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Kyrilli A, Schoinochoriti R, Chatzopoulos V, Bahar N, Bouziotis J, D'Haene N, Salmon I, Ruiz M, Corvilain B. Thyrotropin (TSH) and thyroid autoimmunity are predictive factors for the incidental discovery of papillary thyroid microcarcinoma during thyroidectomy. Endocrine 2024:10.1007/s12020-024-03907-z. [PMID: 38896365 DOI: 10.1007/s12020-024-03907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To identify clinical, biological and pathological risk factors for the incidental discovery of papillary thyroid microcarcinomas (PTMCs) in patients undergoing thyroidectomy for presumed benign conditions. METHODS Cross sectional, single center study, involving all consecutive patients (N = 3015) who were submitted to thyroid surgery between 2001-2019. All medical files were retrospectively reviewed. A total of 1961 patients in the benign group and 145 patients in PTMC group were analyzed. RESULTS No significant differences in age, sex, body mass index, smoking status, thyroid volume or weight and preoperative thyroxine treatment between benign and PTMC groups were observed. Circulating anti- thyroid antibodies, histological thyroiditis and serum thyrotropin (TSH) were significantly associated with PTMC in univariable analysis. Independent risk factors for incidental PTMC by multivariable analysis where possible (OR: 1.51, 95% CI: 0.99-2.28) and certain (OR: 1.74, 95% CI: 1.09-2.78) thyroid autoimmunity (p = 0.002) and higher serum TSH (OR: 1.25, 95% CI: 1.08-1.45, p = 0.03), whereas thyroid lobectomy was associated with a lower risk of PTMC (OR: 0.40, 95% CI: 0.24-0.67, p < 0.001). The most frequent genetic alteration was BRAFV600E mutation, found in 56.3% of PTMC submitted to DNA sequencing. No association between clinical, biological or histological characteristics of PTMC and BRAFV600E mutation was observed. CONCLUSIONS Thyroid autoimmunity and higher preoperative serum TSH level were independent predictors of PTMC incidentally discovered during thyroid surgery. Larger prospective studies are needed to better identify possible risk factors for papillary thyroid carcinoma initiation and progression.
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Affiliation(s)
- Aglaia Kyrilli
- Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium.
| | - Rafaella Schoinochoriti
- Department of Pediatrics, Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Valerie Chatzopoulos
- Department of Radiology, H.U.B.-Institut Jules Bordet, 90 Rue Meylemeersch, 1070, Brussels, Belgium
| | - Nabila Bahar
- Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Jason Bouziotis
- Departement of Biomedical Research Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Nicky D'Haene
- Department of Pathology, Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Isabelle Salmon
- Department of Pathology, Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Maria Ruiz
- Department of Thoracic Surgery, Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Bernard Corvilain
- Department of Endocrinology, Hôpital Universitaire de Bruxelles (H.U.B.)-Hôpital Erasme, 808 Route de Lennik, 1070, Brussels, Belgium
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Zhao H, Liu CH, Lu Y, Liu SZ, Yeerkenbieke P, Cao Y, Xia Y, Gao LY, Liu YW, Liu ZW, Chen SG, Liang ZY, Li XY. BRAF V600E mutation does not predict lymph node metastases and recurrence in Chinese papillary thyroid microcarcinoma patients. Oral Oncol 2024; 152:106755. [PMID: 38547780 DOI: 10.1016/j.oraloncology.2024.106755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 05/01/2024]
Abstract
OBJECT Previous studies suggest BRAFV600E mutation is a marker for poor prognosis in papillary thyroid cancer, however, its ability to further risk stratify papillary thyroid microcarcinoma (PTMC) remains controversial. We aimed to explore the association between BRAFV600E mutation and the clinicopathological features and recurrence in Chinese PTMC patients. METHODS We retrospectively reviewed 2094 PTMC patients who underwent surgery and had a valid BRAFV600E mutation test result. Among them, 1292 patients had complete follow-up data. The mutation incidence was determined. Moreover, the clinicopathological characteristics, disease-free survival (DFS), and response to therapy distribution were compared between the mutation and non-mutation groups. RESULTS BRAFV600E mutation was observed in 90.6 % of all patients and 89.2 % of patients with complete follow-up data. No significant difference was observed in lymph node metastases (LNM) number categories between the mutation and non-mutation groups among all patients (P = 0.329) and 1292 patients (P = 0.408). Neither the 3-year DFS (97.9 % vs. 98.0 %, P = 0.832) nor the response to therapy distribution (P > 0.05) indicated a significant difference between the mutation and non-mutation groups. The 3-year DFS differs among patients having different LNM number categories (99.8 % vs. 98.5 % vs. 77.3 %, P < 0.001). Multivariate analysis revealed that high-volume (over 5) LNM (Total thyroidectomy (TT): OR = 4.000, 95 % CI 2.390-6.694, P < 0.001; Unilateral thyroidectomy (UT): OR = 4.183, 95 % CI 1.565-11.190, P = 0.004), rather than BRAFV600E mutation (P > 0.05), was an independent risk factor of response to therapy. CONCLUSIONS Our results suggested that BRAFV600E mutation could not accurately predict LNM or the recurrence of Chinese PTMC patients. Moreover, high-volume LNM is significantly associated with PTMC prognosis.
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Affiliation(s)
- Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China; Surgery Centre of Diabetes Mellitus, Beijing Shijitan Hospital, Capital Medical University, Beijing 100036, China.
| | - Chun-Hao Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China.
| | - Ying Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China.
| | - Shu-Zhou Liu
- Department of Head & Neck Surgery, Hainan General Hospital, Hainan 570311, China.
| | - Palashate Yeerkenbieke
- Department of General Surgery, Xinjiang Yili Kazak Autonomous Prefecture Friendship Hospital, Xinjiang 835099, China.
| | - Yue Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China.
| | - Yu Xia
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sci-ences & Peking Union Medical College, Beijing 100010, China.
| | - Lu-Ying Gao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sci-ences & Peking Union Medical College, Beijing 100010, China.
| | - Yue-Wu Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China.
| | - Zi-Wen Liu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China.
| | - Shu-Guang Chen
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China.
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Xiao-Yi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100010, China.
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Ding Y, Peng Y, Zhang J, Pan X, Huang X, Zhang CQ. Diagnostic value of contrast-enhanced ultrasound in the diagnosis of papillary thyroid microcarcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37768. [PMID: 38608080 PMCID: PMC11018218 DOI: 10.1097/md.0000000000037768] [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: 08/20/2023] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Using meta-analysis to evaluate the diagnostic value of contrast-enhanced ultrasound (CEUS) in the diagnosis of papillary thyroid microcarcinoma (PTMC). METHODS For this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, WanFang Data, VPCS Data, and China National Knowledge Infrastructure electronic databases for diagnostic studies on PTMC by CEUS from January 2013 to November 2022. Data were not available or incomplete such as case reports, nonhuman studies, etc, were excluded. Random-effects meta-analyses were used to evaluate the diagnostic accuracy of CEUS in diagnosing PTMC. The quality of the evidence was assessed with the QUADAS-2 scale. This study is registered on PROSPERO, number CRD42023409417. RESULTS Of 1064 records identified, 33 were eligible. The results showed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of CEUS in diagnosing PTMC were 0.84 (95% confidence interval [CI] = 0.83-0.86), 0.82 (95% CI = 0.80-0.83), 3.90 (95% CI = 3.23-4.72), 0.21 (95% CI = 0.18-0.25), and 20.01 (95% CI = 14.97-26.74), respectively, and the area under the summary receiver operating characteristic curve was 0.8930 (the Q index was 0.8239). The Deek funnel plot indicated publication bias (P ˂.01). CONCLUSION This meta-analysis provides an overview of diagnostic accuracy of CEUS in diagnosing PTMC which indicates CEUS has a good diagnostic value for PTMC. The limitations of this study are publication bias and strong geographical bias.
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Affiliation(s)
- Yan Ding
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yulan Peng
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Jing Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xueqin Pan
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xu Huang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Chun-Quan Zhang
- Department of Ultrasound, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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Shang S, Yang H, Chen M, Wu J, Shi X, Li X, Feng N, Zheng Z, Liu H, Zhang Y. Correlation between genetic alterations and clinicopathological features of papillary thyroid carcinomas. J Int Med Res 2024; 52:3000605241233166. [PMID: 38456650 PMCID: PMC10924567 DOI: 10.1177/03000605241233166] [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] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To investigate the correlations between multigene alterations and clinicopathological features in papillary thyroid carcinoma (PTC) samples. METHODS In this retrospective study, 111 cytological specimens of thyroid nodules, including 74 PTC samples and 37 benign samples, were analyzed using a 22-gene mutation assay employing next-generation sequencing. Clinicopathological information was retrospectively collected and analyzed. RESULTS Gene alterations were associated with a higher rate of lymph node metastasis (LNM) and thyroid capsular invasion, a lower rate of coexisting Hashimoto's thyroiditis, the classical PTC subtype, and younger age (<45 years). Among the 22 genes tested, the BRAF mutation rates showed a significant difference between the PTC and benign groups. In the subgroup analysis, younger age (odds ratio = 12.512, 95% confidence interval: 3.126-50.087) was an independent risk factor for LNM. In further analyses, BRAF mutation was significantly associated with LNM in the older subgroup (age ≥ 45 years), suggesting that the BRAF mutation test has greater value for determining PTC prognosis in the older age group. CONCLUSIONS Our findings will provide a more comprehensive understanding of the relationship between gene mutations and PTC and may contribute to improved PTC management.
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Affiliation(s)
- Shixuan Shang
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Huimin Yang
- Shanghai Singlera Medical Laboratory, Shanghai, China
| | - Meixiang Chen
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Jin Wu
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Xianjun Shi
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Xiangqin Li
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Ningning Feng
- Shanghai Singlera Medical Laboratory, Shanghai, China
| | | | - Hongmei Liu
- Shanghai Singlera Medical Laboratory, Shanghai, China
| | - Yunzhi Zhang
- Shanghai Singlera Medical Laboratory, Shanghai, China
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Ahmadi S, Landa I. The prognostic power of gene mutations in thyroid cancer. Endocr Connect 2024; 13:e230297. [PMID: 38078934 PMCID: PMC10831542 DOI: 10.1530/ec-23-0297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/11/2023] [Indexed: 01/17/2024]
Abstract
The introduction and generalization of next-generation sequencing techniques have significantly increased the identification of mutations in thyroid tumors from multiple patient cohorts. The understanding of the association between specific mutations and clinical outcomes is gradually leading to individualizing the care of patients with thyroid cancer. BRAFV600 is the most common mutation seen in thyroid cancer patients and unequivocally predicts malignancy, but when considered in isolation, it is not recommended to be used as an independent prognostic factor. Mutations in RAS are the second most common alterations in thyroid cancer but can be found in benign and malignant lesions. Rearrangements involving receptor tyrosine kinases, primarily RET, are found in a subset of thyroid tumors without mutations in either BRAF or RAS. The assessment of additional mutations is increasingly employed in thyroid cancer prognostication. The coexistence of BRAF with alterations in genes such as PIK3CA, TERT promoter, or TP53 is associated with less favorable outcomes. Similar studies have also shown that additional oncogenic mutations in RAS-mutant thyroid carcinoma, such as those affecting the EIF1AX gene, likely predict a more aggressive clinicopathologic behavior. Overall, emerging evidence suggests that the co-occurrence of specific alterations in defined genes with BRAF or RAS mutations can become prognostic tools and useful predictors of thyroid tumor aggressiveness.
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Affiliation(s)
- Sara Ahmadi
- Division of Endocrinology, Thyroid Section, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Iñigo Landa
- Division of Endocrinology, Thyroid Section, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Kim MJ, Moon JH, Lee EK, Song YS, Jung KY, Lee JY, Kim JH, Kim K, Park SK, Park YJ. Active Surveillance for Low-Risk Thyroid Cancers: A Review of Current Practice Guidelines. Endocrinol Metab (Seoul) 2024; 39:47-60. [PMID: 38356210 PMCID: PMC10901665 DOI: 10.3803/enm.2024.1937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
The indolent nature and favorable outcomes associated with papillary thyroid microcarcinoma have prompted numerous prospective studies on active surveillance (AS) and its adoption as an alternative to immediate surgery in managing low-risk thyroid cancer. This article reviews the current status of AS, as outlined in various international practice guidelines. AS is typically recommended for tumors that measure 1 cm or less in diameter and do not exhibit aggressive subtypes on cytology, extrathyroidal extension, lymph node metastasis, or distant metastasis. To determine the most appropriate candidates for AS, factors such as tumor size, location, multiplicity, and ultrasound findings are considered, along with patient characteristics like medical condition, age, and family history. Moreover, shared decision-making, which includes patient-reported outcomes such as quality of life and cost-effectiveness, is essential. During AS, patients undergo regular ultrasound examinations to monitor for signs of disease progression, including tumor growth, extrathyroidal extension, or lymph node metastasis. In conclusion, while AS is a feasible and reliable approach for managing lowrisk thyroid cancer, it requires careful patient selection, effective communication for shared decision-making, standardized follow-up protocols, and a clear definition of disease progression.
