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Chakrabarty N, Mahajan A, Basu S, D’Cruz AK. Comprehensive Review of the Imaging Recommendations for Diagnosis, Staging, and Management of Thyroid Carcinoma. J Clin Med 2024; 13:2904. [PMID: 38792444 PMCID: PMC11122658 DOI: 10.3390/jcm13102904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/01/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Thyroid cancer is the most common head and neck cancer (HNC) in the world. In this article, we comprehensively cover baseline, posttreatment, and follow-up imaging recommendations for thyroid carcinomas along with the eighth edition of the tumor, node, metastasis (TNM) staging system proposed by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC). We include characterization and risk stratification of thyroid nodules on ultrasound (US) proposed by various international bodies. Management guidelines (depending upon the type of thyroid carcinoma) based on the international consensus recommendations (mainly by the American Thyroid Association) are also extensively covered in this article, including the role of a radioiodine scan. The management of recurrent disease is also briefly elucidated in this article. In addition, we cover the risk factors and etiopathogenesis of thyroid carcinoma along with the non-imaging diagnostic workup essential for thyroid carcinoma management, including the significance of genetic mutations. US is the diagnostic imaging modality of choice, with US-guided fine needle aspiration (FNA) being the procedure of choice for tissue diagnosis. The roles of computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) in thyroid carcinoma staging are also specified. Through this article, we aim to provide a comprehensive reference guide for the radiologists and the clinicians in the pursuit of optimal care for patients with thyroid carcinoma.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Anil K. D’Cruz
- Apollo Hospitals, Navi Mumbai 400614, Maharashtra, India;
- Foundation of Head Neck Oncology, Mumbai 400012, Maharashtra, India
- Union International Cancer Control (UICC), 1202 Geneva, Switzerland
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Abelleira E, Jerkovich F. Dynamic risk assessment in patients with differentiated thyroid cancer. Rev Endocr Metab Disord 2024; 25:79-93. [PMID: 38015344 DOI: 10.1007/s11154-023-09857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 11/29/2023]
Abstract
The current approach for patients with differentiated thyroid carcinoma should be individualized according to the risk of recurrence, and this stratification could be used to identify the risk of persistent/recurrent disease in three scenarios: preoperatively, immediately postoperatively, and during long-term follow-up. The initial risk of recurrence will tailor the management of the patient in the preoperative and immediate postoperative settings, while the dynamic risk, which considers the responses to treatment, could guide the decision-making process for remnant ablation and long-term management.This review provides a summary of the existing information regarding the dynamic risk of recurrence and recommended management for patients with differentiated thyroid cancer. The application of this approach is essential to avoid unnecessary treatments for most patients who will have a favorable prognosis. On the other hand, it allows specific therapeutic interventions for those patients at high risk of recurrence. In the future, analysis of tumor biology and prospective studies will surely improve the accuracy of recurrence risk prediction.
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Affiliation(s)
- Erika Abelleira
- Division of Endocrinology, Hospital de Clínicas José de San Martín (UBA), University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, C 1120, Argentina.
| | - Fernando Jerkovich
- Division of Endocrinology, Hospital de Clínicas José de San Martín (UBA), University of Buenos Aires, Córdoba 2351, 5th floor, Buenos Aires, C 1120, Argentina
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Chandekar KR, Satapathy S, Bal C. Impact of radioiodine therapy on recurrence and survival outcomes in intermediate-risk papillary thyroid carcinoma -A systematic review and meta-analysis. Clin Endocrinol (Oxf) 2024; 100:181-191. [PMID: 38050454 DOI: 10.1111/cen.15001] [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: 08/02/2023] [Revised: 10/19/2023] [Accepted: 11/25/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE The utility of radioiodine (RAI) therapy in intermediate-risk papillary thyroid carcinoma (PTC) remains a topic of ongoing discussion. This systematic review and meta-analysis aimed to consolidate existing evidence on the impact of postoperative RAI therapy on recurrence and survival outcomes in intermediate-risk PTC. METHODS A literature search was performed using relevant keywords in PubMed, Scopus, and EMBASE. Articles from January 2008 to March 2023 were included. Odds ratios (ORs) and hazard ratios (HRs) were extracted from the individual articles, and pooled estimates were generated using meta-analysis. RESULTS Eleven articles comprising 56,266 intermediate-risk PTC patients were included. 41,530 (73.8%) patients underwent postoperative RAI therapy, while 14,736 (26.2%) patients were kept on no-RAI (NOI) follow-up. No significant reduction in rates of structural disease recurrence was noted with RAI therapy in comparison to NOI follow-up (pooled univariate OR, 0.73, 95% confidence interval [CI], 0.29-1.87, I2 = 75%). RAI therapy was not a significant predictor of better recurrence-free survival (pooled multivariate HR, 0.21; 95% CI, 0.01-3.74, I2 = 94%). Interestingly, RAI therapy was associated with an overall survival benefit compared to NOI follow-up (pooled multivariate HR, 0.63; 95% CI, 0.48-0.82, I2 = 79%). CONCLUSIONS This meta-analysis did not establish a conclusive benefit of RAI therapy in preventing structural disease recurrence or improving recurrence-free survival in intermediate-risk PTC. However, these results need to be interpreted with caution owing to significant heterogeneity in the existing literature. A prospective, randomised clinical trial is the need of the hour to better understand the effect of RAI therapy on long-term outcomes.
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Affiliation(s)
- Kunal Ramesh Chandekar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Issa PP, Munshi R, Albuck AL, Omar M, Abu Alhuda RF, Metz T, Hussein M, Shama M, Lee GS, Toraih E, Kandil E. Recommend with caution: A meta-analysis investigating papillary thyroid carcinoma tumor progression under active surveillance. Am J Otolaryngol 2023; 44:103994. [PMID: 37607459 DOI: 10.1016/j.amjoto.2023.103994] [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: 03/19/2023] [Accepted: 07/08/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is an indolent disease with favorable outcomes. The non-surgical treatment approach known as active surveillance (AS) has been introduced as an alternative treatment instead of the traditional thyroidectomy. However, 10-15 % of PTC tend to progress. We sought to determine factors predicting the progression of PTC under AS. METHODS A systematic search was performed in January 2022 using PubMed, Embase, Google Scholar, Web of Science, and ScienceDirect. PRISMA guidelines were used by multiple reviewers to extract study characteristics (author name, publication date, journal name, country, institution, and study design), as well as main outcomes and measures. A combination of utilization of thyroid replacement therapy, baseline tumor size and volume, follow-up tumor size and volume, and the presence of lymph node metastasis and its distribution, as well as surveillance duration, were the main measures of this study. RESULTS Nine studies with 4166 patients were included, of which 354 showed tumor progression during AS (15 %; 95%CI = 7 % - 23 %). The average follow-up period was 41.58 months. The mean tumor maximum diameter was 8.54 mm (95%CI = 7.04-10.03). Tumor progression was most commonly secondary to an increase in volume by ≥50 % (75 %; 95%CI = 68 % - 80 %), then increase in diameter by ≥3 mm (41 %; 95%CI = 13 % - 76 %), and finally the development of lymph node metastasis (13 %; 95%CI = 9 % - 19 %). Approximately only 2 % of all patients thus developed new lymph node metastasis. Patient age, sex, and tumor size were not associated with higher risks of tumor progression. 12 % of AS patients eventually underwent surgery, though only 40 % (95%CI = 27 % - 53 %) of these patients displayed tumor progression. CONCLUSIONS Our meta-analysis determined a tumor progression rate of 15 % in patients who underwent AS management, 13 % of which (2 % of all patients) developed lymph node metastasis. We found no protective or risk factors for tumor progression, and that almost half of all patients who underwent delayed surgery did so for reasons other than tumor progression. While not biopsying small (<1 cm) or very low suspicious nodules is already recommended, AS may be an appropriate treatment option in patients appropriately counseled, considering the low risk of advanced tumor progression but also the considerable patient population who fail to adhere to treatment. Alternatively, in aim of preventing overtreatment in patients who would rather take proactive measures against their low-risk carcinoma, minimally-invasive ablation techniques may be an attractive option.
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Affiliation(s)
- Peter P Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America; School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - Ruhul Munshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Aaron L Albuck
- School of Medicine, Tulane University, New Orleans, LA, United States of America
| | - Mahmoud Omar
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Ruba F Abu Alhuda
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Tyler Metz
- School of Medicine, Tulane University, New Orleans, LA, United States of America
| | - Mohammad Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Mohamed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America
| | - Grace S Lee
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America; Genetics Unit, Department of Histology and Cell Biology, Suez Canal University Faculty of Medicine, Ismailia, Egypt
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, United States of America.
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Yang Z, Wang X, Tao T, Zou J, Qiu Z, Wang L, Du H, Chen N, Yin X. Diagnostic value of contrast-enhanced ultrasonography in the preoperative evaluation of lymph node metastasis in papillary thyroid carcinoma: a single-center retrospective study. BMC Surg 2023; 23:325. [PMID: 37875825 PMCID: PMC10599078 DOI: 10.1186/s12893-023-02199-w] [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: 05/22/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) has been recently used for the assessment of cervical lymph node metastasis (LNM) to guide surgical operation in patients with papillary thyroid carcinoma (PTC). However, the specificity and sensitivity of CEUS reported from previous studies are not consistent. The objective of this study was to evaluate the diagnostic value of CEUS for the metastasis of cervical lymph nodes in PTC patients based on data from one regional central hospital. METHODS The diagnostic value of CEUS in preoperative LNM of PTC patients was concluded by comparing the results of CEUS on lymph node status with postoperative pathology examination. In addition, this study conducted hierarchical analysis of PTC patients to explore whether tumor size, different lymph node regions, and Hashimoto's thyroiditis influence the assessment of CEUS. RESULTS This research study ultimately enrolled 965 PTC patients, including 266 males and 699 females with a mean age of 42.27 ± 11.34 years. A total of 527 patients were considered clinical-node negative, and 438 were clinical-node positive before surgery. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the assessment of LNM in PTC patients were 56.00%, 71.00%, 57.06%, 69.76% and 62.59%, respectively. For central and lateral lymph nodes, the accuracy of CEUS in PTC patients was 49.43% and 54.30%, respectively. In addition, it was shown that the accuracy of CEUS in PTC patients with Hashimoto's thyroiditis (HT) slightly decreased to 58.44%, and the accuracy of CEUS in PTC patients with non-HT in turn increased to 64.17%. The accuracy of CEUS in non-papillary thyroid microcarcinoma (PTMC) and PTMC patients was 65.68% and 61.24%, respectively. The accuracy of CEUS in predicting central LNM was significantly different between PTC patients with or without HT (P < 0.001) in this study but not for lateral lymph nodes (P = 0.114). CONCLUSION The accuracy of CEUS in the assessment of LNM in PTC is not consistently satisfactory, especially for central lymph nodes, small tumor diameters, or patients with HT. More diagnostic technologies for abnormal lymph nodes should be considered in PTC patients.
