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Tahara M, Kiyota N, Imai H, Takahashi S, Nishiyama A, Tamura S, Shimizu Y, Kadowaki S, Ito KI, Toyoshima M, Hirashima Y, Ueno S, Sugitani I. A Phase 2 Study of Encorafenib in Combination with Binimetinib in Patients with Metastatic BRAF-Mutated Thyroid Cancer in Japan. Thyroid 2024; 34:467-476. [PMID: 38343359 DOI: 10.1089/thy.2023.0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
Background: Driver mutations at BRAF V600 are frequently identified in papillary thyroid cancer and anaplastic thyroid cancer (ATC), in which BRAF inhibitors have shown clinical effectiveness. This Japanese phase 2 study evaluated the efficacy and safety of a BRAF inhibitor, encorafenib, combined with an MEK inhibitor, binimetinib, in patients with BRAF V600-mutated thyroid cancer. Methods: This phase 2, open-label, uncontrolled study was conducted at 10 institutions targeted patients with BRAF V600-mutated locally advanced or distant metastatic thyroid cancer not amenable to curative treatment who became refractory/intolerant to ≥1 previous vascular endothelial growth factor receptor-targeted regimen(s) or were considered ineligible for those. The primary endpoint was centrally assessed objective response rate (ORR). The secondary endpoints included duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety. Results: We enrolled 22 patients with BRAFV600E-mutated thyroid cancer: 17 had differentiated thyroid cancer (DTC), and 5 had ATC. At data cutoff (October 26, 2022), the median follow-up was 11.5 (range = 3.4-19.0) months. The primary endpoint of centrally assessed ORR was 54.5% (95% confidence interval [CI] 32.2-75.6; partial response in 12 patients and stable disease in 10). The ORRs in patients with DTC and ATC were 47.1% (8 of 17) and 80.0% (4 of 5), respectively. The medians for DOR and PFS by central assessment and for OS were not reached in the overall population, the DTC subgroup, or the ATC subgroup. At 12 months, the rate of ongoing response was 90.9%, and the PFS and OS rates were 78.8% and 81.8%, respectively. All patients developed ≥1 adverse events (AEs): grade 3 AEs in 6 patients (27.3%). No patients developed grade 4-5 AEs. The most common grade 3 AE was lipase increased (4 patients [18.2%]). Those toxicities were mostly manageable with appropriate monitoring and dose adjustment. Conclusions: Treatment with encorafenib plus binimetinib met the primary endpoint criteria and demonstrated clinical benefit in patients with BRAFV600E-mutated thyroid cancer regardless of its histological type, such as DTC or ATC, with no new safety concerns identified. Encorafenib plus binimetinib could thus be a new treatment option for BRAF V600-mutated thyroid cancer. Clinical Trial Registration number: Japan Registry of Clinical Trials: jRCT2011200018.
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Affiliation(s)
- Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Hiroo Imai
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of JFCR, Koto-ku, Tokyo, Japan
| | - Akihiro Nishiyama
- Department of Medical Oncology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Shingo Tamura
- Department of Medical Oncology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Fukuoka, Japan
| | - Yasushi Shimizu
- Department of Medical Oncology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Shigenori Kadowaki
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | | | | | | | - Iwao Sugitani
- Department of Endocrinology, Nippon Medical School Hospital, Bunkyo-ku, Tokyo, Japan
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Matsui M, Jikuzono T, Kure S, Ishibashi O, Akasu H, Sugitani I. Usefulness of Ultrasonographic Detective Flow Imaging for Detecting Parathyroid Tumors: A Report of Two Cases. J NIPPON MED SCH 2024; 90:460-464. [PMID: 36273907 DOI: 10.1272/jnms.jnms.2023_90-604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Parathyroid tumors (PTs) are sometimes difficult to diagnose because they are small and have low-velocity blood flow, which can be missed by current imaging modalities. PTs consist of parathyroid adenoma (PA), parathyroid cyst, and parathyroid carcinoma (PC). Detective flow imaging (DFI) is a new imaging technology that displays low-velocity blood flow. Herein, we report two cases in which DFI was useful for diagnosis of PTs. One patient had a PA and a parathyroid cyst in close proximity, and the other had a PC. To our knowledge, this is the first report to demonstrate the usefulness of DFI in the diagnosis of PTs.
