1
|
Zhang Y, Deng Y, Zhou M, Wu B, Zhou J. Intraglandular dissemination: a special pathological feature. Front Oncol 2024; 14:1428274. [PMID: 39135992 PMCID: PMC11317368 DOI: 10.3389/fonc.2024.1428274] [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: 05/06/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
Intraglandular dissemination is an important pathological feature of thyroid cancer, yet the biological characteristics of this phenomenon remain relatively underexplored. This paper aims to provide a comprehensive overview of its biological behaviors, protein expressions, and identification methods. Several retrospective studies have found that thyroid cancers with intraglandular dissemination have higher rates of lymph node metastasis, capsule invasion, and vascular invasion, exhibiting more aggressive biological behavior. Immunohistochemistry results show abnormal expression of proteins such as FKBP5, CENPF, CX26, KIF11, PTK7, which are associated with poor prognosis in thyroid cancers with intraglandular dissemination, offering potential guidance for specific targeted therapy in the future. Moreover, adjunctive techniques including ultrasound, fine-needle aspiration, and genetic testing offer valuable support in accurately identifying these cases, facilitating moreproactive treatment and closer follow-up.
Collapse
Affiliation(s)
- Yubi Zhang
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Deng
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meng Zhou
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhou
- Department of Thyroid and Breast Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Thyroid and Breast Surgery, People’s Hospital of Dongxihu District Wuhan City and Union Dongxihu Hospital, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
2
|
Coca-Pelaz A, Rodrigo JP, Shah JP, Nixon IJ, Hartl DM, Robbins KT, Kowalski LP, Mäkitie AA, Hamoir M, López F, Saba NF, Nuyts S, Rinaldo A, Ferlito A. Recurrent Differentiated Thyroid Cancer: The Current Treatment Options. Cancers (Basel) 2023; 15:2692. [PMID: 37345029 PMCID: PMC10216352 DOI: 10.3390/cancers15102692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
Differentiated thyroid carcinomas (DTC) have an excellent prognosis, but this is sometimes overshadowed by tumor recurrences following initial treatment (approximately 15% of cases during follow-up), due to unrecognized disease extent at initial diagnosis or a more aggressive tumor biology, which are the usual risk factors. The possible sites of recurrence are local, regional, or distant. Local and regional recurrences can usually be successfully managed with surgery and radioiodine therapy, as are some isolated distant recurrences, such as bone metastases. If these treatments are not possible, other therapeutic options such as external beam radiation therapy or systemic treatments should be considered. Major advances in systemic treatments have led to improved progression-free survival in patients previously considered for palliative treatments; among these treatments, the most promising results have been achieved with tyrosine kinase inhibitors (TKI). This review attempts to give a comprehensive overview of the current treatment options suited for recurrences and the new treatments that are available in cases where salvage surgery is not possible or in cases resistant to radioiodine.
Collapse
Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Juan Pablo Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Jatin P. Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Iain J. Nixon
- Department of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh EH3 9YL, UK;
| | - Dana M. Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, CEDEX, 94805 Villejuif, France;
- Laboratoire de Phonétique et de Phonologie, 75005 Paris, France
| | - K. Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL 32952, USA;
| | - Luiz P. Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, São Paulo 01509-001, Brazil;
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, FI-00014 Helsinki, Finland;
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, 1200 Brussels, Belgium;
| | - Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain; (J.P.R.); (F.L.)