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Affiliation(s)
- Zhixin Yang
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Xiaofeng Wang
- Department of Breast and Thyroid Surgery, Dongying People's Hospital, Dongying City, Shandong, China
| | - Tao Tao
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiali Zou
- Department of Breast and Thyroid, Guiyang Maternal and Child Health Care Hospital & Guiyang Children's Hospital, Guiyang, China
| | - Zhu Qiu
- Key Laboratory of Molecular Oncology and Epigenetics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Long Wang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huimin Du
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ni Chen
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Xuedong Yin
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Raja N, Kumar U, Singh KR, Ramakant P, Mishra AK. Letter to the Editor: Papillary thyroid microcarcinomas that metastasize to lymph nodes. Am J Otolaryngol 2022; 43:103300. [PMID: 34953591 DOI: 10.1016/j.amjoto.2021.103300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/10/2021] [Indexed: 11/27/2022]
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Asya O, Yumuşakhuylu AC, Bağcı P, Kaya H, Gönen A, Gündoğdu Y, Muradov T, Şahin A, Oysu Ç. Relationship of PPARG overexpression with prognostic parameters in papillary thyroid carcinoma. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:34-40. [PMID: 35292786 PMCID: PMC9058936 DOI: 10.14639/0392-100x-n1034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023]
Abstract
Objectives PAX8/PPARG chromosomal rearrangement is frequently seen in thyroid cancer, and PPARG overexpression has been shown in the follicular variant of papillary thyroid carcinoma, but not in papillary thyroid carcinoma other than the follicular variant. The main aim of this study was to investigate the frequency of PPARG overexpression among papillary thyroid carcinoma and if there were any variants of papillary thyroid carcinoma with PPARG overexpression other than the follicular variant. Methods Immunohistochemical analysis of PPARG overexpression was performed using a PPARG monoclonal antibody in a series of 111 paraffin-embedded blocks of thyroid tumours. Of the patients in our study, 100 were diagnosed with papillary thyroid carcinoma, 9 with follicular adenoma and 2 with follicular carcinoma. Results PPARG staining was detected in 19 of the 111 cases. Sixteen patients with PPARG overexpression had papillary thyroid carcinoma and 3 had follicular adenoma. Conclusion PPARG overexpression was detected mainly in follicular-variant papillary thyroid carcinoma. Vascular invasion, lymphatic invasion, thyroid capsule invasion and lymph node positivity were lower in patients with PPARG overexpression.
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Topuz O, Erhan S, Erinç S, Tamam M. A rare case of differentiated thyroid carcinoma with liver metastases. Indian J Nucl Med 2022; 37:186-188. [PMID: 35982810 PMCID: PMC9380802 DOI: 10.4103/ijnm.ijnm_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 12/05/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most frequent type of differentiated thyroid cancers (DTCs) and commonly metastasizes to regional lymph nodes. Distant metastases of DTC typically occur in the lungs and bones. Liver metastases of DTC are very rare and difficult to diagnose. We present a case of a 52-year-old woman who had a previous history of PTC treated by total thyroidectomy and lymph node dissection. The patient received two radioactive iodine-131 (I-131) treatments. The second postradioiodine therapy whole-body scan (WBS) revealed intense iodine uptake in the neck region and in the lungs. After 2 months, during the follow-up period, increase in serum thyroglobulin (Tg) level was detected. Positron-emission tomography–computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) revealed increased FDG uptake in the mass lesion that invaded the muscles in the neck area, lung, bone, and liver. The uptake in liver was interpreted as suspicion of malignancy. The trucut biopsy of the liver masses demonstrated metastases of the thyroid carcinoma with the immunohistochemical thyroid transcription factor-1 and PAX8 positivity observed in these tumor cells. In DTC patients with progressive rapid rise of Tg level, the diagnostic value of I-131 WBS will decrease as the differentiation of the tumor decreases. The combined use of I-131 WBS and FDG PET-CT as diagnostic modalities in these patients will be important in treatment planning in detecting locoregional or distant metastases, especially in patients with negative diagnostic I-131 WBS.
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Sutherland R, Tsang V, Clifton-Bligh RJ, Gild ML. Papillary thyroid microcarcinoma: Is active surveillance always enough? Clin Endocrinol (Oxf) 2021; 95:811-817. [PMID: 34021503 DOI: 10.1111/cen.14529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
The incidence of papillary thyroid carcinoma (PTC) has increased over recent decades. This apparent epidemic has been attributed to the overdiagnosis of small PTC ≤10 mm in diameter (papillary thyroid microcarcinoma [PTMC]) incidentally detected on imaging for unrelated presentations. Although most PTMCs follow an indolent disease course, there is a small but significant proportion of cases that display more biologically aggressive features such as early metastasis and lymph node involvement. Management of PTMC diagnosed preoperatively should be distinguished from managing those PTMCs incidentally discovered after thyroidectomy. Here, we will focus on the challenge of managing the preoperative patient. Current guidelines recommend against routine biopsy of nodules ≤10 mm, even if they display highly suspicious features on ultrasound; however, it is not known how to identify those PTMCs at higher risk of disease progression. In view of their good prognosis even without surgical resection, active surveillance has emerged as an alternative to operative management for low-risk PTMC without lymph node involvement or distant metastasis. This review aims to summarise active surveillance data for PTMC and identify clinical features that may differentiate the indolent majority from those PTMCs that exhibit early disease progression and metastasis.
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Affiliation(s)
- Rosie Sutherland
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
| | - Venessa Tsang
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Roderick J Clifton-Bligh
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
| | - Matti L Gild
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
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Impact of Epithelial-Mesenchymal Immunophenotype on Local Aggressiveness in Papillary Thyroid Carcinoma Invading the Airway. J Clin Med 2021; 10:jcm10194351. [PMID: 34640369 PMCID: PMC8509765 DOI: 10.3390/jcm10194351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Primary thyroid tumours show different levels of aggressiveness, from indolent to rapidly growing infiltrating malignancies. The most effective therapeutic option is surgery when radical resection is feasible. Biomarkers of aggressiveness may help in scheduling extended resections such as airway infiltration, avoiding a non-radical approach. The aim of the study is to evaluate the prognostic role of E-cadherin, N-cadherin, Aryl hydrocarbon receptor (AhR), and CD147 in different biological behaviours. Fifty-five samples from three groups of thyroid carcinomas were stained: papillary thyroid carcinomas (PTCs) infiltrating the airway (PTC-A), papillary intra-thyroid carcinomas (PTC-B) and poorly differentiated or anaplastic thyroid carcinomas (PDTC/ATC). High expressions of N-cadherin and AhR were associated with higher locoregional tumour aggressiveness (p = 0.005 and p < 0.001 respectively); PDTC/ATC more frequently showed a high expression of CD147 (p = 0.011), and a trend of lower expression of E-cadherin was registered in more aggressive neoplasms. Moreover, high levels of AhR were found with recurrent/persistent diseases (p = 0.031), particularly when tumours showed a concomitant high N-cadherin expression (p = 0.043). The study suggests that knowing in advance onco-biological factors with a potential role to discriminate between different subsets of patients could help the decision-making process, providing a more solid therapeutic indication and an increased expectation for radical surgery.
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Póvoa AA, Teixeira E, Bella-Cueto MR, Melo M, Oliveira MJ, Sobrinho-Simões M, Maciel J, Soares P. Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12113186. [PMID: 33138175 PMCID: PMC7693726 DOI: 10.3390/cancers12113186] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Thyroid cancer incidence is increasing, with overdiagnosis being the major driver of the thyroid cancer “epidemic”. Papillary thyroid carcinoma, usually with excellent prognosis, sometimes has an aggressive metastatic pattern. This heterogeneity in progression makes it difficult to tailor treatment strategies for an individual patient. We aimed to identify clinicopathological factors associated with papillary thyroid carcinoma recurrence, persistence, and specific mortality. Our study supports that both pre-surgical factors, such as male gender, presence of psammoma bodies, gross extra-thyroidal extension, and lateral compartment lymph node metastases, as well as lymph vessel invasion, venous invasion, presence of necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of PTC patients. The same is true when analysis is restricted to stage I patients. The importance of this report is to emphasize clinical and imaging pre-surgical thyroid cancer patients’ evaluation for an appropriate surgical treatment and patient prognosis. Abstract Papillary thyroid cancer (PTC) has an indolent nature and usually excellent prognosis. Some PTC clinicopathological features may contribute to the development of aggressive metastatic disease. In this work, we want to evaluate PTC clinicopathological features that are presurgical prognostic predictors of patients’ outcomes and find which indicators are more adequate for tailoring surgical procedures and follow-up. We studied a series of 241 PTC patients submitted to surgery. All patients’ files and histological tumor samples were reviewed. The 8th edition AJCC/UICC (American Joint Committee on Cancer/Union for International Cancer) Controlstaging system and the 2015 American Thyroid Association risk stratification system were used. Total thyroidectomy was performed in 228 patients, lymphadenectomy in 28 patients. Gross extrathyroidal extension (ETE) was present in 10 patients and 31 tumor resection margins were incomplete. Cervical lymph node metastases (LNMs) were present in 34 patients and distant metastases at diagnosis in four patients. In multivariate analysis, male gender (OR = 15.4, p = 0.015), venous invasion (OR = 16.7, p = 0.022), and lateral compartment LNM (OR = 26.7, p = 0.004) were predictors of mortality; psammoma bodies (PBs) (OR = 4.5, p = 0.008), lymph vessel invasion (OR = 6.9, p < 0.001), and gross ETE (OR = 16.1, p = 0.001) were predictors of structural disease status; male gender (OR = 2.9, p = 0.011), lymph vessel invasion (OR = 2.8, p = 0.006), and incomplete resection margins (OR = 4.6, p < 0.001) were predictors of recurrent/persistent disease. Our study supports that the factors helping to tailor patient’s surgery are male gender, presence of PBs, gross ETE, and lateral compartment LNM. Together with pathological factors, lymph vessel invasion, venous invasion, necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of patients.
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Affiliation(s)
- Antónia Afonso Póvoa
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Correspondence: (A.A.P.); (P.S.); Tel.: +351-969-813-884 (A.A.P.)
| | - Elisabete Teixeira
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Maria Rosa Bella-Cueto
- Department of Pathology, Parc Taulí Sabadell Hospital Universitari-Institut d’Investigació i Innovació Parc Taulí-I3PT-Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | - Miguel Melo
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Endocrinology, Centro Hospitalar Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Maria João Oliveira
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
| | - Manuel Sobrinho-Simões
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Jorge Maciel
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
| | - Paula Soares
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
- Correspondence: (A.A.P.); (P.S.); Tel.: +351-969-813-884 (A.A.P.)
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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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Wang Z, Xiang J, Gui Z, Qin Y, Sun W, Huang J, He L, Dong W, Zhang D, Zhang T, Shao L, Lv C, Zhang P, Zhang H. Unilateral Tnm T1 And T2 Papillary Thyroid Carcinoma With Lateral Cervical Lymph Node Metastasis: Total Thyroidectomy or Lobectomy? Endocr Pract 2020; 26:1085-1092. [PMID: 33471710 DOI: 10.4158/ep-2020-0125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to explore the effect of total thyroidectomy (TT) and lobectomy (LT) on the prognosis of unilateral papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis. METHODS Patients with PTC and lateral cervical lymph node metastasis who underwent lateral cervical lymph node dissection between January 2007 and December 2016 were retrospectively reviewed. To investigate the effect of surgical procedure on the prognosis of lymph node metastasis patients, other high-risk factors such as extrathyroidal invasion and large tumor size were excluded. All patients were in Tumor-Node-Metastasis (TNM) stage T1 and T2. Primary end point was recurrence-free survival (RFS). RESULTS Among 264 PTC patients, 104 (39.4%) patients received TT and 160 (60.6%) patients received LT. With a median follow-up of 50 months (interquartile range, 34 to 74 months), 7 patients (2.65%) experienced recurrence. The 5-year RFS in the TT and LT groups was 96.1% and 97.7%, respectively, and was not significantly different (P = .765). Similar results were found when excluding patients who received radioiodine ablation, which were 97.7% and 97.4%, respectively (P = .752). Age ≥55 years (hazard ratio, 7.368; P = .018) and multifocality in the ispi-lateral lobe (hazard ratio, 10.059; P =.006) were identified as independent risk factors of recurrence. CONCLUSION For unilateral TNM T1 and T2 PTC patients with lateral lymph node metastasis, there was no significant difference in the effect of TT and LT for RFS in the absence of other risk factors during the follow-up period. Patient age ≥55 years with multifocality in the unilateral lobe might be independent risk factors for prognosis.
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Affiliation(s)
- Zhihong Wang
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Jingzhe Xiang
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Zhiqiang Gui
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Yuan Qin
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Wei Sun
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Jiapeng Huang
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Liang He
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Wenwu Dong
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Dalin Zhang
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Ting Zhang
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Liang Shao
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Chengzhou Lv
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Ping Zhang
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China
| | - Hao Zhang
- From the Department of Thyroid Surgery, The First Hospital of China Medical University, Heping District Shenyang, Liaoning Province, China..