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Affiliation(s)
- Mami Matsui
- Department of Endocrine Surgery, Nippon Medical School
| | - Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Haruki Akasu
- Department of Endocrine Surgery, Nippon Medical School Musashi Kosugi Hospital
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
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Hoshi M, Jikuzono T, Suzuki S, Ishibashi O, Kawamoto Y, Kure S, Kawamoto M, Ohashi R, Sugitani I. Use of Ultrasonographic Shear Wave Measurements to Diagnose Thyroid Metastasis from Breast Carcinoma. J NIPPON MED SCH 2023; 90:398-403. [PMID: 35644558 DOI: 10.1272/jnms.jnms.2023_90-501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A metastatic thyroid tumor (MTT) arising from breast carcinoma (BC) is rare and sometimes difficult to diagnose. We present a case of MTT from BC; we suspected anaplastic thyroid carcinoma at initial presentation. The patient was a 58-year-old female with a hard nodule in the right anterior neck and a history of breast cancer. Computed tomography indicated tumors on both thyroid lobes, and ultrasonography (US) with shear wave measurement (SWM) showed malignant features. We performed fine needle aspiration cytology (FNAC), the results of which led us to strongly suspect MTT from BC. The surgically resected specimen was evaluated histopathologically, including by immunohistochemistry (IHC), and the diagnosis was confirmed. In addition to FNAC and IHC, SWM is useful to diagnose MTT from BC.
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Affiliation(s)
- Masae Hoshi
- Department of Endocrine Surgery, Kanaji Thyroid Hospital
| | | | | | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Yoko Kawamoto
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Masashi Kawamoto
- Department of Diagnostic Pathology, Shonan Fujisawa Tokushukai Hospital
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
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Nagaoka R, Saitou M, Nagahama K, Okamura R, Akasu H, Igarashi T, Yokoshima K, Ohashi R, Sugitani I. Downhill Varices in the Hypopharynx of a Patient with a Large Thyroid Tumor: A Case Report. J NIPPON MED SCH 2023; 90:408-413. [PMID: 36273906 DOI: 10.1272/jnms.jnms.2023_90-601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Downhill varices are usually caused by superior vena cava (SVC) obstruction due to bronchogenic carcinoma or mediastinal tumors. These structures exhibit retrograde blood flow and are located in the proximal esophagus. Varices in the hypopharynx resulting from mediastinal thyroid tumor are extremely rare. A 70-year-old man with a 35-year history of a growing thyroid tumor on the right side of his neck visited a local hospital. Fine-needle aspiration cytology of the tumor revealed benign goiter. Contrast-enhanced computed tomography showed a huge tumor (13 × 10 × 5 cm) in the right to left lobe of the thyroid that extended into the mediastinum. A well-enhanced mass mimicking hypopharyngeal cancer was identified in the hypopharynx. Endoscopic examination showed varices in the postcricoid region, so biopsy was contraindicated. The preoperative diagnosis was adenomatous goiter and hypopharyngeal varices caused by obstruction of the internal jugular and brachiocephalic vein by the goiter. Total thyroidectomy was performed and the hypopharyngeal varices had disappeared by the next day. The histopathological diagnosis of the thyroid tumor was poorly differentiated carcinoma. Mediastinal thyroid tumor rarely causes downhill varices due to SVC obstruction. However, signs of SVC obstruction were absent in this case, and varices were present in the hypopharynx, not in the upper esophagus. Obstructed venous flow from the thyroid plexus might circulate via the superior laryngeal vein and cause varices in the postcricoid region. When a patient with a large mediastinal tumor has a tumor-like lesion in the hypopharynx, downhill varices should be considered before scheduling a biopsy.
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Affiliation(s)
- Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School
| | - Marie Saitou
- Department of Endocrine Surgery, Nippon Medical School
| | | | | | - Haruki Akasu
- Department of Endocrine Surgery, Nippon Medical School Musashi Kosugi Hospital
| | | | | | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
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Inoue Y, Ebina A, Toda K, Shimbashi W, Yamada K, Mitani H, Tanaka Y, Sugitani I. Surgical strategy for patients with papillary thyroid carcinoma invading the trachea: a comparison of tracheal sleeve resection with end-to-end anastomosis and window resection with tracheocutaneous fistula. Gland Surg 2023; 12:1167-1178. [PMID: 37842530 PMCID: PMC10570975 DOI: 10.21037/gs-23-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/02/2023] [Indexed: 10/17/2023]
Abstract
Background Sleeve resection with end-to-end anastomosis (Procedure A) and window resection with a tracheocutaneous fistula (Procedure B) are the major surgical procedures for patients with papillary thyroid carcinoma (PTC) exhibiting transluminal tracheal invasion. For each procedure, the indications, postoperative course, and treatment results were examined retrospectively. Methods Of 1,456 patients with PTC (maximum tumor diameter >1 cm) who received initial treatment between 1993 and 2013, we reviewed 51 patients. Of these 51 cases, 45 showed full-layer tracheal invasion, and 6 did not reach the tracheal mucosa, but required full-layer tracheal resection. Twenty-four patients underwent Procedure A, and 27 patients underwent Procedure B. Results Regarding surgical procedure selection, Procedure B was selected significantly more frequently than Procedure A for cases with preoperative recurrent laryngeal nerve (RLN) palsy, tumor invasion of the esophagus, clinical lymph node metastasis, or a large number of resected tracheal rings. Postoperative airway-related complications were not significantly different between the procedures, but decreased with the use of intraoperative neuromonitoring (IONM). The postoperative hospital stay was significantly longer for Procedure B than for Procedure A. In addition, the rate of a permanent postoperative tracheostoma was higher with Procedure B than with Procedure A. Local recurrence-free survival (LRFS) and cause-specific survival (CSS) did not differ significantly between the two procedures. Conclusions Certain patients may benefit from Procedure A with IONM in terms of a shorter hospital stay and avoiding the need for a permanent tracheostoma. Although Procedure B was indicated for patients with more advanced disease than Procedure A, treatment outcomes were similar.