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Affiliation(s)
- Min Joo Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, National Cancer Center, Goyang, Korea
| | - Young Shin Song
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ji Ye Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Deparment of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Deparment of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungsik Kim
- Deparment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sue K. Park
- Deparment of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Bandoh N, Goto T, Kato Y, Kubota A, Sakaue S, Takeda R, Hayashi S, Hayashi M, Baba S, Yamaguchi-Isochi T, Nishihara H, Kamada H. BRAF V600E mutation co-existing with oncogenic mutations is associated with aggressive clinicopathologic features and poor prognosis in papillary thyroid carcinoma. Asian J Surg 2024; 47:413-419. [PMID: 37752023 DOI: 10.1016/j.asjsur.2023.09.049] [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: 06/28/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the correlation among mutations in cancer-related genes, clinicopathologic features, and clinical outcome in classical papillary thyroid carcinoma (PTC). PATIENTS AND METHODS A total of 130 patients with classical PTC who underwent curative surgery between April 2012 and June 2023 at Hokuto Hospital were included. Mutations in targeted regions of 160 cancer-related genes were detected by next-generation sequencing (NGS)-based cancer panel testing. RESULTS The BRAF V600E mutation was detected in 108 (83.1%) of 130 PTC patients. Among the 108 patients with the BRAF V600E mutation, other co-existing oncogenic mutations were found in 12 (9.2%) patients. When we divided into 3 groups of no mutations, BRAF V600E mutation alone, and BRAF V600E and other oncogenic mutations, significant differences were observed in terms of tracheal invasion (P = 0.0024), and bilateral neck lymph node metastasis (P = 0.0047). Kaplan-Meier analysis of overall survival (OS) revealed patients with BRAF V600E and other oncogenic mutations had significantly poorer survival than those with BRAF V600E mutation alone (P = 0.0026). Multivariate cox proportional hazard analysis revealed BRAF V600E and other oncogenic mutations was an independent prognostic factor for OS (HR: 10.559; 95%CI: 1.007-110.656, P = 0.0493). CONCLUSIONS The BRAF V600E mutation co-existing with other oncogenic mutations but not the BRAF V600E mutation alone was associated with aggressive clinicopathologic features, resulting in poor prognosis in patients with classical PTC. Detection of oncogenic mutations using NGS-based cancer panel testing could enhance understanding of the clinical features of classical PTC.
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Affiliation(s)
- Nobuyuki Bandoh
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan.
| | - Takashi Goto
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan
| | - Yasutaka Kato
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan
| | - Akinobu Kubota
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan; Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Shota Sakaue
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan; Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Ryuhei Takeda
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan; Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Shuto Hayashi
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan; Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Misaki Hayashi
- Department of Otolaryngology-Head and Neck Surgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan; Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan
| | - Shogo Baba
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan
| | - Tomomi Yamaguchi-Isochi
- Department of Biology and Genetics, Laboratory of Cancer Medical Science, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan
| | - Hiroshi Nishihara
- Keio Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan
| | - Hajime Kamada
- Department of Neurosurgery, Hokuto Hospital, Inadacho Kisen 7-5, Obihiro, Hokkaido, 080-0833, Japan
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Alzahrani AS. Clinical use of Molecular Data in Thyroid Nodules and Cancer. J Clin Endocrinol Metab 2023; 108:2759-2771. [PMID: 37200449 DOI: 10.1210/clinem/dgad282] [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: 04/12/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
Over the past 3 decades, advances in the molecular genetics of thyroid cancer (TC) have been translated into diagnostic tests, prognostic markers, and therapeutic agents. The main drivers in differentiated TC pathogenesis are single-point mutations and gene fusions in components of the Mitogen-activated protein kinase (MAPK) and phosphoinositide-3-kinase-protein kinase B/Akt (PI3K/Akt) pathways. Other important genetic alterations in the more advanced types of TC include TERT promoter, TP53, EIF1AX, and epigenetic alterations. Using this knowledge, several molecular tests have been developed for cytologically indeterminate thyroid nodules. Currently, 3 commercially available tests are in use including a DNA/RNA-based test (ThyroSeq v.3), an RNA-based test (Afirma Gene Sequencing Classifier), and a hybrid DNA/miRNA test, ThyGeNEXT/ThyraMIR. These tests are mostly used to rule out malignancy in Bethesda III and IV thyroid nodules because they all have high sensitivities and negative predictive values. Their common use, predominantly in the United States, has resulted in a significant reduction in unnecessary thyroid surgeries for benign nodules. Some of these tests also provide information on the underlying molecular drivers of TC; this may support decision making in initial TC management planning, although this practice has not yet been widely adopted. More importantly, molecular testing is essential in patients with advanced disease before using specific mono-kinase inhibitors (eg, selpercatinib for RET-altered TC) because these drugs are ineffective in the absence of a specific molecular target. This mini-review discusses the utilization of molecular data in the clinical management of patients with thyroid nodules and TC in these different clinical situations.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine and Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia
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Tang L, Qu RW, Park J, Simental AA, Inman JC. Prevalence of Occult Central Lymph Node Metastasis by Tumor Size in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Curr Oncol 2023; 30:7335-7350. [PMID: 37623013 PMCID: PMC10453273 DOI: 10.3390/curroncol30080532] [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: 05/01/2023] [Revised: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND While papillary thyroid carcinoma (PTC) is associated with high occult central neck metastasis (CNM) rates, prophylactic central neck dissection (pCND) is controversial. This meta-analysis aims to look at the occult CNM rate according to tumor size. METHODS A literature search was conducted in PubMed from inception to April 2023. Inclusion criteria were primary studies that determined occult CNM rates in cN0 PTC by tumor size. Heterogeneity, influential case diagnostics, and proportion data were evaluated with Cochran's Q-test, Baujat plots and Forest plots, respectively. RESULTS Fifty-two studies were included in this meta-analysis. The findings demonstrated an occult CNM rate of 30.3% for tumors ≤ 5 mm, 32.7% for tumors ≤ 1 cm, 46.0% for tumors between 1 and 2 cm, 43.1% for tumors between 2 and 4 cm, and 61.2% for tumors > 4 cm. The heterogeneity of each study group was high, though no publication bias was noted. While there was a trend towards increased occult CNM rates with larger tumors, comparisons between different size cutoffs varied in significance. CONCLUSION This comprehensive review affirms that occult CNM is high and that an ipsilateral pCND can be justified in all PTC patients for accurate differentiation between Stage I and Stage II disease and its clinical implications.
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Affiliation(s)
- Liyang Tang
- Department of Otolaryngology—Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA 92354, USA (J.C.I.)
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Parpounas C, Constantinides V. Advances in Molecular Profiling and Their Potential Influence on the Extent of Surgery in Well-Differentiated Thyroid Carcinoma (WDTC). Life (Basel) 2023; 13:1382. [PMID: 37374164 DOI: 10.3390/life13061382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Thyroid cancer surgery has evolved dramatically with advances in our understanding of the biological behaviour of WDTC. Molecular profiling is shedding light on the subset that may behave aggressively. In an era when thyroid cancer management is becoming increasingly conservative, decision making regarding the extent of surgery must be objectively guided by molecular markers. The aim of the present article is to summarise the current published literature and provide possible practice recommendations. An online search for relevant published articles was performed using several databases. Title, abstract, and full-text screening, along with data extraction, was performed by two independent reviewers after the inclusion and exclusion criteria were defined. A total of 1241 articles were identified, and 82 relevant articles were extracted and scrutinised. BRAF V600E and TERT promoter mutations were found to be associated with an increased risk of disease recurrence and distant metastases. Several other mutations have been identified that enhance disease aggressiveness (such as RET/PTC, PTEN, and TP53). One of the most important determinants of the outcome in WDTC is the extent of surgical resection. The evolution of molecular testing has reached a stage of personalised incorporation into surgical practice. Guidelines for molecular testing and surgery in WDTC will need to be clearly defined, arguably representing the next chapter in the management of the disease.
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Affiliation(s)
- Constantinos Parpounas
- Department of Endocrine Surgery, Evangelistria Medical Centre, 1 Michael Giorgalla Street, 1095 Nicosia, Cyprus
| | - Vasilis Constantinides
- Department of Endocrine Surgery, Evangelistria Medical Centre, 1 Michael Giorgalla Street, 1095 Nicosia, Cyprus
- Medical School, University of Nicosia, 93 Ayiou Nikolaou Street, Engomi, 2408 Nicosia, Cyprus
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Brain metastases of papillary thyroid carcinoma origin are derived from aggressive histologic variants and demonstrate similar adverse morphology in the metastatic lesion. Clin Neurol Neurosurg 2023; 227:107639. [PMID: 36889238 DOI: 10.1016/j.clineuro.2023.107639] [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: 01/06/2023] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Distant metastases of papillary thyroid carcinoma are exceedingly rare. We analyzed all cases of brain metastases of papillary thyroid cancer at our institution and performed a literature review over the past ten years to identify histologic and molecular features of primary and metastatic tumors. METHODS Following institutional review board approval, the entire pathology archives at our institution were searched for cases of papillary thyroid carcinoma metastatic to brain. Patient demographics, histologic features of both primary and metastatic tumors, molecular information, and clinical outcomes were investigated. RESULTS We identified 8 cases of metastatic papillary thyroid carcinoma to brain. The average age at time of diagnosis of metastases was 56.3 years (range: 30-85). Average time from diagnosis of primary thyroid cancer to brain metastasis was 9.3 years (range: 0-24 years). All primary thyroid carcinomas demonstrated aggressive sub-types which were correspondingly seen in brain metastases. Next-generation sequencing revealed the most common mutations were identified in BRAFV600E, NRAS, and AKT1 with one tumor harboring a TERT promoter mutation. Six out of eight patients were deceased at the time of study with an average survival time of 2.3 years (range: 0.17-7 years) following diagnosis of brain metastasis. CONCLUSIONS Based on our study, it is highly unlikely that a low-risk variant of papillary thyroid carcinoma will metastasize to the brain. Therefore, careful and accurate reporting of the papillary thyroid carcinoma subtype in primary thyroid tumors is warranted. Certain molecular signatures are associated with more aggressive behavior and worse patient outcomes and next-generation sequencing should be performed on metastatic lesions.
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Incidental Papillary Microcarcinoma and Papillary Thyroid Carcinoma in Multinodular Goiter. Anal Cell Pathol (Amst) 2023; 2023:2768344. [PMID: 36691406 PMCID: PMC9867591 DOI: 10.1155/2023/2768344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction This study aimed to examine the incidence of incidental papillary microcarcinoma (PMC) and papillary thyroid carcinoma (PTC) in patients with benign multinodular goiter (MNG) and to compare their relationship with some prognostic factors from a new perspective. Methods Bilateral total thyroidectomy (BTT) was used to evaluate the data of 716 patients who underwent a surgery for MNG. The prognostic data for these tumors and the relationship between patients with bilateral and multifocal tumors were evaluated using statistical tests. Results Papillary carcinomas were detected in 201 patients, PMC in 134 of them, and PTCs in 67. Bilaterality was more common in patients with PTCs than in those with PMC. The incidence of bilaterality in male patients with PTC was statistically more common. The presence of intra-tumoral lymphocytes was higher in multifocal PTC cases than in unifocal PTC cases. Conclusion The results revealed that the number of PMC s was high in incidental tumors, and patients with PTC with male sex, bilaterality, multifocality, and tumor capsule invasion were associated with poor prognosis.
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Abstract
Recently, the incidence of thyroid carcinoma has been increasing rapidly worldwide. This is interpreted as an increase in the incidental detection of small papillary thyroid carcinomas by the widespread use of high-resolution imaging techniques such as ultrasonography. However, the mortality rates of thyroid carcinoma have not changed, suggesting that small papillary thyroid carcinomas may be overdiagnosed and overtreated. Active surveillance management has been introduced from Japan since the 1990s, as one of the measures to prevent overtreatment of low-risk papillary thyroid microcarcinoma. Based on the favorable outcomes, active surveillance has been gradually adopted worldwide as an alternative to immediate surgery. The management should be carried out with strict eligibility criteria and close monitoring for cancer progression, under a multidisciplinary team. In addition, an adequate shared decision-making is mandatory for individual patients. Papillary thyroid microcarcinomas with clinically apparent lymph node metastasis, distant metastasis, or invasion to adjacent organs should have surgery.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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14
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Kuchareczko A, Kopczyński J, Kowalik A, Hińcza-Nowak K, Walczyk A, Pałyga I, Trybek T, Szymonek M, Gąsior-Perczak D, Gadawska-Juszczyk K, Mikina E, Płachta I, Suligowska A, Płusa A, Chrapek M, Łopatyński T, Góźdź S, Kowalska A. A Significance of Concomitant BRAF V600E and TERT Mutations in Polish Patients with Papillary Thyroid Microcarcinoma: A Retrospective Cohort Study Based on 430 Cases. Thyroid 2022; 32:1372-1381. [PMID: 35950639 DOI: 10.1089/thy.2022.0155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The incidence of papillary thyroid cancer is increasing worldwide due to more frequent pathological detection of papillary thyroid microcarcinomas (PTMC), which are cancers measuring 1 cm or less in diameter. In rare cases, the course of PTMC can be aggressive, with an increased risk of recurrence/persistent disease. The aim of this study of Polish patients diagnosed with PTMC was to assess the impact of concomitant B-type Raf kinas-activating mutation in codon 600 of exon 15 (BRAFV600E) and telomerase reverse transcriptase (TERT) hotspot mutations on clinicopathological features, response to treatment, potential recurrence, and the final outcome. Methods: A retrospective analysis of the 430 PTMC cases diagnosed during 2001-2020 at a single center was performed. All PTMC cases were assessed histopathologically, and analyses of BRAFV600E and TERT promoter were performed based on DNA isolated from tumor blocks. Results: There were 29/430 (6.7% [confidence interval: 4.6-9.5]) patients in whom the TERTC228T and/or TERTC250T mutations coexisted with the BRAFV600E mutation. A statistical comparison between PTMC cases with concomitant BRAFV600E and TERT hotspot mutations and those without any of those mutations revealed no significant differences between the two groups with respect to risk stratification, response to primary treatment, clinical course, or final disease status. Conclusion: Regardless of the molecular background of PTMC, the overall response to therapy is excellent, and long-term disease-free survival rates can be achieved by most patients.