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Abstract
In 1993, active surveillance of low-risk papillary thyroid microcarcinomas (PTMCs) started in Kuma Hospital, Kobe, Japan. It has spread globally after the publishing of American Thyroid Association (ATA) guidelines. During our hospital's active surveillance program, few patients (8.0%) showed tumor size enlargement ≥3 mm or the new appearance of node metastasis (3.8%) at 10-year follow-up. Conversion surgery was recommended for patients with disease progression. To date, no patients showed significant recurrence or metastasis or died with thyroid carcinoma when patients underwent active surveillance or after surgery due to PTMC progression. Unlike clinical papillary thyroid carcinoma (PTC), elderly patients' PTMCs were less progressive compared to those of young and middle-aged patients, indicating that elderly patients are strong candidates for the active surveillance of their PTMC. Although young patients' PTMCs are the most progressive, >50% and >75% of patients in their 20s and 30s would avoid conversion surgical treatment in their lifetime, respectively (according to estimated lifetime probability), indicating that such young patients are still candidates for active surveillance. It can thus be concluded that active surveillance is appropriate to be first management for PTMCs, based on the accumulation of favorable outcomes of PTMC patients who have undergone active surveillance, as well as the lower incidences of unfavorable events and lower medical cost than immediate surgery.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
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15
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López-Sánchez J, González-Sánchez C, Rodríguez-Rivas AM, Franch-Arcas G, Muñoz-Bellvís L. Omentum metastasis of papillary thyroid carcinoma: a case report. ANZ J Surg 2020; 91:759-760. [PMID: 32960501 DOI: 10.1111/ans.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jaime López-Sánchez
- General and Gastrointestinal Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain
| | - Carmen González-Sánchez
- General and Gastrointestinal Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain
| | | | - Guzmán Franch-Arcas
- General and Gastrointestinal Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain
| | - Luis Muñoz-Bellvís
- General and Gastrointestinal Surgery Department, Salamanca University Hospital, Salamanca, Spain.,Biomedical Research Institute of Salamanca, University of Salamanca, Salamanca, Spain
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16
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Ito Y, Miyauchi A. Active surveillance of low-risk papillary thyroid microcarcinomas in Japan and other countries: a review. Expert Rev Endocrinol Metab 2020; 15:5-12. [PMID: 31902250 DOI: 10.1080/17446651.2020.1707078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022]
Abstract
Introduction: Active surveillance of low-risk papillary thyroid microcarcinomas (PTMCs) was initiated in Japan in 1993 and has since been adopted in many countries, especially after its approval by the American Thyroid Association in 2015.Areas covered: We performed a literature review in Medline/PubMed to identify studies that used active surveillance for PTMCs. Moreover, we performed a literature review about the increased incidence of thyroid microcarcinomas in relation to the relative stability of deaths due to thyroid carcinomas.Expert opinion: No patients showed life-threatening metastasis/recurrence or died of thyroid carcinoma during active surveillance or after conversion surgery following PTMC progression. Thus, active surveillance should be the first-line management of PTMCs without high-risk features. In the future, molecular testing of actively growing PTMCs using cytology specimens could be useful to guide the treatment plan.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Hyogo, Japan
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17
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Albers MB, Nordenström E, Wohlfahrt J, Bergenfelz A, Almquist M. Sentinel Lymph Node Biopsy in Thyroid Cancer. World J Surg 2019; 44:142-147. [DOI: 10.1007/s00268-019-05218-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Zhang HS, Lee EK, Jung YS, Nam BH, Park B. The binary presence or absence of lymph node metastasis or extrathyroidal extension is not associated with survival in papillary thyroid cancers: Implications for staging systems. Cancer Epidemiol 2019; 63:101589. [PMID: 31494519 DOI: 10.1016/j.canep.2019.101589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/30/2019] [Accepted: 08/20/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND The characteristics of diagnosed papillary thyroid cancer (PTC) have changed over time with the increasing trend of early diagnosis, and the survival impact of conventional prognostic factors such as lymph node metastasis (LNM) and extrathyroidal extension (ETE) is controversial. We investigated PTC prognostic factors for overall survival (OS) and disease specific survival (DSS), focusing on LNM, ETE, and their implications for PTC staging systems. METHODS We assessed prognostic factors for OS and DSS in a nationwide sample of Korean PTC patients (N = 5192, median follow-up 121 months) using Cox regression. The binary presence or absence of LNM and ETE, as well as other measures of LNM and ETE, were examined for their survival impact. We also evaluated the relative performance of PTC staging systems before and after revising the staging criteria for LNM and ETE. RESULTS The binary presence of LNM or ETE was not a prognostic factor for OS or DSS, nor were other various measures of LNM. However, the extent of ETE as none, microscopic, or gross independently influenced survival (OS hazard ratio for gross vs. none: 3.28, 95% confidence interval (CI) 1.97-5.46; DSS hazard ratio for gross vs. none: 3.75, 95% CI 1.59-8.81). The performance of PTC staging systems improved when the extent of ETE and/or location of LNM were used as staging components. CONCLUSION The extent of ETE and/or location of LNM may be better survival indicators than their binary presence or absence, and we propose staging criteria revisions to pertinent staging systems to better reflect the contemporary PTC population.
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Affiliation(s)
- Hyun-Soo Zhang
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Biomedical Informatics, College of Medicine, Yonsei University, Seoul, Republic of Korea.
| | - Eun-Kyung Lee
- Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Republic of Korea.
| | - Yuh-Seog Jung
- Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Republic of Korea; Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
| | - Byung-Ho Nam
- Herings, The Institute of Advanced Clinical and Biomedical Research, Seoul, Republic of Korea.
| | - Boyoung Park
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.
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Tuttle RM, Alzahrani AS. Risk Stratification in Differentiated Thyroid Cancer: From Detection to Final Follow-Up. J Clin Endocrinol Metab 2019; 104:4087-4100. [PMID: 30874735 PMCID: PMC6684308 DOI: 10.1210/jc.2019-00177] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Modern management of differentiated thyroid cancer requires individualized care plans that tailor the intensity of therapy and follow-up to the estimated risks of recurrence and disease-specific mortality. DESIGN This summary is based on the authors' knowledge and extensive clinical experience, supplemented by review of published review articles, thyroid cancer management guidelines, published staging systems, and original articles identified through a PubMed search, which included terms such as risk stratification, staging, clinical outcomes, and differentiated thyroid cancer. MAIN OUTCOME MEASURES In the past, risk stratification in differentiated thyroid cancer usually referred to a static estimate of disease-specific mortality that was based on a small set of clinicopathological features available within a few weeks of completing initial therapy (thyroidectomy, with or without radioactive iodine). Today, risk stratification is a dynamic, active process used to predict the appropriateness for minimalistic initial therapy, disease-specific mortality, risk of recurrence, and the most likely response to initial therapy. Rather than being a static prediction available only after initial therapy, modern risk stratification is a dynamic, iterative process that begins as soon as a suspicious nodule is detected and continues through final follow-up. CONCLUSIONS Dynamic risk assessment should be used to guide all aspects of thyroid cancer management, beginning before a definitive diagnosis is made and continuing through the final follow-up visit.
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Affiliation(s)
- R Michael Tuttle
- Endocrinology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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20
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Hasanzad M, Sarhangi N, Aghaei Meybodi HR, Nikfar S, Khatami F, Larijani B. Precision Medicine in Non Communicable Diseases. INTERNATIONAL JOURNAL OF MOLECULAR AND CELLULAR MEDICINE 2019; 8:1-18. [PMID: 32351905 PMCID: PMC7175610 DOI: 10.22088/ijmcm.bums.8.2.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022]
Abstract
Non-communicable diseases (NCDs) are the leading cause of death and disease burden globally, cardiovascular diseases (CVDs) account for the major part of death related to NCDs followed by different types of cancer, chronic obstructive pulmonary disease (COPD), and diabetes. As the World Health Organization (WHO) and the United Nations have announced a 25% reduction in mortality of NCDs by 2025, different communities need to adopt preventive strategies for achieving this goal. Personalized medicine approach as a predictive and preventive strategy aims for a better therapeutic goal to the patients to maximize benefits and reduce harms. The clinical benefits of this approach are already realized in cancer targeted therapy, and its impact on other conditions needs more studies in different societies. In this review, we essentially describe the concept of personalized (or precision) medicine in association with NCDs and the future of precision medicine in prediction, prevention, and personalized treatment.
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Affiliation(s)
- Mandana Hasanzad
- Medical Genomics Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.,Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Sarhangi
- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Aghaei Meybodi
- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Khatami
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Personalized Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Long-Term Outcomes After Hepatic and Pancreatic Resections for Metastases from Thyroid Cancer: a Systematic Review of the Literature. J Gastrointest Cancer 2019; 50:9-15. [PMID: 30618003 DOI: 10.1007/s12029-018-00196-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective of our systematic review was to evaluate the long-term outcomes of surgical resection as a treatment strategy for liver and pancreatic metastases from thyroid cancer (TC). METHODS A systematic search of three electronic databases for articles published up to October 2018 was conducted. All appropriate observational studies and case reports which reported outcomes from patients with TC metastatic to the liver or pancreas were considered eligible for inclusion in the present systematic review. RESULTS A total of 15 studies, which comprised of 16 patients that underwent hepatic or pancreatic resection for TC metastasis, were included in the present systematic review; among them, 5 presented with metastasis to the liver, whereas 11 had pancreatic metastatic disease. The median time interval between the initial thyroidectomy and the diagnosis of metastases (either hepatic or pancreatic) was 60 months (SE 23.8, 95% CI 13.3-106.7) for the entire cohort and the mean overall survival was 37.6 months (SE 8, 95% CI 22-53.3). Five patients with pancreatic metastases presented with recurrence whereas no recurrences were noted in patients with liver metastases. CONCLUSIONS Surgical resection of liver and pancreatic metastases from TC seems to be a safe and efficient treatment option for selected patients. In that setting, long-term outcomes in patients with resected TCLM are encouraging given the absence of recurrence as reported from the included studies, whereas in the case of TCPM, survival is limited due to advanced disease at diagnosis and recurrence rates.
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Occult Contralateral Lateral Lymph Node Metastases in Unilateral N1b Papillary Thyroid Carcinoma. World J Surg 2019; 43:818-823. [PMID: 30465086 DOI: 10.1007/s00268-018-4862-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Therapeutic lateral neck dissection (ND) is recommended for N1b papillary thyroid carcinoma (PTC), while prophylactic contralateral lateral ND is not. Given the paucity of data, we investigated the frequency of and risk factors for occult lymph node metastases (LNM) in the contralateral lateral neck for N1b patients. PATIENTS AND METHODS This is a retrospective study conducted at a cancer center. Inclusion criteria were: unilateral PTC and ipsilateral lateral LNM confirmed by fine-needle aspiration biopsy. Patients with contralateral lateral LNM or bilateral tumor on ultrasound were excluded. All patients were treated with total thyroidectomy, bilateral central ND, ipsilateral therapeutic lateral ND and prophylactic contralateral ND of levels III-IV, followed by radioactive iodine. RESULTS Sixty-three patients met the inclusion criteria. Occult contralateral lateral LNM were found in 23/63 patients (36.5%) who had more LNM in ispilateral (p = .01) and contralateral level VI (p < .0001), more frequent microscopic tumor in the contralateral lobe (p = .017) and a trend toward being at high risk (p = .06). Using receiver operating characteristic analysis, a cutoff of >4 LNM in ipsilateral level VI optimized sensitivity and specificity for predicting contralateral lateral LNM, with a sensitivity of 74%, specificity of 65%, positive predictive value of 55% and negative predictive value of 81%. Neck recurrence occurred in 14%, with only 1 patient recurring only in the contralateral lateral neck (1.5%). CONCLUSION Occult LNM in the contralateral lateral neck was found in 36.5% of patients. Five or more ipsilateral central LNM may aid in predicting contralateral lateral LNM, and high-risk patients may be more at risk. The clinical benefit of prophylactic contralateral lateral ND remains doubtful, however.
