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Prinzi A, Frasca F, Russo M, Le Moli R, Belfiore A, Malandrino P. Lymph Node Ratio as a Predictive Factor of Persistent/Recurrent Disease in Patients With Medullary Thyroid Cancer: A Single-Center Retrospective Study. Endocr Pract 2024; 30:194-199. [PMID: 38008257 DOI: 10.1016/j.eprac.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/22/2023] [Accepted: 11/21/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Thyroidectomy with neck lymph node dissection is curative for most patients with medullary thyroid cancer (MTC). Lymph node ratio (LNR, ie, the ratio between the metastatic and the removed lymph nodes) is a reliable parameter with which to estimate both disease extent and quality of neck dissection. The aim of this study was to investigate the prognostic role of LNR to predict persistent/recurrent disease in patients with MTC. METHODS A single-center, retrospective study of a consecutive cohort of 95 patients with MTC treated with total thyroidectomy and neck dissection. Receiver operating characteristics curve analysis was performed to identify the LNR cut-off. RESULTS LNR was positively associated with tumor size, preoperative and postoperative calcitonin values, postsurgery carcinoembryonic antigen values, persistent/recurrent disease, and the occurrence of distant metastases during follow-up. At multivariate analysis, persistent/recurrent disease was independently associated with the LNR value and was accurately predicted by a cut-off value of 0.12 (area under the curve = 0.85). Indeed, patients with LNR ≥0.12 had a higher probability of developing persistent/recurrent disease (79.3% vs 10.6%, odds ratio = 32.3, 95% CI = 9.8-106.4; P < .001) and distant metastasis (34.5% vs 3.0%, odds ratio = 16.8, 95% CI = 3.4-83.6; P < .001) than patients with LNR <0.12. The median time to progression was 15 months in patients with LNR ≥0.12 whereas it was not reached in patients with LNR <0.12 (hazard ratio: 7.18, 95% CI = 3.01-17.11, P < .001). CONCLUSIONS LNR is a reliable prognostic factor to predict the risk of recurrence, persistence, and distant metastases in patients with MTC.
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Affiliation(s)
- Antonio Prinzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy.
| | - Francesco Frasca
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Marco Russo
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Rosario Le Moli
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Antonino Belfiore
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
| | - Pasqualino Malandrino
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Garibaldi-Nesima Medical Center, University of Catania, Catania, Italy
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Shang F, Liu X, Ren X, Li Y, Cai L, Sun Y, Wen J, Zhai X. Competing-risks model for predicting the prognostic value of lymph nodes in medullary thyroid carcinoma. PLoS One 2023; 18:e0292488. [PMID: 37844021 PMCID: PMC10578593 DOI: 10.1371/journal.pone.0292488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) is an infrequent form malignant tumor with a poor prognosis. Because of the influence of competitive risk, there may suffer from bias in the analysis of prognostic factors of MTC. METHODS By extracting the data of patients diagnosed with MTC registered in the Surveillance, Epidemiology, and End Results (SEER) database from 1998 to 2016, we established the Cox proportional-hazards and competing-risks model to retrospectively analyze the impact of related factors on lymph nodes statistically. RESULTS A total of 2,435 patients were included in the analysis, of which 198 died of MTC. The results of the multifactor competing-risk model showed that the number of total lymph nodes (19-89), positive lymph nodes (1-10,11-75) and positive lymph node ratio (25%-53%,>54%), age (46-60,>61), chemotherapy, mode of radiotherapy (others), tumor size(2-4cm,>4cm), number of lesions greater than 1 were poor prognostic factors for MTC. For the number of total lymph nodes, unlike the multivariate Cox proportional-hazards model results, we found that it became an independent risk factor after excluding competitive risk factors. Competitive risk factors have little effect on the number of positive lymph nodes. For the proportion of positive lymph nodes, we found that after excluding competitive risk factors, the Cox proportional-hazards model overestimates its impact on prognosis. The competitive risk model is often more accurate in analyzing the effects of prognostic factors. CONCLUSIONS After excluding the competitive risk, the number of lymph nodes, the number of positive and the positive proportion are the poor prognostic factors of medullary thyroid cancer, which can help clinicians more accurately evaluate the prognosis of patients with medullary thyroid cancer and provide a reference for treatment decision-making.
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Affiliation(s)
- Fangjian Shang
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaodan Liu
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xin Ren
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yanlin Li
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Lei Cai
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yujia Sun
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Jian Wen
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xiaodan Zhai
- Department of Endocrine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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Chen Z, Mao Y, You T, Chen G. Establishment and validation of a nomogram model for predicting distant metastasis in medullary thyroid carcinoma: An analysis of the SEER database based on the AJCC 8th TNM staging system. Front Endocrinol (Lausanne) 2023; 14:1119656. [PMID: 36875492 PMCID: PMC9975719 DOI: 10.3389/fendo.2023.1119656] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE Medullary thyroid carcinoma (MTC) patients with distant metastases frequently present a relatively poor survival prognosis. Our main purpose was developing a nomogram model to predict distant metastases in MTC patients. METHODS This was a retrospective study based on the Surveillance, Epidemiology, and End Results (SEER) database. Data of 807 MTC patients diagnosed from 2004 to 2015 who undergone total thyroidectomy and neck lymph nodes dissection was included in our study. Independent risk factors were screened by univariate and multivariate logistic regression analysis successively, which were used to develop a nomogram model predicting for distant metastasis risk. Further, the log-rank test was used to compare the differences of Kaplan-Meier curves of cancer-specific survival (CSS) in different M stage and each independent risk factor groups. RESULTS Four clinical parameters including age > 55 years, higher T stage (T3/T4), higher N stage (N1b) and lymph node ratio (LNR) > 0.4 were significant for distant metastases at the time of diagnosis in MTC patients, and were selected to develop a nomogram model. This model had satisfied discrimination with the AUC and C-index of 0.894, and C-index was confirmed to be 0.878 through bootstrapping validation. A decision curve analysis (DCA) was subsequently made to evaluate the feasibility of this nomogram for predicting distant metastasis. In addition, CSS differed by different M stage, T stage, N stage, age and LNR groups. CONCLUSIONS Age, T stage, N stage and LNR were extracted to develop a nomogram model for predicting the risk of distant metastases in MTC patients. The model is of great significance for clinicians to timely identify patients with high risk of distant metastases and make further clinical decisions.
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Affiliation(s)
- Zhufeng Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Internal Medicine, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Yaqian Mao
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Internal Medicine, Fujian Provincial Hospital South Branch, Fuzhou, China
| | - Tingting You
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Medical Intensive Care Unit, Fujian Provincial Hospital, Fuzhou, China
| | - Gang Chen
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China
- Department of Endocrinology, Fujian Provincial Hospital, Fuzhou, China
- *Correspondence: Gang Chen,
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Guideline Adherence and Practice Patterns in the Management of Medullary Thyroid Cancer. J Surg Res 2023; 281:214-222. [PMID: 36191377 DOI: 10.1016/j.jss.2022.08.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 07/05/2022] [Accepted: 08/16/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Little is known about nationwide practice patterns for the management medullary thyroid cancer (MTC) in relation to the 2015 American Thyroid Association guidelines and their impact on survival. METHODS Using the Surveillance, Epidemiology, and End Results Program database (2000-2018), MTC treatment patterns were evaluated in terms of adherence to the 2015 American Thyroid Association guidelines across three time periods (2000-2009, 2010-2015, and 2016-2018). Outcomes of interest were guideline concordance, treatment utilization trends, disease-specific survival (DSS), and overall survival (OS). RESULTS A total of 3332 patients with MTC were identified. Of which, 53.8%, 33.2%, and 11.4% of patients had localized, regional, and distant disease, respectively. In patients with locoregional disease, the rate of guideline-concordant surgery improved over time from 63.0% in 2000-2009 to 76.0% in 2016-2018 (P < 0.001). Guideline-concordant care was associated with increased OS (HR = 1.85, 95% CI: 1.42-2.43, P < 0.001) in patients with localized disease and increased DSS (HR = 1.65, 95% CI: 1.01-2.54, P < 0.001) and OS (HR = 1.89, 95% CI: 1.35-2.58, P < 0.001) in patients with regional disease. The median OS and DSS in patients with distant disease were 31 and 55 mo, respectively, and the rate of chemotherapy use rose from 21.6% to 39.2% (P = 0.003). CONCLUSIONS The rate of guideline-concordant surgery for locoregional MTC increased after guideline publication in 2015, with an observed prolongment in OS and DSS. Chemotherapy use among patients with distant disease has increased over time, but their prognosis remains variable.
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Hao W, Zhao J, Guo F, Gu P, Zhang J, Huang D, Ruan X, Zeng Y, Zheng X, Gao M. Value of lymph node ratio as a prognostic factor of recurrence in medullary thyroid cancer. PeerJ 2023; 11:e15025. [PMID: 36935920 PMCID: PMC10019331 DOI: 10.7717/peerj.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objectives The purpose of this study is to evaluate the relationship between lymph node status (the number of resected lymph nodes; the number of metastatic lymph nodes, LNM, and lymph node ratio, LNR) and biochemical recurrence, disease-free survival (DFS), as well as overall survival (OS) in medullary thyroid carcinoma (MTC). Methods This study enrolled MTC patients at Tianjin Medical University Cancer Institute and Hospital between 2011 and 2019. We used Logistic regression analysis, Cox regression models and Kaplan-Meier test to identify risk factors influencing biochemical recurrence, DFS, and OS. Results We identified 160 patients who satisfied the inclusion criteria from 2011 to 2019. We used ROC analysis to define the cut-off value of LNR with 0.24. Multifocality, preoperative calcitonin levels, pathologic N stage, resected lymph nodes, LNM, LNR, and the American Joint Committee on Cancer (AJCC) clinical stage were significant (P < 0.05) prognostic factors influencing biochemical cure. In univariable analyses, gross extrathyroidal extension, preoperative calcitonin levels, pathologic T classification, pathologic N stage, resected lymph nodes, LNM, LNR, AJCC clinical stage, and biochemical cure were significant (P < 0.05) factors of DFS. When the multivariable analysis was performed, LNR was identified as predictor of DFS (HR = 4.818, 95% CI [1.270-18.276]). Univariable Cox regression models reflected that tumor size, pathologic N stage, and LNR were predictor of OS. Furthermore, multivariable analysis manifested that LNR was predictor of OS (HR = 10.061, 95% CI [1.222-82.841]). Conclusions This study illustrated that LNR was independent prognostic factor of DFS and OS in MTC. In addition, LNR influenced biochemical cure. Further investigations are needed to determine the optimal cut-off value for predicting prognosis.