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Affiliation(s)
- Artur Kuchareczko
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | | | - Artur Kowalik
- Division of Medical Biology, Institute of Biology, Jan Kochanowski University, Kielce, Poland
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Kinga Hińcza-Nowak
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
- Department of Molecular Diagnostics, Holycross Cancer Centre, Kielce, Poland
| | - Agnieszka Walczyk
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Iwona Pałyga
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Tomasz Trybek
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Monika Szymonek
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Danuta Gąsior-Perczak
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | | | - Estera Mikina
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | - Izabela Płachta
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
| | | | - Agnieszka Płusa
- Department of Pathology, Holycross Cancer Centre, Kielce, Poland
| | - Magdalena Chrapek
- Department of Mathematics, Faculty of Natural Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Łopatyński
- Department of General, Oncologic and Metabolic Surgery, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Stanisław Góźdź
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Clinical Oncology, Holycross Cancer Centre, Kielce, Poland
| | - Aldona Kowalska
- Department of Oncology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Endocrinology Clinic of Holycross Cancer Centre, Kielce, Poland
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Wang K, Liu S, Tian Y, Liu C, Gui Z, Yu T, Zhang L. PDZK1 Interacting Protein 1 Promotes the Progression of Papillary Thyroid Cancer. J Clin Endocrinol Metab 2022; 107:2449-2461. [PMID: 35727731 DOI: 10.1210/clinem/dgac376] [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: 04/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The incidence of papillary thyroid cancer (PTC) has increased rapidly in recent decades, and tumor progression events are common in PTC. The purpose of our study is to identify the differentially expressed genes (DEGs) correlated with PTC progression and investigate the function of PDZK1IP1 (PDZK1 interacting protein 1) in PTC. METHODS We first analyzed DEGs associated with PTC progression between paired PTC and normal thyroid tissues in 3 Gene Expression Omnibus data sets (GSE29265, GSE33630, and GSE60542) and The Cancer Genome Atlas (TCGA) database. Data from the TCGA database and our institution were utilized to explore the relationship between PDZK1IP1 expression and clinicopathological characteristics of PTC. The CCK8 cell proliferation assay, clone formation assay, flow cytometry assay, and the xenograft model were used to investigate the function of PDZK1IP1 in PTC. RESULTS Thirty-nine DEGs associated with PTC progression were identified, in which only PDZK1IP1 was upregulated in PTC tissue at both messenger RNA and protein levels. In addition, we found that high expression of PDZK1IP1 in the TCGA database was associated with poor progression-free survival, extrathyroidal extension, high stage, tall cell variant, and BRAFV600E mutation of the PTC (P < 0.001). In our collected samples, high expression of PDZK1IP1 was only related to lymph node metastasis (P < 0.05). Overexpression of PDZK1IP1 significantly promoted proliferation and inhibited apoptosis of PTC cells. Knockdown of PDZK1IP1 significantly inhibited proliferation, promoted apoptosis, and prevented xenograft formation of PTC cells. CONCLUSION PDZK1IP1 is an oncogene for tumorigenesis and development of PTC and might be a potential therapeutic target.
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Affiliation(s)
- Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
- Department of Breast Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China
| | - Shiyang Liu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yao Tian
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Chenguang Liu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhengwei Gui
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Tianyao Yu
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Lin Zhang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Bai C, Yang W, Ouyang R, Li Z, Zhang L. Study of hsa_circRNA_000121 and hsa_circRNA_004183 in papillary thyroid microcarcinoma. Open Life Sci 2022; 17:726-734. [PMID: 35891968 PMCID: PMC9281586 DOI: 10.1515/biol-2022-0080] [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: 09/17/2021] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
We detected the expressions of hsa_circRNA_000121 and hsa_circRNA_ 004183 in papillary thyroid microcarcinoma (PTMC) and explored their relationship with the invasiveness of PTMC. PTMC patients with (n = 30; metastasis group) and without lymph node metastasis (n = 30; nonmetastasis group) were included. The levels of hsa_circRNA_000121, hsa_circRNA_004183, hsa-miR-4763, hsa-miR-6775, sarcoma gene (SRC), and MMP-14 were detected with real-time polymerase chain reaction. Receiver-operating characteristic (ROC) analyzed the diagnostic value of hsa_circRNA_000121 and hsa_circRNA_004183. Binary logistic regression analysis evaluated the relationship of gene expression with PTMC invasiveness. In PTMC tissue samples, compared with the metastasis group, the expression of hsa_circRNA_000121, hsa_circRNA_004183, SRC, and MMP-14 in the nonmetastasis group decreased, while the expression of hsa-miR-4763 and hsa-miR-6775 increased. In peripheral blood, compared with the metastasis group, the expression of hsa_circ_000121 and hsa_circRNA_004183 in the nonmetastasis group decreased. Both hsa_circRNA_000121 and hsa_circRNA_004183 had good sensitivity and specificity for diagnosing PTMC lymph node metastasis, with a cut-off value of 0.796 and 0.938, respectively. However, the gene expressions were not significantly associated with PTMC lymph node metastasis. Hsa_circRNA_000121 may upregulate SRC expression through hsa-miR-4763, while hsa_circRNA 000121 may upregulate MMP-14 expression through hsa-miR-6775, thereby promoting the aggressiveness of PTMC and ultimately leading to cervical lymph node metastasis. hsa_circRNA_000121 and hsa_circRNA_004183 may become potential biomarkers of PTMC aggressiveness.
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Affiliation(s)
- Chao Bai
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Wenwen Yang
- The Second Department of General Internal Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Ru Ouyang
- Department of Endocrinology, Sanya Central Hospital, No. 1154, Jiefang 4th Road, Tianya District, Sanya 572000, China
| | - Zongbao Li
- Department of Endocrinology, Sanya Central Hospital, No. 1154, Jiefang 4th Road, Tianya District, Sanya 572000, China
| | - Li Zhang
- Department of Endocrinology, Sanya Central Hospital, No. 1154, Jiefang 4th Road, Tianya District, Sanya 572000, China
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Correlation between Ultrasonographic Appearance of Papillary Thyroid Microcarcinoma and BRAF V600E Mutation. JOURNAL OF ONCOLOGY 2022; 2022:5916379. [PMID: 35356255 PMCID: PMC8959952 DOI: 10.1155/2022/5916379] [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: 08/12/2021] [Accepted: 02/07/2022] [Indexed: 11/22/2022]
Abstract
The study was conducted to investigate the correlation between the ultrasonographic appearance of a thyroid nodule and the BRAF V600E mutation. Patients with thyroid nodules (n = 186), for which BRAF V600E testing and cytopathology analysis were performed, and who underwent subsequent surgery for nodule resection were enrolled in this study. For each patient, color Doppler ultrasonography was performed to observe the variables of the nodules. The nodules were then characterized using the thyroid imaging reporting and data system classification TI-RADS. Furthermore, the ultrasonographic appearance of the control group, encompassing patients with nodular thyroid goiters, and the case group, encompassing patients with papillary thyroid microcarcinoma (PTMC), was statically analyzed. Similarly, a statistical analysis of the ultrasonographic appearance of the BRAF V600E-positive and BRAF V600E-negative subgroups was also performed. The accuracy was significantly different for the corresponding values when color Doppler ultrasonography, BRAF V600E testing, or cytopathology alone was used for diagnosis. There were significant differences in the ultrasonographic appearance variables between the control and case groups. Comparing with the BRAF V600E-negative subgroup of the case group, the ultrasonographic appearances of the BRAF V600E-positive subgroup showed less circumscribed and more irregularly shaped nodules, with significantly different aspect ratios of >1. The combination of BRAF V600E testing and color Doppler ultrasonography or cytopathology improved the accuracy of the PTMC diagnose. We found that the ultrasonographic appearance of thyroid nodules was related to PTMC.
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Du J, Han R, Chen C, Ma X, Shen Y, Chen J, Li F. Diagnostic Efficacy of Ultrasound, Cytology, and BRAF V600E Mutation Analysis and Their Combined Use in Thyroid Nodule Screening for Papillary Thyroid Microcarcinoma. Front Oncol 2022; 11:746776. [PMID: 35047385 PMCID: PMC8761628 DOI: 10.3389/fonc.2021.746776] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022] Open
Abstract
Background Ultrasound, cytology, and BRAFV600E mutation analysis were applied as valuable tools in the differential diagnosis of thyroid nodules. The aim of the present study was to evaluate the diagnostic efficiency of the three methods and their combined use in screening for papillary thyroid microcarcinoma (PTMC). Methods A total of 1,081 patients with 1,157 thyroid nodules (0.5–1 cm in maximum diameter) classified as thyroid imaging reporting and data system (TIRADS) 4–5 were recruited. All patients underwent ultrasound, fine-needle aspiration (FNA) examination, and an additional BRAFV600E mutation test. TIRADS and Bethesda System for Reporting Thyroid Cytopathology (BSRTC) were adopted to judge the ultrasound and cytological results. The receiver operating characteristic (ROC) curve was established to assess the diagnostic values of different methods. Results Of the 1,157 nodules, 587 were benign and 570 were PTMCs. BRAFV600E mutation test had highest sensitivity (85.4%), specificity (97.1%), accuracy (91.4%), and area under the ROC curve (Az) value (0.913) among the three methods. The combination of BSRTC and BRAFV600E mutation analysis yielded a considerably high sensitivity (96.0%), accuracy (94.3%), and negative predictive value (95.9%) than either BSRTC or BRAFV600E mutation alone (P < 0.0001 for all comparisons). Of all the methods, the combined use of the three methods produced the best diagnostic performance (Az = 0.967), which was significantly higher than that (Az = 0.943) for the combination of BSRTC and BRAFV600E mutation (P < 0.0001). The diagnostic accuracy of the molecular method in the 121 nodules with indeterminate cytology was 90.1% (109/121), which was significantly higher than that of TIRADS classification, 74.4% (90/121) (P = 0.002). Conclusion The combined use of ultrasound, cytology, and BRAFV600E mutation analysis is the most efficient and objective method for diagnosing PTMC. Both BRAFV600E mutation and TIRADS classification are potentially useful adjuncts to differentiate thyroid nodules, especially indeterminate samples classified as BSRTC III.
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Affiliation(s)
- Jing Du
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijun Han
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cui Chen
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaowei Ma
- Department of Laboratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuling Shen
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Chen
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fenghua Li
- Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Active Surveillance of Thyroid Microcarcinomas: a Critical View. Curr Oncol Rep 2022; 24:69-76. [DOI: 10.1007/s11912-021-01177-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/03/2022]
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Yan Z, Gang LW, Yan GS, Zhou P. Prediction of the invasiveness of PTMC by a combination of ultrasound and the WNT10A gene. Front Endocrinol (Lausanne) 2022; 13:1026059. [PMID: 36605938 PMCID: PMC9807605 DOI: 10.3389/fendo.2022.1026059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to predict the invasiveness of papillary thyroid microcarcinoma (PTMC) via ultrasonography in combination with the Wnt family member 10A (WNT10A) gene to provide a reference basis for evaluating the invasive capability of PTMC. METHODS Cancer tissue were collected from 182 patients with unifocal PTMC, and the patients were divided into the invasive group and the non-invasive group based on whether the lesions invaded the thyroid capsules or whether lymph node metastasis occurred. The expression of WNT10A protein was examined. Age, sex, maximum nodule diameter, color Doppler flow imaging (CDFI), nodule echo, microcalcification, aspect ratio, morphology (boundary), nodule location, internal structure, ultrasound-suspected lymph node metastasis (US-LNM), and WNT10A expression were compared between the invasive group and the non-invasive group. Univariate analysis and multivariate logistic regression analysis were performed, and a p value of less than 0.05 indicated that the difference was statistically significant. RESULTS (1) 36 patients in the non-invasive group showed high expression and 66 patients showed low or no expression, while 54 patients in the invasive group showed high expression and 26 patients showed low or no expression, suggesting that the expression level of WNT10A was higher in the invasive group than in the non-invasive group, with a statistically significant difference between the two groups (P<0.01). (2) Univariate analysis showed that there were statistically significant differences between the invasive PTMC group and the non-invasive group in age, sex, maximum nodule diameter, microcalcification, US-LNM and high WNT10A expression. (3) Multivariate analysis showed that the risk factors for invasiveness in patients with PTMC included age < 45 years, maximum nodule diameter > 7 mm, microcalcification, US-LNM and high WNT10A expression. CONCLUSION The risk factors for PTMC invasiveness included age < 45 years, maximum nodule diameter >7 mm, microcalcification, US-LNM and high WNT10A expression. A combination of ultrasonography and WNT10A gene analysis could provide a reference basis for evaluating the invasive capability of PTMC.