| | - Nabil F. Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA;
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
| |
Collapse
|
3
|
Park J, Kang IK, Bae JS, Kim JS, Kim K. Clinical Significance of the Lymph Node Ratio of the Second Operation to Predict Re-Recurrence in Thyroid Carcinoma. Cancers (Basel) 2023; 15:cancers15030624. [PMID: 36765580 PMCID: PMC9913116 DOI: 10.3390/cancers15030624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The purpose of this study was to establish the risk factors for re-recurrences and disease-specific mortality (DSM) in recurrent thyroid cancer. Patients with recurrent thyroid cancer who underwent initial thyroid surgery from January 2000 to December 2019 at Seoul St. Mary's Hospital (Seoul, Korea) were assessed. Clinicopathological characteristics and long-term oncologic outcomes were compared between patients with one recurrence (n = 202) and patients with re-recurrences (n = 44). Logistic regression and cox-regression analyses were conducted to determine the risk factors for re-recurrences and DSM, respectively. Receiver-operating characteristic curve analysis was performed to determine the cutoff value for lymph node ratio (LNR) as a predictor of re-recurrences. DSM was significantly higher in the re-recurrence group compared with the single-recurrence group (6.8% vs. 0.5%, p = 0.019). Surgical treatment at the first recurrence significantly lowered the risk of re-recurrences. Age (≥55), male sex, and LNR (≥0.15) were independent significant risk factors for re-recurrences in patients who underwent surgery at the first recurrence. Surgical resection is the optimal treatment for initial thyroid cancer recurrence. LNR at re-operation is more effective in predicting re-recurrence than the absolute number of metastatic LNs.
Collapse
Affiliation(s)
| | | | | | | | - Kwangsoon Kim
- Correspondence: ; Tel.: +82-2-2258-6784; Fax: +82-2-2258-2138
| |
Collapse
|
4
|
Campopiano MC, Ghirri A, Prete A, Lorusso L, Puleo L, Cappagli V, Agate L, Bottici V, Brogioni S, Gambale C, Minaldi E, Matrone A, Elisei R, Molinaro E. Active surveillance in differentiated thyroid cancer: a strategy applicable to all treatment categories response. Front Endocrinol (Lausanne) 2023; 14:1133958. [PMID: 37152950 PMCID: PMC10157216 DOI: 10.3389/fendo.2023.1133958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Currently, the differentiated thyroid cancer (DTC) management is shifted toward a tailored approach based on the estimated risks of recurrence and disease-specific mortality. While the current recommendations on the management of metastatic and progressive DTC are clear and unambiguous, the management of slowly progressive or indeterminate disease varies according to different centers and different physicians. In this context, active surveillance (AS) becomes the main tool for clinicians, allowing them to plan a personalized therapeutic strategy, based on the risk of an unfavorable prognosis, and to avoid unnecessary treatment. This review analyzes the main possible scenarios in treated DTC patients who could take advantage of AS.
Collapse
|
5
|
Sun W, Di L, Chen L, Li D, Wu Y, Xiang J, Zhou S, Sun T. The outcomes and prognostic factors of patients who underwent reoperation for persistent/recurrent papillary thyroid carcinoma. BMC Surg 2022; 22:374. [PMID: 36324095 PMCID: PMC9632153 DOI: 10.1186/s12893-022-01819-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND While the most suitable approach for treating persistent/recurrent papillary thyroid carcinoma (PTC) remains controversial, reoperation may be considered an effective method. The efficacy of reoperation in patients with locoregional persistent/recurrent PTC, especially those with unsatisfactory radioactive iodine (RAI) ablation results, is still uncertain. This study aimed to clarify the clinical management strategies for locoregional persistent/recurrent PTC and to explore factors that may affect long-term patient outcomes after reoperation. METHODS In total, 124 patients who initially underwent thyroidectomy and variable extents of RAI therapy and finally received reoperation for locoregionally persistent/recurrent PTC were included. The parameters associated with recurrence-free survival (RFS) were analysed using a Cox proportional hazards model. RESULTS Overall, 124 patients presented with structural disease after initial therapy and underwent secondary surgical resection, of whom 32 patients developed further structural disease during follow-up after reoperation. At the time of reoperation, metastatic lymph nodes with extranodal extension (P = 0.023) and high unstimulated thyroglobulin (unstim-Tg) levels after reoperation (post-reop) (P = 0.001) were independent prognostic factors for RFS. Neither RAI avidity nor the frequency and dose of RAI therapies before reoperation affected RFS. CONCLUSIONS Reoperation is an ideal clinical treatment strategy for structural locoregional persistent/recurrent PTC, and repeated empirical RAI therapies performed prior to reoperation may not contribute to the long-term outcomes of persistent/recurrent PTC patients. Metastatic lymph nodes with extranodal extension and post-reop unstim-Tg > 10.1 ng/mL may predict a poor prognosis.