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Dong W, Horiuchi K, Tokumitsu H, Sakamoto A, Noguchi E, Ueda Y, Okamoto T. Time-Varying Pattern of Mortality and Recurrence from Papillary Thyroid Cancer: Lessons from a Long-Term Follow-Up. Thyroid 2019; 29:802-808. [PMID: 30931815 DOI: 10.1089/thy.2018.0128] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Little is known about annual hazard rates of cancer mortality and recurrence for papillary thyroid cancer (PTC). This study investigated the time-varying pattern of cancer death and recurrence from PTC and independent prognostic factors for cause-specific mortality (CSM) and recurrence of PTC. Methods: This retrospective chart review enrolled 466 patients diagnosed with PTC who underwent curative initial surgery between April 1981 and December 1991 with a median follow-up of 18.4 years. Clinical characteristics, cancer mortality (primary endpoint), and recurrence (secondary endpoint) were ascertained. The failure rates of either death or recurrence were estimated using the Kaplan-Meier methods, and annual death/recurrence hazard was depicted using hazard function. Results: In this Japanese cohort where only 1.5% of patients received radioactive iodine therapy, the 10-, 20-, and 30-year CSM rates were 2.7%, 6.2%, and 8.6%, respectively. Eleven (44.0%) cases of death occurred within the first 10 years, whereas 10 (40.0%) and 4 (16.0%) cases occurred within 10-20 and 20-30 years after surgery, respectively. The 10-, 20-, and 30-year recurrence rates were 11.3%, 21.8%, and 29.4%, respectively. Forty-six (54.8%) cases of recurrence occurred within the first 10 years, predominantly within the first five years (31 cases; 36.9%), whereas 29 (34.5%), 7 (8.3%), and 2 (2.4%) cases occurred within 10-20, 20-30, and ≥30 years after surgery, respectively. Age ≥55 years was the only independent prognostic factor for CSM. Age ≥55 years, male, tumor size > 4 cm, extranodal extension, and positive pathological lymph node metastasis were independent prognostic factors for recurrence. The annual hazard curve of cancer mortality presented a double-peaked distribution, with a first peak at the 10th year, and the second peak reaching the maximum at the 20th year after surgery for the entire population. The annual hazard curve of recurrence showed a triple-peaked pattern, with surges at about 12, 22, and 29 years after surgery. Conclusions: Patients with PTC harboring at least one of the prognostic characteristics may be at persistent risk of cancer mortality and recurrence even 10 or more years after initial treatment. Understanding the hazard rate of PTC is key to creating more tailored treatment and surveillance.
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Affiliation(s)
- Wenwu Dong
- 1 Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, P.R. China
- 2 Department of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
| | - Kiyomi Horiuchi
- 2 Department of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Tokumitsu
- 2 Department of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
| | - Akiko Sakamoto
- 2 Department of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
| | - Eiichiro Noguchi
- 2 Department of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshinori Ueda
- 2 Department of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiro Okamoto
- 2 Department of Surgery II, Tokyo Women's Medical University, Tokyo, Japan
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Gambardella C, Patrone R, Di Capua F, Offi C, Mauriello C, Clarizia G, Andretta C, Polistena A, Sanguinetti A, Calò P, Docimo G, Avenia N, Conzo G. The role of prophylactic central compartment lymph node dissection in elderly patients with differentiated thyroid cancer: a multicentric study. BMC Surg 2019; 18:110. [PMID: 31074400 PMCID: PMC7402571 DOI: 10.1186/s12893-018-0433-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Prophylactic central neck lymph-nodes dissection is still a topic of major debate in Literature. There is a lack of randomized controlled trials proving advantages in its application in terms of overall survival and local recurrence. Due to the recent rapid increase of elderly population, differentiated tumor carcinoma diagnosis increased in patients over 65 years old. The aim of this study was to compare recurrence rate, complications rate and histological features of tumors in elderly population. METHODS A retrospective study was carried out collecting data from 371 patients with differentiated thyroid cancer without clinical evidence of lymph-nodes involvement in three Italian referral centers from 2005 to 2015. All patients were aged ≥ 65 years and were divided in two groups based on the performed surgery (total thyroidectomy alone or associated with central lymph-nodes dissection). Moreover, patients were stratified according to the age between 65 and 74 years old and over 75 years old. RESULTS Total thyroidectomy alone was performed in 184 patients (group A) and total thyroidectomy with prophylactic central neck dissection was performed in 187 cases (group B). There was a statistically significant difference in complications between the groups in terms of neck hematoma (0.5% group A vs 3.7% group B), temporary hypoparathyroidism (11.4% group A vs 21.4% group B), and temporary unilateral recurrent nerve injury (1.5% group A vs 6.4% group B). Lymph nodes recurrence rate was 9.2% in group A and 8.5% in group B, with no statistically significant difference. There was a statistically significant difference in patients over 75 years old in terms of temporary hypoparathyroidism (24% group A vs 11% group B), permanent hypoparathyroidism (2,7% group A vs 0,3% group B) and recurrent nerve injury (9,5% group A vs 2% group B). CONCLUSIONS The role of prophylactic central neck dissection is still controversial, especially in elderly patients, and an aggressive surgical approach should be carefully evaluated. The Authors reported a similar low recurrence rate between total thyroidectomy and total thyroidectomy associated with prophylactic central neck dissection, with increased postoperative complications in the lymphadenectomy group and in patients over 75 years old, advocating a tailored surgical approach in elderly population.
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Affiliation(s)
- Claudio Gambardella
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Renato Patrone
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Francesco Di Capua
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Chiara Offi
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudio Mauriello
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Guglielmo Clarizia
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudia Andretta
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Andrea Polistena
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Alessandro Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Pietrogiorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Giovanni Docimo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Nicola Avenia
- Endocrine Surgery Unit, University of Perugia, Piazza dell'Università, 06123, Perugia, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", School of Medicine, Via Sergio Pansini 5, 80131, Naples, Italy
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Pessôa-Pereira D, Medeiros MFDS, Lima VMS, da Silva JC, Cerqueira TLDO, da Silva IC, Fonseca LE, Sampaio LJL, de Lima CRA, Ramos HE. Association between BRAF (V600E) mutation and clinicopathological features of papillary thyroid carcinoma: a Brazilian single-centre case series. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2019; 63:97-106. [PMID: 30916170 PMCID: PMC10522140 DOI: 10.20945/2359-3997000000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/14/2019] [Indexed: 12/09/2022]
Abstract
OBJECTIVES We aimed to investigate the prevalence of the BRAF (V600E) mutation in consecutive cases of papillary thyroid carcinoma (PTC) in patients diagnosed and treated at the Hospital Sao Rafael (Salvador, BA, Brazil) and evaluate its association with clinical and pathological characteristics of PTC. SUBJECTS AND METHODS We retrospectively enrolled in the study a total of 43 consecutive PTC patients who underwent total thyroidectomy. We performed DNA extraction from formalin-fixed paraffin-embedded (FFPE) tumour tissue samples. Polymerase chain reaction (PCR) and direct sequencing were used to determine BRAF (V600E) mutation status. Univariate and multivariate logistic regression analyses were employed to identify independent associations. RESULTS The prevalence of BRAF (V600E) mutation was 65.1% (28/43). A high frequency of older patients (p value: 0.004) was observed among the BRAF-mutated PTC group and, in contrast, a low frequency of concurrent Hashimoto's thyroiditis (HT) (p value: 0.011) was noted. Multivariate analysis confirmed that older age (OR: 1.15; 95% CI: 1.00 - 1.33; p value: 0.047) and HT (OR: 0.05; 95% CI: 0.006-0.40; p value: 0.005) were independent factors associated with BRAF (V600E) mutation. CONCLUSION We found a high prevalence of BRAF (V600E) mutation in PTC cases. Older age and no concurrent HT were independently associated with BRAF (V600E) mutation.
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Affiliation(s)
- Danielle Pessôa-Pereira
- Universidade Federal da BahiaUniversidade Federal da BahiaInstituto de Saúde e CiênciaLaboratório de Estudo da TireoideSalvadorBABrasilDepartamento de Biorregulação, Laboratório de Estudo da Tireoide, Instituto de Saúde e Ciência, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Mateus Fernandes da Silva Medeiros
- Universidade Federal da BahiaUniversidade Federal da BahiaInstituto de Saúde e CiênciaLaboratório de Estudo da TireoideSalvadorBABrasilDepartamento de Biorregulação, Laboratório de Estudo da Tireoide, Instituto de Saúde e Ciência, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Virna Mendonça Sampaio Lima
- Universidade Federal da BahiaUniversidade Federal da BahiaInstituto de Saúde e CiênciaLaboratório de Estudo da TireoideSalvadorBABrasilDepartamento de Biorregulação, Laboratório de Estudo da Tireoide, Instituto de Saúde e Ciência, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Joaquim Custódio da Silva
- Universidade Federal da BahiaUniversidade Federal da BahiaInstituto de Saúde e CiênciaLaboratório de Estudo da TireoideSalvadorBABrasilDepartamento de Biorregulação, Laboratório de Estudo da Tireoide, Instituto de Saúde e Ciência, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Taíse Lima de Oliveira Cerqueira
- Universidade Federal da BahiaUniversidade Federal da BahiaInstituto de Saúde e CiênciaLaboratório de Estudo da TireoideSalvadorBABrasilDepartamento de Biorregulação, Laboratório de Estudo da Tireoide, Instituto de Saúde e Ciência, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Igor Campos da Silva
- Hospital São RafaelDepartamento de Anatomia Patológica e CitopatologiaSalvadorBABrasilDepartamento de Anatomia Patológica e Citopatologia, Hospital São Rafael, Salvador, BA, Brasil
| | - Luciano Espinheira Fonseca
- Hospital São RafaelDepartamento de Anatomia Patológica e CitopatologiaSalvadorBABrasilDepartamento de Anatomia Patológica e Citopatologia, Hospital São Rafael, Salvador, BA, Brasil
- Universidade Federal da BahiaUniversidade Federal da BahiaFaculdade de Medicina da BahiaDepartamento de Anatomia Patológica e Medicina LegalSalvadorBABrasilDepartamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
| | - Luiz José Lobão Sampaio
- Hospital São RafaelDepartamento de Medicina NuclearSalvadorBABrasilDepartamento de Medicina Nuclear, Hospital São Rafael, Salvador, BA, Brasil
| | - Cláudio Rogério Alves de Lima
- Hospital São RafaelDepartamento de Cirurgia de Cabeça e PescoçoSalvadorBABrasilDepartamento de Cirurgia de Cabeça e Pescoço, Hospital São Rafael, Salvador, BA, Brasil
| | - Helton Estrela Ramos
- Universidade Federal da BahiaUniversidade Federal da BahiaInstituto de Saúde e CiênciaLaboratório de Estudo da TireoideSalvadorBABrasilDepartamento de Biorregulação, Laboratório de Estudo da Tireoide, Instituto de Saúde e Ciência, Universidade Federal da Bahia (UFBA), Salvador, BA, Brasil
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Shafique K, LiVolsi VA, Montone K, Baloch ZW. Papillary Thyroid Microcarcinoma: Reclassification to Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): a Retrospective Clinicopathologic Study. Endocr Pathol 2018; 29:339-345. [PMID: 30196478 DOI: 10.1007/s12022-018-9546-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Papillary thyroid microcarcinoma (PTMC) accounts for nearly 50% of newly diagnosed PTC cases. There is considerable debate in literature about the clinicopathologic features and prognostic significance of PTMC and whether it should be treated as a separate entity. Due to lack of agreement and supportive data, the consensus study group that established the criteria for non-invasive thyroid neoplasm with papillary-like features (NIFTP) kept its size above 1 cm i.e., excluding PTMC from this new group. As a result, to date, some patients diagnosed with PTMC get aggressive treatments such as partial or total thyroidectomy and even radioactive iodine ablation. We retrospectively studied clinicopathologic features and long-term follow-up of 48 cases of papillary thyroid microcarcinoma. Of these, 7 cases (15%) had capsular invasion, 2 cases (4%) had extrathyroidal extension, 1 case (2%) had lymphovascular invasion, 5 cases (25%) had lymph node metastases, no case (0%) had any distant metastases, and 1 case had recurrence after long-term follow-up (mean 13.7 years, range 1-21 years). Upon slide review, 8 cases fulfilled the criteria for NIFTP and were sub-classified under this new category. These 8 cases had no recurrence after long-term follow-up (mean 12.1 years, range 7-19 years). In this study, we confirmed the previous published reports exhibiting indolent nature of PTMC and also suggested that PTMC cases that fulfill all the criteria for NIFTP can be sub-classified under this term in order to avoid unnecessary aggressive treatment.