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Chen K, Wang Z, Sun W, Zhang D, Zhang T, He L, Zhang H. Bibliometric insights in advances of papillary thyroid microcarcinoma: Research situation, hot points, and global trends. Front Endocrinol (Lausanne) 2022; 13:949993. [PMID: 36004350 PMCID: PMC9393698 DOI: 10.3389/fendo.2022.949993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Thyroid cancer has been on the rise over the last decade. Papillary thyroid microcarcinoma (PTMC) accounts for more than half of all thyroid cancers. Micropapillary carcinoma of the thyroid is a common but non-fatal form of thyroid cancer. To better comprehend, nearly two decades of scientific outputs were analyzed and summarized using bibliometric methods in this study. METHODS Approximately 1098 publications from 2000 and 2021 were included in WoS database through systematic retrieval. The general information was characterized, and developmental skeleton and research frontiers were explored. CiteSpace, VOSviewer, and R, Tableau were used to evaluate and visualize the results. RESULTS A total of 1098 publications from across 75 countries were identified. The annual number of publications showed an increasing trend in the past 21 years. China, Korea, the United States of America (USA), Italy, and Japan made remarkable contributions to the research of PTMC. Thyroid was the most productive journal. Miyauchi Akira published maximum articles. The utmost productive institution was the University of Ulsan. Risk stratification, active surveillance, and thermal ablation garnered the attention of researchers leading to novel approaches in the clinical diagnosis and treatment of micropapillary thyroid carcinoma. CONCLUSIONS This bibliometric study provides a comprehensive analysis of global productivity, collaboration, and research hotspots within PTMC field, which will aid in directing research toward PTMC in the coming years.
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Affiliation(s)
- Kefan Chen
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Zhongqing Wang
- Department of Information center, the First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Dalin Zhang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Ting Zhang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Liang He
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, China
- *Correspondence: Hao Zhang,
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Tang J, Jiang S, Ma J, Xi X, Li H, Wang L, Zhang B. Nomogram based on radiomics analysis of ultrasound images can improve preoperative BRAF mutation diagnosis for papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2022; 13:915135. [PMID: 36060960 PMCID: PMC9437521 DOI: 10.3389/fendo.2022.915135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The preoperative identification of BRAF mutation could assist to make appropriate treatment strategies for patients with papillary thyroid microcarcinoma (PTMC). This study aimed to establish an ultrasound (US) radiomics nomogram for the assessment of BRAF status. METHODS A total of 328 PTMC patients at the China-Japan Friendship Hospital between February 2019 and November 2021 were enrolled in this study. They were randomly divided into training (n = 232) and validation (n = 96) cohorts. Radiomics features were extracted from the US images. The least absolute shrinkage and selection operator (LASSO) regression was applied to select the BRAF status-related features and calculate the radiomics score (Rad-score). Univariate and multivariate logistic regression analyses were subsequently performed to identify the independent factors among Rad-score and conventional US features. The US radiomics nomogram was established and its predictive performance was evaluated via discrimination, calibration, and clinical usefulness in the training and validation sets. RESULTS Multivariate analysis indicated that the Rad-score, composition, and aspect ratio were independent predictive factors of BRAF status. The US radiomics nomogram which incorporated the three variables showed good calibration. The discrimination of the US radiomics nomogram showed better discriminative ability than the conventional US model both in the training set (AUC 0.685 vs. 0.592) and validation set (AUC 0.651 vs. 0.622). Decision curve analysis indicated the superior clinical applicability of the nomogram compared to the conventional US model. CONCLUSIONS The US radiomics nomogram displayed better performance than the conventional US model in predicting BRAF mutation in patients with PTMC.
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Affiliation(s)
- Jiajia Tang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Shitao Jiang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaojiao Ma
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Xuehua Xi
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Huilin Li
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
| | - Liangkai Wang
- Department of Ultrasound, China-Japan Friendship Hospital, Beijing, China
- Institute of Clinical Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Ultrasound, China-Japan Friendship Hospital, National Center for Respiratory Medicine, National Clinical Research Centerfor Respiratory Diseases, Institute of Respiratory Medicine of Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Bo Zhang,
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Parvathareddy SK, Siraj AK, Iqbal K, Qadri Z, Ahmed SO, Al-Rasheed M, AlQatie AA, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. TERT Promoter Mutations Are an Independent Predictor of Distant Metastasis in Middle Eastern Papillary Thyroid Microcarcinoma. Front Endocrinol (Lausanne) 2022; 13:808298. [PMID: 35360077 PMCID: PMC8962954 DOI: 10.3389/fendo.2022.808298] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/11/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Papillary thyroid microcarcinomas (PTMCs) have been attributed to the recent increased incidence of thyroid cancer. Although indolent, a subset of PTMC could potentially develop distant metastasis (DM). This study aimed to evaluate the clinico-pathological features and molecular characteristics of PTMC and identify the risk factors for DM in PTMC patients from Middle Eastern ethnicity. METHODS We retrospectively analyzed 210 patients with histologically confirmed PTMC. Clinico-pathological associations for DM, BRAF mutation and TERT mutation were analyzed successfully in 184 patients. Multivariate analysis was performed using Cox proportional hazards model and logistic regression analysis. RESULTS Among the PTMC patients included in this cohort, DM was noted in 6.0% (11/184), whereas tumor relapse occurred in 29/184 (15.8%). Of the 11 cases with DM, lung metastasis occurred in 8 cases, bone metastasis in 2 cases and brain metastasis in 1 case. Presence of extrathyroidal extension and male sex were significantly associated with DM. Molecular analysis showed BRAF V600E mutations to be the most frequent, being detected in 45.7% (84/184). TERT promoter mutations were detected in 16 (8.7%) cases and were significantly associated with DM and shorter metastasis-free survival in multivariate analysis. CONCLUSIONS Our study indicates a surprisingly high frequency of TERT promoter mutation in Saudi patients with PTMC. Identifying TERT promoter mutations as an independent predictor of DM in patients with microcarcinoma could explain the inherent aggressive nature of PTMC from Middle Eastern ethnicity and magnify its role in patient risk stratification, which might help in improving therapeutic strategy for these patients.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Kaleem Iqbal
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zeeshan Qadri
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saeeda O. Ahmed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maha Al-Rasheed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmed A. AlQatie
- Department of Radiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- *Correspondence: Khawla S. Al-Kuraya,
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Lin P, Liang F, Ruan J, Han P, Liao J, Chen R, Luo B, Ouyang N, Huang X. A Preoperative Nomogram for the Prediction of High-Volume Central Lymph Node Metastasis in Papillary Thyroid Carcinoma. Front Endocrinol (Lausanne) 2021; 12:753678. [PMID: 35002954 PMCID: PMC8729159 DOI: 10.3389/fendo.2021.753678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/26/2021] [Indexed: 12/07/2022] Open
Abstract
Background High-volume lymph node metastasis (HVLNM, equal to or more than 5 lymph nodes) is one of the adverse features indicating high recurrence risk in papillary thyroid carcinoma (PTC) and is recommended as one of the indications of completion thyroidectomy for patients undergoing thyroid lobectomy at first. In this study, we aim to develop a preoperative nomogram for the prediction of HVLNMs in the central compartment in PTC (cT1-2N0M0), where preoperative imaging techniques perform poor. Methods From October 2016 to April 2021, 423 patients were included, who were diagnosed as PTC (cT1-2N0M0) and underwent total thyroidectomy and prophylactic central compartment neck dissection in our center. Demographic and clinicopathological features were recorded and analyzed using univariate and multivariate logistic regression analysis. A nomogram was developed based on multivariate logistic regression analysis. Results Among the included patients, 13.4% (57 cases) were found to have HVLNMs in the central compartment. Univariate and multivariate logistic regression analysis showed that age (=35 years vs. >35 years), BRAF with V600E mutated, nodule diameter, and calcification independently predicted HVLNMs in the central compartment. The nomogram showed good discrimination with an AUC of 0.821 (95% CI, 0.768-0.875). Conclusion The preoperative nomogram can be used to quantify the probability of HVLNMs in the central compartment and may reduce the reoperation rate after thyroid lobectomy.
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Affiliation(s)
- Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Faya Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingliang Ruan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Han
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianwei Liao
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Renhui Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoming Luo
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nengtai Ouyang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Ramkumar S, Sivanandham S. The Combined Utility of HBME-1 and Galectin-3 Immunohistochemistry and BRAF V600E Mutations in the Diagnosis of Papillary Thyroid Carcinoma. Cureus 2021; 13:e20339. [PMID: 34934597 PMCID: PMC8668044 DOI: 10.7759/cureus.20339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/03/2022] Open
Abstract
Newer diagnostic modalities have revolutionized the pathologist’s approach to diagnosing thyroid malignancies. Molecular characterization of these malignancies has helped circumvent common morphologic diagnostic difficulties by integrating their genotypic, phenotypic, and immunohistochemical features. BRAF V600E mutation has been characterized as highly specific for thyroid carcinoma, especially papillary thyroid carcinoma (PTC); human bone marrow endothelial marker-1 (HBME-1) and galectin-3 are also such markers that are highly specific for PTC. We propose to study HBME-1 and galectin-3 expression and BRAF V600E mutation in thyroid neoplasms and do a comparative analysis to determine whether there is a correlation between BRAF V600E expression and that of HBME-1 and galectin-3. We further propose to analyze the individual and combined diagnosed utility of the above-mentioned ancillary diagnostic techniques.
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Rahman ST, Pandeya N, Neale RE, McLeod DSA, Baade PD, Youl PH, Allison R, Leonard S, Jordan SJ. Tobacco smoking and risk of thyroid cancer according to BRAF V600E mutational subtypes. Clin Endocrinol (Oxf) 2021; 95:891-900. [PMID: 34170568 DOI: 10.1111/cen.14545] [Citation(s) in RCA: 3] [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: 04/18/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Smoking has been associated with a reduced risk of thyroid cancer, but whether the association varies between higher- and lower-risk cancers remains unclear. We aimed to assess the association between smoking and risk of thyroid cancer overall as well as by tumour BRAF mutational status as a marker of potentially higher-risk cancer. DESIGN AND PATIENTS We recruited 1013 people diagnosed with thyroid cancer and 1057 population controls frequency-matched on age and sex. METHODS Multivariable logistic regression was used to assess the association overall and in analyses stratified by tumour characteristics. We used sensitivity analysis to assess the potential for selection bias. RESULTS We found little evidence of an association with current smoking (odds ratio [OR] = 0.93; 95% confidence interval [CI]: 0.69-1.26; current vs. never smoking), but a higher number of pack-years of smoking was associated with a lower risk of thyroid cancer (OR = 0.75; 95% CI: 0.57-0.99; ≥20 pack-years vs. never). However, after correcting for potential selection bias, we observed a statistically significant inverse association between current smoking and risk of thyroid cancer (bias-corrected OR = 0.65; 95% CI: 0.51-0.83). Those with BRAF-positive cancers were less likely to be current smokers than those with BRAF-negative cancers (prevalence ratio: 0.79; 95% CI: 0.62-0.99). CONCLUSION We found smoking was inversely related to thyroid cancer risk and, in particular, current smoking was associated with a reduced risk of potentially more aggressive BRAF-positive than the likely more indolent BRAF-negative papillary thyroid cancers.
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Affiliation(s)
- Sabbir T Rahman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Statistics, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Nirmala Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Donald S A McLeod
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Philippa H Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Roger Allison
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Susan Leonard
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Susan J Jordan
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Papillary Thyroid Cancer Prognosis: An Evolving Field. Cancers (Basel) 2021; 13:cancers13215567. [PMID: 34771729 PMCID: PMC8582937 DOI: 10.3390/cancers13215567] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Over the last couple of decades, the prognostic stratification systems of differentiated thyroid cancer (DTC) patients have been revised several times in an attempt to achieve a tailored clinical management reflecting the single patients’ needs. Such revisions are likely to continue in the near future, since the prognostic value of a number of promising clinicopathological features and new molecular biomarkers are being evaluated. Here, we will review the current staging systems of thyroid cancer patients and discuss the most relevant clinicopathological parameters and new molecular markers that are potentially capable of refining the prognosis. Abstract Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified in more than 98% of PTC, and a new PTC classification into molecular subtypes has been proposed in order to resolve clinical uncertainties still present in the clinical management of patients. Additionally, the prognostic stratification systems have been profoundly modified over the last decade, with a view to refine patients’ staging and being able to choose a clinical approach tailored on single patient’s needs. Here, we will briefly discuss the recent changes in the clinical management of thyroid nodules, and review the current staging systems of thyroid cancer patients by analyzing promising clinicopathological features (i.e., gender, thyroid auto-immunity, multifocality, PTC histological variants, and vascular invasion) as well as new molecular markers (i.e., BRAF/TERT promoter mutations, miRNAs, and components of the plasminogen activating system) potentially capable of ameliorating the prognosis of PTC patients.
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Niciporuka R, Nazarovs J, Ozolins A, Narbuts Z, Miklasevics E, Gardovskis J. Can We Predict Differentiated Thyroid Cancer Behavior? Role of Genetic and Molecular Markers. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1131. [PMID: 34684168 PMCID: PMC8540789 DOI: 10.3390/medicina57101131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/07/2021] [Accepted: 10/15/2021] [Indexed: 12/27/2022]
Abstract
Thyroid cancer is ranked in ninth place among all the newly diagnosed cancer cases in 2020. Differentiated thyroid cancer behavior can vary from indolent to extremely aggressive. Currently, predictions of cancer prognosis are mainly based on clinicopathological features, which are direct consequences of cell and tissue microenvironment alterations. These alterations include genetic changes, cell cycle disorders, estrogen receptor expression abnormalities, enhanced epithelial-mesenchymal transition, extracellular matrix degradation, increased hypoxia, and consecutive neovascularization. All these processes are represented by specific genetic and molecular markers, which can further predict thyroid cancer development, progression, and prognosis. In conclusion, evaluation of cancer genetic and molecular patterns, in addition to clinicopathological features, can contribute to the identification of patients with a potentially worse prognosis. It is essential since it plays a crucial role in decision-making regarding initial surgery, postoperative treatment, and follow-up. To date, there is a large diversity in methodologies used in different studies, frequently leading to contradictory results. To evaluate the true significance of predictive markers, more comparable studies should be conducted.
