently, only four drugs are approved for the treatment of DTC and MTC and several unmet needs are focusing the scientific discussions, including the resistant setting, the off-target side effects that may reduce the efficacy and the molecular knowledge-based combinations. In this review, we aimed to discuss the current molecular landscape and treatment of thyroid cancers, and the ongoing clinical and translational research lines focusing on new drugs and drug combinations to improve the inhibition of driver mutations, such as BRAF and RET, and how systemic therapies that improved outcomes of other cancer types, like immunotherapy and peptide receptor radionuclide therapy, may play a role in the future management of advanced thyroid cancers.
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Affiliation(s)
- Jorge Hernando
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d´Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Pg Vall d´Hebron 119-129, 08035 Barcelona, Spain
| | - Javier Ros
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d´Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Pg Vall d´Hebron 119-129, 08035 Barcelona, Spain
| | - Alvaro Arroyo
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d´Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Pg Vall d´Hebron 119-129, 08035 Barcelona, Spain
| | - Jaume Capdevila
- Medical Oncology Department, Gastrointestinal and Endocrine Tumor Unit, Vall d´Hebron University Hospital, Vall Hebron Institute of Oncology (VHIO), Pg Vall d´Hebron 119-129, 08035 Barcelona, Spain
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12
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Ieni A, Vita R, Cardia R, Giuffré G, Benvenga S, Tuccari G. BRAF Status in Papillary Microcarcinomas of the Thyroid Gland: a Brief Review. Curr Mol Med 2020; 19:665-672. [PMID: 31625469 DOI: 10.2174/1566524019666190717161359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 12/23/2022]
Abstract
Papillary thyroid microcarcinoma (PTMC) is defined by the World Health Organization as papillary cancer measuring 10 mm or less in diameter. Generally, PTMC shows an indolent clinical behavior with a good prognosis, although a minority of PTMC is characterized by an aggressive course. However, efforts to identify this aggressive subset of PTMC after surgery remain inconclusive. Several oncogenic pathways have been identified in thyroid cancer and have been applied translationally to improve prognosis and clinical management. In particular, the BRAFV600E mutation was found more frequently in large, aggressive, recurrent and advanced tumors. We aimed at reviewing studies on BRAFV600E mutation as a prognostic factor in PTMC.
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Affiliation(s)
- Antonio Ieni
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Cardia
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Giuseppe Giuffré
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University of Messina, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
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13
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Ebina A, Togashi Y, Baba S, Sato Y, Sakata S, Ishikawa M, Mitani H, Takeuchi K, Sugitani I. TERT Promoter Mutation and Extent of Thyroidectomy in Patients with 1-4 cm Intrathyroidal Papillary Carcinoma. Cancers (Basel) 2020; 12:cancers12082115. [PMID: 32751594 PMCID: PMC7464551 DOI: 10.3390/cancers12082115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
There are concerns regarding overtreatment in papillary thyroid carcinoma (PTC). BRAF V600E and TERT promoter mutations play important roles in the development of PTC. However, initial surgical approaches for PTC based on genetic characteristics remain unclear. The present study aimed to identify genetic mutations as predictors of prognosis and to establish proper indications for lobectomy (LT) in patients with 1–4 cm intrathyroidal PTC. Prospectively accumulated data from 685 consecutive patients with PTC who underwent primary thyroid surgery at the Cancer Institute Hospital, Tokyo, Japan, between 2001 and 2012 were retrospectively reviewed. Of the 685 patients examined, 538 (78.5%) had BRAF V600E mutation and 133 (19.4%) had TERT promoter mutations. Patients with TERT promoter mutations displayed significantly worse outcomes than those without mutations (10-year cause-specific survival (CSS): 73.7% vs. 98.1%, p < 0.001; 10-year disease-free survival (DFS): 53.7% vs. 93.3%, p < 0.001). As for extent of thyroidectomy among TERT mutation-negative patients with 1–4 cm intrathyroidal PTC, patients who underwent LT showed no significant differences in 10-year CSS and 10-year DFS compared to patients who had total thyroidectomy (TT) under propensity score-matching. Avoiding TT for those patients indicates a possible pathway to prevent overtreatment and reduce postoperative complications.
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Affiliation(s)
- Aya Ebina
- Department of Endocrine Surgery, Nippon Medical School, Tokyo 113-8603, Japan;
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Correspondence: ; Tel.: +81-3-3822-2131
| | - Yuki Togashi
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Satoko Baba
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Yukiko Sato
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
| | - Seiji Sakata
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Masashi Ishikawa
- Department of Anesthesiology, Nippon Medical School, Tokyo 113-8603, Japan;
| | - Hiroki Mitani
- Division of Head and Neck, Cancer Institute Hospital, Tokyo 135-8550, Japan;
| | - Kengo Takeuchi
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Clinical Pathology Center, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, Tokyo 113-8603, Japan;
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14
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Szpak-Ulczok S, Pfeifer A, Rusinek D, Oczko-Wojciechowska M, Kowalska M, Tyszkiewicz T, Cieslicka M, Handkiewicz-Junak D, Fujarewicz K, Lange D, Chmielik E, Zembala-Nozynska E, Student S, Kotecka-Blicharz A, Kluczewska-Galka A, Jarzab B, Czarniecka A, Jarzab M, Krajewska J. Differences in Gene Expression Profile of Primary Tumors in Metastatic and Non-Metastatic Papillary Thyroid Carcinoma-Do They Exist? Int J Mol Sci 2020; 21:E4629. [PMID: 32610693 PMCID: PMC7369779 DOI: 10.3390/ijms21134629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
Molecular mechanisms of distant metastases (M1) in papillary thyroid cancer (PTC) are poorly understood. We attempted to analyze the gene expression profile in PTC primary tumors to seek the genes associated with M1 status and characterize their molecular function. One hundred and twenty-three patients, including 36 M1 cases, were subjected to transcriptome oligonucleotide microarray analyses: (set A-U133, set B-HG 1.0 ST) at transcript and gene group level (limma, gene set enrichment analysis (GSEA)). An additional independent set of 63 PTCs, including 9 M1 cases, was used to validate results by qPCR. The analysis on dataset A detected eleven transcripts showing significant differences in expression between metastatic and non-metastatic PTC. These genes were validated on microarray dataset B. The differential expression was positively confirmed for only two genes: IGFBP3, (most significant) and ECM1. However, when analyzed on an independent dataset by qPCR, the IGFBP3 gene showed no differences in expression. Gene group analysis showed differences mainly among immune-related transcripts, indicating the potential influence of tumor immune infiltration or signal within the primary tumor. The differences in gene expression profile between metastatic and non-metastatic PTC, if they exist, are subtle and potentially detectable only in large datasets.
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Affiliation(s)
- Sylwia Szpak-Ulczok
- Nuclear Medicine and Endocrine Oncology Department; Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (S.S.-U.); (D.H.-J.); (A.K.-B.); (A.K.-G.); (B.J.)
| | - Aleksandra Pfeifer
- Department of Genetic and Molecular Diagnostics of Cancer, Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (A.P.); (D.R.); (M.O.-W.); (M.K.); (T.T.); (M.C.)
| | - Dagmara Rusinek
- Department of Genetic and Molecular Diagnostics of Cancer, Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (A.P.); (D.R.); (M.O.-W.); (M.K.); (T.T.); (M.C.)
| | - Malgorzata Oczko-Wojciechowska
- Department of Genetic and Molecular Diagnostics of Cancer, Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (A.P.); (D.R.); (M.O.-W.); (M.K.); (T.T.); (M.C.)
| | - Malgorzata Kowalska
- Department of Genetic and Molecular Diagnostics of Cancer, Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (A.P.); (D.R.); (M.O.-W.); (M.K.); (T.T.); (M.C.)
| | - Tomasz Tyszkiewicz
- Department of Genetic and Molecular Diagnostics of Cancer, Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (A.P.); (D.R.); (M.O.-W.); (M.K.); (T.T.); (M.C.)
| | - Marta Cieslicka
- Department of Genetic and Molecular Diagnostics of Cancer, Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (A.P.); (D.R.); (M.O.-W.); (M.K.); (T.T.); (M.C.)
| | - Daria Handkiewicz-Junak
- Nuclear Medicine and Endocrine Oncology Department; Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (S.S.-U.); (D.H.-J.); (A.K.-B.); (A.K.-G.); (B.J.)
| | - Krzysztof Fujarewicz
- Institute of Automatic Control, Silesian University of Technology, 44-100 Gliwice, Poland; (K.F.); (S.S.)
| | - Dariusz Lange
- Tumor Pathology Department; Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (D.L.); (E.C.); (E.Z.-N.)
| | - Ewa Chmielik
- Tumor Pathology Department; Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (D.L.); (E.C.); (E.Z.-N.)
| | - Ewa Zembala-Nozynska
- Tumor Pathology Department; Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (D.L.); (E.C.); (E.Z.-N.)
| | - Sebastian Student
- Institute of Automatic Control, Silesian University of Technology, 44-100 Gliwice, Poland; (K.F.); (S.S.)
| | - Agnieszka Kotecka-Blicharz
- Nuclear Medicine and Endocrine Oncology Department; Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (S.S.-U.); (D.H.-J.); (A.K.-B.); (A.K.-G.); (B.J.)
| | - Aneta Kluczewska-Galka
- Nuclear Medicine and Endocrine Oncology Department; Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (S.S.-U.); (D.H.-J.); (A.K.-B.); (A.K.-G.); (B.J.)
| | - Barbara Jarzab
- Nuclear Medicine and Endocrine Oncology Department; Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (S.S.-U.); (D.H.-J.); (A.K.-B.); (A.K.-G.); (B.J.)
| | - Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic; Maria Sklodowska, Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland;
| | - Michal Jarzab
- Breast Unit; Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland;
| | - Jolanta Krajewska
- Nuclear Medicine and Endocrine Oncology Department; Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland; (S.S.-U.); (D.H.-J.); (A.K.-B.); (A.K.-G.); (B.J.)
