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Xiang L, Zhao JH, Tang Y, Tan JW, Li LB, Gong C. Prognostic prediction of patients having classical papillary thyroid carcinoma with a 4 mRNA-based risk model. Medicine (Baltimore) 2024; 103:e38472. [PMID: 38847736 PMCID: PMC11155612 DOI: 10.1097/md.0000000000038472] [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: 06/19/2023] [Accepted: 05/15/2024] [Indexed: 06/10/2024] Open
Abstract
The dysregulation of protein-coding genes involved in various biological functions is closely associated with the progression of thyroid cancer. This study aimed to investigate the effects of dysregulated gene expressions on the prognosis of classical papillary thyroid carcinoma (cPTC). Using expression profiling datasets from the Cancer Genome Atlas (TCGA) database, we performed differential expression analysis to identify differentially expressed genes (DEGs). Cox regression and Kaplan-Meier analysis were used to identify DEGs, which were used to construct a risk model to predict the prognosis of cPTC patients. Functional enrichment analysis unveiled the potential significance of co-expressed protein-encoding genes in tumors. We identified 4 DEGs (SALL3, PPBP, MYH1, and SYNDIG1), which were used to construct a risk model to predict the prognosis of cPTC patients. These 4 genes were independent of clinical parameters and could be functional in cPTC carcinogenesis. Furthermore, PPBP exhibited a strong correlation with poorer overall survival (OS) in the advanced stage of the disease. This study suggests that the 4-gene signature could be an independent prognostic biomarker to improve prognosis prediction in cPTC patients older than 46.
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Affiliation(s)
- Lin Xiang
- Department of Otolaryngology-Head and Neck Surgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China
| | - Jun-Hui Zhao
- Department of Otolaryngology-Head and Neck Surgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China
| | - Yao Tang
- Department of Otolaryngology-Head and Neck Surgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China
| | - Jun-Wu Tan
- Department of Otolaryngology-Head and Neck Surgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China
| | - Liang-Bo Li
- Department of Otolaryngology-Head and Neck Surgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China
| | - Cheng Gong
- Department of Otolaryngology-Head and Neck Surgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China
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2
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Dizdarevic S, McCready VR, Skalonja M. Thyrotoxicosis is no insurance against thyroid cancer. Eur J Nucl Med Mol Imaging 2024; 51:1675-1677. [PMID: 38172355 DOI: 10.1007/s00259-023-06580-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Sabina Dizdarevic
- Department Nuclear Medicine, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK.
- Brighton and Sussex Medical School, University of Sussex and Brighton, Brighton, UK.
| | - V Ralph McCready
- Department Nuclear Medicine, Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Mirza Skalonja
- Department of Nuclear Medicine, District General Hospital Prim Dr Abdulah Nakas, Sarajevo, Bosnia and Herzegovina
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3
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Verma P, Malhotra G, Rao RD, Sonavane S, Agrawal R. Rare Presentations of Differentiated Thyroid Cancer Exposing Dr Jekyll and Mr Hyde Nature of an Otherwise Indolent Disease: Case Series. Clin Nucl Med 2024; 49:e193-e196. [PMID: 38409755 DOI: 10.1097/rlu.0000000000005138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
ABSTRACT Differentiated thyroid carcinoma (DTC) usually manifests as an indolent cancer with good prognosis. However, rarely uncommon sites of metastatic involvement can worsen the prognosis and require aggressive therapeutic approach. Here in, we describe 5 patients (3 women and 2 men) harboring rare sites of metastatic involvement from DTC including the adrenals, colon, kidneys, urinary bladder, brachial plexus, and superior vena cava with contiguous right atrial involvement. The awareness of such rare sites of involvement from DTC is imperative for treating clinicians to plan individualistic approach in management including multiprong therapies for better patient care.
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Affiliation(s)
| | | | | | | | - Ritesh Agrawal
- Department of Endocrine Surgery, Bombay Hospital and Medical Research Centre, Mumbai, India
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4
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Long Y, Jin J, Zhang W. Sufficiency of a Single Negative Thyroglobulin Standard for Judging the Success of Ablation in Low- and Intermediate-risk Differentiated Thyroid Cancer: A Retrospective Study. Endocr Metab Immune Disord Drug Targets 2024; 24:1204-1214. [PMID: 38192150 DOI: 10.2174/0118715303267441231128064729] [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: 07/10/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND We investigated how reduced successful ablation criteria may be used to evaluate radioiodine remnant ablation in patients with low- and intermediate-differentiated thyroid carcinoma (DTC). METHODS Overall, 254 low- and intermediate-risk patients with DTC were categorized into three groups (positive, weak, positive, and negative) on the basis of a visual study of thyroid imaging performed before postoperative iodine treatment. Semi-quantitative analysis parameters were incorporated into the positive Tc-99m pertechnetate scanning to further examine the clinical use of thyroid imaging. We investigated the value of successful judgment criteria and the influencing factors of radioiodine ablation. At the same time, the predictive value of thyroglobulin (Tg) for radioiodine treatment and the overall clinical efficacy were assessed. RESULTS A total of 250 (98.43%) patients were identified as having functional thyroid tissue residue on the Rx-whole-body scan, and 137 (53.94%) patients had positive Tc-99m pertechnetate scans using semi-quantitative analysis. The single Tg standard could not substitute the double standard (χ2c=22.042, p<0.001) for patients with residual thyroid weight by a semiquantitative analysis. However, the semi-quantitative analysis revealed no association between 99mTcO4-thyroid scan and ablation treatment using semi-quantitative analysis; only preablation sTg levels were related with success in the multivariate logistic regression analysis, with a cut-off value of 2.88 ng/mL. The pre-ablation stimulated Tg level was also the primary factor of satisfactory response following follow-up with an optimal cut-off of 6.506 ng/mL. CONCLUSION Even in low- and intermediate-risk patients with DTC, a single negative Tg standard also requires receiving some restrictions in the evaluation of ablation success and is inadequate. Conventional 99mTcO4 thyroid imaging combined with a quantitative analysis program can improve the clinical practice of single negative Tg standard.
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Affiliation(s)
- Yahong Long
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jianhua Jin
- Department of Nuclear Medicine, First Hospital of Shanxi Medical University. Taiyuan 030000, China
| | - Wanchun Zhang
- Department of Nuclear Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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5
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Cao Y, Li J, Du Y, Sun Y, Liu L, Fang H, Liang Y, Mao S. LINC02454 promotes thyroid carcinoma progression via upregulating HMGA2 through CREB1. FASEB J 2023; 37:e23288. [PMID: 37997502 DOI: 10.1096/fj.202301070rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/07/2023] [Accepted: 10/18/2023] [Indexed: 11/25/2023]
Abstract
Thyroid carcinoma (THCA) is the most common malignancy in the endocrine system. Long intergenic non-coding RNA 2454 (LINC02454) exhibits an HMGA2-like expression pattern, but their relationship and roles in THCA are largely unknown. The present purpose was to delineate the roles of LINC02454 in THCA progression and its molecular mechanisms. We collected THCA tissues from patients and monitored patient survival. THCA cell colony formation, migration, and invasion were evaluated. Metastasis was evaluated by examining EMT markers through Western blotting. Gene interaction was determined with ChIP, RIP, RNA pull-down, and luciferase activity assays. A mouse model of a subcutaneous tumor was used to determine the activity of LINC02454 knockdown in vivo. We found that LINC02454 was highly expressed in THCA, and its upregulation was associated with poor survival. The knockdown of LINC02454 repressed colony formation, migration, and invasion. Moreover, loss of LINC02454 inhibited tumor growth and metastasis in mice. HMGA2 promoted LINC02454 transcription via binding to the LINC02454 promoter, and silencing of HMGA2 suppressed malignant behaviors through downregulation of LINC02454. HMGA2 was a novel functional target of LINC02454 in THCA cells, and knockdown of LINC02454-mediated anti-tumor effects was reversed by HMGA2 overexpression. Mechanically, LINC02454 promoted CREB1 phosphorylation and nuclear translocation, and CREB1 was subsequently bound to the HMGA2 promoter to facilitate its expression. LINC02454 cis-regulates HMGA2 transcription via facilitating CREB1 phosphorylation and nuclear translocation, and, in turn, HMGA2 promotes LINC02454 expression, thus accelerating thyroid carcinoma progression. Our results support therapeutic targets of LINC02454 and HMGA2 for THCA.
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Affiliation(s)
- Yan Cao
- Department of Nuclear Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jian Li
- Department of Nuclear Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yongliang Du
- Department of Nuclear Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuxuan Sun
- Department of clinical medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Le Liu
- Department of Nuclear Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hao Fang
- Department of Nuclear Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yan Liang
- Department of Nuclear Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Shanshan Mao
- Department of Tumor Chemotherapy, Haikou People's Hospital, Haikou, China
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Owens C, Fitzhugh A, Harrington K, Paleri V, Sharma B, Shur J, Ap Dafydd D. Incidentally detected 18 F-FDG PET-CT-avid thyroid nodules in patients with advanced malignancy: long-term oncological outcomes from a single-centre retrospective cohort. Nucl Med Commun 2023; 44:810-815. [PMID: 37272278 DOI: 10.1097/mnm.0000000000001720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES In this retrospective study, we assessed the clinical outcomes of patients with a primary malignancy who had incidentally detected thyroid avidity on their staging 18 F-fluorodeoxyglucose PET-computed tomography ( 18 F-FDG PET-CT) examinations. METHODS A focused retrospective search was made using a Radiology Information System to identify only patients with positive thyroid nodules on their 18 F-FDG PET-CT imaging between January 2012 and December 2017. Patient demographics, principal oncological diagnosis, and stage were recorded. The sonographic appearances of thyroid nodules, number of fine needle aspiration (FNA) attempts, final cytology, management plan, and clinical outcome were recorded. Follow-up records were available for between 2 and 7 years. RESULTS Following exclusions, 136 patients were found to have incidental thyroid avidity on their 18 F-FDG PET-CT. A total of 50 of these patients proceeded to thyroid ultrasound assessment. Of these, 37 patients underwent FNA (average 1.3 FNA attempts) with 17 having atypical cytology and 6 diagnosed with an incidental thyroid cancer either by FNA or thyroidectomy. Four patients who underwent surgery had benign pathology. All thyroid cancers identified were indolent papillary cancers without any impact on the treatment plan or survival. CONCLUSION The clinical outcomes of patients with an established primary malignancy are determined by their primary cancer and not by incidentally detected thyroid cancer. It may therefore be reasonable not to formally investigate a proportion of incidental 18 F-FDG PET-CT positive thyroid nodules where added benefit is unlikely. In such cases, a 'watch-and-wait' approach to the thyroid might be considered more appropriate.
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Affiliation(s)
- Cara Owens
- Royal Brompton Hospital
- Royal Marsden Hospital, London, UK
| | | | | | - Vinidh Paleri
- Institute of Cancer Research
- Royal Marsden Hospital, London, UK
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7
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Hakim Tawil JA, Rojas MF, Santivañez JJ, León L, González Devia D. Prognostic factors for recurrence in patients with papillary thyroid carcinoma. EAR, NOSE & THROAT JOURNAL 2023:1455613231158792. [PMID: 36802846 DOI: 10.1177/01455613231158792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The prognostic factors for tumor recurrence and mortality of patients diagnosed with Papillary Thyroid Carcinoma (PTC) with immediate surgery in Colombia has not been reported. OBJECTIVE To retrospectively evaluate the risk factors for recurrence and survival at 10 years in patients with the diagnosis of PTC treated at Fundación Santa Fe deBogota (FSFB). METHODS A total of 486 patients with thyroid surgery accompanied by medical follow-up were recruited. Demographic, clinical, and pathological variables were followed-up for a median period of 10 years. RESULTS The most significant variables for recurrence were tumors with > 4 cm of size (hazard ratio [HR] = 8.1; 95% confidence interval [CI] = 1.7-55) and extrathyroidal spread (HR = 26.7; 95% CI = 3.1-228). CONCLUSION PTC in our population has low rates of mortality (0.6%) and recurrence (9.6%), with an average time of recurrence of 3 years. Size of the lesion, positive surgical margins, extrathyroidal spread, and high postoperative serum thyroglobulin (Tg) level act as prognostic factors that determine the likelihood of recurrence. Unlike other studies, the influence of age and gender does not act as a prognostic factor.