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Affiliation(s)
- Khurram Shafique
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Virginia A LiVolsi
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Kathleen Montone
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 6 Founders, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Zhou YL, Zheng C, Chen YT, Chen XM. Underexpression of INPPL1 is associated with aggressive clinicopathologic characteristics in papillary thyroid carcinoma. Onco Targets Ther 2018; 11:7725-7731. [PMID: 30464521 PMCID: PMC6219113 DOI: 10.2147/ott.s185803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the relationship between INPPL1 gene and clinicopathologic characteristics of papillary thyroid carcinoma (PTC). Patients and methods INPPL1 expression in PTCs was tested by quantitative real-time reverse transcription PCR. The Cancer Genome Atlas (TCGA) RNA-seq data and our mRNA data were used to analyze and reveal the relationship between INPPL1 and aggressive clinicopathologic characteristics of PTC. Results When compared to normal thyroid tissues, INPPL1 was significantly downregulated in PTC tissues, as revealed by our data and TCGA data. INPPL1 underexpression was remarkably related to aggressive clinicopathologic characteristics such as lymph node metastasis (LNM), histological type, tumor size, mulitifocality, and disease stage in TCGA data. Meanwhile, LNM was confirmed to be associated with underexpression of INPPL1 in our data. In addition, logistic analysis clearly showed that underexpression of INPPL1 was an independent factor for LNM in PTC. Conclusion INPPL1 may be a novel tumor suppressor gene in PTC, which was significantly correlated with aggressive clinicopathologic characteristics, especially LNM.
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Affiliation(s)
- Yi-Li Zhou
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Chen Zheng
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Yi-Tong Chen
- Department of Clinical Medicine, Tai Zhou University Medical School, Taizhou, Zhejiang, China
| | - Xue-Min Chen
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China,
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28
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Zhang HS, Lee EK, Jung YS, Nam BH, Jung KW, Kong HJ, Won YJ, Park B. Total thyroidectomy's association with survival in papillary thyroid cancers and the high proportion of total thyroidectomy in low-risk patients: Analysis of Korean nationwide data. Surgery 2018; 165:629-636. [PMID: 30342774 DOI: 10.1016/j.surg.2018.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Papillary thyroid cancer has an excellent prognosis, but the appropriate level of treatment is controversial. We compared survival between total thyroidectomy and less-than-total thyroidectomy, and examined the proportion of patients with papillary thyroid cancer in Korea undergoing total thyroidectomy. METHODS A nationwide sample of 5,230 papillary thyroid cancer patients was included (total thyroidectomy: 4,262, less-than-total thyroidectomy: 968). Using multivariate Cox regression, we compared overall survival and cause-specific survival by the extent of thyroidectomy (total thyroidectomy versus less-than-total thyroidectomy) for a 1:1 optimal match via the propensity score and for the total study population. We also compared overall survival by extent of thyroidectomy and the proportion of total thyroidectomy in different risk groups using papillary thyroid cancer staging systems. RESULTS We saw no difference in overall survival by extent of thyroidectomy in the propensity score matched population and the total study population (hazard ratio for less-than-total thyroidectomy 0.82, 95% confidence interval 0.52-1.29; hazard ratio for less-than-total thyroidectomy 1.03, 95% confidence interval 0.71-1.48, respectively). Similarly, there were no differences in thyroid cancer-specific survival by extent of thyroidectomy. None of the different risk groups showed differences in overall survival by surgical extent, although total thyroidectomy improved overall survival in older females with larger tumors. The proportion of papillary thyroid cancer patients who received a total thyroidectomy was 80% or greater regardless of risk group classification. CONCLUSION Total thyroidectomy had no survival advantage over less-than-total thyroidectomy in Korean papillary thyroid cancer patients except in a specific high-risk group. 80% or more of low-risk papillary thyroid cancer patients received a total thyroidectomy. These results suggest that further patient-centered treatment which considers both quality of life and clinical outcome is needed.
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Affiliation(s)
- Hyun-Soo Zhang
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea; Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Eun-Kyung Lee
- Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Yuh-Seog Jung
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea; Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Byung-Ho Nam
- Herings, Institute of Advanced Clinical and Biomedical Research, Seoul, Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyun-Joo Kong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Center for Thyroid Cancer, Head and Neck Oncology Clinic, National Cancer Center, Goyang, Korea; National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Korea.
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Lai X, Jiang Y, Zhang B, Liang Z, Jiang Y, Li J, Zhao R, Yang X, Zhang X. Preoperative sonographic features of follicular thyroid carcinoma predict biological behavior: A retrospective study. Medicine (Baltimore) 2018; 97:e12814. [PMID: 30313115 PMCID: PMC6203532 DOI: 10.1097/md.0000000000012814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little is known regarding biological behavior of follicular thyroid carcinomas (FTCs) according to ultrasonography features. We investigated whether there was a difference in biological behavior between benign-looking FTCs (B-FTCs) and malignant-looking FTCs (M-FTCs).A total of 55 cases of FTC between January 2000 and December 2015 were included. B-FTCs were defined as showing none of the accepted ultrasonography criteria for malignancy, and M-FTCs were defined as showing at least one of the accepted ultrasonography criteria for malignancy. Clinicopathologic factors and sonographic features were compared between B-FTCs and M-FTCs. Based on the degree of invasiveness, FTCs were divided into minimally invasive FTCs (MI-FTCs) and widely invasive FTCs (WI-FTCs) on pathology. Sonographic features were compared between MI-FTCs and WI-FTCs.Compared with the patients with B-FTCs (31/55, 56.4%), the patients with M-FTCs showed a significantly higher prevalence of WI-FTCs, central lymph node metastases, lateral lymph node metastases as well as extrathyroidal extension (P < .001, P = .012, P = .031, and P = .032, respectively). M-FTCs with more than one malignancy features on ultrasonography showed a significantly higher prevalence of extrathyroidal extension than M-FTCs with only one ultrasonography malignancy feature (P = .022). Compared with MI-FTCs (41/55, 74.5%), an irregular shape, a spiculated/microlobulated boundary, no peripheral halo ring, hypoechogenicity and microcalcification were more frequent in WI-FTCs (P < .001, P = .003, P = .002, P = .015, and P = .016, respectively).Our results demonstrated that B-FTCs had better prognostic indicators than M-FTCs. Therefore, preoperative US features can serve as a useful tool for predicting biological behavior in FTC.
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Affiliation(s)
- Xingjian Lai
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - Yan Jiang
- Department of Ultrasound, Manzhouli China-Mongolia Hospital, Heilongjiang Province
| | - Bo Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - Zhiyong Liang
- Department of Pathology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China
| | - Yuxin Jiang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - Jianchu Li
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - Ruina Zhao
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - Xiao Yang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
| | - Xiaoyan Zhang
- Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing
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Zhang D, Tang J, Kong D, Cui Q, Wang K, Gong Y, Wu G. Impact of Gender and Age on the Prognosis of Differentiated Thyroid Carcinoma: a Retrospective Analysis Based on SEER. Discov Oncol 2018; 9:361-370. [PMID: 30014218 DOI: 10.1007/s12672-018-0340-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/20/2018] [Indexed: 11/25/2022] Open
Abstract
The incidence of thyroid cancer in females is significantly higher than that in males; however, females are more likely to have more favorable outcomes. We aimed to determine the characteristics of differentiated thyroid carcinoma (DTC) subtypes in males and females, and to compare their clinical behavior and survival. A total of 68,337 cases were recruited from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. The disease-specific survival (DSS) of follicular variant papillary thyroid carcinoma (FVPTC) and follicular thyroid carcinoma (FTC) were similar to that of classical variant papillary thyroid carcinoma (CPTC) in male patients (FVPTC vs. CPTC, adjusted hazard ratio (aHR) = 0.947, P = 0.776; FTC vs. CPTC, aHR = 1.512, P = 0.104). In premenopausal female (< 55 years old), FVPTC had better DSS than CPTC (aHR = 0.321, P = 0.038) while FTC had worse DSS than CPTC (aHR = 3.272, P = 0.013); in postmenopausal female, FTC had poorer prognosis than CPTC (aHR = 2.145, P = 0.002), no statistical difference was found between CPTC and FVPTC (aHR = 0.724, P = 0.087). For patients younger than 55 years, women had significantly better DSS compared with men with CPTC (aHR = 0.376, P < 0.001) and FVPTC (aHR = 0.102, P < 0.001). However, no difference was observed in patients older than 55 years. Interestingly, outcomes of FTC were not affected by gender in patients of all ages. These results suggested that different clinical behaviors and outcomes of DTC subtypes should be considered in patients with different genders.
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Affiliation(s)
- Dan Zhang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Deguang Kong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qiuxia Cui
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
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Murakami Y, Shimura T, Okada R, Kofunato Y, Ishigame T, Yashima R, Nakano K, Suzuki S, Takenoshita S. Pancreatic metastasis of papillary thyroid carcinoma preoperatively diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report with review of literatures. Clin J Gastroenterol 2018; 11:521-529. [PMID: 29948817 DOI: 10.1007/s12328-018-0875-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
Pancreatic metastatic tumors from thyroid carcinoma are extremely rare. We report a case of an 80-year-old female with a pancreatic metastatic tumor derived from papillary thyroid carcinoma which was initially resected 158 months prior to detection of the metastatic pancreatic tumor. The patient has encountered cervical lymph-node metastasis on three occasions following the initial operation. Metastatic pancreatic lesions and cervical lymph nodes were first detected using 18-fluorodeoxyglucose positron-emission tomography/computed tomography, and she was preoperatively diagnosed using endoscopic ultrasound-guided fine-needle aspiration biopsy. A coin lesion, 10 mm in size, was detected in the left lung by chest computed tomography with no abnormal uptake in 18-fluorodeoxyglucose positron-emission tomography/computed tomography. Distal pancreatectomy and cervical lymph-node dissection were performed. Adjuvant chemotherapy with weekly paclitaxel was administered because anaplastic transformation had been detected in one of the cervical lymph nodes. The patient eventually died from multiple lung metastases 11 months after removing the metastatic pancreatic lesion. We reported a rare case of a pancreatic metastatic tumor from thyroid carcinoma, and found that 18-fluorodeoxyglucose positron-emission tomography/computed tomography and endoscopic ultrasound-guided fine-needle aspiration biopsy are useful for preoperatively diagnosing tumors.
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Affiliation(s)
- Yuko Murakami
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Tatsuo Shimura
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Ryo Okada
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuhide Kofunato
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Teruhide Ishigame
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Rei Yashima
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Keiichi Nakano
- Department of Thyroid and Endocrinology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Seiichi Takenoshita
- Department of Organ Regulatory Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Šelemetjev S, Bartolome A, Išić Denčić T, Đorić I, Paunović I, Tatić S, Cvejić D. Overexpression of epidermal growth factor receptor and its downstream effector, focal adhesion kinase, correlates with papillary thyroid carcinoma progression. Int J Exp Pathol 2018; 99:87-94. [PMID: 29665129 DOI: 10.1111/iep.12268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/25/2018] [Indexed: 01/18/2023] Open
Abstract
Epidermal growth factor receptor (EGFR) and its downstream effector, focal adhesion kinase (FAK), have been shown to be overexpressed frequently in human malignancies and implicated in tumour aggressiveness. We aimed to investigate the relationship between EGFR and FAK expression and their possible correlation with the clinical phenotype of patients with papillary thyroid carcinoma (PTC). Expression profiles of EGFR and FAK were analysed in PTC tissue samples (n = 104) by immunohistochemistry and Western blotting. Additionally, EGFR and FAK were immunohistochemically analysed in 20 primary tumours paired with their metastatic tissue in lymph nodes. High expression of EGFR and FAK was found in 55.77% and 57.69% cases, respectively, with a strong positive association between them (P < 0.0001, Spearman's correlation coefficient = 0.844). Expression of each molecule and their coexpression correlated significantly with the presence of lymph node metastasis (LNM), degree of tumour infiltration, extrathyroid invasion and pT status of the patients. Western blot analysis confirmed that coexpression of high levels of EGFR and FAK correlated with adverse clinicopathological features. When compared to the corresponding primary tumour, increased or maintained high levels of EGFR and FAK were found in LNM, indicating their concordant expression during lymphatic spread. In conclusion, high levels of EGFR and its downstream effector, FAK, in association with lymphatic spread and tumour infiltration indicate their involvement in PTC progression and suggest that both molecules may predict its aggressive behaviour. Furthermore, FAK could be a potential target for anticancer therapy in patients with advanced thyroid cancer.