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Affiliation(s)
- Weijing Hao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Jingzhu Zhao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Fengli Guo
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital,Binzhou, Shandong, China
| | - Pengfei Gu
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Jinming Zhang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Dongmei Huang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Xianhui Ruan
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yu Zeng
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
- Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin, China
- Tianjin Key Laboratory of General Surgery in Construction, Tianjin Union Medical Center, Tianjin, China
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Liang W, Shi J, Zhang H, Lv G, Wang T, Wang Y, Lv B, Li L, Zeng Q, Sheng L. Total thyroidectomy vs thyroid lobectomy for localized medullary thyroid cancer in adults: A propensity-matched survival analysis. Surgery 2022; 172:1385-1391. [PMID: 35995619 DOI: 10.1016/j.surg.2022.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/11/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to clarify whether the extent of thyroidectomy (total thyroidectomy vs thyroid lobectomy) influences survival in adults with localized medullary thyroid cancer. METHODS Patients with localized medullary thyroid cancer were identified using the Surveillance, Epidemiology, and End Results database (2000-2018). An independent cohort of patients with localized medullary thyroid cancer were retrospectively reviewed from three medical centers in China from 2010 to 2020. The patients were grouped by the extent of surgery (total thyroidectomy vs thyroid lobectomy). Primary end points were overall survival and disease-specific survival. RESULTS From 1,686 patients with medullary thyroid cancer identified in SEER, 1,122 patients met inclusion for matching, with a median follow-up of 99 months. After propensity score matching, 122 patients underwent a total thyroidectomy and 122 patients underwent a thyroid lobectomy. The 10-year overall survival was 85.2% (77.9%-90.7%) and 83.1% (75.5%-90.7%) in total thyroidectomy group and in thyroid lobectomy group, respectively. The 10-year disease-specific survival was 100% and 96.8% (93.1%-100%) in total thyroidectomy group and in thyroid lobectomy group, respectively. There was no statistically significant difference in overall survival or disease-specific survival in patients with localized medullary thyroid cancer undergoing total thyroidectomy or thyroid lobectomy (hazard ratio = 0.83, 95% confidence interval 0.44-1.57, P = .57 and hazard ratio = 0.49, 95% confidence interval 0.10-2.41, P = .39, respectively). Forty-seven patients with localized medullary thyroid cancer were identified in an independent Chinese cohort (n = 29 in total thyroidectomy group vs n = 18 in thyroid lobectomy group). After a median follow-up of 47 months, there was no mortality observed in either group. CONCLUSION This study suggests that the extent of thyroidectomy does not influence survival for patients with early-stage localized medullary thyroid cancer and that thyroid lobectomy might be adequate in this patient population.
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Affiliation(s)
- Weili Liang
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jinyuan Shi
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China; Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Hui Zhang
- Department of Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guixu Lv
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Tiantian Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
| | - Bin Lv
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Luchuan Li
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Qingdong Zeng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Sheng
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, China.
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Machens A, Lorenz K, Weber F, Dralle H. Superiority of metastatic lymph node ratio over number of node metastases and TNM/AJCC N classification in predicting cancer-specific survival in medullary thyroid cancer. Head Neck 2022; 44:2717-2726. [PMID: 36065717 DOI: 10.1002/hed.27181] [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: 05/01/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In medullary thyroid cancer (MTC), it is unclear which nodal classification system, metastatic lymph node ratio (MLNR), number of node metastases, or TNM/AJCC N classification, predicts cancer-specific survival best. METHODS Kaplan-Maier analysis of cancer-specific survival after operation at a tertiary center. RESULTS Included were 505 MTC patients. The spread of the survival curves was greatest after stratification by MLNR (in 0.20 increments), followed by number of node metastases (in 10-node and 20-node increments) and TNM/AJCC classification (N0, N1a, N1b). After collapsing overlapping survival curves, all adjacent curves (MLNRs ≤0.20 vs. 0.21-0.60 vs. >0.60; 0 vs. 1-20 vs. >20 node metastases; and TNM/AJCC N classification N0/N1a vs. N1b) significantly differed between each other. CONCLUSIONS In MTC, MLNR, reflecting intensity of lymphatic spread, predicts cancer-specific survival better than number of node metastases or TNM/AJCC N classification. The applicability of these findings to patients with limited neck dissection requires more research.
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Affiliation(s)
- Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Henning Dralle
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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Wong A, Nabata K, Wiseman SM. Medullary thyroid carcinoma: a narrative historical review. Expert Rev Anticancer Ther 2022; 22:823-834. [PMID: 35694971 DOI: 10.1080/14737140.2022.2089118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Sporadic or hereditary medullary thyroid carcinoma (MTC) is an uncommon thyroid malignancy arising from calcitonin secreting parafollicular C cells. Interestingly, MTC and calcitonin were distinct entities that were discovered independently yet concurrently, and their association was unknown. AREAS COVERED This review aims to present a historical review of the evolution of our understanding of MTC and its tumor marker calcitonin to highlight the prominent individuals that influenced and shaped our knowledge of this uncommon thyroid cancer type up to the dawn of the 21st century. An overview of all published reports of novel research and work summarizing important findings for MTC and calcitonin was carried out. EXPERT OPINION Surgery remains the cornerstone of treatment for localized MTC. However, several new treatment options are either available or in development for advanced or metastatic MTC, including several novel small molecules targeting oncogenic RET and peptide receptor radionuclide therapy, immunotherapy, radioimmunotherapy, and radiofrequency ablation. In the near future, these novel treatments hold promise for therapy of this very distinct thyroid cancer type.
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Affiliation(s)
- Amanda Wong
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Kylie Nabata
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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Kim J, Park J, Park H, Choi MS, Jang HW, Kim TH, Kim SW, Chung JH. Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13225842. [PMID: 34830996 PMCID: PMC8616059 DOI: 10.3390/cancers13225842] [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: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary The anatomical staging system for thyroid cancer only contains categories for lymph node compartments. The metastatic lymph node ratio (LNR), which is the ratio of metastasized lymph nodes to the total number of evaluated lymph nodes, is suggested as a quantitative evaluation tool for lymph node metastasis in patients with medullary thyroid cancer in this study. The initial stratification implemented in this study was helpful in predicting structural recurrence, and LNR was identified as a predictor of disease-free survival. Abstract The lymph node ratio (LNR) has been investigated as a prognostic factor in many different types of cancers, including differentiated thyroid cancer; however, reports regarding medullary thyroid cancer (MTC) are limited. Therefore, this study aims to evaluate LNR as a risk factor for structural recurrence in patients with MTC. Medical records of patients treated for MTC in a single tertiary center between 1995 and 2017 were retrospectively reviewed. LNR is defined as the number of metastatic lymph nodes or lymph node metastases (LNM) divided by the number of retrieved lymph nodes or lymph node yield (LNY). In the survival analysis, recurrence-free survival was defined as the time from the date of total thyroidectomy to recurrence or last follow-up. To identify risk factors influencing structural recurrence, univariable and multivariable Cox proportional hazard models were used. A total of 132 patients were enrolled. The mean age of study participants was 49.7 years, and 86 patients (65%) were women. Structural recurrence was identified in 39 patients at the end of the study period, and the median follow-up period was 8.7 years. In univariable analyses, gross extra thyroidal extension, N stage, postoperative serum calcitonin and carcinoembryonic antigen (CEA) levels, and LNR were significant (p < 0.05) predictors of structural recurrence. In multivariable analysis, postoperative serum calcitonin, postoperative serum CEA, and LNR were identified as a predictor of disease-free survival (p < 0.05). LNR can potentially predict structural recurrence as a quantitative evaluation tool for lymph node metastasis in patients with MTC.
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Affiliation(s)
- Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (H.P.); (M.S.C.); (T.H.K.); (S.W.K.)
| | - Jun Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (H.P.); (M.S.C.); (T.H.K.); (S.W.K.)
| | - Hyunju Park
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (H.P.); (M.S.C.); (T.H.K.); (S.W.K.)
| | - Min Sun Choi
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (H.P.); (M.S.C.); (T.H.K.); (S.W.K.)
| | - Hye Won Jang
- Department of Medical Education, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (H.P.); (M.S.C.); (T.H.K.); (S.W.K.)
| | - Sun Wook Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (H.P.); (M.S.C.); (T.H.K.); (S.W.K.)
| | - Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (H.P.); (M.S.C.); (T.H.K.); (S.W.K.)
- Correspondence:
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Alhumaidi H, Manochakian R, Cochuyt J, Chindris A, Hodge D, Abdulazeez MF, David S, Biswas S, Aggarwal CS, Smallridge RC, Ailawadhi S. Initial treatment of patients with thyroid cancer: Outcomes and factors associated with care at academic versus nonacademic cancer centers. Cancer 2021; 127:1770-1778. [PMID: 33449369 DOI: 10.1002/cncr.33408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Factors associated with receiving initial care for thyroid cancer (TC) at academic centers (ACs) versus nonacademic centers (NACs) and their impact on patient outcomes have not been reported. METHODS The National Cancer Database with TC cases from 2004 to 2013 was evaluated for association of type of center for initial care with socioeconomic factors and disease and treatment characteristics, as well as overall survival (OS; all-cause mortality). RESULTS The patients with TC (n = 200,824) included were predominantly women (74%), non-Hispanic Whites (85%), and from metro areas (84%). Sixty percent received initial care at a NAC. There were no significant differences between treatment groups by age or gender. Among those treated at an AC, a higher proportion belonged to racial/ethnic minorities (16.5%) versus at a NAC (11.6%). Hormone therapy was used more in an AC versus a NAC (60% vs 47%). Patients with all TC pathologies combined had a lower likelihood of death when they received initial care at an AC (hazard ratio [HR], 0.948; P = .0006). Among individual pathologic subtypes, a lower likelihood of death was noted when initial care was received at an AC for follicular (HR, 0.828, P = .0010) and Hurthle cell cancers (HR, 792; P = .0008), as well as stage II papillary thyroid cancer (HR, 0.828; P = .0026), but not for other histopathologic subtypes. CONCLUSIONS Initial care at an AC was associated with lower likelihood of death for patients with TC, especially for those with follicular or Hurthle cell subtypes. Optimal resource use with consideration of patients' socioeconomic and demographic factors is imperative to ensure the most appropriate management of patients with TC in various treatment settings.