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Affiliation(s)
- José Antonio Hakim Tawil
- Head and neck surgeon, Chief of Head and Neck Surgery, Department at Fundación Santa Fe de Bogota University Hospital, Bogotá, Colombia
| | | | - Juan José Santivañez
- General surgeon, Head and Neck Surgery, Department at Fundación Santa Fe de Bogota University Hospital, Bogotá, Colombia
| | - Leonardo León
- Medical Population Epidemiologist, Public health, and epidemiology observatory José Félix Patiño Los Andes University, Bogotá, Colombia
| | - Deyanira González Devia
- Department of Internal Medicine, Endocrinology Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
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8
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van Dijk D, Groen AH, van Dijk BAC, van Veen TL, Sluiter WJ, Links TP, Plukker JTHM. The outcome of treatment in differentiated thyroid cancer according to recommendations in current Dutch and American guidelines. Clin Endocrinol (Oxf) 2023; 98:123-130. [PMID: 35781313 PMCID: PMC10087791 DOI: 10.1111/cen.14795] [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: 03/11/2022] [Revised: 06/06/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Assessment of treatment outcome in current de-escalation for differentiated thyroid cancer (DTC) according to the 2015 Dutch thyroid cancer guidelines (NL-15) and American Thyroid Association guidelines (ATA-15). DESIGN Retrospectively, the recommendations of the NL-15 and ATA-15 guidelines were evaluated to estimate potentially adequate, under- and overtreatment of DTC in patients treated in the University Medical Center Groningen between 2007 and 2017. PATIENTS A total of 240 patients with a cT1-T3aN0-1aM0 DTC fulfilled the inclusion criteria. MEASUREMENTS After actual treatment was given, patients were again categorized according to both guidelines into low, intermediate, or high-risk based on tumour status. Next, they were categorized into a congruent low-risk (n = 60), congruent high-risk (n = 73), or incongruent risk group (n = 107). Follow-up data were used to estimate the proportion of potentially adequate, under-, and overtreatment according to both guidelines. RESULTS Comparing treatment recommended by NL-15 and ATA-15 showed significantly more over- and adequate treatment when following NL-15 recommendations, and more undertreatment following ATA-15 (all: p < .001). Subanalysis of the congruent low-risk group showed overtreatment in 64% when following NL-15 guidelines (p < .001). No treatment differences were found in the congruent high-risk group. Undertreatment was most often seen in the incongruent risk group when following ATA-15 (p < .001). CONCLUSIONS Low-risk patients were treated too aggressively when following NL-15 recommendations, where the less aggressive ATA-15 approach seemed more adequate. Treatment of intermediate risk DTC patients varies greatly, with a relative higher rate of undertreatment according to the recommendations of the ATA-15, advocating further refining of the risk classification in this patient group.
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Affiliation(s)
- Deborah van Dijk
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andries H Groen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boukje A C van Dijk
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim L van Veen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Internal Medicine, Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John T H M Plukker
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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9
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Cotler JH, Nogueira L, McCabe R, Nelson H, Brajcich BC, Boffa DJ, Lum SS, Harris JB, Hawhee V, Mullett TW, Bilimoria KY, Palis BE. Evaluating information loss in the National Cancer Database from cases lost to follow-up. J Surg Oncol 2022; 126:1123-1132. [PMID: 36029288 DOI: 10.1002/jso.26977] [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: 05/12/2022] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Cancer registries must focus on data capture which returns value while reducing resource burden with minimal loss of data. Identifying the optimum length of follow-up data collection for patients with cancer achieves this goal. METHODS A two-step analysis using entropy calculations to assess information gain for each follow-up year, and second-order differences to compare survival outcomes between the defined follow-up periods and lifetime follow-up. A total of 391 567 adult cases, deidentified in the National Cancer Database and diagnosed in 1989. Comparisons examined a subset of 61 908 lung cancer cases, 48 387 colon and rectal cancer cases, and 64 134 breast cancer cases in adults. A total of 4133 pediatric cases were diagnosed in 1989 examining 1065 leukemia cases and 494 lymphoma cases. RESULTS Annual increases in information gain fell below 1% after 16 years of follow-up for adult cases and 9 years for pediatric cases. Comparison of second-order differences showed 62% of the comparisons were similar between 15 years and lifetime follow-up when examining restricted mean survival time. In addition, 90% of the comparisons were statistically similar when comparing hazard ratios. CONCLUSIONS Survival analysis using 15 years postdiagnosis follow-up showed minimal differences in information gain compared to lifetime follow-up.
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Affiliation(s)
- Joseph H Cotler
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
| | - Leticia Nogueira
- Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| | - Ryan McCabe
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
| | - Heidi Nelson
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
| | - Brian C Brajcich
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA.,Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Daniel J Boffa
- Department of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sharon S Lum
- Department of Surgery, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - James B Harris
- Department of Surgery, University of Nevada School of Medicine, Reno, Nevada, USA
| | - Vicki Hawhee
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Timothy W Mullett
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Karl Y Bilimoria
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA.,Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern Medicine, Chicago, Illinois, USA
| | - Bryan E Palis
- Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois, USA
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10
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Murokawa T, Okabayashi T, Oishi K, Sui K, Tabuchi M, Iwata J. Exophytic pancreatic lymphoepithelial cyst incidentally detected in a differentiated thyroid cancer patient on whole-body I-131 scan: a case report. Surg Case Rep 2022; 8:34. [PMID: 35211824 PMCID: PMC8873321 DOI: 10.1186/s40792-022-01389-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Radioiodine (I-131) whole-body scintigraphy (WBS) is a useful modality for identifying functionally preserved thyroid tissue and metastases from differentiated thyroid cancer (DTC); however, the specificity of I-131 uptake is limited, and its accumulation in the pancreas has not been well described. Case presentation A 70-year-old male patient with DTC who had previously undergone total thyroidectomy (pT3N1bM0 Stage IV) received radioiodine treatment at our facility. After treatment, an I-131 WBS revealed abnormal I-131 uptake in the head of the pancreas. Computed tomography identified a round hypodense mass (10 × 20 mm) adjacent to the pancreas head that was impervious to fluorodeoxyglucose (18F-FDG) during subsequent 18F-FDG-positron emission tomography. A diagnosis of pancreatic metastasis from the DTC could not be excluded; therefore, local resection was performed for diagnostic certainty and treatment. Histopathology confirmed the mass to be an exophytic lymphoepithelial cyst (LEC) of the pancreas. The patient also had a transient pancreatic leak which spontaneously resolved after surgery, and he was discharged from the hospital on postoperative day 8. Conclusion To the best of our knowledge, this is the first reported case of an exophytic pancreatic LEC producing a false-positive result during I-131 WBS. Knowledge of all potential I-131 false-positive findings may help improve the management of patients with DTC and circumvent misdiagnoses.
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Affiliation(s)
- Takahiro Murokawa
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan.
| | - Kazuyuki Oishi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Kenta Sui
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Motoyasu Tabuchi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Jun Iwata
- Department of Diagnostic Pathology, Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
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11
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Groen AH, van Dijk D, Sluiter W, Links TP, Bijl HP, Plukker JTM. Postoperative external beam radiotherapy for locoregional control in iodine refractory differentiated thyroid cancer. Eur Thyroid J 2022; 11:e210033. [PMID: 34981752 PMCID: PMC9142801 DOI: 10.1530/etj-21-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022] Open
Abstract
Background The role of postoperative external beam radiotherapy (EBRT) in patients with residual iodine refractory-differentiated thyroid cancer (IR-DTC) is still inconclusive. The aim of this retrospective study was to evaluate locoregional control (LRC) and overall survival (OS), and potential side effects after postoperative EBRT for both microscopic and macroscopic non-radically resected, locally advanced IR-DTC. Methods Between 1990 and 2016, 49 patients with locally advanced IR-DTC received EBRT for microscopic (R1; n = 28) or macroscopic (R2; n = 21) locoregional residual disease. For more insight into the added effect of EBRT, we performed an intrapatient sub-analysis in 32 patients who had undergone more than 1 surgical intervention, comparing LRC after primary, curative-intended surgery with LRC after repeated surgery plus EBRT. To estimate LRC and OS, we used Kaplan-Meier curves. From 2007 onward, we prospectively recorded toxicity data in our head and neck cancer database (n = 10). Results LRC rates 5 years after EBRT were higher for R1 (84.3%) than for R2 (44.9%) residual disease (P = 0.016). The 5-year OS rate after EBRT was 72.1% for R1 and 33.1% for R2 disease (P = 0.003). In the intrapatient analysis (n = 32), LRC rates were 6.3% 5 years after only initial surgery and 77.9% after repeated surgery with EBRT (P < 0.001). Acute toxicity was limited to grade I and II xerostomia, mucositis, and hoarseness; only one patient developed late grade III dysphagia. Conclusions Postoperative EBRT is associated with long-lasting LRC and OS with acceptable toxicity in patients with locally advanced IR-DTC, especially in microscopic residual disease.
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Affiliation(s)
- Andries H Groen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Deborah van Dijk
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim Sluiter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - John T M Plukker
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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12
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Schoonen L, Neele M, van Toor H, van Kinschot CMJ, van Noord C, Visser WE, Groen J, Boesten LSM, Lentjes EGWM, van den Berg SAA, Kos S. Impact of Thyroglobulin and Thyroglobulin Antibody Assay Performance on the Differential Classification of DTC Patients. J Endocr Soc 2022; 6:bvab166. [PMID: 35024538 PMCID: PMC8739647 DOI: 10.1210/jendso/bvab166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 01/14/2023] Open
Abstract
CONTEXT Measurements of thyroglobulin (Tg) and Tg antibodies are crucial in the follow-up of treated differentiated thyroid cancer (DTC) patients. Interassay differences may significantly impact follow-up. OBJECTIVE The aim of this multicenter study was to explore the impact of Tg and Tg antibody assay performance on the differential classification of DTC patients, as described in national and international guidelines. DESIGN Four commonly used Tg and Tg antibody assays were technically compared to reflect possible effects on patients with DTC follow-up. Storage stability at different storage temperatures was also investigated for LIAISON® and Kryptor assays, as this is an underexposed topic in current literature. RESULTS B.R.A.H.M.S. assays yield approximately 50% lower Tg values over the whole range compared to the DiaSorin and Roche assays investigated. These differences between assays may result in potential misclassification in up to 7% of patients if fixed cutoffs (eg, 1 ng/mL) are applied. Poor correlation was also observed between the Tg antibody assays when the method-specific upper limits of normal are used as cutoffs. Storage of Tg and Tg antibodies was possible for 3 to 4 weeks at -20°C and -80°C. Calibration of the assays, however, was found to be crucial for stable results over time. CONCLUSIONS Technical aspects of Tg and Tg antibody assays, including interassay differences, calibration and standardization, and cutoff values, may have a significant clinical impact on the follow-up of DTC patients.