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Affiliation(s)
- Rita Niciporuka
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Jurijs Nazarovs
- Department of Pathology, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia;
| | - Arturs Ozolins
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Zenons Narbuts
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
| | - Edvins Miklasevics
- Institute of Oncology, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia;
| | - Janis Gardovskis
- Department of Surgery, Riga Stradins University, Pilsonu Street 13, LV-1002 Riga, Latvia; (A.O.); (Z.N.); (J.G.)
- Department of Surgery, Pauls Stradins Clinical University Hospital, Pilsonu Street 13, LV-1002 Riga, Latvia
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Zhou SL, Guo YP, Zhang L, Deng T, Xu ZG, Ding C, Sun WC, Zhao YW, Kong LF. Predicting factors of central lymph node metastasis and BRAF V600E mutation in Chinese population with papillary thyroid carcinoma. World J Surg Oncol 2021; 19:211. [PMID: 34256769 PMCID: PMC8278623 DOI: 10.1186/s12957-021-02326-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/02/2021] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the predictive factors of central lymph node metastasis (CLNM) and BRAFV600E mutation in Chinese patients with papillary thyroid carcinoma (PTC). Methods A total of 943 PTC patients who underwent thyroidectomy from 2014 to 2016 at our hospital were enrolled. Those patients were divided into PTC > 10 mm and papillary thyroid microcarcinoma (PTMC) groups by tumor size. The BRAFV600E mutation was examined by quantitative real-time PCR. Univariate and multivariate analyses were used to examine risk factors associated with CLNM and the BRAFV600E mutation. Results The frequency of CLNM was 53% (505/943). Both univariate and multivariate analyses suggested that the risk factors for CLNM in PTC patients were male, younger age, and larger tumor size (P < 0.05). Coexistent Hashimoto thyroiditis (HT) was an independent protective factor against CLNM when the tumor was > 10 mm (P = 0.006). Stratified analysis revealed that male, age ≤ 30 years, and tumor size > 5 mm were independent risk factors for CLNM. The BRAFV600E mutation rate was 85%. Multivariate logistic regression analysis revealed that age (P < 0.001) and coexistent HT (P = 0.005) were independent predictive factors of BRAFV600E mutation in PTC patients. Only age was a risk factor for the BRAFV600E mutation when the tumor was > 10 mm (P = 0.004). In the PTMC group, the BRAFV600E mutation was significantly correlated with tumor size (P < 0.001) and coexistent HT (P = 0.03). Stratified analysis revealed that age > 30 years and tumor size > 5 mm were independent predictive factors of BRAFV600E mutation. Furthermore, the incidence of CLNM was significantly higher in BRAFV600E mutation-positive patients (P = 0.009) when the tumor was ≤ 5 mm. Conclusion The factors male, younger age (≤ 30 years), large tumor size (> 5 mm), and coexistent HT are independent predicative factors for CLNM. The BRAFV600E mutation is associated with both large size and without HT in PTMC patients, age > 30 years in the PTC > 10 mm group. The BRAFV600E mutation was an independent risk factor for CLNM when the tumor was ≤ 5 mm. For optimal management, these features should be comprehensively evaluated to determine the initial surgical approach for PTC patients.
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Affiliation(s)
- Sheng Li Zhou
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, 7# Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Yan Ping Guo
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, 7# Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Lei Zhang
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, 7# Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Tao Deng
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, 7# Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Zi Guang Xu
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, 7# Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Chao Ding
- Department of Thyroid Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, Henan Province, China
| | - Wen Cong Sun
- Department of Thyroid Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, 450003, Henan Province, China
| | - Yue Wu Zhao
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, 7# Weiwu Road, Zhengzhou, 450003, Henan Province, China
| | - Ling Fei Kong
- Department of Pathology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, 7# Weiwu Road, Zhengzhou, 450003, Henan Province, China.
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Yan T, Qiu W, Song J, Ying T, Fan Y, Yang Z. Bilateral multifocality, a marker for aggressive disease, is not an independent prognostic factor for papillary thyroid microcarcinoma: A propensity score matching analysis. Clin Endocrinol (Oxf) 2021; 95:209-216. [PMID: 33660317 DOI: 10.1111/cen.14455] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/03/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Multifocality and bilaterality are common in patients with papillary thyroid microcarcinoma (PTMC). However, their clinical behaviours and prognostic implications remain controversial. OBJECTIVE To investigate the relationship between multifocality and classically aggressive characteristics and outcomes in patients with PTMC. METHODS Clinical data of 3005 patients with PTMC were retrospectively reviewed at a tertiary medical centre. The role of unilateral and bilateral multifocality in aggressive characteristics and clinical outcomes of PTMC was evaluated using propensity score matching (PSM). RESULTS A total of 573 patients had bilateral multifocal disease (B-MFD), 272 had unilateral multifocal disease (U-MFD), and 2160 had unifocal disease (UFD). Univariate analysis showed that patients in the multifocal disease (MFD) groups showed significantly different characteristics compared to patients in the UFD group in terms of age, chronic lymphocytic thyroiditis (CLT), follicular variant PTMC, tumour diameter, aggressive growth, including extrathyroidal extension (ETE), central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM), and TNM stage, and underwent radioactive iodine (RAI) therapy. Further stratified analysis revealed that patients in the B-MFD group reflected the differences between the MFD and UFD groups. However, those in the U-MFD group showed slight differences only in sex, CLT and cell subtypes, compared to the UFD group. In addition, PSM indicated differences in ETE, CLNM and LLNM between the B-MFD and UFD groups (p < .001), while only ETE differed between the U-MFD and UFD groups (p < .001). After a median follow-up period of 60 months, no difference was observed in recurrence-free survival between the UFD and B-MFD (p = .294) or U-MFD (p = .603) groups using PSM. CONCLUSION This propensity score matching analysis provides strong evidence that bilateral multifocality, rather than unilateral multifocality, should be considered as an aggressive marker at presentation, and neither is an independent prognostic factor for clinical outcome in PTMC.
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Affiliation(s)
- Ting Yan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wangwang Qiu
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianlu Song
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Youben Fan
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhili Yang
- Department of Thyroid, Parathyroid, Breast and Hernia Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Cao J, Yun C, Zhu X, Li X, Sun Y, Zhang W. Clinical Analysis of the Short-Term Outcome of Papillary Thyroid Micro Carcinoma After 131I Treatment. Cancer Manag Res 2021; 13:4691-4698. [PMID: 34163244 PMCID: PMC8214364 DOI: 10.2147/cmar.s308012] [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: 02/25/2021] [Accepted: 05/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore the factors that influence the short-term clinical outcome after the first 131I treatment of papillary thyroid micro carcinoma (PTMC). Patients and Methods From October 2015 to June 2018, patients who were diagnosed with PTMC with lymph node metastasis were analyzed retrospectively, excluding patients with incomplete clinical data, distant metastasis, positive TGAb, TSH<30 mIU/L. The baseline data of sex, age, time from last surgery to first 131I treatment, tumor pathology information, and biochemical information were collected before admission. All patients included had radioactive iodine (RAI) with 3.70 GBq. The treatment response of patients was evaluated 6–8 months after discharge. By means of univariate and multivariate analysis, including excellent response (ER) and non-excellent response (NER) groups of clinical data, we assessed the impact of 131I on patients’ outcome. A nomogram model was established based on the above independent risk factors. Results A total of 206 patients (59 males and 147 females, mean age 43.4 ± 10.6 years) were included in the study. The median follow-up time was 169.4 ± 10.5 days, including 139 patients in ER group (67.4%) and 67 patients in NER group (32.5%). Four factors including combining Hashimoto’s thyroiditis, pre-ablative Tg levels, UIE levels, and lateral lymph node numbers were statistically different between ER group and NER group with significance at P < 0.05. Further multivariate analysis showed that Hashimoto’s thyroiditis and Ps-Tg levels could be used as independent factors. The model verification showed that the C-index of the modeling set was 0.822, indicating that the nomogram model had a good predicted accuracy. Conclusion Our data suggest that coexisting Hashimoto’s thyroiditis and elevated Ps-Tg levels are predictive factors for short-term outcome of thyroid micro papillary carcinoma after 131I treatment. Also, the nomogram model had a good predicted accuracy.
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Affiliation(s)
- Jingjia Cao
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Canhua Yun
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Xiaolu Zhu
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Xiao Li
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Yaru Sun
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
| | - Wei Zhang
- Department of Nuclear Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People's Republic of China
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Park J, Lee S, Park J, Park H, Ki CS, Oh YL, Shin JH, Kim JS, Kim SW, Chung JH, Kim K, Kim TH. Proposal of a New Prognostic Model for Differentiated Thyroid Cancer with TERT Promoter Mutations. Cancers (Basel) 2021; 13:cancers13122943. [PMID: 34208345 PMCID: PMC8231155 DOI: 10.3390/cancers13122943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
The role of telomerase reverse transcriptase (TERT) promoter mutations as an independent poor prognostic factor in differentiated thyroid cancer (DTC) patients is well known, but there is no prognostic system that combines the TERT promoter mutation status with tumor-node-metastasis (TNM) stage to predict cancer-specific survival (CSS). A total of 393 patients with pathologically confirmed DTC after thyroidectomy were enrolled. After incorporating wild-type TERT and mutant TERT with stages I, II, and III/IV of the AJCC TNM system 8th edition (TNM-8), we generated six combinations and calculated 10-year and 15-year CSS and adjusted hazard ratios (HRs) for cancer-related death using Cox regression. Then, a new mortality prediction model termed TNM-8T was derived based on the CSS and HR of each combination in the four groups. Of the 393 patients, there were 27 (6.9%) thyroid cancer-related deaths during a median follow-up of 14 years. Patients with a more advanced stage had a lower survival rate (10-year CSS for TNM-8T stage 1, 2, 3, and 4: 98.7%, 93.5%, 77.3%, and 63.0%, respectively; p < 0.001). TNM-8T showed a better spread of CSS (p < 0.001) than TNM-8 (p = 0.002) in the adjusted survival curves. The C-index for mortality risk predictability was 0.880 (95% CI, 0.665-0.957) in TNM-8T and 0.827 (95% CI, 0.622-0.930) in TNM-8 (p < 0.001). TNM-8T, a new prognostic system that incorporates the TERT mutational status into TNM-8, showed superior predictability to TNM-8 in the long-term survival of DTC patients.
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Affiliation(s)
- Jun Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
- Division of Endocrinology, Department of Medicine, Sahmyook Medical Center, Seoul 02500, Korea
| | - Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jiyun Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Hyunju Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | | | - Young-Lyun Oh
- Samsung Medical Center, Department of Pathology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jung-Hee Shin
- Samsung Medical Center, Department of Radiology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jee-Soo Kim
- Samsung Medical Center, Department of Surgery, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Sun-Wook Kim
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Jae-Hoon Chung
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul 06355, Korea
- Correspondence: (K.K.); (T.-H.K.); Tel.: +82-2-3410-6049 (T.-H.K.)
| | - Tae-Hyuk Kim
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
- Correspondence: (K.K.); (T.-H.K.); Tel.: +82-2-3410-6049 (T.-H.K.)
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Hier J, Avior G, Pusztaszeri M, Krasner JR, Alyouha N, Forest VI, Hier MP, Mlynarek A, Richardson K, Sadeghi N, Tamilia M, Payne RJ. Molecular testing for cytologically suspicious and malignant (Bethesda V and VI) thyroid nodules to optimize the extent of surgical intervention: a retrospective chart review. J Otolaryngol Head Neck Surg 2021; 50:29. [PMID: 33910629 PMCID: PMC8082804 DOI: 10.1186/s40463-021-00500-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background Molecular testing has been used for cytologically indeterminate thyroid nodules (Bethesda III and IV), where the risk of malignancy is 10–40%. However, to date, the role of molecular testing in cytologically suspicious or positive for malignancy (Bethesda V and VI) thyroid nodules has been controversial. The aim of this study was to determine whether patients who had molecular testing in Bethesda V and VI thyroid nodules had the optimal extent of surgery performed more often than patients who did not have molecular testing performed. Methods A retrospective chart review of 122 cases was performed: 101 patients from the McGill University teaching hospitals and 21 patients from the Hillel Yaffe Medical center, Technion University. Patients included in the study were those with Bethesda V or VI thyroid nodules who underwent molecular testing (ThyGenext® or ThyroseqV3®) (McGill n = 72, Hillel Yaffe n = 14). Patients with Bethesda V or VI thyroid nodules who did not undergo molecular testing were used as controls (McGill n = 29, Hillel Yaffe n = 7). Each case was reviewed in order to determine whether the patient had optimal surgery. This was defined as total thyroidectomy in the presence of either a positive lymph node, extrathyroidal extension, or an aggressive pathological variant of papillary thyroid carcinoma (tall cell, hobnail, columnar cell, diffuse sclerosing, and solid/trabecular) documented on the final pathology report. In all other cases, a lobectomy/hemi/subtotal thyroidectomy was considered as optimal surgery. Chi-squared testing was performed to compare groups. Results When molecular testing was done, 91.86% (79/86) of surgeries in the molecular testing group were optimal, compared to 61.11% (22/36) in the control group. At McGill University teaching hospitals and at Hillel Yaffe, 91.67% (66/72) and 92.86% (13/14) of surgeries in the intervention group were considered as optimal, respectively. This compares to 58.62% (17/29) at McGill and 71.43% (5/7) at Hillel Yaffe when molecular testing was not performed (p = .001, p = .186). Conclusions In this study, molecular testing in Bethesda V and VI thyroid tumors significantly improved the likelihood of optimal surgery. Therefore, molecular testing may have an important role in optimizing surgical procedures performed in the setting of Bethesda V and VI thyroid nodules. Prospective studies with larger sample sizes are required to further investigate this finding. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-021-00500-6.