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15
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Al-Salam S, Sharma C, Afandi B, Al Dahmani K, Al-Zahrani AS, Al Shamsi A, Al Kaabi J. BRAF and KRAS mutations in papillary thyroid carcinoma in the United Arab Emirates. PLoS One 2020; 15:e0231341. [PMID: 32315324 PMCID: PMC7173769 DOI: 10.1371/journal.pone.0231341] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/22/2020] [Indexed: 01/09/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is the most common malignant thyroid neoplasm comprising 80–90% of all thyroid malignancies. Molecular changes in thyroid follicular cells are likely associated with the development of PTC. Mutations in serine/threonine-protein kinase (BRAF) and Rat sarcoma viral oncogene homolog (RAS) are commonly seen in PTC. Methods In total, 90 cases of PTC are randomly selected from archive paraffin blocks and 10μm sections were cut and processed for DNA extraction. BRAFV600E mutation and 8 types of KRAS mutations were investigated using Real Time PCR. Results BRAFV600E mutation was identified in 46% of PTC while KRAS mutations were seen in 11% of PTC. There was significant correlation between BRAFV600E mutation and PTC larger than 5cm in diameter, positive surgical margin and lymph node metastasis. BRAFV600E mutation was significantly higher in patients with less than 55-year of age than those more than 55-year of age. BRAFV600E mutation was significantly higher in patients with family history of thyroid cancer than those without. There was no significant difference in BRAFV600E mutation between males and females, PTC classic and follicular variants, unifocal and multifocal PTC. There was a significant higher percentage of BRAFV600E mutation in classic PTC than papillary microcarcinoma variant. There was no significant age, gender, histologic type, tumor size, lymph node metastasis, tumor focality, and surgical margin status differences between KRAS mutated and non-mutated PTC. Conclusion BRAFV600E and KRAS mutation are seen in a significant number of PTC in the UAE. BRAF mutation is significantly correlated with large tumor size, positive surgical margins and lymph node metastasis suggesting an association between BRAFV600E mutation and tumor growth and spread.
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Affiliation(s)
- Suhail Al-Salam
- Department of Pathology, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Bachar Afandi
- Endocrine Division, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Ali S. Al-Zahrani
- Department of Medicine, Molecular Endocrinology Division, Alfaisal University, Riyadh, Saudi Arabia
- Department of Molecular Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amal Al Shamsi
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Juma Al Kaabi
- Department of Internal Medicine, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- * E-mail:
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16
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Zhang J, Yan D, He L, Zhang Q, Wen S, Liu P, Zhou H, Peng Y. Expression of Caveolin-1 Is Associated With Thyroid Function in Patients With Human Papillary Thyroid Carcinoma. Dose Response 2020; 18:1559325820919330. [PMID: 32313526 PMCID: PMC7160781 DOI: 10.1177/1559325820919330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to evaluate the levels of caveolin-1 in thyroid
follicular epithelial cells of papillary thyroid cancer, follicular thyroid
cancer, and nonmalignant thyroid nodule benign follicular adenoma, as well
as to explore the relationship between the levels of caveolin-1 and thyroid
function. Methods: Thirty cases of papillary thyroid cancer, 10 cases of follicular thyroid
cancer, 32 cases of nonmalignant thyroid nodule benign follicular adenoma,
and 30 controls were enrolled in this study. Caveolin-1 expression in tissue
specimens obtained from these cases was evaluated by immunohistochemistry
and Western blotting. Results: Caveolin-1 expression in thyroid epithelial cells of patients with papillary
thyroid cancer, particularly female patients, was significantly higher than
that in patients with follicular thyroid cancer and nonmalignant thyroid
nodule benign follicular adenoma (P < .005). Serum
thyroid-stimulating hormone (TSH) levels in the caveolin-1-positive
expression group were lower than that in the caveolin-1-negative expression
group, and the lowest expression of caveolin-1 was detected in tissues of
patients with Graves’ disease. The serum TSH level was associated with
caveolin-1 expression in thyroid epithelial cells. Conclusion: Caveolin-1 may participate in regulating thyroid function and is a potential
biomarker of follicular thyroid cancer.
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Affiliation(s)
- Jingyi Zhang
- Department of Endocrinology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Immunology, Nanjing Medical University, Nanjing, China.,The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China
| | - Dongxia Yan
- Department of Pathology, Ma'anshan People's Hospital, Ma'anshan, China
| | - Lianping He
- College of Experience Industry, Anhui Polytechnic University, Wuhu, Anhui, China
| | - Qing Zhang
- Department of Pathology, Ma'anshan People's Hospital, Ma'anshan, China
| | - Shuang Wen
- Department of Immunology, Nanjing Medical University, Nanjing, China
| | - Peiyu Liu
- Department of Pharmacology, School of Basic Medical Science, Nanjing Medical University, Nanjing, China
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, Nanjing, China
| | - Yongde Peng
- Department of Endocrinology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
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17
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Kim WB, Jeon MJ, Kim WG, Kim TY, Shong YK. Unmet Clinical Needs in the Treatment of Patients with Thyroid Cancer. Endocrinol Metab (Seoul) 2020; 35:14-25. [PMID: 32207260 PMCID: PMC7090306 DOI: 10.3803/enm.2020.35.1.14] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/17/2020] [Accepted: 02/24/2020] [Indexed: 12/13/2022] Open
Abstract
The increased incidence of thyroid cancer is a worldwide phenomenon; however, the issue of overdiagnosis has been most prominent in South Korea. The age-standardized mortality rate of thyroid cancer in Korea steeply increased from 1985 to 2004 (from 0.17 per 100,000 to 0.85 per 100,000), and then decreased until 2015 to 0.42 per 100,000, suggesting that early detection reduced mortality. However, early detection of thyroid cancer may be cost-ineffective, considering its very high prevalence and indolent course. Therefore, risk stratification and tailored management are vitally important, but many prognostic markers can only be evaluated postoperatively. Discovery of preoperative marker(s), especially for small cancers, is the most important unmet clinical need for thyroid cancer. Herein, we discuss some such factors that we recently discovered. Another unmet clinical need is better treatment of radioiodine-refractory (RAIR) differentiated thyroid cancer (DTC) and undifferentiated cancers. Although sorafenib and lenvatinib are available, better drugs are needed. We found that phosphoglycerate dehydrogenase, a critical enzyme for serine biosynthesis, could be a novel therapeutic target, and that the lymphocyte-to-monocyte ratio is a prognostic marker of survival in patients with anaplastic thyroid carcinoma or RAIR DTC. Deeper insights are needed into tumor-host interactions in thyroid cancer to improve treatment.
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Affiliation(s)
- Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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18
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Khatami F, Larijani B, Heshmat R, Nasiri S, Haddadi-Aghdam M, Teimoori-Toolabi L, Tavangar SM. Hypermethylated RASSF1 and SLC5A8 promoters alongside BRAF V600E mutation as biomarkers for papillary thyroid carcinoma. J Cell Physiol 2020; 235:6954-6968. [PMID: 32017063 DOI: 10.1002/jcp.29591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
Circulating cell-free DNA (cfDNA) has been considered as a diagnostic source to track genetic and epigenetic alterations in cancer. We aimed to study mutation in addition to the methylation status in the promoter regions of RASSF1 and SLC5A8 genes in tissues and circulating free DNA samples of patients affected with papillary thyroid carcinoma (PTC) and thyroid nodules as controls. BRAFV600E mutation was studied by ARMS-scorpion real-time polymerase chain reaction method in 57 PTC and 45 thyroid nodule cases. Methylation status of RASSF1 and SLC5A8 promoter regions was analyzed by methylation-specific high-resolution melting curve analysis. BRAFV600E mutation was found in 39 (68.4%) out of 57 PTC tissue samples, while in 33 (49.1%) cases of cfDNA, this mutation was detected. The frequency of BRAFV600E mutation in cfDNA was significantly different between metastatic and nonmetastatic PTC cases (22 of 33 PTC cases vs. 5 of 34 thyroid nodule samples). Methylation levels of three promoter regions of SLC5A8 and proximal promoter region of RASSF1 was significantly different between PTC and thyroid nodule cases in both cfDNA and tissue DNA. In addition, the methylation status of these two genes in tissue DNA was reflected in methylation status observed in cfDNA. This study confirmed that BRAFV600E mutation is better for discrimination between papillary thyroid carcinoma and thyroid nodules. On the other hand, hypermethylation in the more proximal promoter regions to RASSF1 and SLC5A8 genes showed higher sensitivity and more acceptable specificity for this discrimination.