Collapse
Affiliation(s)
- Wenyu Sun
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China
| | - Lu Di
- Department of Internal Medicine, Wusong Hospital, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Duanshu Li
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Yi Wu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Jun Xiang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China
| | - Shichong Zhou
- Department of Ultrasound, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China.
| | - Tuanqi Sun
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, No. 270, Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.
| |
Collapse
|
6
|
Differentiated Thyroid Cancer with Biochemical Incomplete Response: Clinico-Pathological Characteristics and Long Term Disease Outcomes. Cancers (Basel) 2021; 13:cancers13215422. [PMID: 34771585 PMCID: PMC8582549 DOI: 10.3390/cancers13215422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/31/2022] Open
Abstract
Simple Summary Biochemical incomplete response (BIR) is defined as elevated thyroglobulin or rising thyroglobulin antibodies following treatment without structural evidence of disease at 1–2 years after initial treatment. The long-term outcome of such patients is still poorly characterized, with some progressing to structural disease, while others maintain BIR for decades or revert to non-evidence of disease (NED). In this study, we aimed to identify factors that could predict any of the above possible outcomes. In our cohort of 83 BIR patients with a mean follow-up of 12 years, 41% progressed to structural disease. Of them, 11.8% remained BIR, and 38.2% reverted to NED. Abstract Although most patients with differentiated thyroid cancer (DTC) and biochemical incomplete response (BIR) follow a good clinical outcome, progression to structural disease may occur in 8–17% of patients. We aimed to identify factors that could predict the long-term outcomes of BIR patients. To this end, we conducted a retrospective review study of 1049 charts from our Differential Thyroid Cancer registry of patients who were initially treated with total thyroidectomy between 1962 and 2019. BIR was defined as suppressed thyroglobulin (Tg) > 1 ng/mL, stimulated Tg > 10 ng/mL or rising anti-Tg antibodies, who did not have structural evidence of disease, and who were assessed 12–24 months after initial treatment. We found 83 patients (7.9%) matching the definition of BIR. During a mean follow-up of 12 ± 6.6 years, 49 (59%) patients remained in a state of BIR or reverted to no evidence of disease, while 34 (41%) progressed to structural disease. At the last follow-up, three cases (3.6%) were recorded as disease-related death. The American Thyroid Association (ATA) Initial Risk Stratification system and/or AJCC/TNM (8th ed.) staging system at diagnosis predicted the shift from BIR to structural disease, irrespective of their postoperative Tg levels. We conclude that albeit 41% of BIR patients may shift to structural disease, and most have a rather indolent disease. Specific new individual data enable the Response to Therapy reclassification to become a dynamic system to allow for the better management of BIR patients in the long term.
Collapse
|
7
|
Radioactive iodine-125 seed localization as an aid in reoperative neck surgery. Am J Surg 2021; 221:534-537. [PMID: 33546853 DOI: 10.1016/j.amjsurg.2020.12.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Scarring and disrupted tissue planes add to already-complex neck anatomy and make localization of nonpalpable pathology difficult in cervical endocrine reoperations. We describe the use of radioactive iodine-125 seed localization (RSL) in 6 patients with metastatic papillary thyroid carcinoma (PTC) and 2 with recurrent hyperparathyroidism. METHODS Eight patients had 2-D ultrasound-guided RSL of the target lesion, 0-3 days preoperatively. Intraoperative gamma probe (Neoprobe) was used to plan incision placement and localize the implanted seed. Recorded operative variables included: number of lymph nodes (LNs) harvested, estimated blood loss (EBL), operative time, length of stay (LOS) and RSL and operative complications. RESULTS All patients had successful resection of the targeted area and removal of the radioactive seed. There was no seed migration. Two complications occurred in the thyroid group. CONCLUSION Radioactive iodine 125 seeds facilitate successful localization of endocrine pathology during reoperative cervical procedures.
