The Role of Vitamin D as a Prognostic Marker in Papillary Thyroid Cancer

Association between vitamin D status and thyroid cancer: a meta-analysis

Background

Cumulative evidence has suggested that vitamin D deficiency is related with an increased susceptibility to various types of cancers. However, the association between vitamin D and thyroid cancer (TC) has remained to be unknown. Thus, there has been an urgent need for a meta-analysis to summarize existing evidence on vitamin D levels and the risk of TC.

Objective

This meta-analysis aimed to figure out the association between vitamin D level and the risk of TC.

Methods

A systematic search was performed for eligible articles on the association between vitamin D and TC based on PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov. Outcomes were the vitamin D level of cases with TC and the incidence of vitamin D deficiency in cases with TC comparing with the controls. The effect measures included standardized mean difference (SMD), ratio of means (RoM), and odds ratio (OR). A dose-response meta-analysis was performed to assess the correlation between vitamin D level and the risk of TC. Subgroup analyses and meta-regressions were conducted to explore the source of heterogeneity. And publication bias was evaluated through Begg's and Egger's tests.

Results

Results of the meta-analysis revealed lower levels of vitamin D in TC cases comparing with those in control [SMD = -0.25, 95% CI: (-0.38, -0.12); RoM = 0.87, 95% CI: (0.81, 0.94)] and the levels of 1,25 (OH)D in cases with TC were also lower than controls [SMD = -0.49, 95% CI: (-0.80, -0.19); RoM = 0.90, 95% CI: (0.85, 0.96)]. And vitamin D deficiency was associated with the increased risk of TC [OR = 1.49, 95% CI: (1.23, 1.80)]. Additionally, results from the dose-response meta-analysis showed that there is a 6% increase in the risk of TC for each 10 ng/ml decrease in 25 (OH)D levels [OR = 0.94; 95% CI: (0.89, 0.99)].

Conclusions

Individuals with TC had lower levels of vitamin D compared to controls, and vitamin D deficiency was correlated with an increase risk of TC.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=504417, identifier: CRD42024504417.

The association between vitamin D supplementation and the long-term prognosis of differentiated thyroid cancer patients: a retrospective observational cohort study with propensity score matching

Objective

Benefits of vitamin D in various cancers have been reported, but its effects on differentiated thyroid cancer (DTC) have not been established. We aimed to analyze the effect of vitamin D supplementation on the prognosis of DTC.

Methods

A retrospective observational cohort study was conducted on 9,739 DTC patients who underwent thyroidectomy from January 1997 to December 2016. Mortality was classified as all-cause, cancer-related, or thyroid cancer-related. Patients were divided into the "VD group" (supplemented with vitamin D) and the "control group" (without vitamin D supplementation). Propensity score matching was performed in a 1:1 ratio according to age, sex, tumor size, extrathyroidal extension (ETE), and lymph node metastasis (LNM) status, and 3,238 patients were assigned to each group. Kaplan-Meier curves, log-rank test and Cox proportional hazards regression analysis were performed.

Results

The follow-up period was 10.7 ± 4.2 years. Clinicopathological variables between two groups were similar except for all-cause (p<0.001) and total cancer death (p=0.001). From the Kaplan-Meier curve and log-rank test, "VD group" had significantly favorable all-cause (p<0.001) and total cancer mortality (p=0.003), but similar thyroid cancer mortality (p=0.23). In Cox regression, vitamin D intake reduced the risk of all-cause (hazard ratio [HR], 0.617, p=0.001) and total cancer mortality (HR, 0.668, p=0.016) but had no effect on thyroid cancer mortality.

Discussion/conclusion

Vitamin D supplementation was positively associated with all-cause and total cancer mortality in DTC and might be a modifiable prognostic factor for improved survival. Further research will be needed to clarify the effect of vitamin D supplementation on DTC.

Updates in Thyroid Cancer Surgery

This Special Issue of Cancers entitled "Updates in thyroid surgery" is a collection of nine articles that covers a wide range of topics, providing a comprehensive picture of the latest developments in thyroid surgery [...].

Multi-Omics and Management of Follicular Carcinoma of the Thyroid

Follicular thyroid carcinoma (FTC) is the second most common cancer of the thyroid gland, accounting for up to 20% of all primary malignant tumors in iodine-replete areas. The diagnostic work-up, staging, risk stratification, management, and follow-up strategies in patients who have FTC are modeled after those of papillary thyroid carcinoma (PTC), even though FTC is more aggressive. FTC has a greater propensity for haematogenous metastasis than PTC. Furthermore, FTC is a phenotypically and genotypically heterogeneous disease. The diagnosis and identification of markers of an aggressive FTC depend on the expertise and thoroughness of pathologists during histopathological analysis. An untreated or metastatic FTC is likely to de-differentiate and become poorly differentiated or undifferentiated and resistant to standard treatment. While thyroid lobectomy is adequate for the treatment of selected patients who have low-risk FTC, it is not advisable for patients whose tumor is larger than 4 cm in diameter or has extensive extra-thyroidal extension. Lobectomy is also not adequate for tumors that have aggressive mutations. Although the prognosis for over 80% of PTC and FTC is good, nearly 20% of the tumors behave aggressively. The introduction of radiomics, pathomics, genomics, transcriptomics, metabolomics, and liquid biopsy have led to improvements in the understanding of tumorigenesis, progression, treatment response, and prognostication of thyroid cancer. The article reviews the challenges that are encountered during the diagnostic work-up, staging, risk stratification, management, and follow-up of patients who have FTC. How the application of multi-omics can strengthen decision-making during the management of follicular carcinoma is also discussed.