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Affiliation(s)
- Hebah Alhumaidi
- Division of Endocrinology, Mayo Clinic, Jacksonville, Florida
| | - Rami Manochakian
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida
| | - Jordan Cochuyt
- Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Ana Chindris
- Division of Endocrinology, Mayo Clinic, Jacksonville, Florida
| | - David Hodge
- Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | | | - Shishir David
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida
| | - Suman Biswas
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, Florida
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11
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Moses LE, Oliver JR, Rotsides JM, Shao Q, Patel KN, Morris LGT, Givi B. Nodal disease burden and outcome of medullary thyroid carcinoma. Head Neck 2020; 43:577-584. [PMID: 33107153 DOI: 10.1002/hed.26511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/24/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) is a rare malignancy with high incidence of cervical lymph node (CLN) metastasis. We investigated the impact of nodal disease burden on survival. METHODS We searched the National Cancer Database for MTC patients treated surgically. Impact of nodal metastasis on survival was analyzed using Cox univariable and multivariable regression. RESULTS We identified 2627 patients from 2004 to 2015. Positive CLNs were identified in 1433 (54.5%), and 542 (20.6%) had >10 CLN+. Overall survival was 94.5% and 89.6% at 3 and 5 years. Patients with 11 to 20 CLN+ had significantly worse survival than patients with 1 to 10 CLN+ in univariable and multivariable analyses (HR = 3.56 (2.31-5.50) vs 2.26 (1.60-3.20); P < .0001). The ratio of positive to dissected CLN was associated with overall survival. CONCLUSIONS Higher burden of nodal disease is associated with worse survival in MTC. The number of positive nodes could be a valuable prognosticator in addition to the current staging system.
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Affiliation(s)
- Lindsey E Moses
- Department of Otolaryngology, New York University, New York, NY, USA
| | - Jamie R Oliver
- Department of Otolaryngology, New York University, New York, NY, USA
| | - Janine M Rotsides
- Department of Otolaryngology, New York University, New York, NY, USA
| | - Qianhui Shao
- Department of Otolaryngology, New York University, New York, NY, USA
| | - Kepal N Patel
- Department of Surgery, New York University, New York, NY, USA
| | - Luc G T Morris
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak Givi
- Department of Otolaryngology, New York University, New York, NY, USA
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12
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Issa K, Stevens MN, Sun Y, Thomas S, Collins A, Cohen J, Esclamado RM, Rocke DJ. A Retrospective Study of Lymph Node Yield in Lateral Neck Dissection for Papillary Thyroid Carcinoma. EAR, NOSE & THROAT JOURNAL 2020; 101:456-462. [PMID: 33090902 DOI: 10.1177/0145561320967339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Lateral neck dissection (LND) is important in managing papillary thyroid carcinomas (PTCs). This study aimed to evaluate the relationship between lymph node yield (LNY) for LND and patient outcomes, specifically postoperative serum thyroglobulin levels (sTG) and radioiodine uptake on thyroid scan, and to estimate a threshold LNY to signify adequate LND. METHODS Patients diagnosed with PTC who underwent LND from 2006 to 2015 at a single institution were included. Linear regression with restricted cubic splines was used to characterize the association of LNY with outcomes. Outcomes were log-transformed to achieve a more symmetric distribution prior to regression. For nonlinear associations, a Monte Carlo Markov Chain procedure was used to estimate a threshold LNY associated with postoperative outcome. This threshold was then used to define high LNY versus low LNY in the subsequent analyses. RESULTS In total, 107 adult patients were included. There was a significant relationship between LNY and postoperative sTG level (P = .004), but not radioiodine uptake (P = .64). An LNY of 42.96 was identified, which was associated with the maximum change in sTG level. No association was found between LNY groups (LNY ≥ 43 vs < 43) and radioiodine uptake, risk of complication, or longer operative times (all P > .05). High LNY was associated with a decrease in log(sTG) (estimate = -1.855, P = .03), indicating that adequacy of LND is associated with an 84.4% decrease in sTG. CONCLUSION These results suggest an association between LNY and postoperative sTG level, with an estimated threshold of 43 nodes. This has implications for adequate therapeutic LND; additional work is needed to validate thresholds for clinical practice.
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Affiliation(s)
- Khalil Issa
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Madelyn N Stevens
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA.,Department of Otolaryngology-Head and Neck Surgery, 12328Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yuhui Sun
- Department of Biostatistics and Bioinformatics, 12277Duke University, Durham, NC, USA
| | - Samantha Thomas
- Department of Biostatistics and Bioinformatics, 12277Duke University, Durham, NC, USA.,Duke Cancer Institute, 12277Duke University, Durham, NC USA
| | - Alissa Collins
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Jonathan Cohen
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Ramon M Esclamado
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA
| | - Daniel J Rocke
- Department of Head and Neck Surgery & Communication Sciences, 12277Duke University Health System, Durham, NC, USA.,Duke Cancer Institute, 12277Duke University, Durham, NC USA
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13
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Jin M, Megwalu UC, Noel JE. External Beam Radiotherapy for Medullary Thyroid Cancer Following Total or Near-Total Thyroidectomy. Otolaryngol Head Neck Surg 2020; 164:97-103. [PMID: 32746731 DOI: 10.1177/0194599820947696] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Medullary thyroid carcinoma (MTC) often presents with advanced disease and takes an aggressive course as compared with more well-differentiated thyroid cancers. The role of adjuvant therapy, specifically external beam radiotherapy (EBRT), remains disputed. This study investigated the impact of EBRT on survival in MTC. STUDY DESIGN Cross-sectional analysis of a national database. SETTING Patients with MTC were identified from the SEER program (Surveillance, Epidemiology, and End Results). METHODS Collected variables included age, sex, race, T and N stages, lymph node yield, and use of EBRT. Propensity score matching was performed to determine the association of EBRT with overall and disease-specific survival. RESULTS A total of 2046 patients with locoregional MTC were identified. Of these, 152 received EBRT. Patients receiving EBRT were older and had more advanced disease. EBRT was not associated with differences in overall survival (hazard ratio, 1.12; 95% CI, 0.76-1.65) or disease-specific survival (1.66; 0.93-2.95), as well as in subset analysis of age and disease extent. Long-term overall survival was similar, with 77.3% (95% CI, 70.1%-85.3%) and 58.3% (48.2%-70.5%) of patients without EBRT alive at 5 and 10 years, respectively (vs 70.7% [63.2%-79.1%] and 52.3% [43.3%-63.2%] of patients with EBRT). There were no differences in 5- and 10-year disease-specific survival. CONCLUSION EBRT was not associated with improved overall or disease-specific survival in patients with MTC. Decisions regarding EBRT must be made with consideration of morbidity relative to benefit for individual patients.
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Affiliation(s)
- Michael Jin
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University Stanford, California, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University Stanford, California, USA
| | - Julia E Noel
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University Stanford, California, USA
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14
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Rozenblat T, Hirsch D, Robenshtok E, Grozinsky-Glasberg S, Gross DJ, Mazeh H, Benbassat C, Twito O, Levy S, Mizrachi A, Shpitzer T, Bachar G. The prognostic value of lymph node ratio in Medullary thyroid carcinoma: A multi-center study. Eur J Surg Oncol 2020; 46:2023-2028. [PMID: 32389525 DOI: 10.1016/j.ejso.2020.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/12/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION The lymph node ratio (LNR), which represents the proportion of metastatic lymph nodes resected, has been found to be a prognostic variable in several cancers, but data for Medullary thyroid carcinoma (MTC) are sparse. The aim of this study was to determine the value of the LNR in predicting outcome in patients with MTC. MATERIALS AND METHODS A retrospective multicenter study design of 107 patients with MTC who underwent total thyroidectomy with neck dissection between 1984 and 2016. The association of LNR with patient and tumor characteristics and prognostic factors was evaluated. RESULTS Study population consisted of 53.3% female, mean age at diagnosis was 50.3 ± 18.4 years; 16.8% had inherited MTC. LNR was positively correlated with tumor size (p = 0.018) and inversely correlated with age at diagnosis (p = 0.024). A higher LNR was associated with extrathyroidal extension (p < 0.001), multifocality (p = 0.001), bilateral tumor (p = 0.002), distant metastases (p < 0.001), and tumor recurrence (OR = 14.7, p < 0.001). LNR was also correlated to postoperative calcitonin levels (p < 0.001) and carcinoembryonic antigen (p = 0.011). LNR >0.1 was associated with shorter disease-specific survival in patients at risk: tumor larger than 20 mm at diagnosis (p = 0.013), sporadic MTC (p = 0.01), and age above 40 years at diagnosis (p = 0.004). Cox multivariate survival analysis revealed LNR as the only significant independent factor for disease free survival (p = 0.005). CONCLUSIONS This study showed that LNR correlates well with patient and tumor characteristics and prognostic variables. We suggest that LNR should be considered an important parameter for predicting outcome in MTC.
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Affiliation(s)
- Tal Rozenblat
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dania Hirsch
- Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Robenshtok
- Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Simona Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology & Metabolism Service, Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - David J Gross
- Neuroendocrine Tumor Unit, Endocrinology & Metabolism Service, Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Haggi Mazeh
- Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
| | - Carlos Benbassat
- Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Twito
- Institute of Endocrinology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Israel.
| | - Aviram Mizrachi
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Thomas Shpitzer
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gideon Bachar
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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15
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Machens A, Lorenz K, Dralle H. Prediction of biochemical cure in patients with medullary thyroid cancer. Br J Surg 2020; 107:695-704. [PMID: 32108330 DOI: 10.1002/bjs.11444] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/06/2019] [Accepted: 11/02/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of number of node metastases versus metastatic lymph node ratio versus AJCC node category on biochemical cure in medullary thyroid cancer (MTC) is not well defined. METHODS Multivariable logistic regression analysis was used to determine clinical and histopathological variables that contribute to biochemical cure in node-positive MTC. RESULTS Some 584 of 1026 patients with MTC underwent systematic lymph node dissections for node-positive disease; 27·4 per cent (54 of 197) were biochemically cured after the initial operation and 13·5 per cent (42 of 310 patients) after repeat surgery. Cured patients had significantly less extrathyroid extension (11-14 versus 33·2-55·6 per cent), fewer lymph node metastases (median 2-4 versus 12-16), a lower metastatic lymph node ratio (median 0·05-0·08 versus 0·23-0·28), and were less likely to have AJCC pN1b disease (56-76 versus 89·9-91·6 per cent) and distant metastases (0 versus 28·4-37·1 per cent) than patients who were not cured. Biochemical cure curves advanced steadily up to 7-12 node metastases and a metastatic lymph node ratio of 0·33, eventually levelling off after 16-17 node metastases and metastatic lymph node ratios of 0·45-0·65. In logistic regression analysis, number of lymph node metastases (odds ratio (OR) 17·24 for more than 20 metastases, OR 5·28 for 11-20 metastases, OR 2·22 for 6-10 metastases), preoperative basal serum calcitonin (OR 6·24 for over 1000 pg/ml), reoperation (OR 5·34) and extrathyroid extension (OR 2·42) independently predicted failure to reach biochemical cure. CONCLUSION Number of lymph node metastases, unlike metastatic lymph node ratio or AJCC node category, determines likelihood of biochemical cure after initial and repeat surgery for node-positive MTC.