Collapse
|
8
|
Li J, Wu X, Mao N, Zheng G, Zhang H, Mou Y, Jia C, Mi J, Song X. Computed Tomography-Based Radiomics Model to Predict Central Cervical Lymph Node Metastases in Papillary Thyroid Carcinoma: A Multicenter Study. Front Endocrinol (Lausanne) 2021; 12:741698. [PMID: 34745008 PMCID: PMC8567994 DOI: 10.3389/fendo.2021.741698] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/04/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES This study aimed to develop a computed tomography (CT)-based radiomics model to predict central lymph node metastases (CLNM) preoperatively in patients with papillary thyroid carcinoma (PTC). METHODS In this retrospective study, 678 patients with PTC were enrolled from Yantai Yuhuangding Hot3spital (n=605) and the Affiliated Hospital of Binzhou Medical University (n=73) within August 2010 to December 2020. The patients were randomly divided into a training set (n=423), an internal test set (n=182), and an external test set (n=73). Radiomics features of each patient were extracted from preoperative plain scan and contrast-enhanced CT images (arterial and venous phases). One-way analysis of variance (ANOVA) and least absolute shrinkage and selection operator algorithm were used for feature selection. The K-nearest neighbor, logistics regression, decision tree, linear-support vector machine (linear-SVM), Gaussian-SVM, and polynomial-SVM algorithms were used to establish radiomics models for CLNM prediction. The clinical risk factors were selected by ANOVA and multivariate logistic regression. Incorporated with clinical risk factors, a combined radiomics model was established for the preoperative prediction of CLNM in patients with PTCs. The performance of the combined radiomics model was evaluated using the receiver operating characteristic (ROC) and calibration curves in the training and test sets. The clinical usefulness was evaluated through decision curve analysis (DCA). RESULTS A total of 4227 radiomic features were extracted from the CT images of each patient, and 14 non-zero coefficient features associated with CLNM were selected. Four clinical variables (sex, age, tumor diameter, and CT-reported lymph node status) were significantly associated with CLNM. Linear-SVM led to the best prediction model, which incorporated radiomic features and clinical risk factors. Areas under the ROC curves of 0.747 (95% confidence interval [CI] 0.706-0.782), 0.710 (95% CI 0.634-0.786), and 0.764 (95% CI 0.654-0.875) were obtained in the training, internal, and external test sets, respectively. The linear-SVM algorithm also showed better sensitivity (0.702 [95% CI 0.600-0.790] vs. 0.477 [95% CI 0.409-0.545]) and accuracy (0.670 [95% CI 0.600-0.738] vs. 0.642 [95% CI 0.569-0.712]) than an experienced radiologist in the internal test set in the combined radiomics model. The calibration plot reflected a favorable agreement between the actual and estimated probabilities of CLNM. The DCA indicated the clinical usefulness of the combined radiomics model. CONCLUSION The combined radiomics model is a non-invasive preoperative tool that incorporates radiomic features and clinical risk factors to predict CLNM in patients with PTC.
Collapse
Affiliation(s)
- Jingjing Li
- Second Clinical Medicine College, Binzhou Medical University, Yantai, China
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Xinxin Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
| | - Ning Mao
- Department of Radiology, Yantai Yuhuangding Hospital, Yantai, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Guibin Zheng
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Haicheng Zhang
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
| | - Yakui Mou
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Chuanliang Jia
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
| | - Jia Mi
- Precision Medicine Research Center, Binzhou Medical University, Yantai, China
- *Correspondence: Xicheng Song, ; Jia Mi,
| | - Xicheng Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Big Data and Artificial Intelligence Laboratory, Yantai Yuhuangding Hospital, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- *Correspondence: Xicheng Song, ; Jia Mi,
| |
Collapse
|
9
|