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Affiliation(s)
- Sonja Šelemetjev
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
| | - Aleksandar Bartolome
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
| | - Tijana Išić Denčić
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
| | - Ilona Đorić
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
| | - Ivan Paunović
- Center for Endocrine Surgery, Institute for Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetislav Tatić
- Medical Faculty, Institute of Pathology, University of Belgrade, Belgrade, Serbia
| | - Dubravka Cvejić
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
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Tang J, Kong D, Cui Q, Wang K, Zhang D, Liao X, Gong Y, Wu G. Racial disparities of differentiated thyroid carcinoma: clinical behavior, treatments, and long-term outcomes. World J Surg Oncol 2018; 16:45. [PMID: 29506526 PMCID: PMC5836433 DOI: 10.1186/s12957-018-1340-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/14/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The incidence of thyroid cancer in black Americans is significantly lower than that in white Americans, and the impact of race on the prognosis of thyroid cancer remains controversial. The purpose of this study was to determine the risk factors for survival in black and white patients and to compare the survival of differentiated thyroid carcinoma subtypes between these two races. We further investigated the association of lymph node and distant metastases with races. METHODS This is a retrospective analysis using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. A total of 70,346 cases were included in our study. Patients' demographics and cancer- and treatment-related characteristics were compared between the black and white Americans using chi-square and Fisher's exact tests. For multivariate analysis, Cox proportional hazards regression were used to assess the association between potential risk factors and the survival in black and white patients. RESULT Black Americans had a worse overall survival than white Americans (HR = 1.127, P = 0.002). While disease-specific survival (DSS) was comparable, the risk factors for DSS were different between white and black Americans. Black Americans had less lymph node metastasis of classical variant papillary thyroid carcinoma (CPTC, OR = 0.476, P < 0.001) and follicular variant papillary thyroid carcinoma (FVPTC, OR = 0.522, P < 0.001), but not follicular thyroid carcinoma (FTC). However, black Americans with FVPTC, but not CPTC or FTC, had a higher potential of distant metastasis (OR = 1.715, P = 0.026). Furthermore, only white patients with tumor > 2 cm and lymph node metastasis benefited from radioactive iodine. CONCLUSIONS The risk factors for DSS were significantly different in white and black patients. The impact of race should be considered in treatment strategy for thyroid cancer.
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Affiliation(s)
- Jianing Tang
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Deguang Kong
- Department of General Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Qiuxia Cui
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xing Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China
| | - Yan Gong
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China.
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, China.
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de Ridder J, de Wilt JH, Simmer F, Overbeek L, Lemmens V, Nagtegaal I. Incidence and origin of histologically confirmed liver metastases: an explorative case-study of 23,154 patients. Oncotarget 2018; 7:55368-55376. [PMID: 27421135 PMCID: PMC5342423 DOI: 10.18632/oncotarget.10552] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 05/12/2016] [Indexed: 01/05/2023] Open
Abstract
Background The liver is a common metastatic site for a large variety of primary tumors. For both patients with known and unknown primary tumors it is important to understand metastatic patterns to provide tailored therapies. Objective To perform a nationwide exploration of the origins of histological confirmed liver metastases. Results A total of 23,154 patients were identified. The majority of liver metastases were carcinomas (n=21,400; 92%) of which adenocarcinoma was the most frequent subtype (n=17,349; 75%). Most common primary tumors in patients with adenocarcinoma were from colorectal (n=8,004), pancreatic (n=1,755) or breast origin (n=1,415). In women of 50 years and younger, metastatic adenocarcinoma originated more frequently from breast cancer, while in women older than 70 years liver metastases originated more frequently from gastrointestinal tumors. Liver metastases in men older than 70 years originated often from squamous cell lung carcinoma. An unknown primary tumor was detected in 4,209 (18%) patients, although tumor type could be determined in 3,855 (92%) of them. Methods Data were collected using the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA). All histological confirmed liver metastases between January 2001 and December 2010 were evaluated for tumor type, origin of the primary tumor and were correlated with patient characteristics (age, gender). Conclusion The current study provides an overview of the origins of liver metastases in a series of 23,154 patients.
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Affiliation(s)
- Jannemarie de Ridder
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Johannes H.W. de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femke Simmer
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lucy Overbeek
- Foundation PALGA, Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands, Utrecht, The Netherlands
| | - Valery Lemmens
- Netherlands Cancer Registry, Comprehensive Cancer Organisation the Netherlands (IKNL), Eindhoven, The Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Iris Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
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Sapuppo G, Palermo F, Russo M, Tavarelli M, Masucci R, Squatrito S, Vigneri R, Pellegriti G. Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome. J Endocrinol Invest 2017. [PMID: 28646475 DOI: 10.1007/s40618-017-0714-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC), the most common thyroid cancer histotype, has a good prognosis even when spread to the neck lymph node (LN). The prognostic role of LN metastases' location is still controversial. The aim of the present study was to evaluate the clinical relevance of the number and location of LN metastases at presentation in PTCs. METHODS This retrospective study included a consecutive series of 1653 PTC patients followed for a mean period of 5.9 years in a referral thyroid cancer clinic. All patients have undergone thyroidectomy with the dissection of at least six LNs. According to the LN status, patients were subdivided into 569 N0 (34.4%), 644 N1a (39.0%, central compartment) and 440 N1b (26.6%, latero-cervical compartment). RESULTS Age at diagnosis was significantly lower in N1b (39.8, IQR 30.7-51.6) and N1a (40.1, IQR 31.3-50.1) than in N0 (44.7, IQR 36.6-55.0 yrs). The male gender was more prevalent in N1b than in N1a and N0 (F/M = 1.9/1, 4.0/1 and 5.5/1, respectively). Persistent/recurrent disease at last control was significantly more frequent in N1b (29.8%) than in N1a (14.3%), and in N1a than in N0 (4.2%) (p < 0.01 for all). Also, distant metastases were significantly (p < 0.001) more frequent in N1b (14.1%) than in N1a (4.3%) and N0 (1.6%). LN metastases' number (>5) was a significant risk factor for persistent/recurrent disease only for N1a patients. CONCLUSIONS These data indicate that persistent/recurrent disease and distant metastases are significantly more frequent in patients with latero-cervical LN (N1b) metastases and that the LN location should be used for a better postsurgical risk stratification.
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Affiliation(s)
- G Sapuppo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
| | - F Palermo
- Infectious Disease, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Russo
- Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M Tavarelli
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
| | - R Masucci
- Department of Surgical Oncology, Garibaldi-Nesima Medical Center, Catania, Italy
| | - S Squatrito
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
| | - R Vigneri
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy
- Humanitas, Catania Oncology Center, Catania, Italy
- Institute of Biostructures and Bioimages, National Research Council, CNR, Catania, Italy
| | - G Pellegriti
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy.
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Nguyen MLT, Hu J, Hastings KG, Daza EJ, Cullen MR, Orloff LA, Palaniappan LP. Thyroid cancer mortality is higher in Filipinos in the United States: An analysis using national mortality records from 2003 through 2012. Cancer 2017; 123:4860-4867. [PMID: 28881423 DOI: 10.1002/cncr.30958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/06/2017] [Accepted: 08/01/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Well-differentiated thyroid carcinoma has a favorable prognosis, but patients with multiple recurrences have drastically lower survival. Filipinos in the United States are known to have high rates of thyroid cancer incidence and disease recurrence. To the authors' knowledge, it is unknown whether Filipinos also have higher thyroid cancer mortality rates. METHODS The authors studied thyroid cancer mortality in Filipino, non-Filipino Asian (NFA), and non-Hispanic white (NHW) adults using US death records (2003-2012) and US Census data. Age-adjusted mortality rates and proportional mortality ratios (PMRs) were calculated. Sex, nativity status, age at death, and educational attainment also were examined. RESULTS The authors examined 19,940,952 deaths. The age-adjusted mortality rates due to thyroid cancer were highest in Filipinos (1.72 deaths per 100,000 population; 95% confidence interval [95% CI], 1.51-1.95) compared with NFAs (1.03 per 100,000 population; 95% CI, 0.95-1.12) and NHWs (1.17 per 100,000 population; 95% CI, 1.16-1.18). Compared with NHWs, higher proportionate mortality was observed in Filipino women (3-5 times higher) across all age groups, and among Filipino men, the PMR was 2 to 3 times higher in the subgroup aged >55 years. Filipinos who completed a higher educational level had a notably higher PMR (5.0) compared with their counterparts who had not (3.5). CONCLUSIONS Negative prognostic factors for thyroid cancer traditionally include age >45 years and male sex. The results of the current study demonstrate that Filipinos die of thyroid cancer at higher rates than NFA and NHW individuals of similar ages. Highly educated Filipinos and Filipino women may be especially at risk of poor thyroid cancer outcomes. Filipino ethnicity should be factored into clinical decision making in the management of patients with thyroid cancer. Cancer 2017;123:4860-7. © 2017 American Cancer Society.
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Affiliation(s)
- Michelle-Linh T Nguyen
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jiaqi Hu
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
| | - Eric J Daza
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - Mark R Cullen
- Center for Population Health Sciences, Stanford University School of Medicine, Stanford, California
| | - Lisa A Orloff
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Latha P Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California
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Ivanova K, Ananiev J, Aleksandrova E, Ignatova MM, Gulubova M. Expression of E-Cadherin/Beta-Catenin in Epithelial Carcinomas of the Thyroid Gland. Open Access Maced J Med Sci 2017; 5:155-159. [PMID: 28507620 PMCID: PMC5420766 DOI: 10.3889/oamjms.2017.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aberrant activation of Wnt signalling pathway may be a common denominator for the development of thyroid tumorigenesis. It was announced that the loss of E-cadherin rather than β-catenin mutation represents a crucial event in determining the degree of differentiation of thyroid carcinomas. AIM The aim of the study was to evaluate the expression of E-cadherin and β-catenin in the thyroid cancer tissue and to correlate these data with some histological and clinical parameters of the tumours. MATERIAL AND METHODS We investigated 112 patients, having thyroid tumours - papillary, follicular, anaplastic and oncocytic carcinomas immunohistochemically with antibodies against E-cadherin and β-catenin. Survival analyses were done. RESULTS E-cadherin expression was focally retained in the tumour cell membranes and the tumour cell cytoplasm of the papillary, follicular and oncocytic thyroid cancers, weather in anaplastic cancers it was almost lost (p = 0.0042, and p = 0.019, respectively, Fisher's Exact Test). The expression of β-catenin in tumour cytoplasm and membrane in papillary cancers was higher as compared to that in the other tumours (p = 0.111, and p = 0.0104, respectively). CONCLUSION Not surprisingly, the presence of aberrant expression of E-cadherin and β-catenin in thyroid cancer has been associated with better patients' prognosis and better differentiated tumour histology.