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Affiliation(s)
- Lise Schoonen
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, the Netherlands
| | - Marjolein Neele
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, the Netherlands
| | - Hans van Toor
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Caroline M J van Kinschot
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital, Rotterdam, the Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Groen
- Department of Clinical Chemistry, IJsselland Hospital, Capelle aan de IJssel, the Netherlands
| | - Lianne S M Boesten
- Department of Clinical Chemistry, IJsselland Hospital, Capelle aan de IJssel, the Netherlands
| | - Eef G W M Lentjes
- Department of Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sjoerd A A van den Berg
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Snjezana Kos
- Department of Clinical Chemistry, Maasstad Hospital, Rotterdam, the Netherlands
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13
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Topuz O, Erhan S, Erinç S, Tamam M. A rare case of differentiated thyroid carcinoma with liver metastases. Indian J Nucl Med 2022; 37:186-188. [PMID: 35982810 PMCID: PMC9380802 DOI: 10.4103/ijnm.ijnm_152_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 12/05/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most frequent type of differentiated thyroid cancers (DTCs) and commonly metastasizes to regional lymph nodes. Distant metastases of DTC typically occur in the lungs and bones. Liver metastases of DTC are very rare and difficult to diagnose. We present a case of a 52-year-old woman who had a previous history of PTC treated by total thyroidectomy and lymph node dissection. The patient received two radioactive iodine-131 (I-131) treatments. The second postradioiodine therapy whole-body scan (WBS) revealed intense iodine uptake in the neck region and in the lungs. After 2 months, during the follow-up period, increase in serum thyroglobulin (Tg) level was detected. Positron-emission tomography–computed tomography (PET-CT) with 18F-fluorodeoxyglucose (FDG) revealed increased FDG uptake in the mass lesion that invaded the muscles in the neck area, lung, bone, and liver. The uptake in liver was interpreted as suspicion of malignancy. The trucut biopsy of the liver masses demonstrated metastases of the thyroid carcinoma with the immunohistochemical thyroid transcription factor-1 and PAX8 positivity observed in these tumor cells. In DTC patients with progressive rapid rise of Tg level, the diagnostic value of I-131 WBS will decrease as the differentiation of the tumor decreases. The combined use of I-131 WBS and FDG PET-CT as diagnostic modalities in these patients will be important in treatment planning in detecting locoregional or distant metastases, especially in patients with negative diagnostic I-131 WBS.
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14
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Grani G, Cera G, Conzo G, Del Gatto V, di Gioia CRT, Maranghi M, Lucia P, Cantisani V, Metere A, Melcarne R, Borcea MC, Scorziello C, Menditto R, Summa M, Biffoni M, Durante C, Giacomelli L. Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension? J Clin Med 2021; 10:jcm10225277. [PMID: 34830559 PMCID: PMC8624166 DOI: 10.3390/jcm10225277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/09/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022] Open
Abstract
Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of these features are suspected. Our aim was to assess if neck ultrasonography could identify or exclude multifocality or ETE in these patients to tailor the extent of surgery. This retrospective study included patients with previous thyroid surgery, ≥1 first-grade relative with thyroid cancer, and who had undergone pre-surgical ultrasound. ETE was suspected in the case of thyroid border interruption or gross invasion of perithyroidal tissues. Multiple suspicious nodules were defined as suspicion of multifocal cancer. The cohort consisted of 45 patients (median age 49 years, 40 with thyroid cancer, 30 females). The positive predictive value of ultrasonography in predicting multifocality and ETE was 57.14% (25.25–84.03) and 41.67% (21.5–65.1%), respectively, while the negative predictive values were 63.2% (56.4–69.4%) and 72.7% (63.3–80.5%). Pre-operative ultrasound examination is unable to reliably identify or exclude multifocal disease or extrathyroidal extension. In patients scheduled for surgery and with a first-degree relative affected by DTC, a “negative” pre-operative US report does not exclude the potential finding of multifocality and ETE at final histopathology.
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Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Gianluca Cera
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Giovanni Conzo
- Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, I-80131 Naples, Italy;
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Cira Rosaria Tiziana di Gioia
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (C.R.T.d.G.); (V.C.)
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Piernatale Lucia
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
| | - Vito Cantisani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (C.R.T.d.G.); (V.C.)
| | - Alessio Metere
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Maria Carola Borcea
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Chiara Scorziello
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Rosa Menditto
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Marco Summa
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (G.G.); (G.C.); (V.D.G.); (M.M.); (P.L.)
- Correspondence: ; Tel.: +39-0-649-975-130
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy; (A.M.); (R.M.); (M.C.B.); (C.S.); (R.M.); (M.S.); (M.B.); (L.G.)
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15
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Demarchi MS, Seeliger B, Lifante JC, Alesina PF, Triponez F. Fluorescence Image-Guided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism. Cancers (Basel) 2021; 13:cancers13153792. [PMID: 34359693 PMCID: PMC8345196 DOI: 10.3390/cancers13153792] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/08/2021] [Accepted: 07/23/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Hypoparathyroidism is one of the most frequent complications of thyroid surgery, especially when associated with lymph node dissection in cases of thyroid cancer. Fluorescence-guided surgery is an emerging tool that appears to help reduce the rate of this complication. The present review aims to highlight the utility of fluorescence imaging in preserving parathyroid glands during thyroid cancer surgery. Methods: We performed a systematic review of the literature according to PRISMA guidelines to identify published studies on fluorescence-guided thyroid surgery with a particular focus on thyroid cancer. Articles were selected and analyzed per indication and type of surgery, autofluorescence or exogenous dye usage, and outcomes. The Methodological Index for Non-Randomized Studies (MINORS) was used to assess the methodological quality of the included articles. Results: Twenty-five studies met the inclusion criteria, with three studies exclusively assessing patients with thyroid cancer. The remaining studies assessed mixed cohorts with thyroid cancer and other thyroid or parathyroid diseases. The majority of the papers support the potential benefit of fluorescence imaging in preserving parathyroid glands in thyroid surgery. Conclusions: Fluorescence-guided surgery is useful in the prevention of post-thyroidectomy hypoparathyroidism via enhanced early identification, visualization, and preservation of the parathyroid glands. These aspects are notably beneficial in cases of associated lymphadenectomy for thyroid cancer.
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Affiliation(s)
- Marco Stefano Demarchi
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
| | - Barbara Seeliger
- IHU—Strasbourg, Institute of Image-Guided Surgery, 67091 Strasbourg CEDEX, France;
- IRCAD, Research Institute against Digestive Cancer, 67091 Strasbourg CEDEX, France
- Department of General, Digestive, and Endocrine Surgery, Strasbourg University Hospitals, 67091 Strasbourg CEDEX, France
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
| | - Jean-Christophe Lifante
- Department of Endocrine Surgery, Lyon Sud University Hospitals, 69310 Pierre Benite, France;
- Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, 69622 Lyon, France
| | - Pier Francesco Alesina
- Department of Surgery and Center of Minimally Invasive Surgery, Evangelische Kliniken Essen-Mitte, Academic Teaching Hospital of the University of Duisburg-Essen, 45136 Essen, Germany;
- Department of Surgery, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
| | - Frédéric Triponez
- Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-(0)22-372-78-62
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16
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Wu L, Ding Y, Tong H, Zhuang X, Cai J, Si Y, Zhang H, Wang X, Shen M. Long noncoding RNA FER1L4 promotes the malignant processes of papillary thyroid cancer by targeting the miR-612/ Cadherin 4 axis. Cancer Cell Int 2021; 21:392. [PMID: 34289835 PMCID: PMC8296567 DOI: 10.1186/s12935-021-02097-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/15/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Long noncoding RNAs (lncRNAs) have emerged as crucial regulators in various cancers. However, the functional roles of most lncRNA in papillary thyroid cancer (PTC) are not detailly understood. This study aims to investigate the biological function and molecular mechanism of lncRNA Fer-1 like family member 4 (FER1L4) in PTC. METHODS The expression of FER1L4 in PTC was determined via operating quantitative real-time PCR assays. Meanwhile, the clinical significance of FER1L4 in patients with PTC was described. The biological functions of FER1L4 on PTC cells were evaluated by gain and loss of function experiments. Moreover, animal experiments were performed to reveal the effect on tumor growth. Subcellular distribution of FER1L4 was determined by fluorescence in situ hybridization and subcellular localization assays. Luciferase reporter assay and RNA immunoprecipitation assay were applied to define the relationship between FER1L4, miR-612, and Cadherin 4 (CDH4). RESULTS Upregulated expression of FER1L4 in PTC tissues was positively correlated with lymph node metastasis (P = 0.020), extrathyroidal extension (P = 0.013) and advanced TNM stages (P = 0.013). In addition, knockdown of FER1L4 suppressed PTC cell proliferation, migration, and invasion, whereas ectopic expression of FER1L4 inversely promoted these processes. Mechanistically, FER1L4 could competitively bind with miR-612 to prevent the degradation of its target gene CDH4. This condition was further confirmed in the rescue assays. CONCLUSIONS This study first demonstrates FER1L4 plays an oncogenic role in PTC via a FER1L4-miR-612-CDH4 axis and may provide new therapeutic and diagnostic targets for PTC.
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Affiliation(s)
- Luyao Wu
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yu Ding
- Department of Thyroid and Breast Surgery, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Houchao Tong
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Xi Zhuang
- Department of General Surgery, Yixing People's Hospital, Yixing, China
| | - Jingsheng Cai
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yan Si
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Hao Zhang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Xiaoting Wang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Meiping Shen
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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17
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van Velsen EFS, Visser WE, Stegenga MT, Mäder U, Reiners C, van Kemenade FJ, van Ginhoven TM, Verburg FA, Peeters RP. Finding the Optimal Age Cutoff for the UICC/AJCC TNM Staging System in Patients with Papillary or Follicular Thyroid Cancer. Thyroid 2021; 31:1041-1049. [PMID: 33487121 DOI: 10.1089/thy.2020.0615] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Differentiated thyroid cancer (DTC) is the only cancer entity for which the UICC/AJCC (Union for International Cancer Control and American Joint Committee on Cancer) TNM (tumor-node-metastasis) staging system involves an age cutoff as a prognostic criterion. However, the optimal age cutoff has not yet been determined in detail. The aim of our study was therefore to investigate the optimal age cutoff for the TNM staging system to predict disease-specific survival (DSS) with a focus on differences between patients with papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). Methods: We retrospectively studied two large well-described cohorts of adult DTC patients from a Dutch and a German university hospital. DSS was analyzed for DTC overall, and for PTC and FTC separately, using several age cutoffs (per 5-year increment between 20 and 85 years and subsequently 1-year increments between 35 and 55 years), employing the histopathological criteria from the TNM staging system, eighth edition. Results: We included 3074 DTC patients (77% PTC and 23% FTC; mean age at diagnosis was 49 years). Median follow-up was seven years. For DTC and for PTC and FTC separately, the majority of the age cutoffs had a better statistical model performance than a model with no age cutoff. For DTC overall and for PTC, an age cutoff of 50 years had the best statistical model performance, while it was 40 years for FTC. Conclusions: In this large European population of DTC patients, when employing the histopathological criteria of the TNM system (eighth edition), the optimal age cutoff to predict DSS is 50 years rather than the 55 years currently in use. With the optimal age cutoff being 50 years for PTC and 40 years for FTC, there was a substantial difference in age cutoff for the respective histological entities. Therefore, implementation of different age cutoffs for PTC and FTC could improve the predictive value of the TNM staging system.
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Affiliation(s)
- Evert F S van Velsen
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W Edward Visser
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Merel T Stegenga
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Uwe Mäder
- Comprehensive Cancer Center, University Hospital Würzburg, Würzburg, Germany
| | - Christoph Reiners
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Folkert J van Kemenade
- Department of Pathology, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- Department of Surgery, and Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Frederik A Verburg
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
- Department of Radiology and Nuclear Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
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18
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Ahmaddy F, Burgard C, Beyer L, Koehler VF, Bartenstein P, Fabritius MP, Geyer T, Wenter V, Ilhan H, Spitzweg C, Todica A. 18F-FDG-PET/CT in Patients with Advanced, Radioiodine Refractory Thyroid Cancer Treated with Lenvatinib. Cancers (Basel) 2021; 13:cancers13020317. [PMID: 33467085 PMCID: PMC7830971 DOI: 10.3390/cancers13020317] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary In patients with advanced radioiodine refractory differentiated thyroid carcinoma (DTC), therapeutic options are limited. In the “Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (SELECT)”, Lenvatinib significantly prolonged the progression-free survival, resulting in a more frequent use in clinical practice for this patient group. Due to considerable side effects, an accurate assessment of response to treatment is crucial in these patients. Therefore, we aimed to improve treatment individualization and reduce unnecessary therapies by selecting patients who will most likely benefit from Lenvatinib treatment using 2-deoxy-2-[18F] fluoro-D-glucose positron-emission-tomography/computed-tomography. Abstract Background: The tyrosine kinase inhibitor (TKI) Lenvatinib represents one of the most effective therapeutic options in patients with advanced radioiodine refractory differentiated thyroid carcinoma (DTC). We aimed to assess the role of 2-deoxy-2-[18F] fluoro-D-glucose positron-emission-tomography/computed-tomography (18F-FDG-PET/CT) in the monitoring of functional tumor response compared to morphological response. Methods: In 22 patients, a modified Positron Emission Tomography Response Criteria In Solid Tumors (mPERCIST) evaluation before treatment with Lenvatinib and at 3 and 6 month follow up was performed. Further PET-parameters and morphologic tumor response using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 were assessed and their prediction of progression-free survival (PFS) and disease-specific survival (DSS) was evaluated. Results: Most patients were rated stable in morphological evaluation and progressive using a metabolic response. All patients who responded to therapy through RECIST showed a decline in nearly all Positron Emission Tomography (PET)-parameters. For both time-points, non-responders according to mPERCIST showed significantly lower median PFS and DSS, whereas according to RECIST, only DSS was significantly lower. Conclusion: Tumor response assessment by 18F-FDG-PET outperforms morphological response assessment by CT in patients with advanced radioiodine refractory DTC treated with Lenvatinib, which seems to be correlated with clinical outcomes.