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Affiliation(s)
- Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirzad Nasiri
- Departments of Surgery, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Haddadi-Aghdam
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Ladan Teimoori-Toolabi
- Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Seyed M Tavangar
- Department of Pathology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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19
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Kim KJ, Kim SG, Tan J, Shen X, Viola D, Elisei R, Puxeddu E, Fugazzola L, Colombo C, Jarzab B, Czarniecka A, Lam AK, Mian C, Vianello F, Yip L, Riesco-Eizaguirre G, Santisteban P, O'Neill CJ, Sywak MS, Clifton-Bligh R, Bendlova B, Sýkorová V, Xing M. BRAF V600E status may facilitate decision-making on active surveillance of low-risk papillary thyroid microcarcinoma. Eur J Cancer 2019; 124:161-169. [PMID: 31790974 DOI: 10.1016/j.ejca.2019.10.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/05/2019] [Accepted: 10/21/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Conservative active surveillance has been proposed for low-risk papillary thyroid microcarcinoma (PTMC), defined as ≤1.0 cm and lacking clinical aggressive features, but controversy exists with accepting it as not all such PTMCs are uniformly destined for benign prognosis. This study investigated whether BRAF V600E status could further risk stratify PTMC, particularly low-risk PTMC, and can thus help with more accurate case selection for conservative management. METHODS This international multicenter study included 743 patients treated with total thyroidectomy for PTMC (584 women and 159 men), with a median age of 49 years (interquartile range [IQR], 39-59 years) and a median follow-up time of 53 months (IQR, 25-93 months). RESULTS On overall analyses of all PTMCs, tumour recurrences were 6.4% (32/502) versus 10.8% (26/241) in BRAF mutation-negative versus BRAF mutation-positive patients (P = 0.041), with a hazard ratio (HR) of 2.44 (95% CI (confidence interval), 1.15-5.20) after multivariate adjustment for confounding clinical factors. On the analyses of low-risk PTMC, recurrences were 1.3% (5/383) versus 4.3% (6/139) in BRAF mutation-negative versus BRAF mutation-positive patients, with an HR of 6.65 (95% CI, 1.80-24.65) after adjustment for confounding clinical factors. BRAF mutation was associated with a significant decline in the Kaplan-Meier recurrence-free survival curve in low-risk PTMC. CONCLUSIONS BRAF V600E differentiates the recurrence risk of PTMC, particularly low-risk PTMC. Given the robust negative predictive value, conservative active surveillance of BRAF mutation-negative low-risk PTMC is reasonable whereas the increased recurrence risk and other well-known adverse effects of BRAF V600E make the feasibility of long-term conservative surveillance uncertain for BRAF mutation-positive PTMC.
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Affiliation(s)
- Kyeong J Kim
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, South Korea
| | - Sin G Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, South Korea
| | - Jie Tan
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Xiaopei Shen
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - David Viola
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Rossella Elisei
- Section of Endocrinology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Efisio Puxeddu
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - Laura Fugazzola
- Division of Endocrine and Metabolic Diseases, IRCCS Instituto Auxologico Italiano, and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Carla Colombo
- Division of Endocrine and Metabolic Diseases, IRCCS Instituto Auxologico Italiano, and Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Barbara Jarzab
- Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Agnieszka Czarniecka
- Maria Sklodowska-Curie Institute-Oncology Center, Gliwice Branch, Gliwice, Poland
| | - Alfred K Lam
- Cancer Molecular Pathology of School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Caterina Mian
- Department of Medicine, Endocrinology Unit, University of Padua, Italy
| | | | - Linwah Yip
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Garcilaso Riesco-Eizaguirre
- Department of Endocrinology and Nutrition Hospital Universitario La Paz and Hospital, Universitario De Mostoles, 28029 Madrid, Spain; Biomedical Research Institute "Alberto Sols", Consejo Superior De Investigaciones Cientificas and Univeridad Autonoma de Madrid, 28029, Madrid, Spain; Ciberonc, Health Institute Carlos III, 28029 Madrid, Spain
| | - Pilar Santisteban
- Biomedical Research Institute "Alberto Sols", Consejo Superior De Investigaciones Cientificas and Univeridad Autonoma de Madrid, 28029, Madrid, Spain; Ciberonc, Health Institute Carlos III, 28029 Madrid, Spain
| | | | - Mark S Sywak
- Endocrine Surgical Unit, The University of Sydney, Sydney, Australia
| | | | - Bela Bendlova
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Vlasta Sýkorová
- Department of Molecular Endocrinology, Institute of Endocrinology, Prague, Czech Republic
| | - Mingzhao Xing
- Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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20
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Ruiz EML, Niu T, Zerfaoui M, Kunnimalaiyaan M, Friedlander PL, Abdel-Mageed AB, Kandil E. A novel gene panel for prediction of lymph-node metastasis and recurrence in patients with thyroid cancer. Surgery 2019; 167:73-79. [PMID: 31711617 DOI: 10.1016/j.surg.2019.06.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although well-differentiated papillary thyroid cancer may remain indolent, lymph node metastases and the recurrence rates are approximately 50% and 20%, respectively. No current biomarkers are able to predict metastatic lymphadenopathy and recurrence in early stage papillary thyroid cancer. Hence, identifying prognostic biomarkers predicting cervical lymph-node metastases would prove very helpful in determining treatment. METHODS The database of the Cancer Genome Atlas included 495 papillary thyroid cancer samples. Using this database, we developed a machine learning model to define a gene signature that could predict lymph-node metastasis (N0 or N1). Kruskal-Wallis tests, univariate and multivariate logistic and Cox regression models, and Kaplan-Meier analyses were performed to correlate the gene signature with clinical outcomes. RESULTS We identified a panel of 25 genes and constructed a risk score that can differentiate N0 and N1 papillary thyroid cancer samples (P < .001) with a sensitivity of 86%, a specificity of 62%, a positive predictive value of 93%, and a negative predictive value of 42%. This panel represents an independent biomarker to predict metastatic lymphadenopathy (OR = 8.06, P < .001) specifically in patients with T1 lesions (OR = 7.65, P = .002) and disease-free survival (HR = 2.64, P = .043). CONCLUSION This novel 25-gene panel may be used as a potential prognostic marker for accurately predicting lymph-node metastasis and disease-free survival in patients with early-stage papillary thyroid cancer.
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Affiliation(s)
- Emmanuelle M L Ruiz
- Department of Surgery, Division of General, Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Tianhua Niu
- Department of Biochemistry and Molecular Biology, Tulane University School of Medicine, New Orleans, LA; Department of Global Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Mourad Zerfaoui
- Department of Surgery, Division of General, Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Muthusamy Kunnimalaiyaan
- Department of Surgery, Division of General, Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Paul L Friedlander
- Department of Otolaryngology, Tulane University School of Medicine, New Orleans, LA
| | - Asim B Abdel-Mageed
- Department of Urology, Tulane University School of Medicine, New Orleans, LA
| | - Emad Kandil
- Department of Surgery, Division of General, Endocrine and Oncological Surgery, Tulane University School of Medicine, New Orleans, LA.
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21
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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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22
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Perera D, Ghossein R, Camacho N, Senbabaoglu Y, Seshan V, Li J, Bouvier N, Boucai L, Viale A, Socci ND, Untch BR, Gonen M, Knauf J, Fagin JA, Berger M, Tuttle RM. Genomic and Transcriptomic Characterization of Papillary Microcarcinomas With Lateral Neck Lymph Node Metastases. J Clin Endocrinol Metab 2019; 104:4889-4899. [PMID: 31237614 PMCID: PMC6733494 DOI: 10.1210/jc.2019-00431] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 06/19/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Most papillary microcarcinomas (PMCs) are indolent and subclinical. However, as many as 10% can present with clinically significant nodal metastases. OBJECTIVE AND DESIGN Characterization of the genomic and transcriptomic landscape of PMCs presenting with or without clinically important lymph node metastases. SUBJECTS AND SAMPLES Formalin-fixed paraffin-embedded PMC samples from 40 patients with lateral neck nodal metastases (pN1b) and 71 patients with PMC with documented absence of nodal disease (pN0). OUTCOME MEASURES To interrogate DNA alterations in 410 genes commonly mutated in cancer and test for differential gene expression using a custom NanoString panel of 248 genes selected primarily based on their association with tumor size and nodal disease in the papillary thyroid cancer TCGA project. RESULTS The genomic landscapes of PMC with or without pN1b were similar. Mutations in TERT promoter (3%) and TP53 (1%) were exclusive to N1b cases. Transcriptomic analysis revealed differential expression of 43 genes in PMCs with pN1b compared with pN0. A random forest machine learning-based molecular classifier developed to predict regional lymph node metastasis demonstrated a negative predictive value of 0.98 and a positive predictive value of 0.72 at a prevalence of 10% pN1b disease. CONCLUSIONS The genomic landscape of tumors with pN1b and pN0 disease was similar, whereas 43 genes selected primarily by mining the TCGA RNAseq data were differentially expressed. This bioinformatics-driven approach to the development of a custom transcriptomic assay provides a basis for a molecular classifier for pN1b risk stratification in PMC.
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Affiliation(s)
- Dilmi Perera
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Yasin Senbabaoglu
- Department of Bioinformatics & Computational Biology, Genentech, South San Francisco, California
| | | | - Juan Li
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Bouvier
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Boucai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Agnes Viale
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Brian R Untch
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mithat Gonen
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jeffrey Knauf
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - James A Fagin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Berger
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - R Michael Tuttle
- Memorial Sloan Kettering Cancer Center, New York, New York
- Correspondence and Reprint Requests: R. Michael Tuttle, MD, Endocrinology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10021. E-mail:
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23
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Kure S, Ishino K, Kudo M, Wada R, Saito M, Nagaoka R, Sugitani I, Naito Z. Incidence of BRAF V600E mutation in patients with papillary thyroid carcinoma: a single-institution experience. J Int Med Res 2019; 47:5560-5572. [PMID: 31533501 PMCID: PMC6862924 DOI: 10.1177/0300060519873481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Papillary thyroid carcinoma (PTC) accounts for 95% of all thyroid carcinomas. PTC is an epithelial tumor characterized by the proliferation of follicular cells with distinctive nuclear features, and is heterogeneous in terms of its carcinogenesis and behavior. PTC has been associated with several genetic abnormalities, of which the BRAF V600E mutation is the most common. However, reported incidences of this mutation have varied depending on the patient background, population size, or methods. In this study, we investigated the incidence of BRAF V600E mutation and its relationships with clinicopathological characteristics in patients with PTC. Methods Surgical specimens were obtained from 40 patients with PTC who underwent surgery at Nippon Medical School Hospital between 2009 and 2017. DNA from exon 15 of the BRAF gene was extracted and amplified by polymerase chain reaction, followed by direct sequencing. Results The frequency of BRAF V600E mutation increased with age. However, there were no correlations between BRAF V600E mutation and other clinicopathological features including sex, Hashimoto disease, family history of thyroid disease, tumor size, pathological T stage, pathological N stage, lymphovascular invasion, extrathyroidal extension, and metastasis. Conclusions This study demonstrated that PTCs harboring the BRAF V600E mutation increased in an age-dependent manner.