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Affiliation(s)
- Jessica Hier
- Faculty of Medicine, McGill University, 845 Rue Sherbrooke West, Montreal, QC, Canada.
| | - Galit Avior
- Department of Otolaryngology Head and Neck Surgery, Hillel Yaffe Medical Centre, Technion University, Hadera, Israel
| | - Marc Pusztaszeri
- Department of Pathology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Joshua R Krasner
- Faculty of Pharmacology, McGill University, 845 Rue Sherbrooke West, Montreal, QC, Canada
| | - Noura Alyouha
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Veronique-Isabelle Forest
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Michael P Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology Head and Neck Surgery, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Nader Sadeghi
- Department of Otolaryngology Head and Neck Surgery, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Michael Tamilia
- Division of Endocrinology & Metabolism, Sir Mortimer B. David-Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Richard J Payne
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada
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Dong Y, Wang D, Luo Y, Chen L, Bai H, Shen Y, Zhang Y, Chen X, Su X, Zhao J, Liu H, Lu J, Yao Z, Zhao Y, He C, Li X. Comprehensive evaluation of risk factors for lymph node metastasis in patients with papillary thyroid carcinoma. Oncol Lett 2021; 21:188. [PMID: 33574927 PMCID: PMC7816409 DOI: 10.3892/ol.2021.12449] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/26/2020] [Indexed: 01/23/2023] Open
Abstract
With the increasing incidence of papillary thyroid cancer (PTC), it is important to risk-stratify patients who may have a more aggressive tumor biology. The present study aimed to evaluate the risk factors for lymph node metastasis (LNM) in patients with PTC, which may provide a significant reference for clinical diagnosis and treatment. In total, 1,045 patients with PTC [313 with PT microcarcinoma (PTMC) and 732 with non-PTMC] between August 2016 and August 2019 were investigated. The B-type Raf kinase (BRAF) V600E mutation was tested in all samples. The clinical data (sex, age, tumor location, sample type and pathological features) were retrospectively analyzed. Logistic regression analysis was performed to evaluate independent risk factors for LNM. A total of 181/313 (57.8%) PTMC cases and 145/732 (19.8%) non-PTMC cases had a BRAF V600E mutation. In the PTMC cases, significant differences in sex and sample type were identified (BRAF V600E mutation vs. wild-type). In the non-PTMC cases, significant differences in sex and age were identified (BRAF V600E mutation vs. wild-type). Female sex and tumor diameter ≤1 cm were significant independent predictors of LNM in PTC. In PTMC, female sex was a significant independent predictor of LNM. A bilateral tumor was an independent protective factor for LNM in PTC, PTMC and non-PTMC. The BRAF V600E mutation rate of ultrasound-guided fine-needle aspiration cytology was higher compared with FFPE in PTMC (P=0.018). In contrast to previous studies, the results of the present study suggested that being female and having a tumor of diameter ≤1 cm were risk factors for LNM, and that the BRAF wild-type of PTMC may be more aggressive than other types. Notably, the position of the tumor in the bilateral thyroid was also an independent protective factor for LNM. Therefore, ultrasound-guided fine-needle aspiration should be recommended for gene analysis (BRAF V600E) in PTMC. In addition, clinicians should consider an individualized treatment according to gene mutations, sex, age, tumor size and the location of the tumor, in order to achieve an improved therapeutic efficacy.
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Affiliation(s)
- Yan Dong
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
- Department of Microbiology and Immunology, Kunming Medical University, Kunming, Yunnan 650031, P.R. China
| | - Dan Wang
- Department of Clinical Laboratory, People's Hospital of Rongchang District, Rongchang, Chongqing 402460, P.R. China
| | - Yisheng Luo
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Ling Chen
- Key Laboratory of Molecular Biology of Infectious Diseases, Ministry of Education, Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Huili Bai
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Yifan Shen
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Yangli Zhang
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Xueping Chen
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Xinliang Su
- Department of Endocrine Surgery, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Jinqiu Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Huandong Liu
- Department of Neurosurgery, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet 850000, P.R. China
| | - Jungao Lu
- Department of Clinical Laboratory, The Third Affiliated Hospital of Guizhou Medical University, Duyun, Guizhou 558000, P.R. China
| | - Zuoyi Yao
- Department of General Surgery, The Chengdu Fifth People's Hospital, Chengdu, Sichuan 611130, P.R. China
| | - Yajing Zhao
- Department of Ultrasound, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Changlong He
- Key Laboratory of Molecular Biology of Infectious Diseases, Ministry of Education, Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
| | - Xiaosong Li
- Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing 400016, P.R. China
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Sugitani I, Ito Y, Takeuchi D, Nakayama H, Masaki C, Shindo H, Teshima M, Horiguchi K, Yoshida Y, Kanai T, Hirokawa M, Hames KY, Tabei I, Miyauchi A. Indications and Strategy for Active Surveillance of Adult Low-Risk Papillary Thyroid Microcarcinoma: Consensus Statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma. Thyroid 2021; 31:183-192. [PMID: 33023426 PMCID: PMC7891203 DOI: 10.1089/thy.2020.0330] [Citation(s) in RCA: 179] [Impact Index Per Article: 59.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The question of how to manage patients with low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0) has recently become an important clinical issue. Two Japanese centers have conducted prospective clinical trials of active surveillance (AS) for low-risk PTMC since the 1990s, reporting favorable outcomes. This policy has thus seen gradual adoption worldwide to avoid overtreatment. Not all PTMCs are suitable for AS, however, and many physicians still hesitate to apply the management policy in daily clinical practice. A task force on management for PTMC created by the Japan Association of Endocrine Surgery collected and analyzed bibliographic evidence and has produced the present consensus statements regarding indications and concrete strategies for AS to facilitate the management of adult patients diagnosed with low-risk PTMC. Summary: These statements provide indications for AS in adult patients with T1aN0M0 low-risk PTMC. PTMCs with clinical lymph node metastasis, distant metastasis, recurrent laryngeal nerve (RLN) paralysis due to carcinoma invasion, or protrusion into the tracheal lumen warrant immediate surgery. Tumors suspected of aggressive subtypes on cytology are recommended for immediate surgery. Immediate surgery is also recommended for tumors adherent to the trachea or located along the course of the RLN. Practical strategies include diagnosis, decision-making, follow-up, and monitoring related to the implementation of AS. The rate of low-risk PTMC progression is lower in older patients. However, we recommend continuing AS as long as circumstances permit. Future tasks in optimizing management for low-risk PTMC are also described, including molecular markers and patient-reported outcomes. Conclusions: An appropriate multidisciplinary team is necessary to accurately evaluate primary tumors and lymph nodes at the beginning of and during AS, and to adequately reach a shared-decision with individual patients. If appropriately applied, AS of low-risk PTMC is a safe management strategy offering favorable outcomes and preserves quality of life at low cost.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Address correspondence to: Iwao Sugitani, MD, PhD, Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Dai Takeuchi
- Department of Breast and Endocrine Surgery, Nagoya University, Nagoya, Japan
| | | | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan
| | - Masanori Teshima
- Department of Otolaryngology, Head and Neck Surgery, Kobe University, Kobe, Japan
| | - Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University, Maebashi, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | - Isao Tabei
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Yu PC, Tan LC, Zhu XL, Shi X, Chernikov R, Semenov A, Zhang L, Ma B, Wang Y, Zhou XY, Ji QH, Wei WJ, Wang YL. Arms-qPCR Improves Detection Sensitivity of Earlier Diagnosis of Papillary Thyroid Cancers With Worse Prognosis Determined by Coexisting BRAF V600E and Tert Promoter Mutations. Endocr Pract 2021; 27:698-705. [PMID: 33515759 DOI: 10.1016/j.eprac.2021.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The coexistence of BRAF V600E and the telomerase reverse transcriptase (TERT) promoter mutation C228T/C250T is extensively associated with thyroid cancer prognosis. Our study aimed to establish a sensitive method for mutation detection and explore the correlation in detail. METHODS The BRAF and TERT promoter mutation status of 250 papillary thyroid cancers was determined using amplification-refractory mutation system quantitative polymerase chain reaction (ARMS-qPCR) and Sanger sequencing to compare the sensitivity of the 2 methods. Associations between the mutation status and clinicopathological features were then analyzed. RESULTS ARMS-qPCR was more sensitive than Sanger sequencing (BRAF V600E: 75.2% [188 of 250] vs 52.4% [131 of 250], P < .001; TERT promoter C228T/C250T mutation: 12.0% [30 of 250] vs 3.6% [9 of 250], P = .001; comutation: 9.6% [24 of 250] vs 3.2% [8 of 250], P = .005). Both ARMS-qPCR and Sanger sequencing indicated that patients with coexisting BRAF V600E and TERT promoter mutations had an older diagnosis age, higher recurrence rate, and were associated with a more advanced TNM stage and higher metastasis, age, completeness of resection, invasion, and size score. Moreover, ARMS-qPCR helped identify an earlier group stage, which was younger and had smaller tumors and a lower recurrence rate, compared with the group with coexisting BRAF V600E and TERT promoter mutations identified by Sanger sequencing. The newly identified group had a lower metastasis, age, completeness of resection, invasion, and size score and TNM stage. CONCLUSION Patients with coexisting BRAF V600E and TERT promoter mutations had a worse prognosis. ARMS-qPCR, the more sensitive method, can be used to identify patients who have a potentially worse prognosis earlier.
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Affiliation(s)
- Peng-Cheng Yu
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Li-Cheng Tan
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Li Zhu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiao Shi
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Roman Chernikov
- Endocrine Surgery Department, N.I. Pirogov Clinic of High Medical Technologies, Saint-Petersburg State University, Russia
| | - Arseny Semenov
- Endocrine Surgery Department, N.I. Pirogov Clinic of High Medical Technologies, Saint-Petersburg State University, Russia
| | - Ling Zhang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Ben Ma
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Yan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Qing-Hai Ji
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
| | - Wen-Jun Wei
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
| | - Yu-Long Wang
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
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Samà MT, Grosso E, Mele C, Laurora S, Monzeglio O, Marzullo P, Boldorini R, Aluffi Valletti P, Aimaretti G, Scatolini M, Pagano L. Molecular characterisation and clinical correlation of papillary thyroid microcarcinoma. Endocrine 2021; 71:149-157. [PMID: 32621051 DOI: 10.1007/s12020-020-02380-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Papillary thyroid microcarcinoma (mPTC) is defined as a papillary thyroid cancer sized 10 mm or less. Despite their generally indolent clinical course and good prognosis, a subset of mPTCs shows potentially aggressive behaviour. METHODS To search for predictors of clinical outcome of mPTCs, we retrospectively evaluated the genetic tumour profile of 100 patients (23 M/77 F, mean age ± SD 53.8 ± 13.4 years) with histologically confirmed mPTCs through analysis of BRAF, NRAS and TERT promoter mutations as well as RET/PTC translocations. RESULTS Mean follow-up period was 8.4 ± 3.6 years. In 55 cases, mPTC were detected incidentally after surgery. Capsular invasion, bilateralism and multifocality were found in 11/100, 17/100 and 24/100 cases, respectively, while lymph-nodes metastases were present at diagnosis in 9/100 cases. After 3.5 ± 2.0 years, tumour relapse occurred in 6/100 cases and was locoregional in five (two in the thyroid bed, three in laterocervical lymph-nodes), while lung metastasis occurred in one case. Biochemical persistence of disease was seen in 1/100 case. Mutations occurred in 55/100 cases; BRAFV600E was the most frequently detected (49/100) and was associated with higher tumour size, bilateralism and follicular variant but not with capsular invasion. RET/PTC rearrangements were found in 2/100 cases, NRASQ61R in 4/100, while no mutations of TERT promoter gene were detected. Despite the observed association between BRAFV600E mutation and unfavourable histopathological features, we found no direct association with tumour recurrence, distant metastases and mortality. CONCLUSION In our study, the search for the most frequent genetic alterations as prognostic markers in mPTCs would not have changed the therapeutic strategy.