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Affiliation(s)
- Yukari Inoue
- Department of Otorhinolaryngology and Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Aya Ebina
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Toda
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Wataru Shimbashi
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Keiko Yamada
- Division of Ultrasonography, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Hiroki Mitani
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology and Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
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Kazusaka H, Sugitani I, Toda K, Sen M, Saito M, Nagaoka R, Yoshida Y. Patient-Reported Outcomes in Patients with Low-Risk Papillary Thyroid Carcinoma: Cross-Sectional Study to Compare Active Surveillance and Immediate Surgery. World J Surg 2023; 47:1190-1198. [PMID: 36282283 DOI: 10.1007/s00268-022-06786-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND This cross-sectional study compared patient-reported outcomes of low-risk papillary thyroid carcinoma (PTC, T1N0M0) between patients who underwent active surveillance (AS) and those who received immediate surgery, METHODS: Using the State-Trait Anxiety Inventory, Short-Form 36 version 2, and a visual analog scale for neck symptoms, 249 patients under AS and 32 patients underwent immediate surgery were compared. To match the difference in time from the onset of treatment to the survey, we conducted propensity score matching. We also investigated factors affecting anxiety in patients under AS in multiple linear regression analysis. RESULTS In the entire group, patients under AS had significantly longer time from the onset to the survey than patients underwent immediate surgery (7.9 vs. 4.0 years). After matching, AS group showed significantly better trait anxiety and mental component summary (MCS) compared to surgery group, while surgery group showed better role-social component summary. AS group also had significantly better MCS than the Japanese norm-based score. Surgery group displayed worse neck symptoms than AS group. Among AS group, trait anxiety and time from the onset were significant predictors of state anxiety. Compared with the group with < 5 years since starting AS, the group with ≥ 5 years of follow-up showed a significantly better state anxiety only in patients with better trait anxiety. CONCLUSIONS Low-risk PTC patients under AS showed better trait anxiety and mental health than surgery group. After a certain period, the anxiety of patients under AS seems to be improved, especially in patients with better trait anxiety.
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Affiliation(s)
- Hiroko Kazusaka
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
- Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kazuhisa Toda
- Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaomi Sen
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Marie Saito
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Yusaku Yoshida
- Department of Endocrine Surgery, Tokyo Women's Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Abstract
Recently, the incidence of thyroid carcinoma has been increasing rapidly worldwide. This is interpreted as an increase in the incidental detection of small papillary thyroid carcinomas by the widespread use of high-resolution imaging techniques such as ultrasonography. However, the mortality rates of thyroid carcinoma have not changed, suggesting that small papillary thyroid carcinomas may be overdiagnosed and overtreated. Active surveillance management has been introduced from Japan since the 1990s, as one of the measures to prevent overtreatment of low-risk papillary thyroid microcarcinoma. Based on the favorable outcomes, active surveillance has been gradually adopted worldwide as an alternative to immediate surgery. The management should be carried out with strict eligibility criteria and close monitoring for cancer progression, under a multidisciplinary team. In addition, an adequate shared decision-making is mandatory for individual patients. Papillary thyroid microcarcinomas with clinically apparent lymph node metastasis, distant metastasis, or invasion to adjacent organs should have surgery.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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Higashiyama T, Sugino K, Hara H, Ito KI, Nakashima N, Onoda N, Tori M, Katoh H, Kiyota N, Ota I, Suganuma N, Hibi Y, Nemoto T, Takahashi S, Yane K, Ioji T, Kojima S, Kaneda H, Sugitani I, Tahara M. Phase II study of the efficacy and safety of lenvatinib for anaplastic thyroid cancer (HOPE). Eur J Cancer 2022; 173:210-218. [PMID: 35932627 DOI: 10.1016/j.ejca.2022.