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Affiliation(s)
- Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.,Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Kousuke Ishino
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Mitsuhiro Kudo
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Ryuichi Wada
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.,Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Marie Saito
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Zenya Naito
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.,Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
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24
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Park JH, Yoon JH. Lobectomy in patients with differentiated thyroid cancer: indications and follow-up. Endocr Relat Cancer 2019; 26:R381-R393. [PMID: 31018176 DOI: 10.1530/erc-19-0085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 12/21/2022]
Abstract
The extent of thyroid surgery for patients with low- and intermediate-risk differentiated thyroid carcinoma (DTC), with a primary tumour <4 cm and no extrathyroidal extension (ETE) or lymph node (LN) metastases, has shifted in a more conservative direction. However, clinicopathological risk factors, including microscopic ETE, aggressive histology, vascular invasion in papillary thyroid carcinoma (PTC) and intermediate volume of LN metastases, can only be identified after completing thyroid lobectomy. It is controversial whether patients with these risk factors should immediately undergo complete thyroidectomy and/or radioactive iodine remnant ablation or should be monitored without further treatments. Data are conflicting about the prognostic impact of these risk factors on clinical DTC outcomes. Notably, the recurrence rate in patients who underwent thyroid lobectomy is low and the few recurrences that develop during long-term follow-up can readily be detected by neck ultrasonography and treated by salvage surgery with no impact on survival. These findings suggest that a more conservative approach may be a preferred management strategy over immediate completion surgery, despite a slightly higher risk of structural recurrence. Regarding follow-up of post-lobectomy DTC patients, it is reasonable that an initial risk stratification system based on clinicohistological findings be used to guide the short-term follow-up prior to evaluating the response to initial therapy and that the dynamic risk stratification system based on the response to initial therapy be used to guide long-term follow-up.
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Affiliation(s)
- Jae Hyun Park
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Jong Ho Yoon
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea
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25
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Antonelli A, Ferrari SM, Elia G, Patrizio A, Fallahi P. Metastases free thyroid cancer patients harbouring TERT mutations may benefit from a more intensive treatment and follow-up. Gland Surg 2019; 8:298-300. [PMID: 31328110 DOI: 10.21037/gs.2019.05.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Alessandro Antonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giusy Elia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Armando Patrizio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Effect of Sentinel Node Biopsy in Clinically N0, BRAF V600E–Mutated, Small Papillary Thyroid Carcinoma. Clin Nucl Med 2019; 44:359-364. [DOI: 10.1097/rlu.0000000000002465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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27
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Abstract
Controversies exist on how to optimally manage thyroid cancer because the prognosis is often uncertain based on clinical backgrounds. This can now be helped with prognostic genetic markers in thyroid cancer, exemplified by BRAF V600E and TERT promoter mutations, which have been well characterized and widely appreciated. The genetic duet of BRAF V600E/RAS and TERT promoter mutations is a most robust prognostic genetic pattern for poor prognosis of differentiated thyroid cancer. The high negative predictive values of the prognostic genetic markers are equally valuable. The best prognostic value of genetic markers in thyroid cancer is achieved through a clinical risk level-based and genotype-individualized manner.
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Affiliation(s)
- Mingzhao Xing
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
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28
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Kure S, Wada R, Naito Z. Relationship between genetic alterations and clinicopathological characteristics of papillary thyroid carcinoma. Med Mol Morphol 2019; 52:181-186. [DOI: 10.1007/s00795-019-00217-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/10/2019] [Indexed: 12/17/2022]
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29
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Cho JW, Kim WW, Lee YM, Jeon MJ, Kim WG, Song DE, Park Y, Chung KW, Hong SJ, Sung TY. Impact of tumor-associated macrophages and BRAF V600E mutation on clinical outcomes in patients with various thyroid cancers. Head Neck 2019; 41:686-691. [PMID: 30659691 DOI: 10.1002/hed.25469] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/21/2018] [Accepted: 08/17/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Tumor-associated macrophages (TAMs) play a role in thyroid cancer tumor progression and metastasis. This study aimed to investigate the association of TAM density and cluster of differentiation 68 (CD68) expression with thyroid tumors as a prognostic marker and the relationship of these factors with BRAFV600E mutations. METHODS This study included 275 thyroid specimen tissues, including benign and malignant lesions. We compared the clinicopathological features according to thyroid tumor types and evaluated the presence of CD68 expression and BRAFV600E mutations. RESULTS CD68 positive expression increased with aggressiveness of thyroid tumor histologic grades (P < 0.001). In patients with poorly differentiated thyroid cancer (PDTC) and anaplastic thyroid cancer (ATC), CD68 positivity was associated with aggressive adverse clinical outcomes such as extrathyroidal extension, cervical lymph node metastases, and distant metastases (P < 0.05). CONCLUSIONS CD68 positivity was more frequent in advanced and aggressive thyroid cancer types such as PDTC/ATC.
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Affiliation(s)
- Jae Won Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Woong Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Wook Chung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suck Joon Hong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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30
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Bournaud C, Descotes F, Decaussin-Petrucci M, Berthiller J, de la Fouchardière C, Giraudet AL, Bertholon-Gregoire M, Robinson P, Lifante JC, Lopez J, Borson-Chazot F. TERT promoter mutations identify a high-risk group in metastasis-free advanced thyroid carcinoma. Eur J Cancer 2019; 108:41-49. [PMID: 30648628 DOI: 10.1016/j.ejca.2018.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/18/2018] [Accepted: 12/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND TERT promoter mutations are associated with adverse clinicopathological characteristics in thyroid carcinomas and considered as a major indicator of poor outcomes. Nevertheless, most studies have pooled heterogeneous types of thyroid carcinomas and have been conducted retrospectively. We investigated the association between TERT promoter mutations and recurrence in a prospective series of 173 intermediate- to high-risk patients with thyroid cancer. PATIENTS Patients referred for radioiodine treatment after thyroidectomy for intermediate- to high-risk differentiated thyroid carcinoma were included in a prospective observational study and tested for TERT promoter, BRAF, and RAS mutations of their primary tumours. We analysed the relationship between TERT promoter mutations and outcomes. RESULTS The prevalence of TERT promoter mutations was 20.2% (35/173) in the total population. It was significantly higher in tumours harbouring aggressive histological features (poorly differentiated carcinoma, tall cell variant of papillary cancer or widely invasive follicular cancer) than in non-aggressive tumours: 32.7% (16/49) versus 15.3% (19/124; p = 0.020). TERT promoter mutations were also strongly associated with age ≥45 years (p = 0.005), pT4 stage (p = 0.015), metastatic disease (p = 0.014), and extrathyroidal extension (p = 0.002). TERT promoter mutations were associated with poor outcomes in the total population (p < 0.001) but not in the subgroup of non-metastatic patients (p = 0.051). However, they were associated with a worse outcome in patients both free of metastases and devoid of aggressive histological features. Neither BRAF nor RAS mutations were associated with event-free survival in non-metastatic patients. CONCLUSION Although their prognostic value does not seem to overcome that of histology, TERT promoter mutations may help to better define the prognosis of localized thyroid cancer patients without aggressive histology.
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Affiliation(s)
- Claire Bournaud
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Médecine Nucléaire, Bron Cedex, F-69677, France.
| | - Françoise Descotes
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biochimie et Biologie Moléculaire, Pierre Bénite, cedex, F-69495, France
| | - Myriam Decaussin-Petrucci
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service D'Anatomie Pathologique, Pierre Bénite, cedex, F-69495, France; Université Lyon 1, Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon, F-69008, France
| | - Julien Berthiller
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service D'Epidémiologie Clinique, Pôle Information Médicale Evaluation Recherche, Bron Cedex, F-69677, France
| | | | - Anne-Laure Giraudet
- Centre Léon-Bérard, Dardre LaennecMedical Oncologyuat, 28, Rue Laennec, Lyon, cedex, F-69373, France
| | - Mireille Bertholon-Gregoire
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Médecine Nucléaire, Bron Cedex, F-69677, France
| | - Philip Robinson
- Hospices Civils de Lyon, Direction de La Recherche Clinique et de L'Innovation, Lyon, cedex, F-69437, France
| | - Jean-Christophe Lifante
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Chirurgie Générale et Endocrinienne, Pierre Bénite, cedex, F-69495, France; Hospices Civils de Lyon, Fédération D'Endocrinologie, Bron Cedex, F-69677, France
| | - Jonathan Lopez
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Service de Biochimie et Biologie Moléculaire, Pierre Bénite, cedex, F-69495, France; Université Lyon 1, Cancer Research Center of Lyon, INSERM1052 CNRS5286, Lyon, F-69008, France
| | - Françoise Borson-Chazot
- Hospices Civils de Lyon, Fédération D'Endocrinologie, Bron Cedex, F-69677, France; Université Lyon 1, HESPER EA 7425, Lyon, F-69008, France
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Zarkesh M, Zadeh-Vakili A, Akbarzadeh M, Fanaei SA, Hedayati M, Azizi F. The role of matrix metalloproteinase-9 as a prognostic biomarker in papillary thyroid cancer. BMC Cancer 2018; 18:1199. [PMID: 30509240 PMCID: PMC6276227 DOI: 10.1186/s12885-018-5112-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the association between matrix metalloproteinase-9 (MMP-9) expression with BRAF V600E mutation and clinicopathological features, in Iranian papillary thyroid cancer (PTC) patients. METHODS In total, 90 participants including 60 PTC patients (15 males and 45 females) and 30 individuals with benign multinodular goiter (MNG) (5 males and 25 females) which were confirmed by surgical pathology, were investigated. MMP-9 was evaluated at both mRNA and protein levels, using SYBR-Green Real-Time PCR and enzyme-linked immune sorbent assay (ELISA), respectively. BRAF V600E mutation was detected by sequencing. RESULTS Mean age of PTC and MNG patients was 37.6 ± 12.6 and 48.1 ± 13.3 years, respectively (P = 0.001). BRAF V600E mutation was found in 24 of the 60 (40%) PTC cases, with mean tumor size of 1.59 ± 1.20 cm. MMP-9 mRNA levels were elevated in tumoral compared to the adjacent non-tumoral tissues (P = 0.039); moreover, this rise was also observed in PTC patients compared to MNG patients (P = 0.001). The mRNA levels of MMP-9 increased in patients aged≥45 years (P = 0.015), those with lymphovascular invasion (P = 0.003), and higher tumor stages (III and IV) (P = 0.011). The protein level of MMP-9 increased in tumoral compared to adjacent non-tumoral tissues (P < 0.001); this increase was also found in PTC patients compared to MNG participants (P = 0.004). MMP-9 protein level was higher in patients aged≥45 years (P = 0.001), those with lymphovascular invasion (P = 0.036) and higher TNM stages (III and IV) (P = 0.001). Area under the ROC curve (AUC) was 0.70 (95%CI: 0.57-0.83, P = 0.003), with 91.4% sensitivity and 51.9% specificity at the cutoff value of 0.50. CONCLUSION The mRNA and protein levels of MMP-9 had no association with BRAF V600E mutation in Iranian PTC patients. These levels were associated with age, TNM stages, and lymphovascular invasion, being defined as malignant factors. Thus, elevated levels of MMP-9 in PTC patients compared to MNG participants illustrated that it can be used as a potential biomarker to differentiate PTC patients from those with MNG.