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Affiliation(s)
- Freba Ahmaddy
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.A.); (C.B.); (L.B.); (P.B.); (V.W.); (H.I.)
| | - Caroline Burgard
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.A.); (C.B.); (L.B.); (P.B.); (V.W.); (H.I.)
| | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.A.); (C.B.); (L.B.); (P.B.); (V.W.); (H.I.)
| | - Viktoria Florentine Koehler
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (V.F.K.); (C.S.)
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.A.); (C.B.); (L.B.); (P.B.); (V.W.); (H.I.)
- Comprehensive Cancer Center (CCC LMU), University Hospital, LMU Munich, 81377 Munich, Germany
- Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Matthias P. Fabritius
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (M.P.F.); (T.G.)
| | - Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (M.P.F.); (T.G.)
| | - Vera Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.A.); (C.B.); (L.B.); (P.B.); (V.W.); (H.I.)
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.A.); (C.B.); (L.B.); (P.B.); (V.W.); (H.I.)
- Comprehensive Cancer Center (CCC LMU), University Hospital, LMU Munich, 81377 Munich, Germany
- Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Christine Spitzweg
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (V.F.K.); (C.S.)
- Comprehensive Cancer Center (CCC LMU), University Hospital, LMU Munich, 81377 Munich, Germany
- Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, 81377 Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (F.A.); (C.B.); (L.B.); (P.B.); (V.W.); (H.I.)
- Comprehensive Cancer Center (CCC LMU), University Hospital, LMU Munich, 81377 Munich, Germany
- Interdisciplinary Center for Thyroid Carcinoma (ISKUM), University Hospital, LMU Munich, 81377 Munich, Germany
- Correspondence: ; Tel.: +49-89-4400-74653
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19
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Kovatch KJ, Reyes-Gastelum D, Sipos JA, Caoili EM, Hamilton AS, Ward KC, Haymart MR. Physician Confidence in Neck Ultrasonography for Surveillance of Differentiated Thyroid Cancer Recurrence. JAMA Otolaryngol Head Neck Surg 2020; 147:2774497. [PMID: 33355635 PMCID: PMC7758830 DOI: 10.1001/jamaoto.2020.4471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/05/2020] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Neck ultrasonography, a mainstay of long-term surveillance for recurrence of differentiated thyroid cancer (DTC), is routinely used by endocrinologists, general surgeons, and otolaryngologists; however, physician confidence in their ability to use ultrasonography to identify lymph nodes suggestive of cancer recurrence remains unknown. OBJECTIVE To evaluate physicians' posttreatment surveillance practices for DTC recurrence, specifically their use of and confidence in ultrasonography. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 448 physicians in private and academic hospitals who completed a survey on DTC posttreatment practices from October 2018 to August 2019 (response rate, 69%) and self-reported involvement in long-term surveillance for thyroid cancer recurrence. Physicians were identified by patients affiliated with the Surveillance, Epidemiology, and End Results Program registries in Georgia State and Los Angeles County. Of the respondents, 320 physicians who reported involvement with DTC surveillance were included in the analysis. MAIN OUTCOMES AND MEASURES Physician-reported long-term surveillance practices for DTC, including frequency of use and level of confidence in ultrasonography for detecting lymph nodes suggestive of cancer recurrence. RESULTS In the cohort of 320 physicians who reported involvement with DTC surveillance, 186 (60%) had been in practice for 10 years to less than 30 years; 209 (68%) were White; and 212 (66%) were men. The physicians included 170 (56%) endocrinologists, 67 (21%) general surgeons, and 75 (23%) otolaryngologists. Just 84 (27%) physicians reported personally performing bedside ultrasonography. Only 57 (20%) had high confidence (rated quite or extremely confident) in their ability to use bedside ultrasonography to identify lymph nodes suggestive of recurrence; 94 (33%) did not report high confidence in either their ability or a radiologist's ability to use ultrasonography to detect recurrence. Higher confidence in ultrasonography was associated with the general surgery subspecialty (odds ratio [OR], 5.7; 95% CI, 2.2-14.4; reference endocrinology) and with treating a higher number of patients per year (>50 patients: OR, 14.4; 95% CI, 4.4-47.4; 31-50 patients: OR, 8.4; 95% CI, 2.6-26.7; 11-30 patients: OR, 4.3; 95% CI, 1.5-12.1; reference 0-10 patients). CONCLUSIONS AND RELEVANCE Given the importance of neck ultrasonography in long-term surveillance for thyroid cancer, these findings of physicians' low confidence in their own ability and that of radiologists to use ultrasonography to detect recurrence point to a major obstacle to standardizing long-term DTC surveillance practices.
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Affiliation(s)
- Kevin J. Kovatch
- Department of Otolaryngology–Head & Neck Surgery, Vanderbilt Bill Wilkerson Center, Vanderbilt University, Nashville, Tennessee
| | - David Reyes-Gastelum
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | | | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles
| | - Kevin C. Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Megan R. Haymart
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor
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Bayadsi H, Bergman M, Sund M, Hennings J. Invasiveness and Metastatic Aggressiveness in Small Differentiated Thyroid Cancers: Demography of Small Papillary Thyroid Carcinomas in the Swedish Population. World J Surg 2020; 44:461-468. [PMID: 31834455 DOI: 10.1007/s00268-019-05312-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The western world is seeing a rising incidence of thyroid cancer. Improved diagnostic methods do not entirely explain this increase. Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid cancer. Small PTC (≤20 mm) and especially papillary thyroid microcarcinomas (PTMC ≤10 mm) are considered to be low-risk tumors but some cases are considerably more aggressive. Sufficient understanding of these mechanisms is a long-term goal for more efficient and safer treatment of these tumors. METHODS We identified 959 cases of small PTCs in the validated Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery, grouped according to lymph node metastasis. These were analyzed according to age, gender, tumor size and geographic region. RESULTS Patients with N1b disease (lateral lymph nodes metastases) had a smaller tumor size compared to patients with N1a disease (8.6 mm vs 10.1 mm respectively, p < 0.05). Patients and specifically females with N1b disease were younger than those with N0 or N1a disease. Patients with N1b disease had a lower proportion of females (60%) compared to N0 and N1a groups (81% and 78%, respectively). The incidence of operated small PTCs and of lymph node engagement differs between geographic regions in Sweden. CONCLUSIONS Small PTC and especially PTMC seem to show different patterns of aggressiveness and demography regarding lateral lymph node metastases and 7% had N1b disease and tumor <1 cm, underscoring the importance of lymph node evaluation in PTMC patients. More understanding of predictive factors, mechanisms for metastatic disease and causes of regional differences, is needed.
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Affiliation(s)
- Haytham Bayadsi
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden.
| | - Martin Bergman
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden
| | - Joakim Hennings
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden
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21
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Yoon JH, Jeon MJ, Kim M, Hong AR, Kim HK, Shin DY, Kim BH, Kim WB, Shong YK, Kang HC. Unusual metastases from differentiated thyroid cancers: A multicenter study in Korea. PLoS One 2020; 15:e0238207. [PMID: 32841270 PMCID: PMC7447021 DOI: 10.1371/journal.pone.0238207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background Although infrequent, distant metastasis from differentiated thyroid cancer is the main cause of mortality in patients and mostly involves the lung, bone, and brain. Distant metastases to other sites in differentiated thyroid cancer patients are rare, thus, the clinical course of unusual metastases has not been adequately researched. In the present study, the clinico-pathological findings and treatment outcomes of unusual metastases in differentiated thyroid cancer patients in Korea were evaluated. Patients and methods We retrospectively reviewed the medical records of differentiated thyroid cancer patients with unusual metastases in four Korean tertiary hospitals (Chonnam National University Hwasun Hospital, Asan Medical Center, Busan National University Hospital, Severance Hospital). Unusual metastases were diagnosed using (1) cytology or histology and/or (2) imaging studies including fluorodeoxyglucose F 18 positron emission tomography/computed tomography and/or iodine 131 whole body scans with simultaneously elevated serum levels of thyroglobulin. The pathological findings of primary thyroid cancer, diagnostic method for unusual metastases, and treatment responses of unusual metastases were examined. Results In all, 25 unusual metastatic foci of 19 patients were analyzed; 13 patients (68.4%) had papillary thyroid carcinoma including 4 follicular variant papillary thyroid carcinomas. The median time interval between the first diagnosis of primary thyroid cancer and unusual metastases diagnosis was 110 months (11.0–138.0 months). Only 4 patients (21.1%) had synchronous unusual metastases and 6 patients (31.6%) were symptomatic. Unusual metastases included 19 metastases to solid organs (6 to kidney, 5 to liver, 4 to pancreas, 3 to adrenal gland, and 1 to ovary) and 6 to the skin and muscles. Unusual metastases were pathologically proven in 10 patients (52.6%) and 11 of 16 patients (68.8%) who received iodine 131 whole body scans had radioiodine-refractory differentiated thyroid cancer. Among 5 patients treated with tyrosine kinase inhibitors, 4 treated with lenvatinib showed stable disease or a partial response at the first treatment response. Six patients (31.6%) died due to disease progression during the median 20.0-month follow-up period (11.0–55.0 months). Conclusion Unusual metastases from differentiated thyroid cancer are thought to be underestimated due to disease rarity and their metachronous nature with other distant metastases. The most of unusual metastases in differentiated thyroid cancer patients are existed with usual distant metastasis and clinical outcomes of those could not be significantly different from the prognosis of usual distant metastasis.
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Affiliation(s)
- Jee Hee Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - A. Ram Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hee Kyung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho-Cheol Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
- * E-mail:
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Jiang HJ, Hsiao PJ. Clinical application of the ultrasound-guided fine needle aspiration for thyroglobulin measurement to diagnose lymph node metastasis from differentiated thyroid carcinoma-literature review. Kaohsiung J Med Sci 2020; 36:236-243. [PMID: 31909556 DOI: 10.1002/kjm2.12173] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/01/2019] [Indexed: 11/06/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) generally has a good prognosis, but disease recurs in 25% to 30% of PTC patients and significantly reduces the survival rate. Lymph node metastasis (LNM) is reported in 20% to 50% of PTC patients, mainly in the neck, and 20% originates from recurrence. LNM of papillary thyroid carcinoma are a plausible prognostic factor to determine disease recurrence. Currently, fine needle lymph node aspiration for cytology (LN-FN-cytology) is the best modality to diagnose LNM but is limited by diagnostic sensitivity and sample error. Fine needle lymph node aspiration for thyroglobulin measurement (LN-FNA-Tg) could offer a reliable and quantitative diagnostic method for LNM. The combination of LN-FNA-cytology and LN-FNA-Tg could achieve almost 100% diagnostic sensitivity and specificity for LNM. Both treatment guidelines of the American Thyroid Association and European Thyroid Association recommend LN-FNA-Tg to diagnose LNM after total thyroidectomy. Diagnostic accuracy of the LN-FNA-Tg depends on optimal equipment, scanning protocol, skill, and experience of operators. Normal saline is mainly used for aspiration needle wash-out and buffer solution. And radioimmunoassay or immunoradiometric assay are widely used for the LN-FNA-Tg measurement. So far, there is no consensus about the diagnostic threshold of LN-FNA-Tg for positive LNM, but high LN-FNA-Tg, especially higher than 10 ng/mL, strongly favors LNM.