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Affiliation(s)
- Maria Teresa Samà
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy.
| | - Enrico Grosso
- Laboratory of Molecular Oncology, Fondazione Edo ed Elvo Tempia, Ponderano, Biella, Italy
| | - Chiara Mele
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Sara Laurora
- Laboratory of Molecular Oncology, Fondazione Edo ed Elvo Tempia, Ponderano, Biella, Italy
| | - Oriana Monzeglio
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Renzo Boldorini
- Pathology Department, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Paolo Aluffi Valletti
- ENT Division, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, University Hospital "Maggiore della Carità", University of Eastern Piedmont, Novara, Italy
| | - Maria Scatolini
- Laboratory of Molecular Oncology, Fondazione Edo ed Elvo Tempia, Ponderano, Biella, Italy
| | - Loredana Pagano
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Torino, Italy
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Tabriz N, Grone J, Uslar V, Tannapfel A, Weyhe D. BRAF V600E mutation correlates with aggressive clinico-pathological features but does not influence tumor recurrence in papillary thyroid carcinoma-10-year single-center results. Gland Surg 2020; 9:1902-1913. [PMID: 33447541 DOI: 10.21037/gs-20-244] [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: 11/06/2022]
Abstract
Background BRAF V600E mutation is common in papillary thyroid carcinoma (PTC) but its prognostic value and influence on tumor recurrence is controversial. We investigated if BRAF V600E mutation influences tumor behavior and recurrence, and if it can be used as surrogate parameter in PTC. Methods In a single center retrospective study with a median follow-up of 5 years, incidence of BRAF V600E mutation in 186 PTC specimens from 2007-2016 was investigated. Tumor outcome parameters including TNM status, multifocal and invasive growth and tumor recurrence rate were examined. Results In 98 specimens (52.7%) a BRAF V600E mutation (BRAF+), and in 88 specimens (47.3%) no mutation (BRAF-) was detected. There was no gender specific difference. BRAF+ patients were significantly older (mean 5.6 years; P=0.011). BRAF+ tumors were significantly smaller (14.4 vs. 18.3 mm; P=0.018), and more often showed a multifocal (30.6% vs. 17%; P=0.031) and extracapsular tumor growth pattern (pT3b and pT4a; BRAF+ 22.4% vs. BRAF- 10.2%; P=0.026). Although lymph node-status did not differ in both groups, BRAF+ showed a higher infiltration rate of the lateral lymph node compartment (12.2% vs. 5.7%; P=n.s.). Distant metastases occurred only in BRAF+ (3.1% vs. 0%). There was no significant difference in terms of tumor recurrence rate. Conclusions Results regarding the incidence of malignant lymph nodes, tumor growth pattern and tumor multifocality suggest a more aggressive tumor behavior in BRAF+ PTC but this fact does not affect tumor recurrence rate in a five year follow up period. Therefore, the postoperative role of BRAF V600E mutation remains unclear, and a general change of operative procedure and radicality cannot be recommended based on BRAF status alone.
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Affiliation(s)
- Navid Tabriz
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Johannes Grone
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | - Verena Uslar
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
| | | | - Dirk Weyhe
- University Hospital for Visceral Surgery, Pius Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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Yang W, Bai C, Zhang L, Li Z, Tian Y, Yang Z, Wang L, Wu W. Correlation between serum circRNA and thyroid micropapillary carcinoma with cervical lymph node metastasis. Medicine (Baltimore) 2020; 99:e23255. [PMID: 33217846 PMCID: PMC7676571 DOI: 10.1097/md.0000000000023255] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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
The study aims to characterize the circular RNA (circRNA) expression profile that is functionally related with the invasiveness of papillary thyroid microcarcinoma (PTMC).A total of 13 pairs of female patients with non-invasive PTMC or lymph node metastasis PTMC (PTMC (L)) were included and the serum RNA was obtained. CircRNA microarray was performed to identify the circRNA expression profile. Real time-PCR was used to verify circRNA expression. Bioinformatic approaches were adopted to annotate the function of differentially expressed circRNAs and construct the circRNA-miRNA-mRNA network.In total, 400 significantly upregulated and 290 significantly downregulated circRNAs were identified in PTMC (L) compared with PTMC. Among them, 10 circRNAs were selected and validated by real time-PCR. Putative microRNAs (miRNAs) that could bind to the differentially expressed circRNAs were predicted. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses of target genes of the differentially expressed circRNAs revealed that these circRNAs may play an important role in lymph node metastasis. Finally, circRNA targeted miRNAs were predicted and a circRNA-miRNA-mRNA network was constructed for hsa_circRNA_404686.Our results showed that several circRNAs, such as hsa_circRNA_404686, may serve as promising diagnostic marker for PTMC (L) in female.
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Affiliation(s)
- Wenwen Yang
- Department of Endocrinology, Second Hospital affiliated to Xinjiang Medical University
| | - Chao Bai
- Department of Vascular and Thyroid Surgery, First Hospital affiliated to Xinjiang Medical University, Urumqi
| | - Li Zhang
- Sanya Central Hospital, Sanya, PR China
| | | | - Ye Tian
- Department of Vascular and Thyroid Surgery, First Hospital affiliated to Xinjiang Medical University, Urumqi
| | - Zhenwei Yang
- Department of Vascular and Thyroid Surgery, First Hospital affiliated to Xinjiang Medical University, Urumqi
| | - Liang Wang
- Department of Vascular and Thyroid Surgery, First Hospital affiliated to Xinjiang Medical University, Urumqi
| | - Wennian Wu
- Department of Vascular and Thyroid Surgery, First Hospital affiliated to Xinjiang Medical University, Urumqi
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Huang K, Gao N, Bian D, Zhai Q, Yang P, Zhang Y. Associations of BRAF V600E, clinical pathology and imaging factors with the recurrence rate of papillary thyroid microcarcinoma. Exp Ther Med 2020; 20:243. [PMID: 33178341 DOI: 10.3892/etm.2020.9373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 05/13/2020] [Indexed: 01/17/2023] Open
Abstract
In the present study, the recurrence rate of papillary thyroid microcarcinoma (PTMC) was assessed by analyzing postoperative follow-up data of affected patients and its associations with BRAF V600E, clinical pathology and imaging factors were explored. A total of 506 patients with PTMC were selected who underwent surgery from January 2014 to March 2016. The maximal diameter of thyroid nodules was ≤1 cm and all patients who underwent BRAF V600E testing and evaluation for lymph node metastasis. Postoperatively, each patient was regularly followed up to detect recurrence. Categorical variables were comparatively analyzed using univariate Cox linear regression analysis to screen for protective and adverse factors influencing recurrence of PTMC. A stepwise Cox proportional hazards regression model analysis was performed to explore risk factors affecting recurrence. Among the 506 patients, 477 were followed up, 29 were lost to follow-up and 26 patients experienced recurrence. The 5-year recurrent rate of PTMC was 5.45%. The univariate Cox regression analysis indicated that PTMC recurrence was influenced by BRAF V600E, sex, multifocality, capsular invasion and lateral cervical lymph node metastasis (P<0.05), but not by age, tumor location on the thyroid, size, single central lymph node metastasis, distant metastasis and operative approach (P>0.05). The significant factors associated with recurrent PTMC were subjected to stepwise multivariate Cox proportional hazards regression model analysis and the results indicated that BRAF V600E, sex, multifocality and lateral cervical lymph node metastasis were independent factors influencing recurrence in patients with PTMC, with a statistically significant difference (P<0.05). In conclusion, BRAF V600E, sex, multifocality and lateral cervical lymph node metastasis are independent risk factors for recurrent PTMC.
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Affiliation(s)
- Kun Huang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Ningning Gao
- Department of Ultrasonic Diagnosis, Liaoning Province Cancer Hospital and Institute, Shenyang, Liaoning 110042, P.R. China
| | - Donglin Bian
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Qixi Zhai
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Puxu Yang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
| | - Yunfei Zhang
- Department of Ultrasonic Diagnosis, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
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Rahman ST, Pandeya N, Neale RE, McLeod DSA, Bain CJ, Baade PD, Youl PH, Allison R, Leonard S, Jordan SJ. Obesity Is Associated with BRAFV600E-Mutated Thyroid Cancer. Thyroid 2020; 30:1518-1527. [PMID: 32228152 DOI: 10.1089/thy.2019.0654] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Thyroid cancer incidence has increased in many parts of the world since the 1980s, as has the prevalence of obesity. Evidence suggests that people with greater body size have higher thyroid cancer risk. However, it is unclear whether this association is causal or is driven by over-diagnosis of indolent cancers, because overweight/obese people use health services more frequently than those of normal weight, thus conferring greater opportunity for incidental diagnosis. Assessing whether obesity is associated with higher-risk thyroid cancers might help clarify this issue. Methods: We recruited 1013 people diagnosed with thyroid cancer between 2013 and 2016 and 1057 population controls, frequency matched by sex and age group. We used logistic regression to assess the association between body mass index (BMI) and overall thyroid cancer risk as well as by tumor BRAF mutational status as a marker of potentially higher-risk cancer. Results: Overall, obesity was associated with greater risk of thyroid cancer (odds ratio [OR] = 1.72; 95% confidence interval [CI 1.37-2.16] for obese vs. normal BMI). The association with obesity was significantly stronger for BRAF-mutation positive than BRAF-negative papillary thyroid cancers (PTCs; OR = 1.71 [CI 1.17-2.50] for BRAF-positive vs. BRAF-negative cancers). The increased risks associated with overweight/obesity did not vary by histological subtypes or presence/absence of adverse tumor histologic features. Conclusions: Greater risk of BRAF-mutated PTCs among those with high BMI suggests that the association may not merely reflect greater health care service use and indicates an independent relationship between obesity and clinically important thyroid cancer.
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Affiliation(s)
- Sabbir T Rahman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Nirmala Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Rachel E Neale
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Donald S A McLeod
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Chris J Bain
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Peter D Baade
- Cancer Council Queensland, Brisbane, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Australia
| | | | - Roger Allison
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Susan Leonard
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Susan J Jordan
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- School of Public Health, The University of Queensland, Brisbane, Australia
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Ieni A, Vita R, Cardia R, Giuffré G, Benvenga S, Tuccari G. BRAF Status in Papillary Microcarcinomas of the Thyroid Gland: a Brief Review. Curr Mol Med 2020; 19:665-672. [PMID: 31625469 DOI: 10.2174/1566524019666190717161359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 12/23/2022]
Abstract
Papillary thyroid microcarcinoma (PTMC) is defined by the World Health Organization as papillary cancer measuring 10 mm or less in diameter. Generally, PTMC shows an indolent clinical behavior with a good prognosis, although a minority of PTMC is characterized by an aggressive course. However, efforts to identify this aggressive subset of PTMC after surgery remain inconclusive. Several oncogenic pathways have been identified in thyroid cancer and have been applied translationally to improve prognosis and clinical management. In particular, the BRAFV600E mutation was found more frequently in large, aggressive, recurrent and advanced tumors. We aimed at reviewing studies on BRAFV600E mutation as a prognostic factor in PTMC.
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Affiliation(s)
- Antonio Ieni
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Roberto Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Cardia
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Giuseppe Giuffré
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
| | - Salvatore Benvenga
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Master Program on Childhood, Adolescent and Women's Endocrine Health, University of Messina, Messina, Italy.,Interdepartmental Program of Molecular & Clinical Endocrinology, and Women's Endocrine Health, University of Messina, Messina, Italy
| | - Giovanni Tuccari
- Department of Human Pathology "Gaetano Barresi" - Section of Pathological Anatomy, A.O.U. Polyclinic G.Martino, 98125 Messina, Italy
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Long MY, Chen JW, Zhu Y, Luo DY, Lin SJ, Peng XZ, Tan LP, Li HH. Comprehensive circular RNA profiling reveals the regulatory role of circRNA_0007694 in papillary thyroid carcinoma. Am J Transl Res 2020; 12:1362-1378. [PMID: 32355548 PMCID: PMC7191164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/02/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The present study aimed to identify differentially expressed circRNAs in thyroid cancer and verify their potential functions. METHODS Next-generation sequencing was used to identify differentially expressed circRNAs between papillary thyroid carcinoma (PTC) tissues and paired pericarcinomatous tissues. Polymerase chain reaction and Sanger sequencing methods successfully identified hsa_circ_0007694. A hsa_circ_0007694 over-expression vector was prepared to determine the effect of this circRNA on proliferation, migration, invasion, apoptosis, and the cell cycle in PTC cells. An in vivo animal assay was conducted by injecting PTC cells into the chests of mice. Further, RNA-seq was performed, followed by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, to verify the regulatory mechanism of hsa_circ_0007694. Western blotting was used to verify the genes thought to be involved in the hsa_circ_0007694 regulatory pathways based on KEGG analysis. RESULTS We identified a circRNA, hsa_circ_0007694 that was down-regulated in PTC tissues compared to pericarcinomatous tissues. Over-expression of hsa_circ_0007694 promoted apoptosis and inhibited proliferation, migration, and invasion in PTC cells in vitro, and decreased tumor growth in vivo. Transcriptome sequence analysis suggested 129 differentially expressed genes between PTC tissue and paired pericarcinomatous tissue. KEGG analysis and western blotting indicated that the PI3K/AKT/mTOR and Wnt signaling networks are most likely to be related to hsa_circ_0007694 in thyroid cancer. CONCLUSION The circRNA hsa_circ_0007694 is down-regulated in PTC and is therefore a potential therapeutic target.