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Affiliation(s)
- Maryam Zarkesh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Po Box: 19395-4763, Tehran, Iran
| | - Azita Zadeh-Vakili
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Po Box: 19395-4763, Tehran, Iran.
| | - Mahdi Akbarzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Ahmad Fanaei
- Association Professor of General Surgery, Erfan Hospital, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Science, Tehran, Iran
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Goh X, Lum J, Yang SP, Chionh SB, Koay E, Chiu L, Parameswaran R, Ngiam KY, Loh TKS, Nga ME, Lim CM. BRAF mutation in papillary thyroid cancer-Prevalence and clinical correlation in a South-East Asian cohort. Clin Otolaryngol 2018; 44:114-123. [PMID: 30294871 DOI: 10.1111/coa.13238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 05/27/2018] [Accepted: 09/29/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVE BRAF mutation is the commonest mutation seen in papillary thyroid cancer (PTC), but its prevalence and clinical significance vary across countries. We aim to evaluate the prevalence and clinico-pathological correlation of BRAF mutation in PTC patients at our centre. STUDY DESIGN Retrospective cohort study of 75 consecutive archival thyroid specimens, whereby BRAF mutation was detected using a polymerase chain reaction (PCR) technique and correlated with clinical and pathological features and outcomes. SETTING Tertiary university hospital in Singapore. PARTICIPANTS A total of 75 consecutive histologically proven archival thyroid specimens from patients who underwent thyroidectomy for PTC were accrued for this study. MAIN OUTCOME MEASURES Main outcome is to determine the prevalence of the BRAF mutation in our South-East Asian population. Secondary aim is to correlate the mutational status with adverse pathological features like histological variants, multi-focality, lymphovascular invasion and extra-thyroidal extension, clinical features like demographics, TNM stage, recurrence and survival, as well as treatment details like type of surgery performed and radioiodine doses. RESULTS BRAF mutation was detected in 56% (42/75) of PTC. All but one BRAF-mutated PTC had the BRAFV600E mutation. BRAF-mutated tumours were associated with an advanced T-stage (P = 0.049) and were more likely to have a central neck dissection (P = 0.036). There was no significant correlation between BRAF mutation status and clinical outcomes. CONCLUSION The prevalence of BRAF mutation is 56%. BRAF mutation-positive tumours were associated with locally advanced disease, but not poorer survival.
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Affiliation(s)
- Xueying Goh
- Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore
| | - Jeffery Lum
- Department of Pathology, National University Hospital, Singapore
| | - Samantha Peiling Yang
- Division of Endocrinology, University Medicine Cluster, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Siok Bee Chionh
- Division of Endocrinology, University Medicine Cluster, National University Hospital, Singapore
| | - Evelyn Koay
- Department of Pathology, National University Hospital, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Laboratory Medicine, National University Hospital, Singapore
| | - Lily Chiu
- Department of Laboratory Medicine, National University Hospital, Singapore
| | - Rajeev Parameswaran
- Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Kee Yuan Ngiam
- Division of General Surgery, University Surgical Cluster, National University Hospital, Singapore
| | - Thomas Kwok Seng Loh
- Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore.,Department of Otolaryngology - Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore.,Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chwee Ming Lim
- Department of Otolaryngology - Head and Neck Surgery, National University Hospital, Singapore.,Department of Otolaryngology - Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Hemalatha R, Pai R, Manipadam MT, Rebekah G, Cherian AJ, Abraham DT, Rajaratnam S, Thomas N, Ramakant P, Jacob PM. Presurgical Screening of Fine Needle Aspirates from Thyroid Nodules for BRAF Mutations: A Prospective Single Center Experience. Indian J Endocrinol Metab 2018; 22:785-792. [PMID: 30766819 PMCID: PMC6330867 DOI: 10.4103/ijem.ijem_126_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Analysis of BRAF V600E mutation in thyroid fine needle aspirates (FNA) is an important adjunct to cytology, particularly among FNA placed in the "indeterminate category." However, such a prospective evaluation of FNA obtained from patients with thyroid nodules has been lacking from India. MATERIAL AND METHODS FNA from 277 patients were prospectively evaluated for BRAF mutations by Sanger's sequencing. A subset of 30 samples was also analyzed by pyrosequencing using the PyroMark BRAF mutation kit. RESULTS Overall, 27.2% of FNA samples were positive for mutations including 19 (35.8%) of the 53 histologically confirmed papillary thyroid carcinoma (PTC), 2 of the 25 follicular variants of PTC, and 1 anaplastic thyroid carcinoma. Only 1 (2.7%) of the 37 samples in the atypia of undetermined significance/follicular lesion of unknown significance category was BRAF positive. The sensitivity of cytology improved marginally from 67.1% to 68.3% when evaluated with BRAF. Further, a comparison of the clinicopathological characteristics of BRAF positive and negative PTCs showed a significant association (P = 0.05) between lymph node metastasis and BRAF positivity. CONCLUSION BRAF positivity was lower than that reported from East Asia with the test being useful in confirming malignancies among the suspicious of malignancy and malignant categories.
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Affiliation(s)
- Ramamoorthy Hemalatha
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Rekha Pai
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Marie T. Manipadam
- Department of Pathology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Anish J. Cherian
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Deepak T. Abraham
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Simon Rajaratnam
- Department of Endocrinology and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology and Metabolism, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Pooja Ramakant
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Paul M. Jacob
- Department of Endocrine Surgery, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
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Song JY, Sun SR, Dong F, Huang T, Wu B, Zhou J. Predictive Value of BRAF V600E Mutation for Lymph Node Metastasis in Papillary Thyroid Cancer: A Meta-analysis. Curr Med Sci 2018; 38:785-797. [PMID: 30341513 DOI: 10.1007/s11596-018-1945-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 06/21/2018] [Indexed: 12/11/2022]
Abstract
BRAFV600E mutation has been thought to be a valuable molecular marker that may predict a worse prognosis for papillary thyroid cancer (PTC). But whether BRAFV600E mutation is associated with lymph node metastasis (LNM) remains controversial. Different surgical strategies may bring a bias in demonsstrating the association between them. In order to delineate a risk stratification to guide a tailored initial approach to tumors that express BRAFV600E mutation, we performed this meta-analysis by using the articles in which total or near-total thyroidectomy plus bilateral central lymph node dissection was routinely performed to avoid the bias from the surgical strategy. We searched the Medline, Embase and CNKI database for eligible studies from January 2003 to May 2018. Meta-analysis was performed using the STATA 12.0 software. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated under fixed-effects or randomeffects models. Fifteen clinical studies were included with a total of 4909 PTC patients. Our meta-analysis results reported that BRAFV600E mutation was associated with LNM (OR=1.34; 95% CI: 1.09-1.65; P=0.005), as well as central LNM (OR=1.59; 95% CI: 1.35-1.88; P<0.00001). Moreover, in patients with papillary thyroid microcarcinoma, we also confirmed the predictive value of BRAFV600E mutation for LNM (OR=3.49; 95% CI: 2.02-6.02; P<0.00001). This meta-analysis demonstrates that BRAFV600E mutation is closely related to LNM in PTC patients. The results suggest that BRAFV600E mutation can be considered as a risk factor for LNM in PTC. Moreover, combining BRAFV600E mutation with other risk factors to determine the initial surgical treatment may bring benefits for PTC patients.