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Affiliation(s)
- A Machens
- Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), University of Duisburg-Essen, Essen, Germany
| | - K Lorenz
- Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), University of Duisburg-Essen, Essen, Germany
| | - H Dralle
- Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), University of Duisburg-Essen, Essen, Germany.,Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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16
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Wang S, Wang B, Xie C, Ye D. RET Proto-oncogene Gene Mutation Is Related to Cervical Lymph Node Metastasis in Medullary Thyroid Carcinoma. Endocr Pathol 2019; 30:297-304. [PMID: 31494787 DOI: 10.1007/s12022-019-09588-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
RET proto-oncogene (RET) mutations were proved to be related to the development of medullary thyroid carcinoma (MTC). We aimed to analyze the role of RET mutations in cervical lymph node metastasis in patients with MTC. Forty-nine patients with preoperatively diagnosed MTC by fine-needle aspiration cytology (FNAC) who underwent bilateral total thyroidectomy with cervical lymphadenectomy were included. Postoperative RET gene test and pathological analysis were performed with the surgical specimens; serum calcitonin (Ctn) and carcinoembryonic antigen (CEA) levels were tested pre- and postoperatively, to evaluate the association between RET mutations and cervical lymph node metastasis in MTC. In these 49 patients, the RET mutation rates of Exon 11, Exon 10, Exon 11&13, Exon 13, and Exon 16 were 20.4%, 4.1%, 38.8%, 22.4%, and 0%, respectively. The lymph node metastasis rates of patients with RET mutation in the central and lateral compartments were 71.4% and 64.3%, respectively, versus 28.6% and 14.3% of patients without RET mutation. The preoperative basal serum levels of Ctn (234.8 ± 188.4 vs. 44.4 ± 27.5, p < 0.01) and postoperative Ctn (49.8 ± 86.4 vs. 3.7 ± 2.2, p = 0.001) in MTC patients with RET mutations were significantly higher than those in MTC patients without RET mutation. In addition, the preoperative (50.2 ± 76.7 vs. 7.4 ± 6.8, p = 0.001) and postoperative serum levels of CEA (13.2 ± 19.5 vs. 1.3 ± 1.6, p < 0.01) in MTC patients with RET mutations were significantly higher than those in MTC patients without RET mutation (p < 0.05). RET mutation was related to cervical lymph node metastasis in patients with MTC, especially the mutation in Exon 11&13. Patients with RET mutation in Exon 11&13 might be regarded as the predictor for prophylactic ipsilateral total cervical lymphadenectomy even without clear evidence of lateral cervical lymph node metastasis.
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Affiliation(s)
- Sisi Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Bo Wang
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Chao Xie
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Daoxiong Ye
- Department of Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
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17
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Meng K, Luo H, Chen H, Guo H, Xia W. Prognostic value of numbers of metastatic lymph node in medullary thyroid carcinoma: A population-based study using the SEER 18 database. Medicine (Baltimore) 2019; 98:e13884. [PMID: 30608412 PMCID: PMC6344130 DOI: 10.1097/md.0000000000013884] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Lymph node (LN) metastases are widely considered as a vital assessment of disease progression, as well as an essential indicator for biochemical cure of medullary thyroid carcinoma (MTC). Prognostic effect of numbers of metastatic LN has not been fully studied and the optimal cut-point of LN numbers has not been established. This population-based study designed to investigate prognostic value of numbers of positive LN and determinate the prognostic factors.Data were generated from Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2013. X-tile program was applied and cut points for division of LN numbers as low-, medium- and high-risk were 0, 1 to 10, and ≥11. The relationship between numbers of metastatic LN, age, tumor size, extent of tumor, and radiotherapy on overall survival (OS) and disease-specific survival (DSS) were evaluated.A total of 1466 diagnosed primary MTC patients without metastases were eligible for analysis in current study. 945 (64%) patients were classified as no positive LNs, 327 (22%) as 1 to 10 positive LNs, 194 (14%) as ≥11 positive LNs. Patients with older age, tumor size, ≥11 positive LN were associated with unfavorable OS. Those dispensed with radiation had statistically better prognosis than the others. When stratified by age, there was a significant difference in patients ≥45 years within LN categories (log-rank P < .001). When stratified by tumor size, a significant correlation was noted between rising numbers of involved nodes and falling rates of OS in tumor measuring >2cm setting (2-4 cm setting, log-rank P = .003 and >4 cm setting, log-rank P = .014, separately). There was no statistical difference of the area under the curve (AUC) for OS and DSS prediction between LN group and N stage, suggesting the 2 LN systems had the same predictive power for OS and DSS.Numbers of metastatic LN showed prognostic power in survival analysis and remained an independent survival predictor which can be evaluated in MTC treatment decisions for optimum assessment.
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Affiliation(s)
- Kexin Meng
- Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road
| | - Hua Luo
- Department of Breast Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Guang Xing Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, 453 Tiyuchang Rd
| | - Hailong Chen
- Department of Surgical Oncology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang Province, China
| | - Haiwei Guo
- Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road
| | - Wenjie Xia
- Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road
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18
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Opsahl EM, Akslen LA, Schlichting E, Aas T, Brauckhoff K, Hagen AI, Rosenlund AF, Sigstad E, Grøholt KK, Mæhle L, Engebretsen LF, Jørgensen LH, Varhaug JE, Bjøro T. Trends in Diagnostics, Surgical Treatment, and Prognostic Factors for Outcomes in Medullary Thyroid Carcinoma in Norway: A Nationwide Population-Based Study. Eur Thyroid J 2019; 8:31-40. [PMID: 30800639 PMCID: PMC6381913 DOI: 10.1159/000493977] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/21/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Medullary thyroid carcinoma (MTC) is rare. Nationwide population-based studies are important to evaluate its clinical course. OBJECTIVES To describe all patients with MTC in Norway during 1994-2016 and compare time-related trends in diagnostics and surgical treatment, including prognostic factors for biochemical cure and disease-specific survival (DSS). METHODS This retrospective population-based cohort study includes data for 228 out of 237 patients (96%) with MTC; 201 patients were surgically treated. Patients were identified in the 4 regional centers treating MTC and by the Cancer Registry of Norway. Data were collected from patients' files. Trends were compared over 2 study periods. RESULTS MTC accounted for 4.2% of thyroid carcinomas. During the study periods, the incidence increased from 0.18 to 0.25: 100,000 per year, preoperative diagnostics improved with increased use of calcitonin, ultrasound, and fine-needle cytology (p = 0.010, p < 0,001, and p = 0.001), patients were diagnosed at an earlier tumor stage (p = 0.004), and more patients were cured (p = 0.002). Via multivariate analysis of patients with metastatic lymph nodes, independent prognostic factors for cure were: a low ratio of metastatic and total number of dissected lymph nodes (p = 0.021) and no extrathyroidal extension (p = 0.030). Independent prognostic factors for DSS were: no distant metastasis, a younger age, and a low ratio of metastatic and dissected lymph nodes (p = 0.005, p = 0.020, p = 0.022). CONCLUSIONS Preoperative diagnostics have improved over time with increased therapeutic control. A low ratio of metastatic and dissected lymph nodes predicts better outcomes in patients with metastatic lymph nodes.
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Affiliation(s)
- Else Marie Opsahl
- Section of Breast and Endocrine Surgery, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Else Marie Opsahl, MD, Section for Breast and Endocrine Surgery, Department of Oncology Oslo University Hospita, PO Box 4950 Nydalen, NO–0424 Oslo (Norway), E-Mail
| | - Lars Andreas Akslen
- Section for Pathology, Department of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway
- Department of Pathology, Haukeland University Hospital Bergen, Bergen, Norway
| | - Ellen Schlichting
- Section of Breast and Endocrine Surgery, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Turid Aas
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Irene Hagen
- Department of Breast and Endocrine Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Alf Frimann Rosenlund
- Section of Breast and Endocrine Surgery, Department of Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Eva Sigstad
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | | | - Lovise Mæhle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Lars Fredrik Engebretsen
- Center for Medical Genetics and Molecular Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Medical Genetics, St. Olavs University Hospital, Trondheim, Norway
| | - Lars H. Jørgensen
- Department of Thoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jan Erik Varhaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Trine Bjøro
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
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19
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Incidence and survival differences in esophageal cancer among ethnic groups in the United States. Oncotarget 2018; 8:47037-47051. [PMID: 28410201 PMCID: PMC5564542 DOI: 10.18632/oncotarget.16694] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 03/06/2017] [Indexed: 12/20/2022] Open
Abstract
Objectives This study was performed to identify the differences in incidence, clinicopathological features, and survival in esophageal cancer among ethnic groups in the United States and to determine the reasons for the differences. Result A total of 49,766 patients were included. Black and Asian groups had a higher proportion of squamous cell carcinoma (ESCC) (85.5% and 75.4%, respectively) and mid-esophagus tumor (43.2% and 37.7% respectively) than the non-Hispanic white and Hispanic white groups. The incidences of ESCC in all ethnic groups declined since 1973, especially in black males. At the same time, incidences of esophageal adenocarcinoma (EAC) dramatically increased in white males since 1973. And incidences of ESCC and EAC were the lowest and stable in Asian female. Multivariable models showed that patients who were male, or black, or had larger tumors, or positive lymph nodes had an increased risk of death from esophageal cancer, while patients with ESCC or diagnosed after 2005 or treated with surgery had a lower likelihood of death. For ESCC, the black patients had the lowest DSS, while for EAC there were no significant differences in DSS among the ethnic/racial groups. Materials and Method From the Surveillance, Epidemiology, and End Results Program database, patients diagnosed with esophageal cancer from 1998-2013 were identified. Differences in incidences, clinicopathological features, treatments, and disease-specific survival (DSS) in four broad racial/ethnic groups were compared. Conclusion Histological type distribution between racial groups could be an important consideration in the incidence and the survival trend but other factors could also have an effect.