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Affiliation(s)
- Koni Ivanova
- Medical Faculty, Trakia University, General and Clinical Pathology, Stara Zagora, Bulgaria
| | - Julian Ananiev
- Medical Faculty, Trakia University, General and Clinical Pathology, Stara Zagora, Bulgaria
| | - Elina Aleksandrova
- Medical Faculty, Trakia University, General and Clinical Pathology, Stara Zagora, Bulgaria
| | | | - Maya Gulubova
- Medical Faculty, Trakia University, General and Clinical Pathology, Stara Zagora, Bulgaria
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Pereira F, Pereira SS, Mesquita M, Morais T, Costa MM, Quelhas P, Lopes C, Monteiro MP, Leite V. Lymph Node Metastases in Papillary and Medullary Thyroid Carcinoma Are Independent of Intratumoral Lymphatic Vessel Density. Eur Thyroid J 2017; 6:57-64. [PMID: 28589086 PMCID: PMC5422756 DOI: 10.1159/000457794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/19/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Blood and lymph vessel invasion are well-recognized markers of tumor aggressiveness, as these are the routes that lead to metastases. Thyroid tumors, depending on the histological variant, tend to have distinctive biological behaviors and use different vascular routes to metastasize, yet the mechanisms underlying the metastatic process are still poorly understood. OBJECTIVES The aim of this study was to assess how the lymph vessel density (LVD) in different histological types of thyroid tumors, and in their surrounding tissue, correlate with the presence of lymph node metastases (LNM) and tumor pathological features. METHODS Lymph vessels of papillary thyroid carcinomas (PTC), of the classical (CVPTC, n = 50) and follicular variants (FVPTC, n = 18), and medullary thyroid carcinomas (MTC, n = 34) were immunohistochemically stained against antigen D2-40. The stained area was quantified using a computerized morphometric analysis tool and correlated with the tumor pathological characteristics. RESULTS LVD within all analyzed thyroid tumor subtypes was significantly lower than in the surrounding thyroid tissues (p < 0.001). Despite intratumoral LVD being significantly higher in CVPTC than in FVPTC, and peritumoral LVD being significantly higher in MTC than in PTC (p < 0.05), no correlations were found between LVD (either intratumoral or peritumoral) and the presence of lymph node metastasis. CONCLUSIONS As no LVD differences were found amongst thyroid tumors with or without LNM, dissemination is more likely to depend on the tumor ability to invade the abundant lymph vessel network of the surrounding thyroid tissue than on the ability of the tumor to promote de novo lymphangiogenesis.
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Affiliation(s)
- Filipe Pereira
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Sofia S. Pereira
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Lisbon, Portugal
| | - Marta Mesquita
- Serviço de Anatomia Patológica, Instituto Português Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal
| | - Tiago Morais
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Madalena M. Costa
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Pedro Quelhas
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Lisbon, Portugal
- Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal
| | - Carlos Lopes
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Lisbon, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Lisbon, Portugal
| | - Mariana P. Monteiro
- Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - Valeriano Leite
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
- Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal
- *Valeriano Leite, Serviço de Endocrinologia, Instituto Português de Oncologia de Lisboa, Francisco Gentil, R. Prof. Lima Basto, PT-1099-023 Lisbon (Portugal), E-Mail
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Perisa MM, Sarcevic B, Troselj KG, Grsic K, Sitic S, Seiwerth S. Expression of nm23-H1 and COX-2 in thyroid papillary carcinoma and microcarcinoma. Oncol Lett 2017; 13:3547-3555. [PMID: 28521457 PMCID: PMC5431143 DOI: 10.3892/ol.2017.5876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 01/06/2017] [Indexed: 12/19/2022] Open
Abstract
The expression of non-metastatic expressed/non-metastatic 23 nucleoside diphosphate kinase 1 (nm23-H1) and cyclooxygenase 2 (COX-2) proteins in thyroid carcinoma have been analysed in a number of previous studies, but this requires further study. The current study focused on the expression levels of nm23-H1 and COX-2 in 130 human thyroid papillary carcinoma (PTC) tissues. Of the 130 PTC tissues, 55 were classified as microcarcinoma and may provide information on the development of the specific characteristics of this tumour type. Routine histopathological examination and immunohistochemical detection of nm23-H1 and COX-2 expression was performed on 130 PTC tissues from patients treated in the Clinical Hospital for Tumours (Zagreb, Croatia) between January 2000 and December 2007. The stain intensity of nm23-H1 and COX-2 proteins was compared with the characteristics of the patients and the tumour. The highest overall expression rate of nm23-H1 and COX-2 was 90 and 67.6%, respectively, and the joint expression of these proteins was statistically significant. The median expression level of nm23-H1 was significantly increased in the classical and follicular histological group of the PTC tissues compared with tissues from other histological groups. The median expression level of COX-2 was significantly increased in the follicular histological group, and reduced in the diffuse-sclerosing group of PTC tissues. All the metastatic microcarcinoma tissues had increased expression levels of the two proteins in comparison with microcarcinoma tissues without lymph node metastases; however, this variation was only statistically significant for COX-2 expression levels. Therefore the results of the current study indicate that COX-2 protein levels may be able to differentiate which thyroid papillary microcarcinoma tumours possess metastatic potential.
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Affiliation(s)
- Marija Milkovic Perisa
- Department of Pathology, School of Medicine, University Hospital for Tumours, Sisters of Charity Clinical Hospital Center, Zagreb 10000, Croatia.,Department of Pathology, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Bozena Sarcevic
- Department of Pathology, School of Medicine, University Hospital for Tumours, Sisters of Charity Clinical Hospital Center, Zagreb 10000, Croatia
| | - Koraljka Gall Troselj
- Laboratory for Epigenomics, Division of Molecular Medicine, Rudjer Bošković Institute, Zagreb 10000, Croatia
| | - Kresimir Grsic
- Division of Head and Neck Surgery, Department of Surgical Oncology, University Hospital for Tumours, Sisters of Charity Clinical Hospital Center, Zagreb 10000, Croatia
| | - Sanda Sitic
- Department of Pathology, School of Medicine, University Hospital for Tumours, Sisters of Charity Clinical Hospital Center, Zagreb 10000, Croatia
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Šelemetjev S, Ðoric I, Paunovic I, Tatic S, Cvejic D. Coexpressed High Levels of VEGF-C and Active MMP-9 Are Associated With Lymphatic Spreading and Local Invasiveness of Papillary Thyroid Carcinoma. Am J Clin Pathol 2016; 146:594-602. [PMID: 27806941 DOI: 10.1093/ajcp/aqw184] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Papillary thyroid carcinoma (PTC) usually has a good prognosis, but some patients develop an aggressive course of the disease, leading to a poor outcome. Vascular endothelial growth factor C (VEGF-C) and matrix metalloproteinase 9 (MMP-9) have been shown to play roles in tumor progression in various human malignancies. METHODS We analyzed VEGF-C and active MMP-9 expression profiles in PTC samples using immunohistochemistry and Western blotting. RESULTS Immunohistochemistry showed positive staining for VEGF-C and active MMP-9 in 83% and 57% of PTCs, respectively (n = 60), with a positive correlation between their expression levels (Spearman, P < .001). Concomitant high expression of VEGF-C and active MMP-9 correlated with the presence of lymph node metastasis (P = .005), pT status (P = .004), pTNM tumor stage (P = .005), and particularly the degree of tumor infiltration (P < .001, Fisher exact test). Densitometric analysis of Western blot bands confirmed correlation between VEGF-C and active MMP-9 expression (Wilcoxon and Spearman tests) and significant association with the clinicopathologic parameters (Mann-Whitney and Kruskal-Wallis tests). CONCLUSIONS Association of coexpressed high levels of VEGF-C and active MMP-9 with lymphatic spreading and local invasiveness of PTC suggests their potential usefulness as predictive biomarkers of aggressive PTC behavior.
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Affiliation(s)
| | - Ilona Ðoric
- From the Institute for the Application of Nuclear Energy-INEP
| | - Ivan Paunovic
- Center for Endocrine Surgery, Institute for Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetislav Tatic
- Institute of Pathology, Medical Faculty, University of Belgrade, Belgrade-Zemun, Serbia
| | - Dubravka Cvejic
- From the Institute for the Application of Nuclear Energy-INEP
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Kelil T, Keraliya AR, Howard SA, Krajewski KM, Braschi-Amirfarzan M, Hornick JL, Ramaiya NH, Tirumani SH. Current Concepts in the Molecular Genetics and Management of Thyroid Cancer: An Update for Radiologists. Radiographics 2016; 36:1478-1493. [DOI: 10.1148/rg.2016150206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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42
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Gweon HM, Koo HR, Son EJ, Kim JA, Youk JH, Hong SW, Lim BJ. Prognostic role of the Bethesda System for conventional papillary thyroid carcinoma. Head Neck 2016; 38:1509-14. [DOI: 10.1002/hed.24466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/17/2015] [Accepted: 02/19/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hye Mi Gweon
- Department of Radiology; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Republic of Korea
- Department of Radiology; Hanyang University College of Medicine; Seoul Republic of Korea
| | - Hye Ryoung Koo
- Department of Radiology; Hanyang University College of Medicine; Seoul Republic of Korea
| | - Eun Ju Son
- Department of Radiology; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Republic of Korea
| | - Jeong-Ah Kim
- Department of Radiology; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Republic of Korea
| | - Ji Hyun Youk
- Department of Radiology; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Republic of Korea
| | - Soon Won Hong
- Department of Pathology; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Republic of Korea
| | - Beom Jin Lim
- Department of Pathology; Yonsei University College of Medicine, Gangnam Severance Hospital; Seoul Republic of Korea
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Bartolome A, Boskovic S, Paunovic I, Bozic V, Cvejic D. Stomatin-like protein 2 overexpression in papillary thyroid carcinoma is significantly associated with high-risk clinicopathological parameters and BRAFV600E mutation. APMIS 2016; 124:271-7. [PMID: 26750533 DOI: 10.1111/apm.12505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/02/2015] [Indexed: 11/29/2022]
Abstract
Stomatin-like protein 2 (SLP-2), a member of the stomatin protein family, has emerged as a potential molecular hallmark of tumor progression in several human malignancies. The aim of this study was to analyze SLP-2 expression pattern in benign and malignant thyroid tumors (n = 210) and to examine its relationship with clinicopathological parameters and BRAFV600E mutation in thyroid cancer. SLP-2 immunohistochemical expression was not detected in benign adenomas and was absent/weak in follicular and anaplastic carcinomas. High expression levels of SLP-2, found only in papillary thyroid carcinoma (PTC), particularly in the classical variant, were significantly associated with adverse clinicopathological parameters: lymph node metastasis (p = 0.002), extrathyroid invasion (p < 0.001), pT status (p < 0.001), and advanced tumor stage (p = 0.001). Additional genotyping of PTC cases for the BRAFV600E mutation revealed for the first time a close relation between SLP-2 overexpression and the presence of BRAF mutation (p = 0.02) with high positive rates of lymph node metastasis (70%) and extrathyroid invasion (80%) in these cases. The significant association of SLP-2 overexpression with unfavorable clinicopathological characteristics and BRAFV600E mutation indicates that SLP-2 may have a role in aggressiveness of BRAF-mutated PTC and that SLP-2 evaluation could be clinically useful in identification of high-risk PTC patients.
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Affiliation(s)
- Aleksandar Bartolome
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
| | - Srdjan Boskovic
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
| | - Ivan Paunovic
- Center for Endocrine Surgery, Institute for Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, Belgrade, Serbia
| | - Vesna Bozic
- Department of Endocrine and Cardiovascular Pathology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dubravka Cvejic
- Institute for the Application of Nuclear Energy - INEP, University of Belgrade, Belgrade-Zemun, Serbia
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Papillary Thyroid Cancer and Lung Adenocarcinoma Presenting as Two Primary Malignancies in a Patient with Symptomatic Goiter. Case Rep Med 2015; 2015:394958. [PMID: 26290667 PMCID: PMC4531192 DOI: 10.1155/2015/394958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Accepted: 07/15/2015] [Indexed: 11/26/2022] Open
Abstract
In rare instances, patients may be diagnosed with two different primary malignancies. Though such synchronous malignancies have been documented in sporadic case reports, the overwhelming majority of malignancies involving multiple organs can be attributed to a primary source. Papillary thyroid carcinoma and lung adenocarcinoma are rarely diagnosed within the same year. Our case report presents a patient who was diagnosed with these two malignancies during her same hospital visit. Biopsies results proved that the two malignancies were in fact separate entities and not a consequence of metastasis from a primary source.