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Affiliation(s)
- He-Jiun Jiang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pi-Jung Hsiao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Ho AS, Luu M, Zalt C, Morris LG, Chen I, Melany M, Ali N, Patio C, Chen Y, Mallen St.-Clair J, Braunstein GD, Sacks WL, Zumsteg ZS. Mortality Risk of Nonoperative Papillary Thyroid Carcinoma: A Corollary for Active Surveillance. Thyroid 2019; 29:1409-1417. [PMID: 31407637 PMCID: PMC7476400 DOI: 10.1089/thy.2019.0060] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Active surveillance is established as an alternative to surgery for papillary thyroid microcarcinomas, but inclusion criteria and mortality risk for pursuing a nonsurgical approach have not been clearly defined. To gauge the feasibility of expanding active surveillance thresholds, we investigated the effects of increasing size and age on disease-specific survival (DSS) in a large nonoperative thyroid cancer cohort, compared against a matched group of surgical patients. Methods: Papillary thyroid carcinoma patients staged T1-4N0M0 were identified in the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2015, stratified by nonsurgical and surgical management. Propensity score matching was performed to adjust for imbalances in covariates. Multivariable models were constructed using restricted cubic splines to model nonlinear relationships of age and tumor size with DSS. Results: Overall, 1453 nonoperative patients and 54,718 surgical patients met the inclusion criteria. Collectively, increasing age and size after certain thresholds independently led to greater differences in DSS between nonsurgical and surgical patients. For younger ages (14-55 years), surgical approach compared with nonsurgical approach was not associated with any difference in the 10-year DSS among 0-4 cm cancers (99.8% vs. 100%, p = 0.470), 4.1-6 cm cancers (98.8% vs. 100%, p = 0.599), or >6 cm cancers (97.3% vs. 100%, p = 0.718). Older patients with larger tumors (>75 years, >6 cm) demonstrated the greatest difference in DSS (48.1% vs. 91.3%, p < 0.001). Similar results were found when applying propensity score matching. For age, restricted cubic spline plots showed minimal relative survival hazard in nonoperative cases beginning after age 60 years, with a change point illustrating acceleration in relative hazard beyond age 72 years. For size, relative survival hazard was observed after 2.0 cm and increased slowly with nodule growth up to an inflection point of 4.5 cm. Beyond this, mortality risk escalated with each additional year without plateau. Conclusions: Increasing age and size lead to progressively greater mortality risk without surgery, but only beyond certain thresholds. We define escalating gradients at which a nonsurgical approach may be deemed appropriate, and beyond which survival benefits from surgery become apparent. Such findings reconcile controversial observations regarding age and size in active surveillance and further reshape evolving treatment paradigms in thyroid cancer.
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Affiliation(s)
- Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
- Address correspondence to: Allen S. Ho, MD, Department of Surgery, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 590W, Los Angeles, CA 90048
| | - Michael Luu
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Cynthia Zalt
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
| | - Luc G.T. Morris
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Irene Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michelle Melany
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nabilah Ali
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chrysanta Patio
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yufei Chen
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Department of Surgery, and Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon Mallen St.-Clair
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Glenn D. Braunstein
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wendy L. Sacks
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Division of Endocrinology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary S. Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, California
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
- Zachary S. Zumsteg, MD, Department of Radiation Oncology, Cedars-Sinai Medical Center, SOCCI AC1004, 8700 Beverly Blvd, Los Angeles, CA 90048
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Zunino A, Pitoia F, Faure E, Reyes A, Sala M, Sklate R, Ilera V, Califano I. Unusual metastases from differentiated thyroid carcinoma: analysis of 36 cases. Endocrine 2019; 65:630-636. [PMID: 31327159 DOI: 10.1007/s12020-019-01991-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 06/22/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Metastases of differentiated thyroid cancer (DTC) in sites different from lungs and bone are unusual (UM); their impact in management and prognosis remains unknown. Our aim was to evaluate the prevalence of UM, to describe their characteristics and to analyze their impact in disease outcome and mortality. METHODS We retrospectively reviewed the file records from 8 different centers. Those patients with DTC and UM were included. UM were diagnosed by: (i) biopsy/cytology and/or (ii) radioiodine (RAI) uptake associated to elevated thyroglobulin (Tg) levels and/or c) presence of one or more structural lesion/s with 18-FDG uptake in the PET/CT scan and elevated Tg levels. RESULTS Thirty-six (0.9%) out of a total of 3982 DTC patients were diagnosed with UM; 75% had papillary histology. The most frequent localization was central nervous system (CNS, 31%). UM were metachronous in 75%, symptomatic in 55.6% and fulfilled RAI-refractoriness criteria in 77.8% of cases. Metastatic lesions in lung/bone and/or locoregional disease were present in 34 cases (94.4%). Diagnosis of UM changed the therapeutic approach in 72.2% of patients. After a median follow up of 13 months, 21 (58.3%) patients died from DTC related causes. In 8 of them CNS progression was the immediate cause of death. CONCLUSIONS Prevalence of UM was low; they were frequently metachronic and RAI-refractory. Although UM were found in patients with widespread disease, their diagnosis usually led to changes in therapy. UM were associated with poor prognosis and high frequency of disease-specific mortality.
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Affiliation(s)
- Anabela Zunino
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Fabián Pitoia
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Eduardo Faure
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Adriana Reyes
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Mónica Sala
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Rosana Sklate
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Verónica Ilera
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
| | - Inés Califano
- Thyroid Department of Sociedad Argentina de Endocrinología y Metabolismo, Díaz Vélez 3889 (C1200AAF), Ciudad Autónoma de Buenos Aires, Argentina
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Hartl DM, Hadoux J, Guerlain J, Breuskin I, Haroun F, Bidault S, Leboulleux S, Lamartina L. Risk-oriented concept of treatment for intrathyroid papillary thyroid cancer. Best Pract Res Clin Endocrinol Metab 2019; 33:101281. [PMID: 31208873 DOI: 10.1016/j.beem.2019.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Adapting treatment and follow-up according to the risk of recurrence and/or death from thyroid cancer is a relatively recent concept of "personnalized" medicine, developed particularly to avoid overtreatment of low-risk thyroid cancer which represents the majority of thyroid cancers diagnosed in the world today. For low-risk thyroid cancer, this decrease in extent of treatment involves the extent of surgery-total thyroidectomy, lobectomy or no surgery with active surveillance-but also the indications, doses and methods of stimulation when or if administering radioactive iodine (RAI), the indication for suppressive thyroxin therapy and the extent and modalities for follow-up that should be adapted to the risk of recurrence. The aim is to optimize medical resources and quality of life, particularly for low-risk patients whose life expectancy is that of the general population.
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Affiliation(s)
- Dana M Hartl
- Gustave Roussy, Department of Head and Neck Oncology, Thyroid Surgery Unit, 114 Rue Edouard Vaillant, Villejuif, 94805, France.
| | - Julien Hadoux
- Gustave Roussy, Nuclear Medicine and Endocrine Oncology, 114 Rue Edouard Vaillant, Villejuif, 94805, France
| | - Joanne Guerlain
- Gustave Roussy, Department of Head and Neck Oncology, Thyroid Surgery Unit, 114 Rue Edouard Vaillant, Villejuif, 94805, France
| | - Ingrid Breuskin
- Gustave Roussy, Department of Head and Neck Oncology, Thyroid Surgery Unit, 114 Rue Edouard Vaillant, Villejuif, 94805, France
| | - Fabienne Haroun
- Gustave Roussy, Department of Head and Neck Oncology, Thyroid Surgery Unit, 114 Rue Edouard Vaillant, Villejuif, 94805, France
| | - Sophie Bidault
- Gustave Roussy, Department of Radiology, 114 Rue Edouard Vaillant, Villejuif, 94805, France
| | - Sophie Leboulleux
- Gustave Roussy, Nuclear Medicine and Endocrine Oncology, 114 Rue Edouard Vaillant, Villejuif, 94805, France
| | - Livia Lamartina
- Gustave Roussy, Nuclear Medicine and Endocrine Oncology, 114 Rue Edouard Vaillant, Villejuif, 94805, France
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REGγ ablation impedes dedifferentiation of anaplastic thyroid carcinoma and accentuates radio-therapeutic response by regulating the Smad7-TGF-β pathway. Cell Death Differ 2019; 27:497-508. [PMID: 31243343 PMCID: PMC7205985 DOI: 10.1038/s41418-019-0367-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/17/2019] [Accepted: 05/30/2019] [Indexed: 01/11/2023] Open
Abstract
Anaplastic thyroid cancer (ATC) is the most aggressive human thyroid malignancy, characterized by dedifferentiation and resistance to radioiodine therapy. The underlying mechanisms regulating ATC dedifferentiation are largely unknown. Here, we show that REGγ, a noncanonical proteasome activator highly expressed in ATC, is an important regulator of differentiation in ATC cells. Ablation of REGγ significantly restored expression of thyroid-specific genes, enhanced iodine uptake, and improved the efficacy of 131I therapy in ATC xenograft models. Mechanistically, REGγ directly binds to the TGF-β signaling antagonist Smad7 and promotes its degradation, leading to the activation of the TGF-β signal pathway. With gain- and loss-of-function studies, we demonstrate that Smad7 is an important mediator for the REGγ function in ATC cell dedifferentiation, which is supported by expression profiles in human ATC tissues. It seems that REGγ impinges on repression of thyroid-specific genes and promotion of tumor malignancy in ATC cells by activating the TGF-β signal pathway via degradation of Smad7. Thus, REGγ may serve as a novel therapeutic target for allowing radioiodine therapy in anaplastic thyroid cancer patients with poor prognosis.
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Abstract
Thyroid hormone suppression therapy is designed to lower serum thyrotropin (TSH) levels using doses of thyroid hormone in excess of what would normally be required to maintain a euthyroid state. The basis of this therapy is the knowledge that TSH is a growth factor for thyroid cancer, so that lower serum TSH levels might be associated with decreased disease activity. However, clinical studies have not documented improved outcomes with TSH suppression, except in patients with the most advanced disease. Furthermore, there are a number of negative outcomes related to aggressive thyroid hormone therapy, including osteoporosis, fracture, and cardiovascular disease. Therefore, a graded approach to TSH suppression is recommended by the American Thyroid Association, based on initial risk and ongoing risk assessment.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Naples 80131, Italy
| | - David S Cooper
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
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Higher plasma GlycA, a novel pro-inflammatory glycoprotein biomarker, is associated with reduced life expectancy: The PREVEND study. Clin Chim Acta 2019; 488:7-12. [DOI: 10.1016/j.cca.2018.10.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/27/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023]
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29
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Gray JL, Singh G, Uttley L, Balasubramanian SP. Routine thyroglobulin, neck ultrasound and physical examination in the routine follow up of patients with differentiated thyroid cancer-Where is the evidence? Endocrine 2018; 62:26-33. [PMID: 30128957 PMCID: PMC6153587 DOI: 10.1007/s12020-018-1720-3] [Citation(s) in RCA: 6] [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: 05/19/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Patients with differentiated thyroid cancer (DTC) typically have a favourable prognosis and recurrence as late as 45 years after diagnosis has been reported. International clinical guidelines for monitoring recommend routine thyroglobulin, ultrasound and physical examination for the detection of recurrence. The aim of this review was to systematically review whether routine monitoring using thyroglobulin (Tg), neck ultrasound and physical examination for recurrence in differentiated thyroid cancer patients is effective in improving patient survival and/or quality of life. METHODS Primary studies were retrieved via a comprehensive search of three electronic bibliographic databases (PubMed, Web of Science Core Collection and Cochrane Library) without time restriction. Eligible studies must have reported on disease-free patients with DTC subject to long-term routine surveillance. The primary and secondary outcomes of interest were overall survival (or other survival parameters) and quality of life, respectively. RESULTS Literature searches yielded 5529 citations, which were screened by two reviewers. 241 full texts were retrieved. No randomised controlled trials or two-arm cohort studies on the effectiveness of any of the three specified interventions were identified. However, three 'single-arm' studies reporting long-term follow-up outcomes in patients undergoing regular surveillance were identified and appraised. CONCLUSIONS This review highlights a lack of empirical evidence to support current use of routine surveillance in DTC. Although early detection is possible, routine surveillance may lead to unnecessary intervention.
