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Yang J, Han Y, Min Y, Chen C, Chen J, Xiang K, Liao J, Feng Y, Hu D, Yin G. Prophylactic central neck dissection for cN0 papillary thyroid carcinoma: is there any difference between western countries and China? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1176512. [PMID: 37576962 PMCID: PMC10413573 DOI: 10.3389/fendo.2023.1176512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background Recommendations for the performance of prophylactic central neck dissection (pCND) in patients with clinically node-uninvolved (cN0) papillary thyroid carcinoma (PTC) are not the same. This meta-analysis set out to compare the effectiveness of pCND with total thyroidectomy (TT) in different countries and regions, mainly between western countries and China. Methods The electronic databases PubMed, EMBASE, and Cochrane Library were searched for studies published until August 2022. The incidence rate of cervical lymph node metastases (LNMs), locoregional recurrences (LRRs), and postoperative complications were pooled by a random-effects model. Subgroup analyses based on different countries and regions were performed. Results Eighteen studies involving 5,346 patients were analyzed. In the subgroup of western countries, patients undergoing pCND with TT had a significantly lower LRR rate [69/1,804, 3.82% vs. 139/2,541, 5.47%; odds ratio (OR) = 0.56; 95% CI 0.37-0.85] and a higher rate of temporary hypoparathyroidism (HPT) (316/1,279, 24.71% vs. 194/1,467, 13.22%; OR = 2.23; 95% CI 1.61-3.08) than that of the TT alone group, while no statistically significant difference was found in the rate of permanent HPT and temporary and permanent recurrent laryngeal nerve (RLN) injury. In the Chinese subgroup, the pCND with TT group had a significantly higher incidence rate of both temporary HPT (87/374, 23.26% vs. 36/324, 11.11%; OR = 2.24; 95% CI 1.32-3.81) and permanent HPT (21/374, 5.61% vs. 4/324, 1.23%; OR = 3.58; 95% CI = 1.24-10.37) than that of the TT alone group, while no significant difference was detected in the rate of LRR and temporary and permanent RLN injury. Conclusion Compared with the TT alone for cN0 PTC patients, pCND with TT had a significantly lower LRR rate while having a higher temporary HPT rate in Europe, America, and Australia; however, it showed no significant difference in decreasing LRR rate while having a significantly raised rate of temporary and permanent HPT in China. More population-based results are required to advocate precision medicine in PTC. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022358546.
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Affiliation(s)
- Jiaxin Yang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuling Han
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Min
- Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Cheng Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jialin Chen
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Xiang
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiahu Liao
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Feng
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bukarica S, Antić J, Fratrić I, Kravarušić D, Pajić M, Jokić R. Thyroid Surgery in Children: A 5-Year Retrospective Study at a Single Paediatric Surgical Center and Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121818. [PMID: 36553262 PMCID: PMC9776859 DOI: 10.3390/children9121818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/26/2022]
Abstract
The aim of this study was to analyse and evaluate our 5-year experience in paediatric thyroid surgery, as well as the specificities of this kind of surgery in the literature. This retrospective study was based on 19 operations in 17 patients aged from 5 to 17 years who were operated on due to thyroid pathology from 2017 until 2022. We presented data on surgical procedures and complications following surgery. Most of the patients were adolescent girls. The most common clinical presentations included enlarged thyroid gland, followed by thyroid nodules and hyperthyroidism. Eight total thyroidectomies, five left lobectomies, five right lobectomies, and three central neck dissections were performed. The most common histopathological diagnosis was hyperplastic diffuse colloid goitre, followed by papillary carcinoma, cystic nodule, follicular adenoma, Hashimoto thyroiditis and toxic adenoma. Postoperative course was uneventful, with four mild complications (one wound infection, one manifest hypocalcaemia, and two transitory recurrent laryngeal nerve paralysis). In our literature review, eighteen full-text articles were included and analysed. This study demonstrated that thyroid surgery in paediatric population is a safe and efficient procedure. Thyroid pathology in children significantly differs from that in the adults, and paediatric surgeons should be included into the team managing such cases.