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Takami H, Ito Y, Okamoto T, Onoda N, Noguchi H, Yoshida A. Revisiting the guidelines issued by the Japanese Society of Thyroid Surgeons and Japan Association of Endocrine Surgeons: a gradual move towards consensus between Japanese and western practice in the management of thyroid carcinoma. World J Surg 2015; 38:2002-10. [PMID: 24671301 DOI: 10.1007/s00268-014-2498-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In 2010, the Japanese Society of Thyroid Surgeons (JSTS) and Japanese Association of Endocrine Surgeons (JAES) established new guidelines entitled "Treatment of Thyroid Tumors." Since then, several new studies, including those that address the treatment of differentiated thyroid carcinoma (DTC) have been published, and the DTC treatment policy not only of Japanese physicians but those in Western countries has continued to evolve. METHODS We selected six clinical questions regarding the treatment of DTC and revisited them based on newly published data from Western countries and Japan. RESULTS More data have accumulated about treatment of low-risk papillary microcarcinoma. It has become clear that conservative treatment (observation) of low-risk papillary microcarcinoma in elderly patients is an acceptable alternative to immediate surgery. Total thyroidectomy versus hemithyroidectomy for low-risk papillary thyroid carcinoma (PTC) has become an important issue, and some publications after 2010 indicated that hemithyroidectomy is adequate for these low-risk patients. Unfortunately, no published manuscripts on prophylactic central node dissection offered good evidence regarding its indications or included a large number of patients. Also, it was not evident that prophylactic lateral node dissection improves cause-specific survival, although it might reduce lymph node recurrence especially in PTC patients with large tumors, distant metastases, or clinical central node metastases. Although completion total thyroidectomy was not recommended for minimally invasive follicular thyroid carcinoma in our guidelines, it may be better to perform it in elderly patients and those with a large tumor or extensive vascular invasion. Radioactive iodine (RAI) ablation after total thyroidectomy is still performed almost routinely in many Western institutions, although recent studies showed that ablation is not beneficial in low-risk patients. In Japan, because of legal restrictions, most patients did not undergo RAI ablation, and their prognoses are excellent. CONCLUSIONS Recently, policy for treating DTCs has changed not only in Western countries but also in Japan, resulting in a gradual move toward consensus between Western practice and ours. We will continue to present the best treatments for patients with thyroid carcinoma each time we revise our guidelines.
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Noda S, Onoda N, Morisaki T, Kashiwagi S, Takashima T, Hirakawa K. The significance and the predictive factors of microscopic lymph node metastasis in patients with clinically node negative papillary thyroid cancer: A retrospective cohort study. Int J Surg 2015; 20:52-7. [PMID: 26079502 DOI: 10.1016/j.ijsu.2015.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/11/2015] [Accepted: 06/07/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND The management of pathological lateral node involvement (pN1b) from papillary thyroid cancer (PTC) are controversial. METHODS A consecutive series of 246 patients, diagnosed with clinically node negative (cN0) PTC who had undergone surgery with prophylactic lateral node dissection, and without postoperative radioactive iodine administration from 2001 to 11, were reviewed to clarify the significance of pN1b. RESULTS Eighty-five (35%) patients had pN1b disease. One-half and 30% had pN1b in younger (age less than 45) and older patients (age 45 or over), respectively. Tumor size (≥ 21 mm) could predict pN1b disease in older patients. Patients with pN1b disease recurred more frequently (9 cases, 10.6%) than those without (4 cases, 2.4%), and 2 cases with pN1b died of the disease. CONCLUSIONS pN1b disease was commonly found in patients with PTC even when they were diagnosed clinically as node negative. pN1b disease with prognostic meaning was often found in the older patients with larger PTC indicating the necessity for adjuvant treatments.
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Affiliation(s)
- Satoru Noda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan.
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Tamami Morisaki
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Shinichiro Kashiwagi
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Tsutomu Takashima
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
| | - Kosei Hirakawa
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, Japan
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Rapoport A, Curioni OA, Amar A, Dedivitis RA. Review of survival rates 20-years after conservative surgery for papillary thyroid carcinoma. Braz J Otorhinolaryngol 2015; 81:389-93. [PMID: 26120098 PMCID: PMC9442766 DOI: 10.1016/j.bjorl.2014.08.020] [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: 03/06/2014] [Accepted: 08/24/2014] [Indexed: 12/05/2022] Open
Abstract
Introduction A less extensive thyroidectomy could be used for patients in the low risk group. Objective To perform a critical follow-up after lobectomy with isthmusectomy for the treatment of papillary thyroid carcinoma in patients with a single nodule limited to the periphery of the lobe. Methods Thirty-one patients with thyroid papillary carcinoma operated on till 1993 were selected. They had undergone lobectomy with isthmusectomy. This is a retrospective cohort study in which the oncological outcome (contralateral and regional recurrence) and the reoperation complications (recurrent nerve paralysis/paresis and hypoparathyroidism) were evaluated. Descriptive analysis was employed. Results In the last decade (2003–2013), 6 (20%) contralateral recurrences were observed in the remaining lobe and in 1 of these cases (3%), contralateral lymph node metastases were noted. A completion thyroidectomy plus lymphadenectomy was performed, without modification of global survival. Conclusion Because of the rate of 20% of contralateral recurrence after a 20-year follow-up, we suggest modification of the surgical paradigm for total thyroidectomy as an initial therapy.
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Affiliation(s)
- Abrão Rapoport
- Department of Surgery, Medicine School, Universidade de São Paulo (USP), São Paulo, SP, Brazil; Department of Health, Hospital Heliópolis, São Paulo, SP, Brazil
| | - Otávio Alberto Curioni
- Lusíada Foundation (UNILUS), São Paulo, SP, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, Hospital Heliópolis, São Paulo, SP, Brazil
| | - Ali Amar
- Lusíada Foundation (UNILUS), São Paulo, SP, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, Hospital Heliópolis, São Paulo, SP, Brazil
| | - Rogério Aparecido Dedivitis
- Larynx Group, Department of Head and Neck Surgery, Hospital das Clínicas, Medicine School, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
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Aboelnaga EM, Ahmed RA. Difference between papillary and follicular thyroid carcinoma outcomes: an experience from Egyptian institution. Cancer Biol Med 2015; 12:53-9. [PMID: 25859412 PMCID: PMC4383844 DOI: 10.7497/j.issn.2095-3941.2015.0005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/11/2015] [Indexed: 01/08/2023] Open
Abstract
Objective Differentiated thyroid carcinomas (DTCs) are classified into papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). DTCs are analyzed as a single group in clinical studies that investigated the prognostic factors and prognosis of these malignancies. However, the biological behaviors of these carcinomas significantly differ. In the present study, we aimed to detect differences in the outcomes between PTC and FTC in Mansoura University Hospital in Egypt. Methods A total of 558 patients with histologically proven thyroid carcinomas from January 2003 to December 2012 were retrospectively enrolled. The clinical and pathological data of patients were reviewed. Results Large primary tumor size, lymph node involvement, extrathyroid extension, and distant metastasis were significant poor prognostic factors for overall survival (OS) in old PTC patients. Cox hazard analysis showed that the patient’s age, extra thyroid extension, and distant metastasis were the only independent prognostic factors. In FTC patients, only the distant metastasis and degree of tumor invasion were significant poor prognostic factors in OS univariate analysis. However, these factors were nonsignificant in multivariate analysis. The 10-year OS rates were 97% and 89% for PTC and FTC, respectively (P=0.003). The 10-year disease-free survival (DFS) rates were 77.2% in PTC vs. 65% in FTC (P=0.179). Conclusion The significant prognostic factors vary between the two types of DTCs. Therefore, PTC and FTC patients need to be analyzed and reported independently. PTC survival is widely and significantly affected by age, extrathyroid extension, and distant metastasis. By contrast, these factors were nonsignificant in FTC, which showed poorer survival than PTC.
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Affiliation(s)
- Engy M Aboelnaga
- 1 Clinical Oncology and Nuclear Medicine Department, 2 Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
| | - Rehab Allah Ahmed
- 1 Clinical Oncology and Nuclear Medicine Department, 2 Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
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Li F, Chen G, Sheng C, Gusdon AM, Huang Y, Lv Z, Xu H, Xing M, Qu S. BRAFV600E mutation in papillary thyroid microcarcinoma: a meta-analysis. Endocr Relat Cancer 2015; 22:159-68. [PMID: 25593071 PMCID: PMC4629836 DOI: 10.1530/erc-14-0531] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The prognostic value of the BRAFV600E mutation, resulting in poor clinical outcomes of papillary thyroid carcinoma, has been generally confirmed. However, the association of BRAFV600E with aggressive clinical behaviors of papillary thyroid microcarcinoma (PTMC) has not been firmly established in individual studies. We performed this meta-analysis to examine the relationship between BRAFV600E mutation and the clinicopathological features of PTMC. We conducted a systematic search in PubMed, EMBASE, and the Cochrane library for relevant studies. We selected all the studies that reported clinicopathological features of PTMC patients with information available on BRAFV600E mutation status. Nineteen studies involving a total of 3437 patients met these selection criteria and were included in the analyses. The average prevalence of the BRAFV600E mutation was 47.48%, with no significant difference with respect to patient sex (male versus female) and age (younger than 45 years versus 45 years or older). Compared with the WT BRAF gene, the BRAFV600E mutation was associated with tumor multifocality (odds ratio (OR) 1.38; 95% CI, 1.04-1.82), extrathyroidal extension (OR 3.09; 95% CI, 2.24-4.26), lymph node metastases (OR 2.43; 95% CI, 1.28-4.60), and advanced stage (OR 2.39; 95% CI, 1.38-4.15) of PTMC. Thus, our findings from this large meta-analysis definitively demonstrate that BRAFV600E-mutation-positive PTMC are more likely to manifest with aggressive clinicopathological characteristics. In appropriate clinical settings, testing for the BRAFV600E mutation is likely to be useful in assisting the risk stratification and management of PTMC.
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Affiliation(s)
- Fei Li
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment o
| | - Guangqi Chen
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Chunjun Sheng
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Aaron M Gusdon
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Yueye Huang
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Zhongwei Lv
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Huixiong Xu
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Mingzhao Xing
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Shen Qu
- Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment of Neurology and NeuroscienceWeill Cornell Medical College, New York, New York 10065, USADepartments of Nuclear MedicineUltrasound MedicineShanghai Tenth People's Hospital, Shanghai 200072, ChinaThyroid InstituteTongji University, Shanghai 200072, ChinaDivision of EndocrinologyDiabetes and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA Department of EndocrinologyShanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yan Chang Middle Road, Shanghai 200072, ChinaFirst Clinical Medical CollegeNanjing Medical University, Nanjing 210029, ChinaJiangsu Institute of Nuclear MedicineWuxi 214063, ChinaDepartment of CardiologyShanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, ChinaDepartment o
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Kakudo K, Wakasa T, Ohta Y, Yane K, Ito Y, Yamashita H. Prognostic classification of thyroid follicular cell tumors using Ki-67 labeling index: risk stratification of thyroid follicular cell carcinomas. Endocr J 2015; 62:1-12. [PMID: 25195708 DOI: 10.1507/endocrj.ej14-0293] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This review emphasizes that the so-called high-risk thyroid carcinoma is not a distinct tumor entity, but a group of tumors with different histologies. High-grade histological features, such as tumor necrosis, increased mitoses, and nuclear pleomorphism, together with high Ki-67 labeling index (more than 10%), are good indicators of high-risk thyroid carcinoma and suggest a possible risk for anaplastic transformation. This review proposes the stratification of patients with thyroid carcinoma into low-, moderate-, and high-risk groups based on Ki-67 labeling index, which should be useful for the clinical management of patients, even after initial surgery. Currently, both the aggressive variant of papillary carcinoma and poorly differentiated carcinoma are aggressively treated by a completion of total thyroidectomy with prophylactic lymph node dissection followed by radioactive iodine treatment. Therefore, patients with moderate-risk or high-risk thyroid carcinoma based on Ki-67 labeling index should also be considered candidates for this treatment strategy.
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Affiliation(s)
- Kennichi Kakudo
- Department of Pathology and Laboratory Medicine, Nara Hospital Kinki University Faculty of Medicine, Ikoma-city 630-0293, Japan
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