1
|
Barrio MJ, Pozdeyev N, Raeburn CD, McIntyre RC, Marshall CB, Haugen B, La Greca A. Pre-operative thyroglobulin measurement for thyroid cancer risk of recurrence and response to therapy. Am J Surg 2024:115818. [PMID: 39004566 DOI: 10.1016/j.amjsurg.2024.115818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Thyroid cancer has an overall favorable prognosis, but no pre-operative biochemical marker has been shown to distinguish between low and high-risk disease or predict response to therapy. METHODS We retrospectively reviewed 162 patients that underwent thyroid surgery for thyroid cancer between 2006 and 2022 in whom a pre-operative thyroglobulin level (Tg) was measured. We subdivided patients into low, intermediate and high-risk thyroid cancer and based on their response to therapy per ATA guidelines. RESULTS We showed that as pre-operative Tg level increased, patients were more likely to have high-risk disease (p < 0.01). We found a linear association between the primary tumor size and high-risk histology with pre-operative Tg (p < 0.01). Pre-operative Tg level was significantly associated with response to therapy following initial surgical management. Specifically, as pre-operative Tg increases, patients were less likely to achieve an excellent response (p < 0.01). CONCLUSIONS Our retrospective analysis demonstrated that pre-operative Tg is significantly associated with ATA structural risk of recurrence and response to therapy and may have the potential to guide initial therapy and follow-up management.
Collapse
Affiliation(s)
- Martin Jose Barrio
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States; Department of Biomedical Informatics, University of Colorado School of Medicine, 1890 N. Revere Court, Mailstop F600, Aurora, CO, 80045, United States
| | - Christopher D Raeburn
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Robert C McIntyre
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, 12605 E. 16th Ave Aurora, CO, 80045, United States
| | - Bryan Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States
| | - Amanda La Greca
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States.
| |
Collapse
|
2
|
Kim MJ, Lee MC, Lee GH, Choi HS, Cho SW, Kim SJ, Lee KE, Park YJ, Park DJ. Extent of surgery did not affect recurrence during 7-years follow-up in papillary thyroid cancer sized 1-4 cm: Preliminary results. Clin Endocrinol (Oxf) 2017; 87:80-86. [PMID: 28338234 DOI: 10.1111/cen.13336] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE There is debate whether hemithyroidectomy is sufficient for patients with papillary thyroid cancer (PTC) sized 1-4 cm. Therefore, we investigated whether hemithyroidectomy affects recurrence rate compared with thyroidectomy in patients with PTC sized 1-4 cm. DESIGN Retrospective observational study. PATIENTS We included 147 patients with 1-4 cm PTC who underwent hemithyroidectomy between 2004 and 2008. They were matched with 298 patients who underwent thyroidectomy, comparing age, sex, tumour size, multiplicity, extrathyroidal extension status and lymph node (LN) metastasis status. MEASUREMENTS Recurrence-free survival (RFS) was compared between hemithyroidectomy and thyroidectomy groups. RESULTS Median follow-up length was 7 years, during which there were nine (6.1%) and 17 (5.7%) recurrences in hemithyroidectomy and thyroidectomy groups, respectively. Recurrence-free survival in the hemithyroidectomy group was not different from that in the thyroidectomy group regardless of variant, multifocality, LN metastasis and radioactive iodine treatment. However, in subgroup analysis, hemithyroidectomy significantly increased the risk of recurrence in patients with contralateral nodules on the preoperative imaging. CONCLUSIONS Recurrence after hemithyroidectomy was not different from that after thyroidectomy during a median follow-up of 7 years. However, because thyroidectomy might be favoured in patients with contralateral nodules at preoperative evaluation, a thorough evaluation of the contralateral thyroid lobe is necessary.