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Qu N, Shi RL, Lu ZW, Liao T, Wen D, Sun GH, Li DS, Ji QH. Metastatic lymph node ratio can further stratify risk for mortality in medullary thyroid cancer patients: A population-based analysis. Oncotarget 2018; 7:65937-65945. [PMID: 27588396 PMCID: PMC5323204 DOI: 10.18632/oncotarget.11725] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/09/2016] [Indexed: 12/13/2022] Open
Abstract
Medullary thyroid cancer (MTC) has a propensity to cervical lymph node metastases (LNM). Recent studies have shown that both the number of involved lymph nodes (LNs) and the metastatic lymph node ratio (MLNR) confer prognostic information. This study was to determine the predictive value of MLNR on cancer-specific survival (CSS) in SEER (Surveillance, Epidemiology and End Results)-registered MTC patients treated with thyroidectomy and lymphadenectomy between 1991 and 2012, investigate the cutoff points for MLNR in stratifying risk of mortality and provide evidence for selection of appropriate treatment strategies. X-tile program determined 0.5 as optimal cut-off value for MLNR in terms of CSS in 890 MTC patients. According to multivariate Cox regression analysis, MLNR (0.50–1.00) is a significant independent prognostic factor for CSS (hazard ratio 2.161, 95% confidence interval 1.327–3.519, p=0.002). MLNR (0.50–1.00) has a greater prognostic impact on CSS in female, non-Hispanic white, T3/4, N1b and M1 patients. The lymph node yield (LNY) influences the effect of MLNR on CSS; LNY ≥9 results in MLNR (0.50–1.00) having a higher HR for CSS than MLNR (0.00-0.49). In conclusion, higher MLNRs predict poorer survival in MTC patients. Eradication of involved nodes ensures accurate staging and maximizes the ability of MLNR to predict prognosis.
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Affiliation(s)
- Ning Qu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Rong-Liang Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.,Department of General Surgery, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Zhong-Wu Lu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tian Liao
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Duo Wen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Guo-Hua Sun
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Duan-Shu Li
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Randle RW, Bates MF, Schneider DF, Sippel RS, Pitt SC. Survival in patients with medullary thyroid cancer after less than the recommended initial operation. J Surg Oncol 2017; 117:1211-1216. [PMID: 29266278 DOI: 10.1002/jso.24954] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/20/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES We aimed to evaluate the disease specific-survival (DSS) of patients with Medullary Thyroid Cancer (MTC) confined to the central neck based on the extent of the initial operation. METHODS This retrospective review of patients with MTC from the SEER registry from 2004 to 2012 excluded patients with lateral neck involvement or distant metastases. RESULTS The cohort (n = 766) included 85(11%) less than total thyroidectomies (TT), 212(28%) TT alone, and 469(61%) TT with lymph node excision. Mean tumor size was similar (2.2cm for <TT, 1.9 for TT alone, and 2.2 for TT with nodes, p=0.13). Patients receiving a TT with nodal excision were more likely to have multifocal tumors (8% <TT, 22% TT alone, and 27% TT with nodes, P < 0.001), and extrathyroidal extension (1% <TT, 4% TT alone, and 9% TT with nodes, P = 0.005). Even after controlling for significant predictors of DSS, extent of the initial operation did not predict survival (HR 0.28 for <TT, 95% CI 0.26-3.11 and HR 0.62 for TT alone, 95% CI 0.17-2.22 compared to TT with nodes, P = NS for all). CONCLUSION According to population-based SEER registry data, the extent of initial resection may not significantly change DSS in patients with MTC confined to the central neck.
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Affiliation(s)
- Reese W Randle
- Department of General Surgery, Section of Endocrine Surgery, University of Kentucky, Lexington, Kentucky
| | - Maria F Bates
- Department of General Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin
| | - David F Schneider
- Department of General Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin
| | - Rebecca S Sippel
- Department of General Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin
| | - Susan C Pitt
- Department of General Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin
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Randle RW, Balentine CJ, Leverson GE, Havlena JA, Sippel RS, Schneider DF, Pitt SC. Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years. Surgery 2016; 161:137-146. [PMID: 27842913 DOI: 10.1016/j.surg.2016.04.053] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/31/2016] [Accepted: 04/09/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The impact of recent medical advances on disease presentation, extent of operation, and disease-specific survival for patients with medullary thyroid cancer is unclear. METHODS We used the Surveillance, Epidemiology, and End Results registry to compare trends over 3 time periods, 1983-1992, 1993-2002, and 2003-2012. RESULTS There were 2,940 patients diagnosed with medullary thyroid cancer between 1983 and 2012. The incidence of medullary thyroid cancer increased during this time period from 0.14 to 0.21 per 100,000 population, and mean age at diagnosis increased from 49.8 to 53.8 (P < .001). The proportion of tumors ≤1 cm also increased from 11.4% in 1983-1992, 19.6% in 1993-2002, to 25.1% in 2003-2012 (P < .001), but stage at diagnosis remained constant (P = .57). In addition, the proportion of patients undergoing a total thyroidectomy and lymph node dissection increased from 58.2% to 76.5% during the study period (P < .001). In the most recent time interval, 5-year, disease-specific survival improved from 86% to 89% in all patients (P < .001) but especially for patients with regional (82% to 91%, P = .003) and distant (40% to 51%, P = .02) disease. CONCLUSION These data demonstrate that the extent of operation is increasing for patients with medullary thyroid cancer. Disease-specific survival is also improving, primarily in patients with regional and distant disease.
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Affiliation(s)
- Reese W Randle
- Department of Surgery, University of Wisconsin, Madison, WI.
| | | | | | | | | | | | - Susan C Pitt
- Department of Surgery, University of Wisconsin, Madison, WI
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Chandeze MM, Noullet S, Faron M, Trésallet C, Godiris-Petit G, Tissier F, Buffet C, Leenhardt L, Chereau N, Menegaux F. Can We Predict the Lateral Compartment Lymph Node Involvement in RET-Negative Patients with Medullary Thyroid Carcinoma? Ann Surg Oncol 2016; 23:3653-3659. [DOI: 10.1245/s10434-016-5292-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 12/15/2022]
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Li D, Du XL, Ren Y, Liu P, Li S, Yang J, Lv M, Chen L, Wang X, Li E, Yang J, Yi M. Comparative Analysis of Clinicopathologic Features of, Treatment in, and Survival of Americans with Lung or Bronchial Cancer. PLoS One 2016; 11:e0156617. [PMID: 27244238 PMCID: PMC4886968 DOI: 10.1371/journal.pone.0156617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/17/2016] [Indexed: 01/12/2023] Open
Abstract
Ethnic disparities in lung and bronchial cancer diagnoses and disease-specific survival (DSS) rates in the United States are well known. However, few studies have specifically assessed these differences in Asian subgroups. The primary objectives of the retrospective analysis described herein were to identify any significant differences in clinicopathologic features, treatment, and survival rate between Asian lung cancer patients and lung cancer patients in other broad ethnic groups in the United States and to determine the reasons for these differences among subgroups of Asian patients with lung or bronchial cancer. We searched the Surveillance, Epidemiology, and End Results Program database to identify patients diagnosed with lung or bronchial cancer from 1990 to 2012. Differences in clinicopathologic features, treatment, and DSS rate in four broad ethnic groups and eight Asian subgroups were compared. The study population consisted of 849,088 patients, 5.2% of whom were of Asian descent. Female Asian patients had the lowest lung and bronchial cancer incidence rates, whereas male black patients had the highest rates. Asian patients had the best 5-year DSS rate. In our Asian subgroup analysis, Indian/Pakistani patients had the best 5-year DSS rate, whereas Hawaiian/Pacific Islander patients had the worst 5-year DSS rates. We found the differences in DSS rate among the four broad ethnic groups and eight Asian subgroups when we grouped patients by age and disease stage, as well. Asian patients had better DSS rates than those in the other three broad ethnic groups in almost every age and disease-stage group, especially in older patients and those with advanced-stage disease. In conclusion, we found that clinicopathologic features and treatment of lung and bronchial cancer differ by ethnicity in the United States, and the differences impact survival in each ethnic group.
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Affiliation(s)
- Dan Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, United States of America
| | - Yinghong Ren
- Department of Internal Medicine, Shangluo Central Hospital, Shangluo, Shaanxi, China
| | - Peijun Liu
- Department of Translational Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Shuting Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jiao Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Meng Lv
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ling Chen
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Wang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Enxiao Li
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jin Yang
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail: (MY); (Jin Yang)
| | - Min Yi
- Department of Medical Oncology The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail: (MY); (Jin Yang)
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Heaton CM, Chang JL, Orloff LA. Prognostic Implications of Lymph Node Yield in Central and Lateral Neck Dissections for Well-Differentiated Papillary Thyroid Carcinoma. Thyroid 2016; 26:434-40. [PMID: 26825749 DOI: 10.1089/thy.2015.0318] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this study was to evaluate the relationship between lymph node yield (LNY) from central (CND) and lateral (LND) neck dissections and risk of recurrence in patients undergoing primary surgery for well-differentiated papillary thyroid carcinoma (WDPTC). METHODS Clinical data were reviewed from all patients with biopsy-proven WDPTC who underwent primary total thyroidectomy with CND or LND at the authors' institution from 2005 to 2009. Patient demographics and tumor characteristics were obtained, and clinical data with at least five-year follow-up were used. Within the CNDs and LNDs, total number of nodes removed (LNY), total positive nodes removed, and the ratio of positive lymph nodes to LNY were determined. RESULTS One hundred fifty-two patients were included in the study, with average follow-up of 69 months. Of 125 patients who underwent CND, 20 had central neck disease recurrence. The LNY of patients with central neck recurrence was significantly less than those who had no recurrence (2.5 vs. 10.3; p < 0.0001). Of 71 patients who underwent LND, 23 had ipsilateral lateral neck disease recurrence. The LNY of patients with lateral neck recurrence was significantly less than those who did not recur (10.5 vs. 24.6; p < 0.0001). Higher rates of recurrence were associated with smaller LNY in both groups. For both groups, lower LNY remains predictive of recurrence on multivariate analysis controlling for pT stage, pN stage, American Joint Committee on Cancer stage, and radioactive iodine treatment. CONCLUSIONS Higher LNY in CNDs and LNDs is associated with lower rates of papillary thyroid carcinoma recurrence in the central and lateral neck. To minimize the risk of recurrence and the need for secondary therapy with revision surgery and/or radiation, surgeons should perform thorough, compartment-oriented CNDs and LNDs when nodal surgery is undertaken.