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Affiliation(s)
- Jing-Yong Song
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department of Gastrointestinal Surgery, Hainan Cancer Hospital, Haikou, 570000, China
| | - Shi-Ran Sun
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Fang Dong
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bin Wu
- Department of Orthopaedics Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jing Zhou
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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35
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Rusinek D, Pfeifer A, Krajewska J, Oczko-Wojciechowska M, Handkiewicz-Junak D, Pawlaczek A, Zebracka-Gala J, Kowalska M, Cyplinska R, Zembala-Nozynska E, Chekan M, Chmielik E, Kropinska A, Lamch R, Jurecka-Lubieniecka B, Jarzab B, Czarniecka A. Coexistence of TERT Promoter Mutations and the BRAF V600E Alteration and Its Impact on Histopathological Features of Papillary Thyroid Carcinoma in a Selected Series of Polish Patients. Int J Mol Sci 2018; 19:ijms19092647. [PMID: 30200646 PMCID: PMC6163174 DOI: 10.3390/ijms19092647] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 01/15/2023] Open
Abstract
TERT promoter (TERTp) mutations are important factors in papillary thyroid carcinomas (PTCs). They are associated with tumor aggressiveness, recurrence, and disease-specific mortality and their use in risk stratification of PTC patients has been proposed. In this study we investigated the prevalence of TERTp mutations in a cohort of Polish patients with PTCs and the association of these mutations with histopathological factors, particularly in coexistence with the BRAF V600E mutation. A total of 189 consecutive PTC specimens with known BRAF mutational status were evaluated. TERTp mutations were detected in 8.5% of cases (16/189) with the C228T mutation being the most frequent. In six of the PTC specimens (3.2%), four additional TERTp alterations were found, which included one known polymorphism (rs2735943) and three previously unreported alterations. The association analysis revealed that the TERTp hotspot mutations were highly correlated with the presence of the BRAF V600E mutation and their coexistence was significantly associated with gender, advanced patient age, advanced disease stage, presence of lymph node metastases, larger tumor size, and tumor-capsule infiltration. While correlations were identified, the possibility of TERTp mutations being key molecular modulators responsible for PTC aggressiveness requires further studies.
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Affiliation(s)
- Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Aleksandra Pfeifer
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Malgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Agnieszka Pawlaczek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Jadwiga Zebracka-Gala
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Malgorzata Kowalska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Renata Cyplinska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Ewa Zembala-Nozynska
- Tumor Pathology Department, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Mykola Chekan
- Tumor Pathology Department, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Aleksandra Kropinska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Roman Lamch
- Tumor Pathology Department, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Beata Jurecka-Lubieniecka
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Agnieszka Czarniecka
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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O'Hare K, O'Regan E, Khattak A, Healy ML, Toner M. Reclassification as NIFTP: a Retrospective Review in a Single Institution with an Emphasis on Workload. Endocr Pathol 2018; 29:231-235. [PMID: 29978374 DOI: 10.1007/s12022-018-9538-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study was to determine the number of cases of papillary thyroid carcinoma (PTC) which could be reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in our institute over a 10-year period, document their clinical status and assess the number of slides that had to be reviewed per case to exclude NIFTP. The histopathology reports for thyroid resections for all papillary carcinoma over a 10-year period (2007-2016) were reviewed. Five hundred forty-five histopathology reports were reviewed, and 71 cases were identified as potential cases of NIFTP. Forty-nine (69%) cases had been referred from external departments and the slides were not available for review. Of the remaining 22 (31% of 71) cases, 5 were reclassified as NIFTP. The 17 cases that were not reclassified as NIFTP required review of 114 of 356 slides (median 5.5 slides per case) was required to exclude NIFTP. For the 5 NIFTP cases, 58 slides were reviewed (median 12 slides per case). We found that review of the histology reports alone was adequate for exclusion in most cases, e.g. classic PTC or EVPTC cases with documented lymphovascular invasion or capsular invasion. As a single exclusion criterion is required for exclusion from reclassification as NIFTP, this can be achieved efficiently. Two of the five patients received radioactive iodine [RAI] as per standard treatment at time of diagnosis, on the basis of tumour size. None have recurrent or metastatic disease with mean follow-up of 5.8 years.
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Affiliation(s)
- Kevin O'Hare
- Department of Histopathology, St. James Hospital, Dublin, Ireland.
| | - E O'Regan
- Department of Histopathology, St. James Hospital, Dublin, Ireland
- Department of Oral and Maxillofacial Surgery, Medicine and Pathology, Dublin Dental University Hospital, Dublin, Ireland
| | - A Khattak
- Department of Endocrinology, St. James Hospital, Dublin, Ireland
| | - M L Healy
- Department of Endocrinology, St. James Hospital, Dublin, Ireland
| | - M Toner
- Department of Histopathology, St. James Hospital, Dublin, Ireland
- Department of Oral and Maxillofacial Surgery, Medicine and Pathology, Dublin Dental University Hospital, Dublin, Ireland
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Post-operative radioiodine therapy (RaIT) as adjuvant therapy in low–intermediate risk differentiated thyroid cancer. Clin Transl Imaging 2018. [DOI: 10.1007/s40336-018-0298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kim H, Kim BH, Kim YK, Kim JM, Oh SY, Kim EH, Lee MJ, Kim JH, Jeon YK, Kim SS, Lee BJ, Kim YK, Kim IJ. Prevalence of BRAFV600E Mutation in Follicular Variant of Papillary Thyroid Carcinoma and Non-Invasive Follicular Tumor with Papillary-Like Nuclear Features (NIFTP) in a BRAFV600E Prevalent Area. J Korean Med Sci 2018; 33:e75. [PMID: 29962924 PMCID: PMC6021356 DOI: 10.3346/jkms.2018.33.e75] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/29/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND BRAFV600E mutation status and prevalence of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has not yet been reported in Korea. The aim of this study was to investigate the significance of the BRAFV600E mutation in the follicular variant of papillary thyroid carcinoma (FVPTC) and to determine the prevalence of NIFTP in BRAFV600E mutation-prevalent Korean patients. METHODS This study retrospectively analyzed 1,417 consecutive patients who underwent total thyroidectomy with routine prophylactic central lymph node dissection for papillary thyroid carcinoma (PTC). BRAFV600E mutation analysis was performed routinely using multiplex polymerase chain reaction by applying dual priming oligonucleotide. Clinicopathological characteristics and ultrasonographic findings were compared between BRAFV600E mutation-positive and -negative groups for FVPTC. Pathologists reviewed the pathology slides according to consensus diagnostic criteria for the encapsulated FVPTC and NIFTP. RESULTS The prevalence of the BRAFV600E mutation in all subtypes of PTC was 61.0% (861/1,411). FVPTC presented a BRAFV600E mutation rate of 27.3%. The FVPTC patients with BRAFV600E mutation were older than those with no BRAFV600E mutation (P = 0.021). The prevalence of NIFTP was 0.18% among all PTC patients (2/1,411) and the proportion of NIFTP among FVPTC was 9.1% (2/22). CONCLUSION The BRAFV600E mutation is prevalent in Korean patients with FVPTC in a region with high frequency of the BRAFV600E mutation and very low prevalence of NIFTP compared with that reported in western studies.
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Affiliation(s)
- Hyereen Kim
- Hyereen Kim's Internal Medicine Clinic, Yangsan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young Keum Kim
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Korea
| | - Jeong Mi Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seo Young Oh
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun Heui Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Min Jin Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Jong Ho Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joo Lee
- Department of Otolaryngology, Pusan National University School of Medicine, Busan, Korea
| | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Makay Ö, Özdemir M, Şenyürek YG, Tunca F, Düren M, Uludağ M, Hacıyanlı M, Içöz G, Işgör A, Özbaş S, Özcan Z, Tezelman S. Surgical approaches for papillary microcarcinomas: Turkey's perspective. Turk J Surg 2018; 34:89-93. [PMID: 30023969 DOI: 10.5152/turkjsurg.2018.3596] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/02/2016] [Indexed: 11/22/2022]
Abstract
Objectives The incidence of papillary microcarcinomas, which are defined as thyroid cancers of <10mm in size, has been increasing in the last decade. Herein, we present internet-based questionnaire results performed by the Turkish Association of Endocrine Surgery with the aim to evaluate the perspective of the management of papillary microcarcinomas in Turkey. Material and Methods The user-friendly questionnaire consisted of 13 questions in total. These questions mainly addressed the surgical management of nodules and cancer of <1 cm in size. Patient management before, during, and after surgical intervention was also included; additionally, the "active surveillance approach" was questioned. Results There were 420 responders in total who were of multidisciplinary origin (endocrinologists, surgeons, nuclear medicine specialists, pathologists, and oncologists). Total thyroidectomy was the predominant treatment approach (65%) for the classical type of microcarcinoma limited in one lobe, whereas in cases of microcarcinomas incidentally diagnosed during hemithyroidectomy, complementary surgery approach was advised by 40% of the responders. The responders found capsule invasion (86%) and patient based management (94%) of high importance. The percentage of the responders who recommended radioactive iodine ablation in incidental cancers having no aggressive criteria was 51%. The survey participants that were against routine central dissection in these cases accounted for 73% of the responders. The recommendation of active surveillance (follow-up without any interventional therapy) was limited with 9% responders. Conclusion The results of the questionnaire demonstrated that there have been various choices in Turkey for the surgical treatment of the papillary microcarcinomas.
