Anaplastic thyroid-carcinoma - a retrospective clinical and immunohistochemical study

Microvessel density in differentiated thyroid carcinoma: A systematic review and meta-analysis

BACKGROUND

Microvessel density (MVD) has been proposed as a direct quantification method of tumor neovascularization. However, the current literature regarding the role of MVD in differentiated thyroid carcinoma (DTC) remains inconclusive.

AIM

To appraise the effect of tumoral MVD on the survival of patients with DTC.

METHODS

This meta-analysis was based on the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic databases Medline, Web of Science, and Scopus were systematically screened. A fixed-effects or random-effects model was used, according to the Cochran Q test. The data were then extracted and assessed on the basis of the Reference Citation Analysis (https://www.referencecitationanalysis.com/).

RESULTS

A total of nine studies were included in the present study. Superiority of low MVD tumors in terms of 10-year disease free survival (OR: 0.21, 95%CI: 0.08–0.53) was recorded. Lowly vascularized thyroid cancers had a lower recurrence rate (OR: 13.66, 95%CI: 3.03–61.48). Moreover, relapsing tumors [weighed mean difference (WMD): 11.92, 95%CI: 6.32–17.52] or malignancies with regional lymph node involvement (WMD: 8.53, 95%CI: 0.04–17.02) presented with higher tumoral MVD values.

CONCLUSION

MVD significantly correlates with the survival outcomes of thyroid cancer patients. However, considering several study limitations, further prospective studies of higher methodological and quality level are required.

Interventional bronchoscopy in the treatment of tracheal obstruction secondary to advanced thyroid cancer

BACKGROUND

Surgery is the choice treatment for symptomatic tracheal obstruction due to malignant thyroid disease. Few additional therapeutic alternatives are available: radiotherapy (RT), chemotherapy (CT) or radioiodine therapy (1311). Only few studies on interventional bronchoscopy (IB) as well as alternative or palliative procedures have been reported so far. This study is a retrospective report of results of IB performed in patients with severe tracheal obstruction due to advanced thyroid cancer.

SETTING

Pulmonary and Endocrinology Units of a University Hospital.

PATIENTS AND INTERVENTIONS

From January 2, 2000 to March 1, 2004 14 consecutive patients [5 males, mean age: 62.2+/-10.7 (SD) yr] underwent IB due to tracheal obstruction for anaplastic (ATC: 7 patients), differentiated (DTC: 5), medullary (MTC: 1) and non-epithelial malignant (NEMN: 1) thyroid cancer. Eight out of 14 patients had local advanced inoperable disease, 6 had local relapse after surgery, 1311 or RT. Ten out of 14 patients suffered from severe dyspnea. In 4 patients airway patency was maintained by insertion of a stent; in 3 the tracheal lesion was removed by Nd-YAG laser; in 7 both procedures were performed.

RESULTS

All 10 patients with dyspnea showed an improvement in symptoms. Early and late complications were observed in 4 and in 3 patients, respectively. All but 4 DTC patients died 11.9+/-14.2 months after the diagnosis (4.20+/-5.1 after IB). In 4 DTC patients still alive 90.7+/-59.2 since diagnosis and 16.7+/-9.2 months since IB, the airway dilatations allowed further treatments like 131-I and/or RT.

CONCLUSIONS

Interventional bronchoscopy, including Nd-YAG laser and airways stenting are alternatives to surgery in inoperable thyroid-induced tracheal obstruction. Moreover, airway dilatation improves dyspnea and may allow further treatment.