The Role of Genetic Polymorphisms in Differentiated Thyroid Cancer: A 2023 Update

Thyroid cancer is the most common endocrine malignancy, with an increasing trend in the past decades. It has a variety of different histological subtypes, the most frequent one being differentiated thyroid cancer, which refers to papillary carcinoma, the most common histological type, followed by follicular carcinoma. Associations between genetic polymorphisms and thyroid cancer have been investigated over the years and are an intriguing topic for the scientific world. To date, the results of associations of single nucleotide polymorphisms, the most common genetic variations in the genome, with thyroid cancer have been inconsistent, but many promising results could potentially influence future research toward developing new targeted therapies and new prognostic biomarkers, thus consolidating a more personalized management for these patients. This review focuses on emphasizing the existing literature data regarding genetic polymorphisms investigated for their potential association with differentiated thyroid cancer and highlights the opportunity of using genetic variations as biomarkers of diagnosis and prognosis for thyroid cancer patients.

VITAMIN D LEVEL AND ITS RELATIONSHIP WITH CANCER STAGE IN PATIENTS WITH DIFFERENTIATED THYROID CARCINOMA

BACKGROUND

Differentiated thyroid carcinoma (DTC) has witnessed an increase in incidence and although it is considered to have a slow grow potential and a 90% 10-year survival rate, local or distant metastases can be observed in 20%. It is essential to recognize other factors associated with malignancy and poor prognosis. Vitamin D and its deficiency has proven useful as a prognostic biomarker for many types of cancer, including thyroid cancer.

AIM

Evaluate the relationship between vitamin D status in DTC and benign thyroid disorders patients and correlation between vitamin D and histopathological findings in DTC group.

METHODS

Study included 170 patients with confirmed DTC and 200 with benign thyroid pathology. Evaluation included 25-hydroxy vitamin D [25(OH)D], ultrasound and histopathologic features.

RESULTS

In DTC patients, mean value of vitamin D was significantly lower (17.86 ng/mL ± 9.31 DS versus 20.26 ng/mL ± 9.31 DS, p=0.029). Statistical analysis confirmed a negative correlation between vitamin D levels and tumor size (T) according to TNM classification (r=-0.176, p=0.02).

CONCLUSIONS

Vitamin D level was significantly lower in the DTC group and 25(OH)D levels may be correlated with histopathology features like tumor size and aggressiveness according to TNM classification.

Benign nodules of the thyroid gland and 25-hydroxy-vitamin D levels in euthyroid patients

BACKGROUND

The presence of nodules in the thyroid gland is common in iodine-deficient areas of the world. Recently, vitamin D levels were found to be lower than normal and sometimes deficient in malignant nodules of the thyroid.

OBJECTIVE

Evaluate the relationship between the serum vitamin D levels and benign thyroid nodules in euthyroid patients.

DESIGN

Cross-sectional.

SETTING

Tertiary care center in Turkey.

PATIENTS AND METHODS

Patients referred to the general surgery outpatient clinic and diagnosed with thyroid nodules were the study group. The control group consisted of healthy individuals without thyroid nodules. Age, BMI, thyroid ultrasonography, serum 25-hydroxyvitamin D, free T3, free T4, thyroid stimulating hormone, calcium, magnesium, phosphorous, total protein, albumin, glucose, creatinine levels and glomerular filtration rate (GFR) were compared between groups.

MAIN OUTCOME MEASURE

Serum 25-hydroxy-vitamin D levels and size of the thyroid nodules.

SAMPLE SIZE AND CHARACTERISTICS

Of 849 individuals, 453 were patients with thyroid nodules and 396 were healthy individuals.

RESULTS

The mean serum vitamin D levels of patients with thyroid nodules were significantly lower than controls (P<.001). Serum vitamin D levels along with serum total protein levels and eGFR were independent variables associated with the presence of a thyroid nodule (P<.001, p=.005 and P=.017, respectively).

CONCLUSION

These findings suggest vitamin D deficiency might be one of the pathophysiologic factors in development of thyroid nodules.

LIMITATION

Single-center and possible information bias.

CONFLICTS OF INTEREST

None.

Papillary Thyroid Cancer Prognosis: An Evolving Field

Simple Summary

Over the last couple of decades, the prognostic stratification systems of differentiated thyroid cancer (DTC) patients have been revised several times in an attempt to achieve a tailored clinical management reflecting the single patients’ needs. Such revisions are likely to continue in the near future, since the prognostic value of a number of promising clinicopathological features and new molecular biomarkers are being evaluated. Here, we will review the current staging systems of thyroid cancer patients and discuss the most relevant clinicopathological parameters and new molecular markers that are potentially capable of refining the prognosis.

Abstract

Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified in more than 98% of PTC, and a new PTC classification into molecular subtypes has been proposed in order to resolve clinical uncertainties still present in the clinical management of patients. Additionally, the prognostic stratification systems have been profoundly modified over the last decade, with a view to refine patients’ staging and being able to choose a clinical approach tailored on single patient’s needs. Here, we will briefly discuss the recent changes in the clinical management of thyroid nodules, and review the current staging systems of thyroid cancer patients by analyzing promising clinicopathological features (i.e., gender, thyroid auto-immunity, multifocality, PTC histological variants, and vascular invasion) as well as new molecular markers (i.e., BRAF/TERT promoter mutations, miRNAs, and components of the plasminogen activating system) potentially capable of ameliorating the prognosis of PTC patients.