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Affiliation(s)
- Svetlana Bukarica
- Department of Paediatric Surgery, Institute for Healthcare of Children and Youth of Vojvodina, 21000 Novi Sad, Serbia
- Department of Surgery, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Jelena Antić
- Department of Paediatric Surgery, Institute for Healthcare of Children and Youth of Vojvodina, 21000 Novi Sad, Serbia
- Department of Surgery, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Ivana Fratrić
- Department of Paediatric Surgery, Institute for Healthcare of Children and Youth of Vojvodina, 21000 Novi Sad, Serbia
- Department of Surgery, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Correspondence:
| | - Dragan Kravarušić
- Department of Paediatric Surgery, Institute for Healthcare of Children and Youth of Vojvodina, 21000 Novi Sad, Serbia
- Department of Surgery, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Miloš Pajić
- Department of Paediatric Surgery, Institute for Healthcare of Children and Youth of Vojvodina, 21000 Novi Sad, Serbia
- Department of Surgery, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Radoica Jokić
- Department of Paediatric Surgery, Institute for Healthcare of Children and Youth of Vojvodina, 21000 Novi Sad, Serbia
- Department of Surgery, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
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Sparano C, Moog S, Hadoux J, Dupuy C, Al Ghuzlan A, Breuskin I, Guerlain J, Hartl D, Baudin E, Lamartina L. Strategies for Radioiodine Treatment: What’s New. Cancers (Basel) 2022; 14:cancers14153800. [PMID: 35954463 PMCID: PMC9367259 DOI: 10.3390/cancers14153800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.
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Affiliation(s)
- Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Sophie Moog
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Julien Hadoux
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Corinne Dupuy
- UMR 9019 CNRS, Université Paris-Saclay, Gustave Roussy, 94800 Villejuif, France
| | - Abir Al Ghuzlan
- Département de Biologie et Pathologie Médicales, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Ingrid Breuskin
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Joanne Guerlain
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Dana Hartl
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Eric Baudin
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Livia Lamartina
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
- Correspondence:
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Mei X, Yao X, Feng F, Cheng W, Wang H. Risk and outcome of subsequent malignancies after radioactive iodine treatment in differentiated thyroid cancer patients. BMC Cancer 2021; 21:543. [PMID: 33980182 PMCID: PMC8117631 DOI: 10.1186/s12885-021-08292-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/30/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We identified differentiated thyroid cancer (DTC) survivors from SEER registries and performed Poisson regression to calculate the relative risks (RRs) of subsequent malignancies (SMs) by different sites associated with radioactive iodine (RAI) treatment, and the attributable risk proportion of RAI for developing different SMs. RESULTS We identified 4628 of 104,026 DTC patients developing a SM after two years of their DTC diagnosis, with a medium follow-up time of 113 months. The adjusted RRs of developing SM associated with RAI varied from 0.98 (0.58-1.65) for neurologic SMs to 1.37 (1.13-1.66) for hematologic SMs. The RRs of developing all cancer combined SMs generally increased with age at DTC diagnosis and decreased with the latency time. We estimated that the attributable risk proportion of RAI treatment is only 0.9% for all cancer combined SMs and 20% for hematologic SMs, which is the highest among all SMs. The tumor features and mortalities in patients treated with and without RAI are generally comparable. CONCLUSION With the large population based analyses, we concluded that a low percentage of DTC survivors would develop SMs during their follow-up. Although the adjusted RR of SMs development increased slightly in patients receiving RAI, the attributable risk proportion associated with RAI was low, suggesting the absolute number of SMs induced by RAI in DTC survivors would be low. The attributable risk proportion of RAI treatment is the highest in hematological SMs, but when in consideration of its low incidence among all DTC survivors, the absolute number of hematological SMs was low.