Collapse
Affiliation(s)
- Min Joo Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Chul Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hoon Sung Choi
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon-si, Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
3
|
Bradley NL, Wiseman SM. Papillary thyroid microcarcinoma: the significance of high risk features. BMC Cancer 2017; 17:142. [PMID: 28209140 PMCID: PMC5311854 DOI: 10.1186/s12885-017-3120-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 02/07/2017] [Indexed: 01/01/2023] Open
Abstract
Background Papillary carcinomas that measure 1.0cm or less are diagnosed as papillary thyroid microcarcinomas (PTMs). The clinical significance and recommendations for management of these PTMs is still evolving. The objective of the study was to compare the characteristics of small (<5mm) to large (≥ 5mm) papillary thyroid microcarcinomas. Methods Amongst 1459 sequential patients undergoing thyroid surgery at a single center, 132 (9%) cases were diagnosed with PTM. We performed a retrospective analysis of these cases using Fisher’s Exact Test. The statistical significance was set at p < 0.05 a priori. Results A relationship between large PTM and high risk features was observed only for extra-thyroidal cancer extension (ETE). Six of 57 large PTM (11%) but none of the 75 small PTM had ETE (p < 0.01). Lymph node metastases were associated with both small PTM (5/9 cases) and large PTM (4/9 cases). A distant metastases was diagnosed in association with a small PTM. Conclusions For PTM, neither small cancer size, nor the absence of high-risk features, excluded the possibility of synchronous lymph node metastases.
Collapse
Affiliation(s)
- Nori L Bradley
- Department of Surgery, St. Paul's Hospital & University of British Columbia, St. Paul's Hospital Department of Surgery, Room C303, Burrard Building, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, St. Paul's Hospital Department of Surgery, Room C303, Burrard Building, 1081 Burrard Street, Vancouver, V6Z 1Y6, BC, Canada.
| |
Collapse
|
4
|
Sullivan MC, Graham PH, Alexander EK, Ruan DT, Nehs MA, Gawande AA, Moore FD, Howitt BE, Strickland KC, Krane JF, Barletta JA, Cho NL. Prevalence of Contralateral Tumors in Patients with Follicular Variant of Papillary Thyroid Cancer. J Am Coll Surg 2016; 224:1021-1027. [PMID: 28017809 DOI: 10.1016/j.jamcollsurg.2016.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Thyroid lobectomy alone is being performed increasingly for patients with encapsulated follicular variant of papillary thyroid carcinoma (fvPTC). However, the prevalence of contralateral disease in these patients is unknown. We investigated the presence of synchronous disease in fvPTC to improve decision making about the extent of surgical resection and need for surveillance. STUDY DESIGN We performed a retrospective review of patients who underwent thyroid surgery from October 2009 to February 2013 with a diagnosis of fvPTC as their primary lesion. We collected information on patient demographics, nodule size, multifocality, fine-needle aspiration results, lymphovascular invasion, extrathyroidal extension, and lymph node metastasis. Tumors were divided into noninvasive and invasive/infiltrative fvPTC categories. Characteristics of solitary and bilateral fvPTC were compared. RESULTS We identified 124 patients with final pathology demonstrating fvPTC. The most common fine-needle aspiration diagnosis was "suspicious for malignancy" (n = 53). Sixty-five contralateral tumors were identified in 44 of 124 patients (35.5%) and included fvPTC (n = 40), classical PTC (n = 22), tall cell PTC (n = 2), and follicular carcinoma (n = 1). Fifty contralateral tumors were 1 to 5 mm, 10 measured 6 to 9 mm, and 5 were ≥10 mm. Contralateral disease correlated significantly with lymphovascular invasion (p = 0.037) and larger primary lesions (p = 0.020). There was no significant difference noted in extrathyroidal extension or lymph node metastasis. Both noninvasive and invasive/infiltrative fvPTC demonstrated similar rates of contralateral disease. CONCLUSIONS Bilateral disease is common in fvPTC, primarily in the form of papillary microcarcinomas. Future monitoring of the contralateral lobe should be discussed with fvPTC patients who do not undergo completion thyroidectomy.