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Affiliation(s)
- Chase M Heaton
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco , San Francisco, California
| | - Jolie L Chang
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco , San Francisco, California
| | - Lisa A Orloff
- 2 Department of Otolaryngology-Head and Neck Surgery, Stanford University , Stanford, California
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Wells SA, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, Lee N, Machens A, Moley JF, Pacini F, Raue F, Frank-Raue K, Robinson B, Rosenthal MS, Santoro M, Schlumberger M, Shah M, Waguespack SG. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 2015; 25:567-610. [PMID: 25810047 PMCID: PMC4490627 DOI: 10.1089/thy.2014.0335] [Citation(s) in RCA: 1289] [Impact Index Per Article: 143.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The American Thyroid Association appointed a Task Force of experts to revise the original Medullary Thyroid Carcinoma: Management Guidelines of the American Thyroid Association. METHODS The Task Force identified relevant articles using a systematic PubMed search, supplemented with additional published materials, and then created evidence-based recommendations, which were set in categories using criteria adapted from the United States Preventive Services Task Force Agency for Healthcare Research and Quality. The original guidelines provided abundant source material and an excellent organizational structure that served as the basis for the current revised document. RESULTS The revised guidelines are focused primarily on the diagnosis and treatment of patients with sporadic medullary thyroid carcinoma (MTC) and hereditary MTC. CONCLUSIONS The Task Force developed 67 evidence-based recommendations to assist clinicians in the care of patients with MTC. The Task Force considers the recommendations to represent current, rational, and optimal medical practice.
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Affiliation(s)
- Samuel A. Wells
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sylvia L. Asa
- Department of Pathology, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Rossella Elisei
- Department of Endocrinology, University of Pisa, Pisa, Italy
| | - Douglas B. Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Gagel
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Machens
- Department of General, Visceral, and Vascular Surgery, University Hospital, University of Halle-Wittenberg, Halle/Saale, Germany
| | - Jeffrey F. Moley
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Furio Pacini
- Section of Endocrinology and Metabolism, Department of Internal Medicine, Endocrinology and Metabolism and Biochemistry, University of Siena, Policlinico Santa Maria alle Scotte, Siena, Italy
| | - Friedhelm Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Karin Frank-Raue
- Endocrine Practice, Moleculargenetic Laboratory, Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Bruce Robinson
- University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | - M. Sara Rosenthal
- Departments of Internal Medicine, Pediatrics and Behavioral Science, University of Kentucky, Lexington, Kentucky
| | - Massimo Santoro
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Universita' di Napoli “Federico II,” Napoli, Italy
| | - Martin Schlumberger
- Institut Gustave Roussy, Service de Medecine Nucleaire, Université of Paris-Sud, Villejuif, France
| | - Manisha Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Steven G. Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Fochtmann A, Haymerle G, Kunstfeld R, Pammer J, Grasl MC, Erovic BM. Prognostic significance of lymph node ratio in patients with Merkel cell carcinoma. Eur Arch Otorhinolaryngol 2014; 272:1777-83. [DOI: 10.1007/s00405-014-3116-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/20/2014] [Indexed: 01/11/2023]
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Kong F, Li H, Fan Y, Zhang X, Cao S, Yu J, Ren X, Hao X. Overweight patients achieve ideal body weight following curative gastrectomy resulting in better long-term prognosis. Obes Surg 2013; 23:650-6. [PMID: 23371777 DOI: 10.1007/s11695-012-0847-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) and long-term outcome in gastric cancer patients following radical gastrectomy continues to be debated. We investigated the association between BMI, clinicopathological features, and prognosis in Chinese gastric carcinoma patients. METHODS A retrospective consecutive cohort study was performed on 1,296 patients who underwent gastrectomy with curative intent at the Tianjin Cancer Institute Hospital between 1999 and 2004. The clinicopathological characteristics, overall 5-year survival rate (OS), and preoperative and six-month postoperative BMIs of both overweight (BMI ≥ 25 kg/m(2); H-BMI; n = 364) and non-overweight (BMI <25 kg/m(2); N-BMI; n = 932) patients were compared. RESULTS Among these patients, 364 (28.1 %) were overweight. The OS was significantly higher in the H-BMI than N-BMI group (33.2 vs. 24.1 %, respectively; p < 0.001). Preoperative and six-month postoperative BMIs were 27.1 ± 2.0 and 24.8 ± 2.0 kg/m(2), respectively, in the H-BMI group (p < 0.001), whereas they were 21.7 ± 2.2 and 20.7 ± 2.2 kg/m(2), respectively, in the N-BMI group (p = 0.007). There was significantly better differentiation (p = 0.034), less distant metastases (p = 0.006), and a lower metastatic lymph node ratio (p = 0.014) observed in the H-BMI groups. Multivariate analyses indicated age, BMI, pathological tumor depth, distant metastases, metastatic lymph node ratio, and tumor size as independent prognostic factors. CONCLUSIONS Our findings suggest that overweight patients were less likely to have tumors with aggressive features and can achieve ideal body weight following curative gastrectomy, possibly resulting in better long-term prognosis.
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Affiliation(s)
- Fanming Kong
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Huanhuxi Road, Hexi District, Tianjin, China
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Vas Nunes JH, Clark JR, Gao K, Chua E, Campbell P, Niles N, Gargya A, Elliott MS. Prognostic implications of lymph node yield and lymph node ratio in papillary thyroid carcinoma. Thyroid 2013; 23:811-6. [PMID: 23373961 DOI: 10.1089/thy.2012.0460] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The lymph node yield (LNY) and the lymph node ratio (LNR) have been shown to be important prognostic factors in oral, colon, and gastric cancers. The role of the LNY and LNR in papillary thyroid cancer (PTC) is unclear. The aims of this study were to determine if a high LNR and a low LNY decrease disease-free survival rates. This study further aimed to determine an optimum nodal yield. METHODS A retrospective analysis was conducted of 198 patients with PTC undergoing total thyroidectomy with neck dissection between 1987 and 2011. The LNY and LNR were adjusted by relevant covariates in a multivariate Cox regression analysis with Andersen-Gill extension. RESULTS The LNR was associated with a decrease in disease-free survival (hazard ratio 3.2 [95% confidence interval 1.4-7.3], p=0.005). Patients with an LNR of 0.30 or higher had a 3.4 times higher risk of persistent or recurrent disease compared with patients with an LNR of 0.00 ([95% confidence interval 1.1-10.5], p=0.031). Conversely, patients with an LNR of 0.11 or lower had an 80% chance of remaining disease free during 5 years of follow-up. The LNY showed no significant independent effect and an optimum nodal yield was not determined. CONCLUSIONS The LNR is an important independent prognostic factor in PTC and can be used in conjunction with existing staging systems. A clinical relevant cut-off point of 0.3 (one positive lymph node out of three total) is proposed. No prognostic implications for LNY were identified.
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Tuttle RM, Ganly I. Risk stratification in medullary thyroid cancer: Moving beyond static anatomic staging. Oral Oncol 2013; 49:695-701. [DOI: 10.1016/j.oraloncology.2013.03.443] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Meijer JAA, Bakker LEH, Valk GD, de Herder WW, de Wilt JHW, Netea-Maier RT, Schaper N, Fliers E, Lips P, Plukker JT, Links TP, Smit JA. Radioactive iodine in the treatment of medullary thyroid carcinoma: a controlled multicenter study. Eur J Endocrinol 2013; 168:779-86. [PMID: 23462866 DOI: 10.1530/eje-12-0943] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Radioactive iodine (RAI) therapy in medullary thyroid carcinoma (MTC) is applied in some centers, based on the assumption that cross-irradiation from thyroid follicular cells may be beneficial. However, no systematic studies on the effect of RAI treatment in MTC have been performed. The aim of this study was to analyze the effect of RAI treatment on survival in MTC patients. DESIGN Retrospective multicenter study in eight University Medical Centers in The Netherlands. METHODS Two hundred and ninety three MTC patients without distant metastases who had undergone a total thyroidectomy were included between 1980 and 2007. Patients were stratified by clinical appearance, hereditary stage, screening status, and localization. All patients underwent regular surgical treatment with additional RAI treatment in 61 patients. Main outcome measures were disease-free survival (DFS) and disease-specific survival (DSS). Cure was defined as biochemical and radiological absence of disease. RESULTS In multivariate analysis, stratification according to clinical appearance (P=0.72), hereditary stage (P=0.96), localization (P=0.69), and screening status (P=0.31) revealed no significant effects of RAI treatment on DFS. Multivariate analysis showed no significant difference in DSS for the two groups stratified according to clinical appearance (P=0.14). Owing to limited number of events, multivariate analysis was not possible for DSS in the other groups of stratification. CONCLUSIONS Based on the results of the present analysis, we conclude that RAI has no place in the treatment of MTC.
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Affiliation(s)
- J A A Meijer
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
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Prognostic impact of N staging in 715 medullary thyroid cancer patients: proposal for a revised staging system. Ann Surg 2013; 257:323-9. [PMID: 22968075 DOI: 10.1097/sla.0b013e318268301d] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This institutional study aimed at quantifying a medullary thyroid cancer (MTC) patient's risk of lung, liver, or bone metastasis. BACKGROUND Without quantitative information regarding risk factors for lung, liver, and bone metastasis, risk stratification is liable to be haphazard, resulting in poor cost-effectiveness of screening programs. METHODS Included in this study were 715 patients with MTC for whom histopathologic information was available for each lymph node removed. RESULTS Seventy-two patients (10.1%) were diagnosed with lung metastasis, 58 patients (8.1%) with liver metastasis, and 34 patients (4.8%) with bone metastasis. Multivariate analyses were limited to patients revealing no more than 1 type of distant metastasis to avoid confounding by other distant metastasis. Extrathyroidal extension and 1 to 10 involved nodes indicated a small risk of lung metastasis [3%-4%; odds ratio (OR) 3-4], tumors greater than 40 mm and 11 to 20 involved nodes implied an intermediate risk (13%; OR 6), and more than 20 involved nodes entailed a high risk (26%-30%; OR 14-16). In the multivariate logistic regressions on liver and bone metastasis, in which the number of involved nodes was omitted on statistic grounds, extrathyroidal extension signified a strong risk of liver metastasis (19%, OR 23), whereas no clinical-pathologic variables were significantly associated with bone metastasis. Cumulative rates of lung, liver, and bone metastasis, plotted against the number of lymph node metastases, were similar. DISCUSSION N categories encompassing 1 to 10 (N1), 11 to 20 (N2), and more than 20 (N3) lymph node metastases are important prognostic classifiers that should be incorporated into MTC staging systems for better risk stratification.