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Affiliation(s)
- Jessica L Gray
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Gautam Singh
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Lesley Uttley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
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Sunavala-Dossabhoy G. Radioactive iodine: An unappreciated threat to salivary gland function. Oral Dis 2018; 24:198-201. [PMID: 29480611 DOI: 10.1111/odi.12774] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 02/06/2023]
Abstract
Thyroid cancer is an endocrine malignancy whose prevalence is increasing in the United States. Nearly 57,000 new cases of thyroid cancer are estimated to be diagnosed in 2017. The standard of care for differentiated thyroid cancer is thyroidectomy followed by ablation of thyroid remnants with high-dose radioactive iodine (131 I). Apart from thyroid glands, 131 I accumulates in cells of salivary glands and compromises its function. Xerostomia is, therefore, a frequent and often persistent complaint of patients. Despite adoption of standard preventive measures, parenchymal damage and chronic salivary dysfunction are observed in a substantial number of patients. Saliva is important for oral homeostasis, and its reduction increases the risk of oral morbidity. As differentiated thyroid cancer patients have an excellent survival rate, preservation of salivary gland function carries added significance. A focus on treatments that preserve or restore long-term salivary flow can significantly improve the quality of life of thyroid cancer survivors.
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Affiliation(s)
- G Sunavala-Dossabhoy
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center and Feist-Weiller Cancer Center, Shreveport, LA, USA
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Lamartina L, Grani G, Durante C, Borget I, Filetti S, Schlumberger M. Follow-up of differentiated thyroid cancer - what should (and what should not) be done. Nat Rev Endocrinol 2018; 14:538-551. [PMID: 30069030 DOI: 10.1038/s41574-018-0068-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The treatment paradigm for thyroid cancer has shifted from a one-size-fits-all approach to more personalized protocols that range from active surveillance to total thyroidectomy followed by radioiodine remnant ablation. Accurate surveillance tools are available, but follow-up protocols vary widely between centres and clinicians, owing to the lack of clear, straightforward recommendations on the instruments and assessment schedule that health-care professionals should adopt. For most patients (that is, those who have had an excellent response to the initial treatment and have a low or intermediate risk of tumour recurrence), an infrequent assessment schedule is sufficient (such as a yearly determination of serum levels of TSH and thyroglobulin). Select patients will benefit from second-line imaging and more frequent assessments. This Review discusses the strengths and weaknesses of the surveillance tools and follow-up strategies that clinicians use as a function of the initial treatment and each patient's risk of recurrence.
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Affiliation(s)
- Livia Lamartina
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Giorgio Grani
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Cosimo Durante
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Isabelle Borget
- Department of Biostatistic and Epidemiology, Gustave Roussy and University Paris-Saclay, Villejuif, France
| | - Sebastiano Filetti
- Dipartimento di Medicina Interna e Specialità Mediche, Università di Roma "Sapienza", Rome, Italy
| | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, Villejuif, France.
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Wong CKH, Choi EPH, Woo YC, Lang BHH. Measurement properties of ThyPRO short-form (ThyPRO-39) for use in Chinese patients with benign thyroid diseases. Qual Life Res 2018; 27:2177-2187. [PMID: 29671250 DOI: 10.1007/s11136-018-1857-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To evaluate the validity and reliability of a newly-translated Thyroid-specific Patient-Reported Outcome short-form (ThyPRO-39) instrument for ethnic-Chinese patients suffering from benign thyroid diseases. METHODS The translation and cross-cultural adaptation of the English ThyPRO-39 were performed using the double forward translation, reconciliation, single backward translation, and cognitive debriefing, followed by a panel review. Cross-sectional data of 308 patients with benign thyroid diseases were utilized for this psychometric evaluation of ThyPRO-39 instrument. Convergent validity between similar construct in the ThyPRO-39, SF-6D, and SF-12v2 was assessed using Spearman correlations. The internal construct validity was assessed by corrected item-total correlations. Sensitivity of the ThyPRO-39 domain scores was determined by performing known group comparisons by independent t test. The internal consistency reliability was assessed by Cronbach's alpha coefficient. RESULTS Significant floor effects were observed in 9 out of 13 domains of the ThyPRO-39. The hypothesized correlations between similar constructs in the ThyPRO-39 and the SF-12v2 and SF-6D were generally observed, supporting convergent validity. The internal construct validity was supported in most items, except eight items in six scales. Scale score of hyperthyroid symptoms of the ThyPRO-39 was significantly higher in the group with Graves' disease or hyperthyroid disease than the group without Graves' disease nor hyperthyroid disease. Scale scores of eye symptoms and impaired daily life were significantly higher in the incidental group than the non-incidental group. For six domains (hyperthyroid symptoms, hypothyroid symptoms, eye symptoms, tiredness, depressivity, and emotional susceptibility), Cronbach's alpha did not reach the recommended standard of 0.7. CONCLUSIONS This was the first psychometric study to translate and adapt the ThyPRO-39 instrument for non-Caucasian patients, and report its validity and reliability for use in Chinese patients with benign thyroid diseases. Given the low item-total correlations in eight items and low internal consistency reliability in respective scales of the ThyPRO-39, we suggest that the improvement of those eight items should produce a more valid and reliable ThyPRO-39 instrument.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Edmond P H Choi
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Y C Woo
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Brian H H Lang
- Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
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Jiang H, Wu C, Chiang F, Chiou H, Chen I, Hsiao P. Reliable sonographic features for nodal thyroglobulin to diagnose recurrent lymph node metastasis from papillary thyroid carcinoma. Clin Otolaryngol 2018; 43:1065-1072. [DOI: 10.1111/coa.13103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- H.‐J. Jiang
- Division of Endocrinology and Metabolism Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
- Department of Internal Medicine Kaohsiung Municipal Ta‐Tung Hospital Kaohsiung Taiwan
| | - C.‐W. Wu
- Department of Otolaryngology‐Head and Neck Surgery Kaohsiung Medical University Kaohsiung Taiwan
- School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - F.‐Y. Chiang
- Department of Otolaryngology‐Head and Neck Surgery Kaohsiung Medical University Kaohsiung Taiwan
- School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
| | - H.‐Y.C. Chiou
- Division of Endocrinology and Metabolism Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - I.‐J. Chen
- Department of Nuclear Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
| | - P.‐J. Hsiao
- Division of Endocrinology and Metabolism Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan
- School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan
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Pajamäki N, Metso S, Hakala T, Ebeling T, Huhtala H, Ryödi E, Sand J, Jukkola-Vuorinen A, Kellokumpu-Lehtinen PL, Jaatinen P. Long-term cardiovascular morbidity and mortality in patients treated for differentiated thyroid cancer. Clin Endocrinol (Oxf) 2018; 88:303-310. [PMID: 29154445 DOI: 10.1111/cen.13519] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/02/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Thyroid hormone suppression therapy has been widely used in the treatment of thyroid cancer, but concerns have been raised about the cardiovascular risks of this treatment. The objective of this study was to evaluate long-term cardiovascular morbidity and mortality in patients treated for differentiated thyroid cancer (DTC) and to assess the effect of TSH suppression and radioiodine (RAI) treatment on the cardiovascular outcome. DESIGN Retrospective cohort study. PATIENTS AND MEASUREMENTS Patients (n = 901) treated for DTC between 1981 and 2002 at 2 Finnish University hospitals were compared with a randomly chosen reference group (n = 4485) matched for age, gender and the place of residence. Kaplan-Meier and Cox regression analyses were used to estimate the risk of morbidity or death due to different cardiovascular diseases (CVD) after the diagnosis of DTC. RESULTS Morbidity due to any CVD (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.05-1.28) and due to all arrhythmias (HR 1.25, CI 1.06-1.48) and atrial fibrillation (AF) (HR 1.29, CI 1.06-1.57) was more frequent in the DTC patients than in the controls. The increased cardiovascular morbidity was confined to patients with a mean TSH level below 0.1 mU/L (HR 1.27, CI 1.03-1.58) and to those treated with RAI (HR 1.18, CI 1.05-1.31). Cardiovascular mortality, however, was lower among the patients than the controls (HR 0.73, CI 0.58-0.92), due to a lower mortality from coronary artery disease. CONCLUSIONS Differentiated thyroid cancer patients have an increased CVD morbidity, which is mostly accountable to AF and to TSH suppression below 0.1 mU/L.
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Affiliation(s)
- Nelli Pajamäki
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Tipotie Health Centre, Social and Health Services, City of Tampere, Tampere, Finland
| | - Saara Metso
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Tommi Hakala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Tapani Ebeling
- Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Essi Ryödi
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Heart Center Co., Tampere University Hospital, Tampere, Finland
| | - Juhani Sand
- Päijät-Häme Central Hospital, Lahti, Finland
| | | | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Pia Jaatinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
- Division of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
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Trimboli P, Imperiali M, Piccardo A, CampennÌ A, Giordani I, Ruggeri RM, Baldari S, Orlandi F, Giovanella L. Multicentre clinical evaluation of the new highly sensitive Elecsys® thyroglobulin II assay in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2018; 88:295-302. [PMID: 28960391 DOI: 10.1111/cen.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A highly sensitive thyroglobulin assay (Elecsys® Tg II, Roche Diagnostics, Penzberg, Germany) has become available for monitoring patients with differentiated thyroid cancer (DTC). Here, we evaluated the clinical performance of Elecsys® Tg II assay in a multicentre patients series and compare it with the established Access® Tg assay (Beckman Coulter, Brea, CA, USA). DESIGN Retrospective analysis on prospectively selected patients in four thyroid cancer referral centres with uniform DTC management. PARTICIPANTS All DTC cases diagnosed, treated and followed up in four tertiary referral centres for thyroid cancer since January 2005 (n = 1456) were retrieved, and predefined selection criteria were applied to prevent relevant enrolment biases. A series of 204 patients was finally selected for this study. MEASUREMENTS Samples had been stored at -80°C. Tg was measured by fully automated immunometric Elecsys® Tg II and Access® Tg assays in a centralized laboratory. RESULTS Two hundred and four DTC were finally included. Of these, 10.8% had structural recurrence (sREC), and 81.4% showed no evidence of disease (NED) at the end of follow-up. There was a significant analytical bias between methods that cannot be used interchangeably. Using ROC curve analysis, the best basal and rhTSH-stimulated Tg cut-offs to detect sREC were 0.41 μg/L and 1.82 μg/L for Elecsys® and 0.36 μg/L and 1.62 μg/L for Access® assay, respectively. Using Cox proportional hazard regression, Tg was the only independent predictor of cancer relapse. CONCLUSIONS Using appropriate assay-specific cut-offs, the clinical performance of the Elecsys® Tg II assay was comparable to that provided by the well-established Access® Tg assay.