Collapse
Affiliation(s)
| | - Paul H Graham
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erik K Alexander
- Department of Medicine, Thyroid Unit, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Daniel T Ruan
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - Brooke E Howitt
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | - Jeffrey F Krane
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | | | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA.
| |
Collapse
|
5
|
Lodewijk L, Kluijfhout WP, Kist JW, Stegeman I, Plukker JTM, Nieveen van Dijkum EJ, Bonjer HJ, Bouvy ND, Schepers A, de Wilt JHW, Netea-Maier RT, van der Hage JA, Burger JWA, Ho G, Lee WS, Shen WT, Aronova A, Zarnegar R, Benay C, Mitmaker EJ, Sywak MS, Aniss AM, Kruijff S, James B, Grogan RH, Brunaud L, Hoch G, Pandolfi C, Ruan DT, Jones MD, Guerrero MA, Valk GD, Borel Rinkes IHM, Vriens MR. Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1 cm. Langenbecks Arch Surg 2016; 401:365-73. [PMID: 27013326 PMCID: PMC4851685 DOI: 10.1007/s00423-016-1393-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/26/2016] [Indexed: 01/11/2023]
Abstract
Purpose Traditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm. Methods A retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma. Results A total of 1313 patients were included, of whom 426 (32 %) had a contralateral carcinoma. The contralateral carcinomas consisted of 288 (67 %) papillary thyroid carcinomas (PTC), 124 (30 %) follicular variant of a papillary thyroid carcinoma (FvPTC), 5 (1 %) follicular thyroid carcinomas (FTC), and 3 (1 %) Hürthle cell carcinomas (HTC). Ipsilateral multifocality was strongly associated with the presence of contralateral carcinomas (OR 2.62). Of all contralateral carcinomas, 82 % were ≤10 mm and of those 99 % were PTC or FvPTC. Even if the primary tumor was a FTC or HTC, the contralateral carcinoma was (Fv)PTC in 92 % of cases. Conclusions This international multicenter study performed on patients with DTC larger than 1 cm shows that contralateral carcinomas occur in one third of patients and, independently of primary tumor subtype, predominantly consist of microPTC.
Collapse
Affiliation(s)
- Lutske Lodewijk
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wouter P Kluijfhout
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jakob W Kist
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Inge Stegeman
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - John T M Plukker
- University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | | | - H Jaap Bonjer
- VU Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Nicole D Bouvy
- Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Abbey Schepers
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Johannes H W de Wilt
- Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Romana T Netea-Maier
- Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jos A van der Hage
- Netherlands Cancer Institute, Plesmanlaan 121 - 123, 1066 CX, Amsterdam, The Netherlands
| | - Jacobus W A Burger
- Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Gavin Ho
- University of California San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Wayne S Lee
- University of California San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Wen T Shen
- University of California San Francisco Medical Center, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Anna Aronova
- Weill Cornell Medical Center, 525 E 68th St, New York, NY, 10065, USA
| | - Rasa Zarnegar
- Weill Cornell Medical Center, 525 E 68th St, New York, NY, 10065, USA
| | - Cassandre Benay
- McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Elliot J Mitmaker
- McGill University Health Centre, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
| | - Mark S Sywak
- Endocrine Surgery Unit, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Ahmad M Aniss
- Endocrine Surgery Unit, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Schelto Kruijff
- Endocrine Surgery Unit, University of Sydney, Camperdown, NSW, 2006, Australia
| | - Benjamin James
- The University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Raymon H Grogan
- The University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL, 60637, USA
| | - Laurent Brunaud
- Centre Hospitalier Universitaire de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Guillaume Hoch