Xu S, Li Q, Wang Z, Huang H, Wang X, Liu S, Liu J. Evaluating the risk of re-recurrence in patients with persistent/recurrent thyroid carcinoma after initial reoperation. Surgery 2020; 169:837-843. [PMID: 33127094 DOI: 10.1016/j.surg.2020.09.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/02/2020] [Accepted: 09/22/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the 2015 American Thyroid Association guidelines proposed initial and response-to-therapy risk stratifications were adequately validated in untreated papillary thyroid cancer patients, it is still unknown how they work in persistent/recurrent papillary thyroid cancer patients. This study aimed to evaluate and revise the stratifications in these patients. METHODS This retrospective study included patients who received the first reoperation with complete thyroid resection but without radioactive iodine ablation. Stratifications were performed considering the persistent/recurrent tumor characteristics and thyroglobulin levels 1 to 6 months after reoperation and then revised with new prognostic factors and adjusted thyroglobulin cutoff values, respectively. Prognostic performance was evaluated with Kaplan-Meier curves, proportion of variation explained, and Harrell's concordance index. RESULTS Among a total of 232 patients, 5-year re-recurrence free survival rates were 92.4%, 86.2%, and 74.5% in low-, intermediate-, and high-risk patients, respectively (all P > .05) and 97.0%, 96.3%, and 81.6% in excellent response, intermediate response, and biochemical incomplete response groups, respectively (excellent response versus intermediate response, P > .05; intermediate response versus biochemical incomplete response, P < .05). After incorporating age at reoperation, recurrent primary size, and recurrent lymph node number, the high-risk group had significantly compromised re-recurrence free survival versus the intermediate-risk group (76.2% vs 91.6%). After adjusting thyroglobulin values, 5-year re-recurrence free survival rates were 96.4%, 85.9%, and 75.8% in excellent response (<1 ng/mL), intermediate response (1-10 ng/mL), and biochemical incomplete response (≥10 ng/mL) groups, respectively (all P < .05), with a higher proportion of variation explained (12.8% vs 10.1%) and concordance index (0.669 vs 0.615) compared with the American Thyroid Association version. CONCLUSION The revised American Thyroid Association initial and response-to-therapy risk stratifications have acceptable predictive value for persistent/recurrent papillary thyroid cancer patients.
Collapse
Affiliation(s)
- Siyuan Xu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Qingfeng Li
- Department of Head and Neck Surgical Oncology, Anyang Cancer Hospital, Anyang, P.R. China
| | - Zhiqi Wang
- Department of Head and Neck Surgical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Hui Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China.
| |
Collapse
|
10
|
Cambil T, Terrón JA, Marín C, Martín T. 125I radioactive seed localization (RSL) in surgery of cervical metastasis of thyroid cancer. Rev Esp Med Nucl Imagen Mol 2020; 39:140-145. [PMID: 32402777 DOI: 10.1016/j.remn.2019.11.003] [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: 09/16/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of this work is the evaluation of usefulness of radioactive seed localization (RSL) for the detection of cervical recurrence of thyroid cancer in order to improve the surgical outcome. MATERIAL AND METHOD Ten patients with thyroid cancer and lymph node involvement (4 naive and 6 with cervical recurrence) evidenced by ultrasound, cytology/Tg-FNAB (reoperated group) were selected for this procedure. A 125I seed was placed in the metastatic lesion using a needle guided by ultrasound. During surgery, a handheld gamma probe/portable gammacamera were used for lesion localization and excision. After removing the target tissue, it was verified that the seed was included in the excised tissue. Surgical intervention duration, lesion location, seed activity, thyroglobulin level, effective radiation dose, complications and the degree of surgical resection were analyzed. RESULTS All the marked nodes were positive in histology. The mean duration of the ultrasound procedure was 11.4±3.4minutes. Seed was kept inside the patient, in average, during 4days (1-7) and the average surgical time was 44.7±29.1minutes. We found 21 metastatic specimens with an average diameter 13.9±6.3mm. The mean activity of the implanted seed was 71.27±21.6MBq (42.8-105) In the reoperated group, thyroglobulin level was 2.08±1.56ng/dl and decreased after surgery to 0.13±0.12ng/dl, P<.01. Only one case of transient hypoparathyroidism was found in the total group. CONCLUSIONS The introduction of RSL in our unit has shown benefits for the patient and medical team, being a safe and effective procedure that also improves surgical programming.
Collapse
Affiliation(s)
- T Cambil
- Departamento de Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España
| | - J A Terrón
- Departamento de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - C Marín
- Departamento de Cirugía General, Hospital Universitario Virgen Macarena, Sevilla, España
| | - T Martín
- Departamento de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, Sevilla, España.
| |
Collapse
|
11
|
125I Radioactive Seed Localization (RSL) in surgery of cervical metastasis of thyroid cancer. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|