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Affiliation(s)
- Miao-Yun Long
- Department of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
| | - Jin-Wu Chen
- Medical Examination Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
| | - Yue Zhu
- Department of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
| | - Ding-Yuan Luo
- Department of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
| | - Shao-Jian Lin
- Department of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
| | - Xin-Zhi Peng
- Department of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
| | - Lang-Ping Tan
- Department of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
| | - Hong-Hao Li
- Department of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou 510000, China
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Koelsch B, Theurer S, Staniszewska M, Heupel J, Koch A, Mergener S, Walk F, Fischer C, Kutritz A, Schmid KW, Kindler-Röhrborn A. An Animal Model Further Uncovers the Role of Mutant Braf V600E during Papillary Thyroid Cancer Development. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:702-710. [PMID: 31953036 DOI: 10.1016/j.ajpath.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022]
Abstract
Papillary thyroid carcinomas (PTCs) account for 90% of human thyroid cancer cases, which represent 1% of all cancer cases. They are likely to develop from papillary thyroid microcarcinomas (PTMCs), found in up to 36% of healthy individuals, due to rare progression events (0.01%). Although the prognosis of PTCs is excellent, 5% to 10% of tumors display an unfavorable outcome. About 45% of PTCs exhibit activating BRAFV600E mutations. Rats of the inbred BD strains postnatally exposed to the carcinogen N-ethyl-N-nitrosourea developed PTMCs, which closely resembled their human counterparts judging from their histology, size, and marginal tendency to progress. DNA sequencing revealed mutations in exon 15 of the Braf gene identical to the human BRAFV600E mutation in 82% of the cases. Predominantly a 50:50 ratio of wild-type to mutant Braf alleles was seen regardless of tumor size or animal age, indicating that the Braf mutation is an early, if not the initial, event in rat PTMC development. Surprisingly, most PTMCs carrying a confirmed BrafV600E mutation did not display BrafV600E protein expression. As the BrafV600Egene is supposed to be the driver in PTC development, down-regulation of expression should contribute to the low risk for progression of PTMC. This model system will enable further insights into the molecular mechanisms of PTMC initiation and progression to PTC, further translating into targeted tumor prevention strategies/therapies.
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Affiliation(s)
- Bernd Koelsch
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Sarah Theurer
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Magdalena Staniszewska
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Jacqueline Heupel
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Amelie Koch
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Svenja Mergener
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Franziska Walk
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Christine Fischer
- Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Andrea Kutritz
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Kurt W Schmid
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Andrea Kindler-Röhrborn
- Institute of Pathology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany.
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Ma H, Wang R, Fang J, Zhong Q, Chen X, Hou L, Feng L, Chen X, Huang Z, Zhao H. A meta-analysis evaluating the relationship between B-type Raf kinase mutation and cervical lymphatic metastasis in papillary thyroid cancer. Medicine (Baltimore) 2020; 99:e18917. [PMID: 32000400 PMCID: PMC7004699 DOI: 10.1097/md.0000000000018917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND B-type Raf kinase (BRAF) mutation is proved to be a critical predictive factor in papillary thyroid cancer (PTC) with aggressive characteristics. However, the association between BRAF mutation and cervical lymphatic metastasis in PTC is controversial. METHODS We searched papers on the study of BRAF mutation and cervical lymphatic metastasis in PTC patients through PubMed, Web of Science, Embase, and Cochranelibrary. The BRAF (+) cases, BRAF (-) cases, and cervical lymphphatic metastatic cases in both BRAF (+) and BRAF (-) groups were collected. After Quality assessment, statistical Analysis (funnel plot and Harbord evaluation, Random-effect model, heterogeneity, subgroup analysis, sensitivity analysis, and metacum analysis) were done by the Review Manager (RevMan) 5.3 and stata14 statistical software. RESULTS There were 78 cross-section studies which met our inclusion criteria. And all of them had no selection bias, publication bias, or any other bias. A significant association existed between BRAF mutation and cervical lymph node metastasis (LNM) (odds ratio [OR] = 1.63; 95% confidence interval [CI]: 1.44-1.84; P < .05). Overall, 46 studies were conducted among East Asians. Twenty four articles had provided the data of central lymph node metastasis (CLNM), 11 articles with the data of lateral lymph node metastasis (LLNM), and classic/conventional PTC (CPTC) was analyzed in 10 studies. Subgroup analyses were performed based on ethnicity, metastatic site, and subtype of PTC. Significant association between BRAF (+) mutation and cervical LNM were indicated in East Asians (OR = 1.73; 95% CI: 1.49-2.02; P < .05), in non-East Asians (OR = 1.57; 95% CI: 1.26-1.96; P < .05), and in CLNM (OR = 1.80; 95% CI: 1.56-2.07; P < .05). While no significant association was found in LLNM (OR = 1.37; 95% CI: 0.76-2.48; P = .29 > .05) and in CPTC (OR = 1.32; 95% CI: 0.97-1.80; P = .08 > .05). We did not find any other major changes when sensitivity analysis was performed. The metacum analysis showed no significant association existed before 2012. While a significant association began to exist between BRAF mutation and LNM from 2012, and this association became stable from 2017. CONCLUSIONS We consider that a significant association exists between BRAF mutation and cervical LNM. Further meta-analysis on subgroup may reveal some valuable factors between BRAF gene mutation and LNM. And we do not recommend that BRAF (+) as the biomarker for LNM in PTC.
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Affiliation(s)
- Hongzhi Ma
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Ru Wang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Jugao Fang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Qi Zhong
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Xiao Chen
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Lizhen Hou
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Ling Feng
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Xiaohong Chen
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Zhigang Huang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tong Ren Hospital, Capital Medical University, Beijing
| | - Huanhu Zhao
- School of Pharmacy, Minzu University of China, China
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High iodine effects on the proliferation, apoptosis, and migration of papillary thyroid carcinoma cells as a result of autophagy induced by BRAF kinase. Biomed Pharmacother 2019; 120:109476. [DOI: 10.1016/j.biopha.2019.109476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/11/2022] Open
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Paragliola RM, Corsello A, Del Gatto V, Papi G, Pontecorvi A, Corsello SM. Lenvatinib for thyroid cancer treatment: discovery, pre-clinical development and clinical application. Expert Opin Drug Discov 2019; 15:11-26. [PMID: 31608696 DOI: 10.1080/17460441.2020.1674280] [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: 01/13/2023]
Abstract
Introduction: About one third of patients affected with thyroid cancer present with recurrent disease. Unresectability, advanced disease and radioiodine refractoriness are considered poor prognostic factors. Treatment with small molecules inhibiting molecular signaling can be considered for patients with progressive disease, when other therapeutic strategies cannot be applied. Lenvatinib is a tyrosine kinase inhibitor targeting multiple molecular factors involved in angiogenesis and tumor progression. Preclinical studies have demonstrated the utility of lenvatinib as a targeted therapy for different tumors, including both differentiated and anaplastic thyroid cancer.Areas covered: The authors provide an overview of the preclinical development of lenvatinib in the treatment of thyroid cancer and review its clinical application. They also provide their expert opinion on its development.Expert opinion: Preclinical studies have helped in the understanding of the mechanisms of thyroid carcinogenesis and in the development of a targeted therapy. These findings have represented the rationale for the use of lenvatinib in clinical trials, which have confirmed its utility but yet failed to prove a clear benefit in overall survival. The decision to start a systemic treatment with lenvatinib must be personalized for each patient evaluating the risk/benefits ratio. Treatment emergent adverse events must be considered and reasonably managed by a multidisciplinary approach.
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Affiliation(s)
- Rosa Maria Paragliola
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Corsello
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valeria Del Gatto
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giampaolo Papi
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Pontecorvi
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Maria Corsello
- Endocrinology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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48
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Ji W, Xie H, Wei B, Shen H, Liu A, Gao Y, Wang L. Relationship between BRAF V600E gene mutation and the clinical and pathologic characteristics of papillary thyroid microcarcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:3492-3499. [PMID: 31934195 PMCID: PMC6949828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aims to investigate the relationship between BRAF V600E gene mutation and the clinical and pathologic characteristics of patients with papillary thyroid microcarcinoma (PTMC). METHODS A retrospective analysis was conducted on the clinical and pathologic characteristics of 89 patients with PTMC, who had complete medical records. The BRAF V600E gene mutation was detected by real-time immunofluorescence quantitative PCR. Then, the BRAF V600E gene mutation and the clinical and pathologic data of these patients were statistically analyzed. RESULTS Among the 89 patients with PTMC, 67 patients had a BRAF V600E mutation with a mutation rate of 75.3%. 38 patients (42.6%) had cervical lymph node metastasis. 43 patients had capsular invasion (48.3%) and 40 patients (44.9%) had tumor multifocality confirmed by postoperative pathology. BRAF V600E mutation was not associated with gender, age, capsular invasion, tumor multifocality, cervical lymph node metastasis, or higher TNM stage. However, cervical lymph node metastasis was associated with age and tumor invasion of the capsule. Thus, cervical lymph node metastasis was most likely in patients < 45 years old and patients with capsular invasion. CONCLUSION BRAF V600E mutation is common in PTMC, but is not associated with clinicopathologic factors, such as age, gender, tumor multifocality, cervical lymph node metastasis, capsular invasion, or tumor TNM stage. Cervical lymph node metastasis is more likely in patients < 45 years old and patients with capsular invasion.
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Affiliation(s)
- Wei Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical UniversityBeijing, P. R. China
| | - Hong Xie
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical UniversityBeijing, P. R. China
| | - Bojun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical UniversityBeijing, P. R. China
| | - Hong Shen
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical UniversityBeijing, P. R. China
| | - Aizhu Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical UniversityBeijing, P. R. China
| | - Ying Gao
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical UniversityBeijing, P. R. China
| | - Lingling Wang
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical UniversityBeijing, P. R. China
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49
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Hsu Y, Lee J, Chien M, Chen M, Leung C, Cheng S. Is papillary thyroid microcarcinoma a biologically different disease? A propensity score‐matched analysis. J Surg Oncol 2019; 120:1023-1030. [DOI: 10.1002/jso.25670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/04/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Yi‐Chiung Hsu
- Department of Biomedical Sciences and EngineeringNational Central University Taoyuan City Taiwan
| | - Jie‐Jen Lee
- Department of SurgeryMacKay Memorial Hospital and Mackay Medical College Taipei Taiwan
| | - Ming‐Nan Chien
- Division of Endocrinology and Metabolism, Department of Internal MedicineMacKay Memorial Hospital and Mackay Medical College Taipei Taiwan
| | - Ming‐Jen Chen
- Department of SurgeryMacKay Memorial Hospital and Mackay Medical College Taipei Taiwan
- Department of Pharmacology, School of Medicine, College of MedicineTaipei Medical University Taipei Taiwan
| | - Ching‐Hsiang Leung
- Division of Endocrinology and Metabolism, Department of Internal MedicineMacKay Memorial Hospital and Mackay Medical College Taipei Taiwan
| | - Shih‐Ping Cheng
- Department of SurgeryMacKay Memorial Hospital and Mackay Medical College Taipei Taiwan
- Department of Pharmacology, School of Medicine, College of MedicineTaipei Medical University Taipei Taiwan
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50
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Liu Y, He L, Yin G, Cheng L, Zeng B, Cheng J, Yang L. Association analysis and the clinical significance of BRAF gene mutations and ultrasound features in papillary thyroid carcinoma. Oncol Lett 2019; 18:2995-3002. [PMID: 31452778 PMCID: PMC6704325 DOI: 10.3892/ol.2019.10641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 06/14/2019] [Indexed: 12/13/2022] Open
Abstract
The aim of the present study was to evaluate the associations between the B-Raf proto-oncogene serine/threonine kinase (BRAF)V600E mutation and conventional and contrast-enhanced ultrasonographic features in patients with papillary thyroid carcinoma (PTC), and to subsequently investigate the clinical value of these associations. In total, 207 thyroid nodules (diameter ≤2 cm) were selected. Conventional ultrasound, contrast-enhanced ultrasound, BRAFV600E mutational analysis and ultrasound-guided fine-needle aspiration biopsy were preoperatively performed, and histopathological assessment of PTC was postoperatively confirmed. The nodules were divided into 2 groups based on the BRAFV600E mutational analysis, namely the mutant or the wild-type variant groups, and the association analyses of the ultrasonographic features between these 2 groups were performed. Overall, 74.9% (155/207) of the PTC nodules had the BRAFV600E mutation, while 25.1% (52/207) had the wild-type BRAF allele. The 2 groups were analyzed using univariate logistic regression analysis, which demonstrated no significant differences regarding morphology, boundary, hypoechogenicity of the nodules, blood flow signal, enhancement uniformity, enhancement degree and clearance time (P>0.05). Moreover, the 2 groups demonstrated significant differences regarding the aspect ratio, microcalcification, nodule size following enhancement, enhancement mode and enhancement time (P<0.05). A multivariate logistic regression analysis was performed to further validate the association of these features with the BRAFV600E mutation; however, only microcalcification [odds ratio (OR), 2.256; 95% confidence interval (CI), 1.160–5.500; P=0.020] and nodule size following enhancement (OR, 2.119; 95% CI, 1.039–4.321; P=0.039) were associated with the BRAF mutational status. The associations found between the two ultrasonographic features and BRAFV600E mutation indicate that they can predict the BRAF mutational status to provide a reliable basis for clinical diagnosis and treatment.
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Affiliation(s)
- Ying Liu
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Lingyun He
- Department of Scientific Research and Education Section, Chongqing Health Center for Women and Children, Chongqing 401120, P.R. China
| | - Guobing Yin
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Long Cheng
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Bin Zeng
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
| | - Juan Cheng
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University and Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400010, P.R. China
| | - Lu Yang
- Department of Breast and Thyroid Surgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P.R. China
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