- Centre Hospitalier Universitaire de Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54000, Nancy, France
| | - Chiara Pandolfi
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Daniel T Ruan
- Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Michael D Jones
- The University of Arizona Medical Center, 3838 N Campbell Ave, Tucson, AZ, 85719, USA
| | - Marlon A Guerrero
- The University of Arizona Medical Center, 3838 N Campbell Ave, Tucson, AZ, 85719, USA
| | - Gerlof D Valk
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Menno R Vriens
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,Department of Surgery (G.04.228), University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| |
Collapse
|
6
|
Wang W, Su X, He K, Wang Y, Wang H, Wang H, Zhao Y, Zhao W, Zarnegar R, Fahey TJ, Teng X, Teng L. Comparison of the clinicopathologic features and prognosis of bilateral versus unilateral multifocal papillary thyroid cancer: An updated study with more than 2000 consecutive patients. Cancer 2015; 122:198-206. [PMID: 26506214 DOI: 10.1002/cncr.29689] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Weibin Wang
- Cancer Center; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
- Department of Surgery; New York Presbyterian Hospital-Weill Cornell Medical College; New York New York
| | - Xingyun Su
- Cancer Center; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Kuifeng He
- Cancer Center; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Yanli Wang
- Department of Pathology; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Haiyong Wang
- Cancer Center; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Haohao Wang
- Cancer Center; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Yinu Zhao
- Department of Ophthalmology; Second Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Wenhe Zhao
- Department of Surgical Oncology; Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Rasa Zarnegar
- Department of Surgery; New York Presbyterian Hospital-Weill Cornell Medical College; New York New York
| | - Thomas J. Fahey
- Department of Surgery; New York Presbyterian Hospital-Weill Cornell Medical College; New York New York
| | - Xiaodong Teng
- Department of Pathology; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| | - Lisong Teng
- Cancer Center; First Affiliated Hospital, Zhejiang University School of Medicine; Hangzhou China
| |
Collapse
|
7
|
Jung MJ, Kwon SK. Expression of glucagon-like Peptide-1 receptor in papillary thyroid carcinoma and its clinicopathologic significance. Endocrinol Metab (Seoul) 2014; 29:536-44. [PMID: 25559577 PMCID: PMC4285044 DOI: 10.3803/enm.2014.29.4.536] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Incretin-based therapies are rapidly becoming one of the main glycemic control strategies in diabetes. Considering the large numbers of papillary thyroid carcinomas (PTCs) and possible effects of glucagon-like peptide-1 (GLP-1) on cell proliferation, the expression of GLP-1 receptor (GLP-1R) in PTC is likely to have clinical significance. We performed this study to evaluate the expression of GLP-1R in PTC and the clinical meaning of GLP-1R expression in PTC. METHODS Fifty-six cases of PTC, four cases of medullary thyroid cancer (MTC), seven cases of nodular hyperplasia and 56 normal thyroid tissue samples were selected for immunostaining for GLP-1R. Clinical parameters were obtained by retrospective review of medical records. RESULTS Immunohistochemical staining for GLP-1R showed immunoreactivity in 18 of 56 cases of PTC (32.1%). All four cases of MTC exhibited cytoplasmic GLP-1R expression. Nodular hyperplasia exhibited immunoreactivity in two of seven cases (28.6%). All normal thyroid follicular cells showed negative immunoreactivity. In univariable and multivariable analyses, tumor multifocality was negatively correlated with GLP-1R expression. Extrathyroidal extension showed positive association with GLP-1R expression that was almost significant. Sex, age, tumor size, and lymph node metastasis were not significantly associated with GLP-1R expression. CONCLUSION Some parts of PTC tissues express GLP-1R, and GLP-1R expression in PTC was negatively correlated with tumor multifocality. The long-term influence of pharmacologically increased GLP-1 on thyroid follicular cells and development and progression of tumors originating from thyroid follicular cells should be investigated.