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Affiliation(s)
- Özer Makay
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Murat Özdemir
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Yasemin Giles Şenyürek
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Fatih Tunca
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Mete Düren
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Mehmet Uludağ
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Mehmet Hacıyanlı
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Gökhan Içöz
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Adnan Işgör
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Serdar Özbaş
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Zehra Özcan
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
| | - Serdar Tezelman
- Departments of General Surgey (Ö.M., M.Ö. , G.İ.) and Nuclear Medicine (Z.Ö.), Ege University School of Medicine, İzmir, Turkey; Department of General Surgey (Y.G.Ş., F.T.), İstanbul University İstanbul School of Medicine, İstanbul, Turkey; Department of General Surgery (M.D.), İstanbul University Cerrahpaşa School of Meidicine, İstanbul, Turkey; Department of General Surgey (M.U.), Şişli Etfal Training and Research Hospital, İstanbul, Turkey; Department of General Surgery (M.H.), İzmir Katip Çelebi University, Atatürk Tranining and Research Hospital; Department of General Surgery (A.İ.), Bahçeşehir University School of Medicine, İstanbul, Turkey; Department of General Surgery (S.Ö.), Güven Hospital, Ankara, Turkey; Department of General Surgery (S.T.), Koç University School of Medicine, İstanbul, Turkey
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Kim M, Jeon MJ, Oh HS, Park S, Kim TY, Shong YK, Kim WB, Kim K, Kim WG, Song DE. BRAF and RAS Mutational Status in Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features and Invasive Subtype of Encapsulated Follicular Variant of Papillary Thyroid Carcinoma in Korea. Thyroid 2018; 28:504-510. [PMID: 29439609 DOI: 10.1089/thy.2017.0382] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is an indolent thyroid tumor previously known as noninvasive subtype of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). The absence of BRAFV600E mutations has been considered characteristic of NIFTPs. However, a recent study from Korea found that 28.6% of NIFTPs harbored a BRAF mutation. This study evaluated BRAF and RAS mutations in NIFTPs and invasive subtype of EFVPTCs. METHODS This study enrolled 32 patients with NIFTP and 48 with invasive EFVPTC. BRAF, NRAS, HRAS, and KRAS mutations were evaluated by direct sequencing using DNA from fresh-frozen tissues and formalin-fixed, paraffin-embedded tissue samples. RESULTS The primary tumor size of NIFTP was smaller than that of invasive EFVPTC (median 2.8 cm vs. 3.2 cm; p = 0.03). Cervical lymph node metastases were found in only four (8%) patients with invasive EFVPTC. There was no BRAF mutation in NIFTPs, whereas invasive EFVPTCs had three (6%) BRAFV600E mutations and one (2%) BRAFK601E mutation. RAS mutations were detected in 15 (47%) NIFTPs and 22 (46%) invasive EFVPTCs. NRAS mutations in codon 61 were the most common mutations in NIFTPs (34%) and invasive EFVPTCs (27%). There was no significant difference in the frequency of RAS mutations between the two groups. CONCLUSIONS There was no BRAF mutation in any of the NIFTPs. RAS mutations, particularly mutations in codon 61 of NRAS, were the most common mutations in both NIFTPs and invasive EFVPTCs. The presence of a RAS mutation is not helpful for preoperative differentiation between NIFTPs and invasive EFVPTCs.
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Affiliation(s)
- Mijin Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Min Ji Jeon
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hye-Seon Oh
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Suyeon Park
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Tae Yong Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Young Kee Shong
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Bae Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Kyunggon Kim
- 2 Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Won Gu Kim
- 1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Dong Eun Song
- 3 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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Raue F, Frank-Raue K. Thyroid Cancer: Risk-Stratified Management and Individualized Therapy. Clin Cancer Res 2018; 22:5012-5021. [PMID: 27742787 DOI: 10.1158/1078-0432.ccr-16-0484] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/24/2016] [Indexed: 11/16/2022]
Abstract
Thyroid cancer is the most common endocrine malignancy. Differentiated thyroid cancer (DTC) with the two subtypes, papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC), is the most frequent subtype of thyroid cancer; more rare subtypes are medullary thyroid cancer (MTC) and anaplastic thyroid cancer (ATC). The incidence of DTC has increased rapidly in recent years due to the more frequent use of imaging methods such as ultrasound of the neck and fine-needle aspiration (FNA) of thyroid nodules. After total thyroidectomy and radioiodine treatment, DTC remains an indolent and curable disease in most patients, whereas the cure rate in MTC is lower and depends on early diagnosis. Most ATCs are incurable. In recent years, there has been great progress in identifying genetic changes in thyroid cancer, and genetic testing of FNA samples or blood samples provides useful information for clinical decision making. Tumor staging, either postoperatively or by imaging, and measuring the tumor markers thyroglobulin for DTC and calcitonin for MTC, allow for dynamic risk-adapted stratification for follow-up procedures. In advanced metastatic thyroid cancer, molecular targeted therapy using tyrosine kinase receptor inhibitors, including sorafenib, lenvantinib, vandetanib, and cabozantinib, helps control tumor progression and prolongs progression-free survival. Using a dynamic risk-stratified approach to manage thyroid cancer, the outcomes for most thyroid cancer patients are excellent compared with those for other cancers. The major challenge in the future is to identify high-risk patients and to treat and monitor them appropriately. Clin Cancer Res; 22(20); 5012-21. ©2016 AACR SEE ALL ARTICLES IN THIS CCR FOCUS SECTION, "ENDOCRINE CANCERS REVISING PARADIGMS".
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Affiliation(s)
- Friedhelm Raue
- Molecular Laboratory, Endocrine Practice, Heidelberg, Germany.
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Jung SL, Baek JH, Lee JH, Shong YK, Sung JY, Kim KS, Lee D, Kim JH, Baek SM, Sim JS, Na DG. Efficacy and Safety of Radiofrequency Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study. Korean J Radiol 2018; 19:167-174. [PMID: 29354014 PMCID: PMC5768499 DOI: 10.3348/kjr.2018.19.1.167] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/24/2017] [Indexed: 12/31/2022] Open
Abstract
Objective To assess the efficacy and safety of thyroid radiofrequency (RF) ablation for benign thyroid nodules by trained radiologists according to a unified protocol in a multi-center study. Materials and Methods From 2010 to 2011, 345 nodules from 345 patients (M:F = 43:302; mean age ± SD = 46.0 ± 12.7 years, range = 15–79) who met eligibility criteria were enrolled from five institutions. At pre-ablation, the mean volume was 14.2 ± 13.2 mL (1.1–80.8 mL). For 12 months or longer after treatment, 276 lesions, consisting of 248 solid and 28 predominantly cystic nodules, were followed. All operators performed RF ablation with a cool-tip RF system and two standard techniques (a transisthmic approach and the moving-shot technique). Volume reduction at 12 months after RF ablation (the primary outcome), therapeutic success, improvement of symptoms as well as of cosmetic problems, and complications were evaluated. Multiple linear regression analysis was applied to identify factors that were independently predictive of volume reduction. Results The mean volume reduction at 12 months was 80.3% (n = 276) and at the 24-, 36-, 48-, and 60-month follow-ups 84.3% (n = 198), 89.2% (n = 128), 91.9% (n = 57), and 95.3% (n = 6), respectively. Our therapeutic success was 97.8%. Both mean symptom and cosmetic scores showed significant improvements (p < 0.001). The rate of major complications was 1.0% (3/276). Solidity and applied energy were independent factors that predicted volume reduction. Conclusion Radiofrequency ablation performed by trained radiologists from multiple institutions using a unified protocol and similar devices was effective and safe for treating benign thyroid nodules.
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Affiliation(s)
- So Lyung Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Kee Shong
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Jin Yong Sung
- Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Kyu Sun Kim
- Department of Radiology, Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Ducky Lee
- Department of Internal Medicine, Thyroid Center, Daerim St. Mary's Hospital, Seoul 07442, Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seon Mi Baek
- Department of Radiology, Sharing and Happiness Hospital, Busan 48101, Korea
| | - Jung Suk Sim
- Department of Radiology, Withsim Clinic, Seongnam 13590, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging & Intervention Center, Seoul 06524, Korea
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43
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Roth MY, Witt RL, Steward DL. Molecular testing for thyroid nodules: Review and current state. Cancer 2017; 124:888-898. [DOI: 10.1002/cncr.30708] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Mara Y. Roth
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine; University of Washington; Seattle Washington
| | - Robert L. Witt
- Department of Otolaryngology; Thomas Jefferson University; Philadelphia Pennsylvania
- Multidisciplinary Head and Neck Clinic, Helen F. Graham Cancer Center; Newark Delaware
| | - David L. Steward
- Department of Otolaryngology; University of Cincinnati; Cincinnati Ohio
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Amoako-Tuffour Y, Graham ME, Bullock M, Rigby MH, Trites J, Taylor SM, Hart RD. Papillary thyroid cancer recurrence 43 Years following Total Thyroidectomy and radioactive iodine ablation: a case report. Thyroid Res 2017; 10:8. [PMID: 29051792 PMCID: PMC5634945 DOI: 10.1186/s13044-017-0043-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/04/2017] [Indexed: 12/04/2022] Open
Abstract
Background Recurrent papillary thyroid carcinoma (PTC) beyond the first two decades of definitive treatment (i.e. total thyroidectomy and radioactive iodine ablation) is a rare occurrence. Case presentation We present a case of a 71-year old Caucasian female with a distant history of PTC treated with total thyroidectomy and radioactive iodine ablation who experienced recurrence of her disease 43 years following initial diagnosis and definitive treatment. She presented with palpable left-sided neck mass and subsequently underwent a level II, III, neck dissection and adjuvant iodine ablation. This case presents the latest recurrence in papillary thyroid cancer documented to date in the literature. Conclusion This case exemplifies the need for the head and neck surgeon, radiation oncologist, general practitioner and radiologist to consider new lateral neck mass as late-presenting recurrence of PTC until proven otherwise regardless of low recurrence rates beyond two decades from treatment and low prognostic risk scores.