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Yi M, Liu P, Li X, Mittendorf EA, He J, Ren Y, Nayeemuddin K, Hunt KK. Comparative analysis of clinicopathologic features, treatment, and survival of Asian women with a breast cancer diagnosis residing in the United States. Cancer 2012; 118:4117-25. [PMID: 22460701 DOI: 10.1002/cncr.27399] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 11/18/2011] [Accepted: 11/28/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND It has been established that disparities by ethnicity in the rates of breast cancer diagnoses and disease-specific survival (DSS) exist in the United States. However, few studies have assessed differences specifically between Asians and other ethnic groups or among Asian subgroups. METHODS The authors used the Surveillance, Epidemiology, and End Results database to identify patients who were diagnosed with invasive breast cancer between 1988 and 2008. Clinicopathologic features, treatment, and DSS rates were compared among broad ethnic groups and among Asian subgroups. RESULTS In total, there were 658,691 patients in the study, including 511,701 non-Hispanic white (NHW) women (77.7%), 57,890 black women (8.8%), 45,461 Hispanic white (HW) women (6.9%), and 43,639 Asian women (6.6%). The Asian cohort was divided into the following subgroups: Filipino, Chinese, Japanese, Indian/Pakistani, Korean, Vietnamese, Hawaiian/Pacific Islander, and other. Patients in all the Asian subgroups, except Japanese, were younger at diagnosis than NHW patients. After adjustment for disease stage, Japanese patients diagnosed with stage I through III disease had better DSS rates than patients in the NHW group or in the other Asian subgroups. Hawaiian/Pacific Islander patients with stage III or IV disease had worse DSS rates than NHW patients and patients in the other Asian subgroups. All other Asian subgroups had DSS rates similar to the DSS rate in the NHW group. [Formula: see text] CONCLUSIONS The current results indicated that disparities exist for Asian women with breast cancer who reside in the United States compared with NHW groups and among Asian subgroups. Differences in presenting clinicopathologic features may affect DSS rates, suggesting that further investigation of these disparities is warranted to increase early detection and treatment for specific subgroups.
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Affiliation(s)
- Min Yi
- Department of Translational Medicine, The First Affiliated Hospital of Xian Jiaotong University, School of Medicine, Xian, China.
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Yip J, Orlov S, Orlov D, Vaisman A, Hernández KG, Etarsky D, Kak I, Parvinnejad N, Freeman JL, Walfish PG. Predictive value of metastatic cervical lymph node ratio in papillary thyroid carcinoma recurrence. Head Neck 2012; 35:592-8. [DOI: 10.1002/hed.23047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2012] [Indexed: 12/17/2022] Open
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Lang BHH, Yih PCL, Shek TWH, Wan KY, Wong KP, Lo CY. Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma. J Surg Oncol 2012; 106:966-71. [PMID: 22718439 DOI: 10.1002/jso.23201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/30/2012] [Indexed: 01/06/2023]
Abstract
BACKGROUND Determinants for adequate lymph node yield (LNY) in prophylactic central neck dissection (pCND) for papillary thyroid carcinoma (PTC) remain unclear. We aimed to determine factors affecting LNY in pCND. METHODS Of 230 patients, 109 (47.4%) had total thyroidectomy and unilateral pCND. A specimen of ≥ 6 central lymph nodes (CLNs) was considered adequate. Factors such as patient clinicopathologic features, specimen dimensions, and pathologists' experience were compared between those with LNY < 6 (n = 52) and LNY ≥ 6 (n = 57). A multivariate analysis was conducted to identify independent factors for LNY ≥ 6. RESULTS Age, sex, presentation, body mass index, tumor characteristics, TNM stages, MACIS score, and pathologist's experience were not significant determinants for LNY ≥ 6. In the univariate analysis, the length (P = 0.021), width (P = 0.047), thickness (P = 0.024), and pN1a (P = 0.042) were significant determinants but in the multivariate analysis, the length (OR = 1.486 (95% CI: 1.053-2.097), P = 0.024) was the only independent factor for LNY ≥ 6. Postoperative vocal cord palsy, hypoparathyroidism, stimulated thyroglobulin and recurrences were similar between LNY <6 and ≥ 6. CONCLUSIONS Length (or the longest measured dimension) of the fresh CLN specimen was the only factor assuring LNY ≥ 6. Surgical complications and short-term outcomes appeared similar between LNY <6 or ≥ 6.
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Preoperative basal calcitonin and tumor stage correlate with postoperative calcitonin normalization in patients undergoing initial surgical management of medullary thyroid carcinoma. Surgery 2012; 150:1168-77. [PMID: 22136837 DOI: 10.1016/j.surg.2011.09.043] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 09/23/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND The optimal initial operative management of medullary thyroid cancer (MTC) and the use of biomarkers to guide the extent of operation remain controversial. We hypothesized that preoperative serum levels of calcitonin and carcinoembryonic antigen (CEA) correlate with extent of disease and postoperative levels reflect the extent of operation performed. METHODS We assessed retrospectively clinical and pathologic factors among patients with MTC undergoing at least total thyroidectomy; these factors were correlated with biomarkers using regression analyses. RESULTS Data were obtained from 104 patients, 28% with hereditary MTC. Preoperative calcitonin correlated with tumor size (P < .001) and postoperative serum calcitonin levels (P = .01) after multivariable adjustment for lymph node positivity, extent of operation, and hereditary MTC. No patient with a preoperative calcitonin level of <53 pg/mL (n = 20) had lymph node metastases. TNM stage (P = .001) and preoperative calcitonin levels (P = .04), but not extent of operation, independently correlated with the failure to normalize postoperative calcitonin. Postoperative CEA correlated with positive margins (adjusted P = 04). Neither preoperative nor postoperative CEA was correlated with lymph node positivity or extent of surgery. CONCLUSION Preoperative serum calcitonin and TMN stage, but not extent of operation, were independent predictors of postoperative normalization of serum calcitonin levels. Future studies should evaluate preoperative serum calcitonin levels as a determinate of the extent of initial operation.
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Yi M, Mittendorf EA, Cormier JN, Buchholz TA, Bilimoria K, Sahin AA, Hortobagyi GN, Gonzalez-Angulo AM, Luo S, Buzdar AU, Crow JR, Kuerer HM, Hunt KK. Novel staging system for predicting disease-specific survival in patients with breast cancer treated with surgery as the first intervention: time to modify the current American Joint Committee on Cancer staging system. J Clin Oncol 2011; 29:4654-61. [PMID: 22084362 DOI: 10.1200/jco.2011.38.3174] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE American Joint Committee on Cancer (AJCC) staging is used to determine breast cancer prognosis, yet patient survival within each stage shows wide variation. We hypothesized that differences in biology influence this variation and that addition of biologic markers to AJCC staging improves determination of prognosis. PATIENTS AND METHODS We identified a cohort of 3,728 patients who underwent surgery as the first intervention between 1997 and 2006. A Cox proportional hazards model, with backward stepwise exclusion of factors and stratification on pathologic stage (PS), was used to test the significance of adding grade (G), lymphovascular invasion (L), estrogen receptor (ER) status (E), progesterone receptor (PR) status, combined ER and PR status (EP), or combined ER, PR, and human epidermal growth factor receptor 2 status (M). We assigned values of 0 to 2 to these disease-specific survival (DSS) -associated factors and assessed six different staging systems: PS, PS + G, PS + G L, PS + G E, PS + G EP, and PS + G M. We compared 5-year DSS rates, Akaike's information criterion (AIC), and Harrell's concordance index (C-index) between systems. Surveillance, Epidemiology, and End Results data were used as the external validation cohort (n = 26,711). RESULTS Median follow-up was 6.5 years, and 5-year DSS rate was 97.4%. The PS + G E status staging system was most precise, with a low AIC (1,931.9) and the highest C-index (0.80). PS + G E status was confirmed to stratify outcomes in internal bootstrapping samples and the external validation cohort. CONCLUSION Our results validate an improved breast cancer staging system that incorporates grade and ER status. We recommend that biologic markers be incorporated into revised versions of the AJCC staging system.
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Affiliation(s)
- Min Yi
- The University of Texas MD Anderson Cancer Center, Houston, 77030, USA
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Takada H, Kikumori T, Imai T, Sawaki M, Shibata A, Kiuchi T. Patterns of lymph node metastases in papillary thyroid carcinoma: results from consecutive bilateral cervical lymph node dissection. World J Surg 2011; 35:1560-6. [PMID: 21538186 DOI: 10.1007/s00268-011-1133-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In patients with papillary thyroid carcinoma (PTC), the appropriate extent of lymph node dissection has not yet been established due to lack of accurate patterns of lymph node metastases (LNM). The aim of this study was to clarify the LNM pattern in PTC patients based on our institution's experience with a consistent technique of bilateral neck dissection, and to consider the rational extent of lymph node dissection. METHODS Between 1990 and 1999, 152 consecutive patients with PTC who underwent curative total thyroidectomy and bilateral neck dissection as initial treatment were analyzed. The patterns of LNM according to clinicopathological classification were analyzed using the lymph node ratio (LNR; number of metastatic lymph nodes/number of dissected nodes) and frequency (FLNM; number of patients with LNM/number of dissected patients) in cervical compartments. RESULTS Regardless of clinicopathological classification, LNR in the central compartment was consistently higher than in other compartments, and FLNM in the ipsilateral lateral compartment was consistently higher than in other compartments except for multifocal tumors. The LNR and FLNM in the contralateral lateral compartment were significantly higher in advanced (≥T3) cases than in cases with smaller tumors (T1) and were comparable to those in the ipsilateral lateral compartment in advanced (≥T3) cases. CONCLUSIONS The pattern of LNR provided a better reflection of the patterns of LNM. In terms of the LNR, central neck dissection is the basic extent of lymph node dissection for all clinically apparent PTC. In advanced patients, it is also advisable to include bilateral lateral neck dissection.