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Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M Imperiali
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - A Piccardo
- Department of Nuclear Medicine, Ente Ospedaliero "Ospedali Galliera", Genova, Italy
| | - A CampennÌ
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - I Giordani
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy
| | - S Baldari
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - F Orlandi
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Muhanhali D, Zhai T, Jiang J, Ai Z, Zhu W, Ling Y. Long Non-coding Antisense RNA TNRC6C-AS1 Is Activated in Papillary Thyroid Cancer and Promotes Cancer Progression by Suppressing TNRC6C Expression. Front Endocrinol (Lausanne) 2018; 9:360. [PMID: 30038597 PMCID: PMC6046411 DOI: 10.3389/fendo.2018.00360] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/18/2018] [Indexed: 01/08/2023] Open
Abstract
Context: Evidences have shown the important role of long non-coding antisense RNAs in regulating its cognate sense gene in cancer biology. Objective: Investigate the regulatory role of a long non-coding antisense RNA TNRC6C-AS1 on its sense partner TNRC6C, and their effects on the aggressiveness and iodine-uptake ability of papillary thyroid cancer (PTC). Design: TNRC6C-AS1 was identified as the target long non-coding RNA in PTC by using microarray analysis and computational analysis. In vitro gain/loss-of-function experiments were performed to investigate the effects of TNRC6C-AS1 and TNRC6C on proliferation, apoptosis, migration, invasion and iodine-uptake ability of TPC1 cells. Expression levels of TNRC6C-AS1 and TNRC6C of 30 cases of PTC tissues and its adjacent normal thyroid tissues were determined. Results: Downregulation of TNRC6C-AS1 or overexpression of TNRC6C inhibited proliferation, migration and invasion of TPC1 cells, while apoptosis and iodine uptake was promoted in TPC1 cells. Suppression of TNRC6C-AS1 significantly increased the expression of TNRC6C in TPC1 cells. The inhibitory effect of TNRC6C-AS1 knockdown on cell proliferation, migration and invasion was attenuated when the expression of TNRC6C was suppressed simultaneously, indicating TNRC6C is a functional target of TNRC6C-AS1. The expression of TNRC6C-AS1 was significantly higher, while the TNRC6C mRNA and protein were significantly lower in PTC tissues than normal adjacent tissues. There was a significant inverse correlation between TNRC6C-AS1 and TNRC6C mRNA in PTC tissue samples. Conclusions: TNRC6C-AS1 promotes the progression of PTC and inhibits its ability of iodine accumulation by suppressing the expression of TNRC6C. Targeting TNRC6C-AS1 - TNRC6C axis may be a new promising treatment for PTC.
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Affiliation(s)
- Dilidaer Muhanhali
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyu Zhai
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingjing Jiang
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhilong Ai
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Ling
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yan Ling
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Gerss J, Maier T, Schober O, Vrachimis A, Riemann B. Peace of mind for patients with differentiated thyroid cancer? Nuklearmedizin 2017; 52:115-20. [DOI: 10.3413/nukmed-0563-13-02] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 06/10/2013] [Indexed: 01/25/2023]
Abstract
SummaryDifferentiated thyroid carcinomas (DTC) have an excellent prognosis, with 10-year overall survival rates over 90%. In addition, DTC patients benefit from their lifelong medical surveillance. The aim of the study was to compare the patients’ overall survival with that of a matched general population. Patients and methods: We have analyzed 1497 consecutive patients with DTC, who underwent radioiodine therapy in Münster, Germany, according to international standards. We classified our patients according to the current 7th edition of the UICC (Union Internationale Contre le Cancer) classification and we compared the overall survival of the patients with the expected survival based on age and sex of the general population as provided by the Federal Statistical Office, Germany. Results: There were no significant differences in overall survival rates between DTC patients of the cohort in stages I to IVa compared to the expected survival based on age and sex of the general population. However, patients in stage IVc showed a significantly worse overall survival rate using the log-rank test (p < 0.0001). Conclusion: Patients with DTC showed excellent overall survival rates in stages I, II, III and IVa. All patients, except for those in stage IVc (M1 ≥ 45 years), had overall survival rates similar to the general population.
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van Tienhoven-Wind LJN, Gruppen EG, Sluiter WJ, Bakker SJL, Dullaart RPF. Life expectancy is unaffected by thyroid function parameters in euthyroid subjects: The PREVEND cohort study. Eur J Intern Med 2017; 46:e36-e39. [PMID: 29122438 DOI: 10.1016/j.ejim.2017.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Eke G Gruppen
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands; Department of Nephrology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Nephrology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Robin P F Dullaart
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, The Netherlands.
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Zerdoud S, Leboulleux S, Clerc J, Leenhardt L, Bournaud C, Al Ghuzlan A, Keller I, Bardet S, Giraudet AL, Groussin L, Sebag F, Garrel R, Lamy PJ, Toubert ME, Mirallié É, Hindié E, Taïeb D. Traitement par iode 131 des cancers thyroïdiens différenciés : recommandations 2017 des sociétés françaises SFMN/SFE/SFP/SFBC/AFCE/SFORL. MEDECINE NUCLEAIRE-IMAGERIE FONCTIONNELLE ET METABOLIQUE 2017. [DOI: 10.1016/j.mednuc.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Sojak J, Sičák M, Kališ A, Slašťan M. Papillary Thyroid Carcinoma: Analysis of the Central Compartment's Lymph Nodes Metastases. ACTA MEDICA (HRADEC KRÁLOVÉ) 2017; 60:44-50. [PMID: 28591551 DOI: 10.14712/18059694.2017.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Papillary thyroid carcinoma is typical by regional lymph nodes metastases. Therefore we decided to analyse associated risk factors. OBJECTIVE In this retrospective study we focused on the incidence of metastatic involvement of the central compartment's lymph nodes correlated with age, size of the primary tumour, infiltration of thyroid gland capsule, positive lymphangioinvasion in order to assess risk factors. METHOD We analysed group of 156 patients with papillary carcinoma, who have undergone total thyroidectomy and bilateral elective central compartment neck dissection. We evaluated the occurrence of metastases, size, infiltration and lymphangioinvasion based on definitive histology of the whole group and separately for subgroups of patients under and over 45 years. RESULT We found metastatic involvement in 88 (56.4%) patients. When comparing the subgroups of patients under (73 patients) and over 45 years (83 patients), we found metastases in 56 vs. 32 (76.7% vs. 38.6%) patients. In the subgroup of younger patients we found significant higher incidence of metastases compared with the group of over 45 years, P < 0.001 (P = 0.000027). We found significant higher incidence of metastases in patients with positive capsule infiltration in the whole group, P < 0.001 (P = 0.00049); in the subgroup of under 45 years, P < 0.001 (P = 0.00091) and in patients with positive lymphangioinvasion in the whole group, P < 0.01 (P = 0.00177); in the subgroup of over 45 years, P < 0.001 (P = 0.0002). In patients with metastases we found tumour size ≥1cm more frequently in all groups. CONCLUSION We recorded higher incidence of regional metastases in patients under 45 years, positive capsule infiltration, lymphangioinvasion. Age under 45 years itself does not correlate with less aggressive disease, to the contrary some of other analysed risk factors correlate with more aggressive disease.
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Affiliation(s)
- Ján Sojak
- Biomedical Centre Martin JFM CU, Slovakia. .,Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin (JFM CU), Department of Pathological Physiology JFM CU, Slovakia. .,Slovak Medical University in Bratislava, Faculty of Medicine, The Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital in Ružomberok, Slovakia.
| | - Marian Sičák
- Slovak Medical University in Bratislava, Faculty of Medicine, The Clinic of Otorhinolaryngology and Head and Neck Surgery, Central Military Hospital in Ružomberok, Slovakia
| | - Adrian Kališ
- Catholic University in Ružomberok, Faculty of Health, Department of Pathological Anatomy, Central Military Hospital in Ružomberok, Slovakia
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Giovanella L, Imperiali M, Trimboli P. Role of serum cytokeratin 19 fragment (Cyfra 21.1) as a prognostic biomarker in patients with differentiated thyroid cancer. Sci Rep 2017; 7:7359. [PMID: 28779086 PMCID: PMC5544692 DOI: 10.1038/s41598-017-07915-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/04/2017] [Indexed: 12/16/2022] Open
Abstract
Differentiated thyroid cancers (DTC) account for up to 85% of thyroid cancers and generally display an excellent prognosis. However, in a minority of cases, DTC progress toward less differentiated phenotypes leading to distant metastases and even disease-related deaths. Circulating biomarkers are warranted to complement the gold standard DTC marker thyroglobulin (Tg) in identifying and monitoring such cases. We measured serum Tg and Cyfra 21.1 6 to 12 months after primary treatment in 473 DTC patients. A complete response of Tg was related to an excellent outcome in all cases. Among patients with incomplete Tg response Cyfra 21.1 levels <2.07 ng/mL were associated to favorable outcome while higher levels greatly increased the risk of disease related recurrences and deaths. Both markers retained independent prognostic values in multivariate analysis. In conclusion, Cyfra 21.1 is a tool available to independently predict survival of DTC patients not achieving excellent response after primary treatment.
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Affiliation(s)
- L Giovanella
- Oncology Institute of Southern Switzerland, Department of Nuclear Medicine and Thyroid Centre, 6500, Bellinzona, Switzerland.
| | - M Imperiali
- Ente Ospedaliero Cantonale, Department of Clinical Chemistry and Laboratory Medicine, 6500, Bellinzona, Switzerland
| | - P Trimboli
- Oncology Institute of Southern Switzerland, Department of Nuclear Medicine and Thyroid Centre, 6500, Bellinzona, Switzerland
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Trimboli P, Zilioli V, Imperiali M, Ceriani L, Giovanella L. High-sensitive basal serum thyroglobulin 6-12 months after thyroid ablation is strongly associated with early response to therapy and event-free survival in patients with low-to-intermediate risk differentiated thyroid carcinomas. Eur J Endocrinol 2017; 176:497-504. [PMID: 28137736 DOI: 10.1530/eje-16-1011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/12/2017] [Accepted: 01/30/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE High-sensitive thyroglobulin assays (hsTg) has decreased the need for stimulated Tg measurements in patients with differentiated thyroid carcinoma (DTC). However, multiple assays analyzing the same samples may report different values. Accordingly, appropriate assay-specific cut-off levels should be selected in representative patient series. Here, we evaluate the role of a new hsTg assay in low-to-intermediate risk DTC patients and select appropriate assay-specific clinical cut-off limits. DESIGN This was a retrospective study. The response to treatment was assessed according to ATA. METHODS Patients with low-to-intermediate risk DTC treated and regularly followed-up in our thyroid center. Tg was measured on the Kryptor Compact Plus Instrument (BRAHMS Thermo Fisher Scientific). RESULTS The study series comprised 201 DTC patients and excellent response (ER) was demonstrated in 184 (91.5%). Optimized threshold of basal Tg (onT4-Tg) measured 6-12 months after initial treatment was set by ROC curves analysis at 0.28 ng/mL. Having onT4-Tg <0.28 ng/mL at 6-12 months after treatment was associated with longer disease-free survival of Kaplan-Meier (P < 0.001), ER at early follow-up (odds ratio (OR): 165, P < 0.001) and absence of relapse during follow-up (OR: 328, P = 0.0001). CONCLUSIONS Patients with low- and intermediate-risk DTC could be considered cured when they have onT4-Tg levels <0.28 ng/mL coupled with negative imaging at their first post-ablation visit.
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Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - V Zilioli
- Department of Nuclear MedicineBolzano Regional Hospital, Bolzano, Italy
| | - M Imperiali
- Department of Laboratory MedicineEnte Ospedaliero Cantonale, Bellinzona, Switzerland
| | - L Ceriani
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Laboratory MedicineEnte Ospedaliero Cantonale, Bellinzona, Switzerland
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Groen AH, Klein Hesselink MS, Plukker JTM, Sluiter WJ, van der Horst-Schrivers ANA, Brouwers AH, Lentjes EGWM, Muller Kobold AC, Links TP. Additional value of a high sensitive thyroglobulin assay in the follow-up of patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2017; 86:419-424. [PMID: 27588675 DOI: 10.1111/cen.13180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/09/2016] [Accepted: 08/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Thyroglobulin (Tg) is an excellent tumour marker, as detectable or increasing Tg levels are highly indicative of persistent or recurrent differentiated thyroid carcinoma (DTC). The clinical value of a highly sensitive (hs)-Tg assay in patients with DTC has not yet been established. The aim of this study was to investigate the additional value of unstimulated hs-Tg measurements (Tg-on) compared to stimulated IRMA-Tg measurements (Tg-off) in the follow-up of patients with DTC. DESIGN, PATIENTS, MEASUREMENTS We retrospectively studied patients treated for DTC between 2006 and 2013 and compared hs-Tg and IRMA-Tg measurements. The study group consisted of 99 DTC patients in remission; Tg-on was measured 3 months after remnant ablation and Tg-off 6 months after ablation. RESULTS In the study group, 44 patients showed a hs-Tg-on <0·15 μg/l (functional sensitivity); of these, 43 had an IRMA-Tg-off measurement <1·0 μg/l, resulting in a negative predictive value of 97·7% and a positive predictive value of 56·4%. CONCLUSIONS The hs-Tg-on measurement is able to predict patients with an IRMA-Tg-off <1·0 μg/l, and therefore decreases the need for Tg stimulation after ablation.