Collapse
Affiliation(s)
- Min Jung Jung
- Department of Pathology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Su Kyoung Kwon
- Department of Endocrinology and Metabolism, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.
| |
Collapse
|
8
|
Kim KJ, Kim SM, Lee YS, Chung WY, Chang HS, Park CS. Prognostic significance of tumor multifocality in papillary thyroid carcinoma and its relationship with primary tumor size: a retrospective study of 2,309 consecutive patients. Ann Surg Oncol 2014; 22:125-31. [PMID: 25092159 DOI: 10.1245/s10434-014-3899-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tumor multifocality is frequently observed in papillary thyroid carcinoma (PTC), but its prognostic value is controversial. We investigated the prognostic significance of multifocality in PTCs larger than 1 cm and papillary thyroid microcarcinomas (PTMC). METHODS Medical records and pathologic results of 2,309 patients who received thyroidectomy and lymph node dissection for PTC were retrospectively reviewed. We identified 648 patients who had PTC with a primary tumor exceeding 1 cm, and 1,661 patients with PTMC. In each group, we compared patients with unifocal and multifocal disease. Cox regression analyses of disease persistence and recurrence were performed to identify the prognostic significance of multifocality. RESULTS The mean follow-up period was 5.6 years. In the analyses of PTCs larger than 1 cm, the multifocal group included more extensive thyroid surgeries (p = 0.039), radioactive iodine therapies with higher doses (p < 0.001), and significantly higher rates of disease persistence and recurrence (p = 0.001) compared with the unifocal group. In analogous analyses of patients with PTMC, disease persistence and recurrence did not differ significantly between the unifocal and multifocal groups. Cox regression analyses indicated that multifocality was an independent risk factor for disease persistence and recurrence in patients who had PTC with a tumor exceeding 1 cm, but not in patients with PTMC. CONCLUSION Tumor multifocality appears to be an important prognostic factor for PTCs larger than 1 cm, but may have little or no prognostic significance for PTMC.
Collapse
Affiliation(s)
- Kuk-Jin Kim
- Thyroid Cancer Center, Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
9
|
Multifocal papillary thyroid carcinoma—a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg 2013; 399:141-54. [DOI: 10.1007/s00423-013-1145-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 11/10/2013] [Indexed: 12/18/2022]
|
10
|
Kuo SF, Lin SF, Chao TC, Hsueh C, Lin KJ, Lin JD. Prognosis of multifocal papillary thyroid carcinoma. Int J Endocrinol 2013; 2013:809382. [PMID: 24489543 PMCID: PMC3892555 DOI: 10.1155/2013/809382] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/09/2013] [Accepted: 12/11/2013] [Indexed: 01/06/2023] Open
Abstract
This study was to investigate the clinical features and therapeutic outcomes of multifocal papillary thyroid microcarcinoma (PTMC). A total of 2,418 papillary thyroid carcinoma (PTC) patients had undergone thyroidectomy in one medical center between 1977 and 2010. There were 483 (20.0%) diagnosed with multifocal PTC. The percentage of multifocal PTC was higher in PTMC patients (22.0%) than in non-PTMC patients (19.5%). Demographic and clinical characteristics of PTMC and multifocal PTC in PTC patients were traced. Multifocal PTC patients presented with smaller tumors at an older age, and a higher percentage underwent total or complete thyroidectomy. These patients also showed a higher incidence of postoperative disease progression than did unifocal PTC patients. Comparison of 483 patients with multifocal PTMC and non-PTMC tumors showed a higher incidence of postoperative disease progression in patients with non-PTMC; otherwise, there was no statistical difference in disease-specific and total mortality between these two groups. In conclusion, the incidence of multifocal PTMC was not lower than that of non-PTMC, and postoperative therapies were necessary for both multifocal PTMC and non-PTMC patients.
Collapse
Affiliation(s)
- Sheng-Fong Kuo
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Shu-Fu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Tzu-Chieh Chao
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Kun-Ju Lin
- Department of Nuclear Medicine; Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
| | - Jen-Der Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan
- *Jen-Der Lin:
| |
Collapse
|