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Affiliation(s)
- Hideki Takada
- Department of Breast and Endocrine Surgery, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Ríos A, Rodríguez JM, Febrero B, Acosta JM, Torregrosa N, Parrilla P. [Prognostic value of clinical, histopathological and immunohistochemical features in medullary thyroid cancer]. Med Clin (Barc) 2011; 139:277-83. [PMID: 22032817 DOI: 10.1016/j.medcli.2011.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 07/10/2011] [Accepted: 07/12/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE To analyze the importance of various clinical, histopathological and immunohistochemical features in the prognosis of resected medullary thyroid carcinoma. PATIENTS AND METHODS A total of 55 cases of medullary thyroid carcinoma consecutively operated were investigated. The data referring to clinical features were collected in the patient's clinical history. The histopathological and immunohistochemical features of the tumors were taken from their pathological anatomy report. RESULTS Survival at one year was 96 ± 2%; at 5 years 91 ± 4%; at 10 years 88 ±6%; at 15 years 83 ± 7%; and at 20 years 61 ± 14%. Among epidemiological features, tumor type was significantly related with the disease (best familial prognosis; P=.035); among histopathological features, the presence of C cell hyperplasia and the presence of tumor necrosis had a significant relationship (P=.0005 and P=.039); among immunohistochemical features, positivity for p53 and for c-erb-b2 (P=.023 and P=.022); and finally, among staging data, TNM clinical staging (P=.015), size (P=.046) and the presence of distant metastases (P=.002). According to Cox's regression model, the only variables indicating a poor prognosis were: the existence of necrosis (P=.039; OR=6.513) and tumor size>4 cm (P=.027; OR=14.196). CONCLUSIONS The survival rate was mainly determined by tumor size and the presence of tumor necrosis. None of the immunohistochemical markers had a significant influence on survival.
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Affiliation(s)
- Antonio Ríos
- Servicio de Cirugía General y del Aparato Digestivo I, CIBEREHD, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
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Noullet S, Trésallet C, Godiris-Petit G, Hoang C, Leenhardt L, Menegaux F. Surgical management of sporadic medullary thyroid cancer. J Visc Surg 2011; 148:e244-9. [DOI: 10.1016/j.jviscsurg.2011.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Raval MV, Sturgeon C, Bentrem DJ, Elaraj DM, Stewart AK, Winchester DJ, Ko CY, Reynolds M. Influence of lymph node metastases on survival in pediatric medullary thyroid cancer. J Pediatr Surg 2010; 45:1947-54. [PMID: 20920711 DOI: 10.1016/j.jpedsurg.2010.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/07/2010] [Accepted: 06/09/2010] [Indexed: 12/12/2022]
Abstract
PURPOSE Lymph node metastases (LNM) from medullary thyroid cancer (MTC) are common in adults and are a poor prognostic factor. Less is known about LNM in children, who often have hereditary forms of MTC. Guidelines recommend prophylactic thyroidectomy in early childhood, but randomized prospective trials are not feasible. We hypothesized that LNM is associated with poor prognosis in children. METHODS Patients with MTC 21 years or younger from the National Cancer Data Base from 1985 to 2007 were studied. Multivariable logistic regression was used to identify factors associated with lymph node evaluation. Survival was estimated using the Kaplan-Meier method. RESULTS Of 430 patients, 276 (64.2%) had nodal evaluation with LNM present in 121 (28.1%). Older patients, those with tumors larger than 2 cm, and those with involved margins were more likely to have LNM (all P < .05). Patients undergoing total thyroidectomy, those with involved margins, and older patients were more likely to undergo lymph node evaluation after controlling for patient, tumor, and hospital factors (all P < .05). Over time an increasing number of patients with MTC have undergone total thyroidectomy. Patients 16 to 21 years of age had lower 10-year overall survival compared to patients 0 to 15 years old (88.7% vs 98.1%, P = .005). Lymph node metastases were also associated with decreased 10-year overall survival (84.4% vs 100%, P < .001). CONCLUSIONS In pediatric MTC, LNM predict poorer overall survival. Adequate lymph node assessment can provide valuable prognostic information for the pediatric MTC patient. Lymph node assessment should be considered for older pediatric patients undergoing surgery for hereditary MTC or biopsy confirmed MTC.
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Affiliation(s)
- Mehul V Raval
- Division of Research and Optimal Patient Care, Cancer Programs, American College of Surgeons, Chicago, IL 60611-3211, USA.
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Yi M, Giordano SH, Meric-Bernstam F, Mittendorf EA, Kuerer HM, Hwang RF, Bedrosian I, Rourke L, Hunt KK. Trends in and outcomes from sentinel lymph node biopsy (SLNB) alone vs. SLNB with axillary lymph node dissection for node-positive breast cancer patients: experience from the SEER database. Ann Surg Oncol 2010; 17 Suppl 3:343-51. [PMID: 20853057 DOI: 10.1245/s10434-010-1253-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Complete axillary lymph node dissection (ALND) after a positive sentinel lymph node biopsy (SLNB) remains the standard practice. As nodal surgery has long been considered a staging procedure without a clear survival benefit, the need for ALND in all patients is debatable. The purpose of this study was to examine differences in survival for patients undergoing SLNB alone versus SLNB with complete ALND. METHODS Patients with breast cancer who underwent SLNB and were found to have nodal metastases were identified from the Surveillance, Epidemiology, and End Results database (1998-2004). Clinicopathologic and outcomes data were examined for patients who underwent SLNB alone versus SLNB with ALND. RESULTS We identified 26,986 patients with disease-positive lymph nodes; 4,425 (16.4%) underwent SLNB alone, and 22,561 (83.6%) underwent SLNB with ALND. Patients were significantly more likely to undergo SLNB alone if they were older (median 59 years old) or if the tumor was low grade and estrogen receptor positive. From 1998 to 2004, the proportion of patients with micrometastasis in the sentinel lymph nodes who underwent SLNB alone increased from 21.0 to 37.8% (P < 0.001). At a median follow-up of 50 months, there were no statistically significant differences in overall survival (OS) between patients who underwent SLNB alone versus complete ALND. CONCLUSIONS There is an increasing trend toward omitting ALND in patients with micrometastatic nodal disease identified by SLNB. Compared with SLNB alone, completion ALND does not seem to be associated with improved survival for breast cancer patients with micrometastasis in the sentinel lymph nodes.
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Affiliation(s)
- Min Yi
- Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Survival in 12,653 breast cancer patients with extensive axillary lymph node metastasis in the anthracycline era. Med Oncol 2010; 27:1420-4. [PMID: 20049562 DOI: 10.1007/s12032-009-9396-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022]
Abstract
Institutional data are conflicting regarding the prognosis of breast cancer patients with extensive (≥10) axillary lymph node (ALN) metastases. We hypothesized that overall survival (OS) and disease specific survival (DSS) improved after the introduction of anthracycline-based therapy in 1997. We used the Surveillance, Epidemiology, and End results (SEER) database to identify breast cancer patients with ≥10 ALN metastases diagnosed between 1988 and 2004. Patients were categorized according to whether they were diagnosed prior to the FDA approval of anthracyclines (pre-anthracycline era, pre-AE) or after approval (post-anthracycline era, post-AE). Univariate analyses of OS and DSS were performed using the Kaplan-Meier method and differences assessed via the log rank test. Anthracycline era as an independent predictor of OS and DSS was evaluated using Cox proportional hazards models with patient age, hormone receptor status, tumor size, use of radiation therapy, and number of metastatic ALNs as covariates. Entry criteria were met by 12,653 patients. Of these, 5,655 (44.7%) and 6,998 (55.3%) were treated in the pre-AE and post-AE, respectively. On univariate analysis, post-AE patients experienced significantly improved rates of OS (P<0.001) and DSS (P<0.001) relative to pre-AE patients. On multivariate analysis, treatment in the post-AE favorably influenced both OS (Hazard Ratio [HR] 0.90, 95% Confidence Interval [CI] 0.84-0.96) and DSS (HR 0.84, CI 0.79-0.91). Both OS and DSS are poor in patients with extensive ALN metastases. Patients with advanced breast cancer treated in the post-AE demonstrated superior OS and DSS.
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Current World Literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:401-5. [PMID: 19687666 DOI: 10.1097/med.0b013e32833118e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Manxhuka-Kerliu S, Devolli-Disha E, Gerxhaliu A, Ahmetaj H, Baruti A, Loxha S, Thaqi H. Prognostic values of thyroid tumours. Bosn J Basic Med Sci 2009; 9:111-9. [PMID: 19485942 DOI: 10.17305/bjbms.2009.2829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Thyroid cancer accounts for approximately 1% of total cancer cases in developed countries. The aim of this study has been to analyze the histopathological variants of thyroid tumours with regard to gender and age. Despite their relative rarity in our material, they exhibit a wide range of morphological patterns and biological behaviour. During the period from 2001-2007, 138 biopsy cases of thyroid tumours, which were fixed in buffered neutral formalin and embedded in paraffin, have been reviewed. Tissue sections (4microm thick) were cut and stained with hematoxylin and eosin (H&E). Follicular adenomas have been found in 39, 1% of cases, thyroid carcinomas in 60, 12%, whereas thyroid secondary carcinomas have been found in 0, 72% of cases. As far as histological variants of thyroid carcinomas are concerned, most frequently found were papillary carcinomas in 39,85% of cases; followed by follicular carcinomas in 9,42% of cases; follicular variants of papillary carcinomas in 5,79% of cases; medullary carcinomas in 3,62% of cases, while anaplastic and Hurthle cell carcinomas have been found in 0,72% of cases each. All histological variants of thyroid tumours occurred more frequently in women than in men. Papillary carcinoma has been found in 80% of female cases. Thyroid tumours in our material mainly occurred in the third, the fourth and the fifth decade of life. Our data indicate that apart from the fact that papillary carcinomas, well differentiated, and characterised by relatively good prognosis, were most frequent variants, certain morphological variants of it were associated with poor prognosis.
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Disease-Free Survival and Prognostic Significance of Metastatic Lymph Node Ratio in T1-T2 N Positive Breast Cancer Patients. A Population Registry-Based Study in a European Country. World J Surg 2009; 33:1659-64. [DOI: 10.1007/s00268-009-0078-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19:565-612. [PMID: 19469690 DOI: 10.1089/thy.2008.0403] [Citation(s) in RCA: 773] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. METHODS Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. RESULTS Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research. CONCLUSIONS One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.
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Metze K. Lymph Node Yield as a Prognostic Factor in Cancer Studies—Due to Undersampling of Tumor-Free Lymph Nodes at Higher N Stages? Ann Surg Oncol 2008; 16:1080-2; author reply 1083. [DOI: 10.1245/s10434-008-0142-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 08/12/2008] [Indexed: 01/21/2023]
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