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Affiliation(s)
- Xiaoran Mei
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoqin Yao
- The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Fang Feng
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weiwei Cheng
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hui Wang
- Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Clinical response to radioactive iodine therapy for prophylactic central neck dissection is not superior to total thyroidectomy alone in cN0 patients with papillary thyroid cancer. Nucl Med Commun 2017; 38:1036-1040. [DOI: 10.1097/mnm.0000000000000756] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Li J, Liang J, Zhao T, Lin Y. Noninferior response in BRAF(V600E) mutant nonmetastatic papillary thyroid carcinoma to radioiodine therapy. Eur J Nucl Med Mol Imaging 2016; 43:1034-9. [PMID: 26780618 DOI: 10.1007/s00259-015-3305-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/29/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE As the most frequent and specific genetic alteration in papillary thyroid carcinoma (PTC), BRAF(V600E) has an intimate relationship with more invasive tumour and higher postoperative recurrence risk in PTC patients. We investigate the effect of radioactive iodine (RAI) therapy on the clinical outcome in PTC patients with the BRAF(V600E) mutation without distant metastases. METHODS This retrospective study included PTC 228 patients without distant metastases who underwent total or near-total thyroidectomy and RAI treatment in our hospital from January 2011 to July 2014. The BRAF(V600E) status of the primary lesions was determined and the patients were divided into two groups according to the presence of the mutation. Serological and imaging data were collected at a median follow-up of 2.34 years after RAI administration. Suppressed and stimulated thyroglobulin (Tg), Tg antibody, diagnostic whole-body scintigraphy, and other imaging examinations were used to assess clinical outcome, which was defined as excellent response, indeterminate response, biochemical incomplete response and structural incomplete response. RESULTS The BRAF(V600E) mutation was observed in 153 of the 228 patients (67.1 %). The clinicopathological features did not differ between the BRAF(V600E) mutatation and wild-type groups except age at diagnosis (P = 0.000), tumour size (P = 0.023) and TNM stage (P = 0.003). Older age and more advanced TNM stage were prevalent in the BRAF(V600E) mutatation group, whereas tumours were slightly larger in the BRAF(V600E) wild-type group. The response to RAI therapy was evaluated in both the entire series and the patients with a high recurrence risk, and no significant difference in response was found between the BRAF(V600E) mutatation and the wild-type groups (P = 0.881 and P = 0.851, respectively). CONCLUSION The clinical response to timely postsurgical RAI therapy is not inferior in BRAF(V600E) mutation PTC patients without distant metastases, which suggests that RAI therapy might improve the general clinical outcome in this patient group.
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Affiliation(s)
- Jiao Li
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Jun Liang
- Department of Oncology, Peking University International Hospital, Beijing, 102206, China
| | - Teng Zhao
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Yansong Lin
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Beijing, 100730, China.
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Zhao ZH, Li FQ, Han JK, Li XJ. Effect of 131I 'clear residual thyroid tissue' after surgery on the function of parathyroid gland in differentiated thyroid cancer. Exp Ther Med 2015; 10:2079-2082. [PMID: 26668598 PMCID: PMC4665356 DOI: 10.3892/etm.2015.2812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/19/2015] [Indexed: 11/06/2022] Open
Abstract
Thyroid cancer is a common malignant tumor of the endocrine glands. Although surgery is the optimal treatment utilized, the disease is characterized by recurrence and metastasis. The aim of the present study was to determine the effect of iodine-131 (131I) ‘clear residual thyroid tissue’ following surgery on the treatment of differentiated thyroid cancer (DTC) and its effect on the function of the parathyroid gland. A total of 160 patients diagnosed with DTC, who were consecutively admitted to our Hospital between June 2012 and June 2014 and underwent total thyroidectomy or subtotal resection, were included in the present study. After three months, the patients were administered 131I ‘clear residual thyroid tissue’ treatment and underwent a whole body scan after 1 week to determine whether ‘clear residual thyroid tissue’ treatment was successful or not. The treatment was repeated within 3 months if not successful. Of the 160 patients, 24 patients had cancer metastasis (15.0%). The average dose of 131I used for the first time was 6.4+1.2 GBq and the treatment was successful in 66 cases (41.3%). The average treatment time was 2.8±0.6 therapy sessions. The results showed that, prior to and following the first treatment and at the end of the follow up, levels of the parathyroid hormone, serum calcium and phosphorus were compared, and no statistically significant difference (P>0.05) was observed. There were 5 patients with persistent hypothyroidism and 8 patients with transient hypothyroidism. The levels of thyroglobulin were significantly decreased, and the difference was statistically significant (P<0.05). A total of 48 patients (30%) with hypothyroidism were identified. In conclusion, the results have shown that DTC resection and 131I ‘clear residual thyroid tissue’ treatment did not significantly impair the parathyroid function, thereby improving the treatment effect.
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Affiliation(s)
- Zhi-Hua Zhao
- Department of Nuclear Medicine, Qilu Hospital, Shangdong University, Jinan, Shangdong 250012, P.R. China ; Department of Nuclear Medicine, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Feng-Qi Li
- Department of Nuclear Medicine, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Jian-Kui Han
- Department of Nuclear Medicine, Qilu Hospital, Shangdong University, Jinan, Shangdong 250012, P.R. China
| | - Xian-Jun Li
- Department of Nuclear Medicine, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
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