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Affiliation(s)
- Yaw Amoako-Tuffour
- Department of Diagnostic Radiology, Dalhousie University, 3rd Floor Victoria Building, VG Site, QEII Health Sciences Centre, 1276 South Park Street, PO BOX 9000, Halifax, NS B3H 2Y9 Canada
| | - M Elise Graham
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - Martin Bullock
- Department of Anatomical Pathology, Dalhousie University, 1459 Oxford Street, Halifax, NS B3H 4R2 Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - Jonathan Trites
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
| | - Robert D Hart
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, 3rd Floor Dickson Building, VG Site, QEII Health Sciences Centre, 5820 University Ave, Halifax, NS B3H 2Y9 Canada
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45
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Rusinek D, Chmielik E, Krajewska J, Jarzab M, Oczko-Wojciechowska M, Czarniecka A, Jarzab B. Current Advances in Thyroid Cancer Management. Are We Ready for the Epidemic Rise of Diagnoses? Int J Mol Sci 2017; 18:E1817. [PMID: 28829399 PMCID: PMC5578203 DOI: 10.3390/ijms18081817] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/16/2017] [Accepted: 08/16/2017] [Indexed: 02/07/2023] Open
Abstract
A rising incidence of thyroid cancers (TCs) mainly small tumors, observed during recent years, lead to many controversies regarding treatment strategies. TCs represent a distinct molecular background and clinical outcome. Although in most cases TCs are characterized by a good prognosis, there are some aggressive forms, which do not respond to standard treatment. There are still some questions, which have to be resolved to avoid dangerous simplifications in the clinical management. In this article, we focused on the current advantages in preoperative molecular diagnostic tests and histopathological examination including noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). We discussed the controversies regarding the extent of thyroid surgery and adjuvant radioiodine therapy, as well as new treatment modalities for radioiodine-refractory differentiated thyroid cancer (RR-DTC). Considering medullary thyroid cancer (MTC), we analyzed a clinical management based on histopathology and RET (ret proto-oncogene) mutation genotype, disease follow-up with a special attention to serum calcitonin doubling time as an important prognostic marker, and targeted therapy applied in advanced MTC. In addition, we provided some data regarding anaplastic thyroid cancer (ATC), a highly lethal neoplasm, which lead to death in nearly 100% of patients due to the lack of effective treatment options.
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Affiliation(s)
- Dagmara Rusinek
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Michal Jarzab
- 3rd Department of Radiotherapy and Chemotherapy, Breast Unit, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Malgorzata Oczko-Wojciechowska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Agnieszka Czarniecka
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Institute-Cancer Center, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-101 Gliwice, Poland.
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Choi EK, Chong A, Ha JM, Jung CK, O JH, Kim SH. Clinicopathological characteristics including BRAF V600E mutation status and PET/CT findings in papillary thyroid carcinoma. Clin Endocrinol (Oxf) 2017; 87:73-79. [PMID: 28329426 DOI: 10.1111/cen.13335] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/07/2017] [Accepted: 03/19/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We assessed the associations between FDG uptake in primary papillary thyroid carcinomas (PTCs) and clinicopathological features, including the BRAF V600E mutation, using quantitative and qualitative analyses of preoperative PET/CT data. DESIGN AND PATIENTS This was a retrospective review of 106 patients with PTC who underwent PET/CT scans between February 2009 and January 2011 before undergoing total thyroidectomy. Data collected from surgical specimens were compared with FDG uptake in the primary tumour using quantitative and qualitative analyses of preoperative PET/CT data. Clinicopathological data included the primary tumour size, subtype, capsular invasion, extrathyroid extension, multifocality, BRAF V600E mutation status, lymph node metastasis and distant metastasis. RESULTS The SUVmax of the primary tumour was significantly higher in patients with a primary tumour >1 cm, extrathyroid extension or the BRAF V600E mutation than in patients without these features (P<.001, .049 and <.001). Univariate analyses showed that primary tumour size, extrathyroid extension and BRAF V600E mutation status were associated with the SUVmax of the PTC. Multivariate analysis indicated that primary tumour size and the BRAF V600E mutation were associated with the SUVmax of the PTC. In a visual assessment, the primary tumour size was larger in FDG-avid than in non-FDG-avid PTCs (P<.001). There was no significant difference in the presence of multifocality, thyroid capsular invasion, extrathyroid extension, BRAF V600E mutation, lymph node metastasis or distant metastasis between FDG-avid and non-FDG-avid PTCs. CONCLUSIONS Primary tumour size and the BRAF V600E mutation are significant factors associated with the SUVmax on preoperative PET/CT in patients with PTC.
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Affiliation(s)
- Eun Kyoung Choi
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Jung-Min Ha
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Chan Kwon Jung
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joo Hyun O
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sung Hoon Kim
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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47
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Preoperative clinicopathological characteristics of patients with solitary encapsulated follicular variants of papillary thyroid carcinomas. J Surg Oncol 2017; 116:746-755. [DOI: 10.1002/jso.24700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/11/2017] [Indexed: 01/09/2023]
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48
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Han SA, Jang JH, Won KY, Lim SJ, Song JY. Prognostic value of putative cancer stem cell markers (CD24, CD44, CD133, and ALDH1) in human papillary thyroid carcinoma. Pathol Res Pract 2017; 213:956-963. [PMID: 28687160 DOI: 10.1016/j.prp.2017.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 04/17/2017] [Accepted: 05/03/2017] [Indexed: 01/06/2023]
Abstract
We hypothesized that cancer stem cells (CSCs) are responsible for the poor outcome and aggressive clinicopathological factors. We surveyed the expression of selected CSC markers that are specifically expressed in thyroid papillary carcinoma (PTC). A total of 80 patients with PTC from 2011 to 2012 were enrolled. We selected CD24, CD44, CD133, and dehydrogenase 1 (ALDH1), as they have been suggested to be candidate CSC markers. Expression of these markers was investigated by immunohistochemical (IHC) staining. IHC staining for CD24, CD44, CD133 and ALDH1 was evaluated according to staining intensity and proportion. The intensity and proportion scores were multiplied together for a total score, which was either 0-2 (negative) or 3-7 (positive). IHC for CD133 in PTC was positive in 49 (61.3%) patients, and CD24 was positive in 28 (35.0%). Seventy-eight (97.5%) patients were CD44 positive and 79 (98.8%) were ALDH1 positive. When we assessed the relationship between CSC markers and clinicopathological factors in PTC, CD24 expression was inversely correlated with multifocality (p=0.045; odds ratio [OR], 0.370; 95% confidence interval [CI], 0.138-0.991) and CD44 expression was significantly correlated with a BRAF mutation (p=0.001; OR, 7.091; 95% CI, 4.101-12.262). However, CD133 and ALDH1 were not associated with any of the clinicopathological parameters. CD24 expression was inversely correlated with multifocality, and CD44 expression was significantly correlated with a BRAF mutation. Therefore, CD24 and CD44 are related to clinicopathological aggressive features and important for determining surgical extent in patients with PTC.
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Affiliation(s)
- Sang-Ah Han
- Department of surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Hoon Jang
- Graduate School, Department of Medicine, Kyung Hee University, Korea
| | - Kyu Yeoun Won
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Jig Lim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jeong-Yoon Song
- Department of surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
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49
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Abd Elmageed ZY, Sholl AB, Tsumagari K, Al-Qurayshi Z, Basolo F, Moroz K, Boulares AH, Friedlander P, Miccoli P, Kandil E. Immunohistochemistry as an accurate tool for evaluating BRAF-V600E mutation in 130 samples of papillary thyroid cancer. Surgery 2017; 161:1122-1128. [DOI: 10.1016/j.surg.2016.06.081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/21/2016] [Accepted: 06/27/2016] [Indexed: 02/07/2023]
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50
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Vuong HG, Duong UNP, Altibi AMA, Ngo HTT, Pham TQ, Tran HM, Gandolfi G, Hassell L. A meta-analysis of prognostic roles of molecular markers in papillary thyroid carcinoma. Endocr Connect 2017; 6:R8-R17. [PMID: 28219937 PMCID: PMC5424840 DOI: 10.1530/ec-17-0010] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 02/20/2017] [Indexed: 12/19/2022]
Abstract
The prognostic role of molecular markers in papillary thyroid carcinoma (PTC) is a matter of ongoing debate. The aim of our study is to investigate the impact of RAS, BRAF, TERT promoter mutations and RET/PTC rearrangements on the prognosis of PTC patients. We performed a search in four electronic databases: PubMed, Scopus, Web of Science and Virtual Health Library (VHL). Data of hazard ratio (HR) and its 95% confidence interval (CI) for disease-specific survival (DSS) and disease-free survival (DFS) were directly obtained from original papers or indirectly estimated from Kaplan-Meier curve (KMC). Pooled HRs were calculated using random-effect model weighted by inverse variance method. Publication bias was assessed by using Egger's regression test and visual inspection of funnel plots. From 2630 studies, we finally included 35 studies with 17,732 patients for meta-analyses. TERT promoter mutation was significantly associated with unfavorable DSS (HR = 7.64; 95% CI = 4.00-14.61) and DFS (HR = 2.98; 95% CI = 2.27-3.92). BRAF mutations significantly increased the risk for recurrence (HR = 1.63; 95% CI = 1.27-2.10) but not for cancer mortality (HR = 1.41; 95% CI = 0.90-2.23). In subgroup analyses, BRAF mutation only showed its prognostic value in short-/medium-term follow-up. Data regarding RAS mutations and RET/PTC fusions were insufficient for meta-analyses. TERT promoter mutation can be used as an independent and reliable marker for risk stratification and predicting patient's outcomes. The use of BRAF mutation to assess patient prognosis should be carefully considered.
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Affiliation(s)
- Huy Gia Vuong
- Department of PathologyCho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Uyen N P Duong
- Pham Ngoc Thach University of MedicineHo Chi Minh City, Vietnam
| | | | - Hanh T T Ngo
- Department of PathologyUniversity of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Thong Quang Pham
- Department of PathologyCho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Hung Minh Tran
- Faculty of MedicineUniversity of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Greta Gandolfi
- Laboratory of Translational ResearchArcispedale S. Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Lewis Hassell
- Department of PathologyUniversity of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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