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Affiliation(s)
- Andries H Groen
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - John T M Plukker
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Wim J Sluiter
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Eef G W M Lentjes
- Department of Clinical Chemistry and Hematology, Laboratory of Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anneke C Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
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Powers JL, Strathmann FG, Straseski JA. Thyroglobulin Antibody Screen Prior to Mass Spectrometry Provides Measurable Cost Savings and Optimal Laboratory Utilization. Am J Clin Pathol 2017; 147:309-314. [PMID: 28395053 DOI: 10.1093/ajcp/aqw228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods that allow accurate quantitation of thyroglobulin (Tg) in the presence of Tg antibodies (TgAbs) have recently become available. Due to cost differences between LC-MS/MS and immunoassay, some laboratories now offer a reflex test strategy that uses LC-MS/MS only for TgAb-positive samples. The goal of this study was to examine utilization of Tg testing strategies and cost savings. METHODS Test ordering patterns were examined for over 150,000 orders for TgAb and Tg in our laboratory. The average list price was determined from three separate commercial laboratories offering this testing. RESULTS Data showed that 89% of orders for Tg used the reflex test option, resulting in a savings of over $3 million compared with testing all samples by LC-MS/MS. Of the Tg by LC-MS/MS orders not using the reflex option, 1,663 also included a separate order for TgAb on the same patient sample, representing approximately $170,000 in potentially unnecessary costs from TgAb-negative samples. CONCLUSIONS Identifying situations to use more expensive testing methods (eg, LC-MS/MS) only when necessary, such as for TgAb-positive patients, leads to considerable cost savings and a more economical use of valuable health care resources.
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Affiliation(s)
- Jennifer L Powers
- From the Department of Pathology, University of Utah, Salt Lake City
| | | | - Joely A Straseski
- From the Department of Pathology, University of Utah, Salt Lake City
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Kim EY, Hyun KH, Park YL, Park CH, Yun JS. Risk factors associated with high thyroglobulin level following radioactive iodine ablation, measured 12 months after treatment for papillary thyroid carcinoma. Ann Surg Treat Res 2017; 92:1-8. [PMID: 28090499 PMCID: PMC5234424 DOI: 10.4174/astr.2017.92.1.1] [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: 06/13/2016] [Revised: 08/05/2016] [Accepted: 09/03/2016] [Indexed: 12/04/2022] Open
Abstract
Purpose The measurement of serum thyroglobulin (Tg) of papillary thyroid carcinoma patients, 12 months after total thyroidectomy and radioactive iodine (RAI) ablation following thyroxine hormone withdrawal (T4-off Tg) or recombinant human thyroid-stimulating hormone stimulation (rhTSH-Tg), is standard method for monitoring disease status. The aim of this study was to find predictive factors for detectable T4-off Tg during follow-up. Methods A retrospective review was conducted of 329 patients who underwent total thyroidectomy and RAI ablation between October 2008 and August 2012. Subjects were assigned to high (>1 ng/mL, n = 53) and low (≤1 ng/mL, n = 276) groups, based on T4-off Tg measured 12 months postoperatively. Demographic and clinicopathological characteristics at diagnosis and follow-up were compared between the 2 groups. Results The low and high T4-off Tg groups differed with respect to tumor size, preoperative Tg, ablative Tg, cervical lymph node metastasis, thyroglobulinemia out of proportion to results of diagnostic whole body scan, and American Thyroid Association 3-level stratification and restratification. Multivariate analysis confirmed that ablative Tg > 1.0 ng/mL (odds ratio [OR], 10.801; P = 0.001), more than 5 cervical lymph node metastasis (OR, 6.491; P = 0.003), and thyroglobulinemia out of proportion (OR, 9.221; P = 0.000) were risk factors. Conclusion Ablative Tg >1.0 ng/mL, more than 5 cervical lymph node metastasis, and thyroglobulinemia out of proportion were independent factors for T4-off Tg >1 ng/mL 12 months postoperative. In low-risk patients without these risk factors, the possible omission of Tg measurements could be considered during follow-up.
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Affiliation(s)
- Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kee Hoon Hyun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Kelly T, Denmark L, Lieberman DZ. Elevated levels of circulating thyroid hormone do not cause the medical sequelae of hyperthyroidism. Prog Neuropsychopharmacol Biol Psychiatry 2016; 71:1-6. [PMID: 27302764 DOI: 10.1016/j.pnpbp.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/24/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinicians have been reluctant to use high dose thyroid (HDT) to treat affective disorders because high circulating levels of thyroid hormone have traditionally been equated with hyperthyroidism, and understood as the cause of the medical sequelae of hyperthyroidism, such as osteoporosis and cardiac abnormalities. This conclusion is not supported by (HDT) research. METHODS A literature review of research related to the morbidity and mortality of HDT treatment was performed. RESULTS There exists a large body of research involving the use of HDT treatment to prevent the recurrence of differentiated thyroid cancer and to treat affective disorders. A review of this literature finds a lack of support for HDT as a cause of osteoporosis, nor is there support for an increase in morbidity or mortality associated with HDT. This finding contrasts with the well-established morbidity and mortality associated with Graves' disease, thyroiditis, and other endogenous forms of hyperthyroidism. DISCUSSION The lack of evidence that exogenous HDT causes osteoporosis, cardiac abnormalities or increases mortality compared with the significant morbidity and mortality of hyperthyroidism requires an alternative cause for the medical sequelae of hyperthyroidism. One possibility is an autoimmune mechanism. CONCLUSION High circulating levels of thyroid hormone is not the cause of the sequela of hyperthyroidism. The reluctance to using high dose thyroid is unwarranted.
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Affiliation(s)
- Tammas Kelly
- George Washington University, Department of Psychiatry and Behavioral Sciences, 2120 L St NW, Suite 600, Washington, DC 20037, United States(1); The Depression & Bipolar Clinic of Colorado, 400 East Horsetooth Road, Suite 300, Fort Collins, CO 80525, United States(2).
| | - Lawrence Denmark
- The Depression & Bipolar Clinic of Colorado, 400 East Horsetooth Road, Suite 300, Fort Collins, CO 80525, United States(2)
| | - Daniel Z Lieberman
- George Washington University, Department of Psychiatry and Behavioral Sciences, 2120 L St NW, Suite 600, Washington, DC 20037, United States(1)
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Uprety D, Khanal A, Arjyal L, Bista A, Basnet B, Kandel P, Gogireddy TR, Adhikari J. The risk of secondary primary malignancy in early stage differentiated thyroid cancer: a US population-based study. Acta Oncol 2016; 55:1375-1377. [PMID: 27579851 DOI: 10.1080/0284186x.2016.1196829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Dipesh Uprety
- Abington Memorial Hospital, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Amit Khanal
- University of Illinois, Chicago, Illinois, USA
| | - Lubina Arjyal
- BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Amir Bista
- Robert Packer Hospital/Guthrie Clinic, Sayre, Pennsylvania, USA
| | | | | | | | - Janak Adhikari
- Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Wong CKH, Lang BHH, Lam CLK. A systematic review of quality of thyroid-specific health-related quality-of-life instruments recommends ThyPRO for patients with benign thyroid diseases. J Clin Epidemiol 2016; 78:63-72. [PMID: 27020087 DOI: 10.1016/j.jclinepi.2016.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 03/03/2016] [Accepted: 03/15/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To appraise the measurement properties of thyroid-specific health-related quality-of-life (HRQOL) instruments and to provide recommendations on the choice of HRQOL instruments. STUDY DESIGN AND SETTING Systematic review of English-language literature published between 1993 and 2015 identified psychometric studies involving patients with thyroid disease through a search of Pubmed, Web of Science, Embase, and OVID MEDLINE. HRQOL instruments were graded on methodological quality and overall levels of evidence using a COSMIN checklist. RESULTS After a review of 742 original studies, 23 studies reporting 14 standardized HRQOL instruments targeted for Graves' ophthalmopathy (n = 4), hypothyroidism (n = 3), thyroid cancer (n = 2), other thyroid disease (n = 3), and nonthyroid tumor sites (n = 2) were identified. Hypothesis testing was evaluated most frequently. The 84-item thyroid-specific patient-reported outcome measure (ThyPRO) and 16-item Graves' ophthalmopathy-specific Quality-of-Life (GO-QOL) instruments were the most extensively evaluated instrument. The highest number of positive ratings in overall level of psychometric evidence was found in ThyPRO, GO-QOL, and 11-item Thyroid Treatment Satisfaction Questionnaire (ThyTSQ) instruments. CONCLUSION The ThyPRO is recommended for the assessment of HRQOL in patients with benign thyroid diseases while measurement properties of GO-QOL and ThyTSQ are satisfactory in measuring HRQOL of patients with Graves' ophthalmopathy and hypothyroidism, respectively.
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Affiliation(s)
- Carlos K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong.
| | - Brian H H Lang
- Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong
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Tanase K, Thies ED, Mäder U, Reiners C, Verburg FA. The TNM system (version 7) is the most accurate staging system for the prediction of loss of life expectancy in differentiated thyroid cancer. Clin Endocrinol (Oxf) 2016; 84:284-291. [PMID: 25740466 DOI: 10.1111/cen.12765] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/10/2015] [Accepted: 02/26/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Many prognostic systems have been developed for differentiated thyroid cancer. It is unclear which one of these performs 'best'. Our aim was to compare staging systems applicable to our patient database to identify which best predicts DTC-related loss of life expectancy and DTC-specific mortality. DESIGN Database study of patients with DTC treated in our centre between 1978 (earliest available data) up to and including 1 July 2014. All were staged in accordance with the AMES, Clinical Class, Memorial Sloan Kettering, Ohio State University, TNM versions 5 and 6/7, University of Alabama, University of Münster and qTNM systems. PATIENTS A total of 2257 patients with differentiated thyroid cancer. MEASUREMENTS Loss of life expectancy expressed as relative survival and thyroid cancer-specific mortality. Comparison was based on P values of univariate Cox regression analyses as well as analysis of the proportion of variance explained (PVE). RESULTS Median available follow-up time was 7·2 years (range: 0-35·1 years). Three hundred and twenty-seven patients died, 149 of whom died of DTC. Version 7 of the TNM system was best for predicting DTC-related mortality (P = 7·1 × 10-52 ; PVE = 0·296), followed by TNM version 5 (P = 6·7 × 10-44 ; PVE = 0·255). For prediction of loss of life expectancy, version 7 of the TNM system was also best, closely followed by the Clinical Class system (P both < 2 × 10-16 ). CONCLUSIONS The UICC/AJCC TNM system version 7 outperforms other prognostic classification systems based on extent of disease at the start of treatment both for prediction of differentiated thyroid cancer-related death and for prediction of loss life expectancy.
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Affiliation(s)
- Karina Tanase
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Elena-Daphne Thies
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Uwe Mäder
- Comprehensive Cancer Center, University of Würzburg, Würzburg, Germany
| | - Christoph Reiners
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
| | - Frederik A Verburg
- Department of Nuclear Medicine, University of Würzburg, Würzburg, Germany
- Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany
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50
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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