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Anaplastic thyroid cancer (ATC) is a rare and highly aggressive cancer for which effective systemic therapy has long been sought. Here, we assessed the efficacy and safety of lenvatinib in patients with unresectable ATC. PATIENTS AND METHODS The study was investigator-initiated and conducted under a multicenter, open-label, nonrandomized, phase II design. Eligibility criteria included pathologically proven ATC; unresectable measurable lesion as defined by RECIST 1.1; age 20 years or older; ECOG PS 0-2; and adequate organ function. The primary end-point was overall survival. Secondary end-points were progression-free survival, objective response rate, disease control rate, clinical benefit rate, and safety. RESULTS Of 52 patients enrolled from 17 institutions, 42 patients who were confirmed to have ATC were included for efficacy analysis, and 50 patients were included for safety analysis. The estimated 1-year overall survival rate was 11.9% (95% CI, 4.4%-23.6%). One patient (2.4%) achieved complete response, four patients (9.5%) partial response, and 26 patients (61.9%) stable disease, including nine patients (21.4%) who demonstrated durable stable disease, giving an objective response rate of 11.9%, disease control rate of 73.8%, and clinical benefit rate of 33.3%. Adverse events of any grade were observed in 45 patients (90.0%), the most common of which of any grade included loss of appetite (48.0%), fatigue (48.0%), hypertension (44.0%), and palmar-plantar erythrodysesthesia syndrome (26.0%). CONCLUSION Lenvatinib treatment resulted in disappointing survival for unresectable ATC patients. Although the number of responders was small, responses were durable, indicating that lenvatinib may be beneficial for selected patients. Further investigation to identify suitable candidates for lenvatinib monotherapy is needed.
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Affiliation(s)
| | | | - Hisato Hara
- Department of Breast and Endocrine Surgery, Tsukuba University, Tsukuba, Japan
| | - Ken-Ichi Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Noriaki Nakashima
- Division of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Kobe, Japan; Department of Breast & Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroshi Katoh
- Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naomi Kiyota
- Oncology/Hematology, Kobe University Hospital Cancer Center, Kobe, Japan
| | - Ichiro Ota
- Nara Medical University, Kashihara, Japan
| | | | - Yatsuka Hibi
- Fujita Health University Hospital, Toyoake, Japan
| | - Toshimitsu Nemoto
- Department of Otorhinolaryngology, Japanese Red Cross Narita Hospital, Chiba, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Katsunari Yane
- Department of Otolaryngology-Head and Neck Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Tetsuya Ioji
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Shinsuke Kojima
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Hideaki Kaneda
- Translational Research Center for Medical Innovation, Kobe, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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9
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Brose MS, Smit JWA, Lin CC, Tori M, Bowles DW, Worden F, Shen DHY, Huang SM, Tsai HJ, Alevizaki M, Peeters RP, Takahashi S, Rumyantsev P, Guan R, Babajanyan S, Ozgurdal K, Sugitani I, Pitoia F, Lamartina L. Multikinase Inhibitors for the Treatment of Asymptomatic Radioactive Iodine-Refractory Differentiated Thyroid Cancer: Global Noninterventional Study (RIFTOS MKI). Thyroid 2022; 32:1059-1068. [PMID: 35950621 DOI: 10.1089/thy.2022.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Sorafenib and lenvatinib are multikinase inhibitors (MKIs) approved for patients with radioactive iodine-refractory (RAI-R) differentiated thyroid cancer (DTC). There is no consensus on when to initiate MKI treatment. The objective of this study was to evaluate time to symptomatic progression (TTSP) in patients with RAI-R DTC for whom the decision to treat with an MKI was made at study entry. Methods: International, prospective, open-label, noninterventional cohort study (NCT02303444). Eligible patients had asymptomatic progressive RAI-R DTC, with ≥1 lesion ≥1 cm in diameter and life expectancy ≥6 months. The decision to treat with an MKI was at the treating physician's discretion. Primary endpoint was TTSP from study entry. Two cohorts were evaluated: patients for whom a decision to initiate an MKI was made at study entry (Cohort 1) and patients for whom there was a decision not to initiate an MKI at study entry (Cohort 2). Cohorts were compared descriptively. Results: The full analysis set (FAS) comprised 647 patients. The median duration of observation was 35.5 months (range <1-59.4). Of 344 MKI-treated patients, 209 received sorafenib, 191 received lenvatinib, and 19 received another MKI at some point. Median TTSP was 55.4 months (interquartile range [IQR] 18.6-not estimable [NE]) overall, 55.4 months (IQR 15.2-NE) in Cohort 1 (n = 169), and 51.4 months (IQR 20.0-NE) in Cohort 2 (n = 478). TTSP ≥36 months was achieved in 64.5% of patients overall, 59.5% of patients in Cohort 1, and 66.4% of patients in Cohort 2. Median overall survival from classification as RAI-R was 167 months and median progression-free survival from start of MKI therapy was 19.2 months and from start of sorafenib therapy 16.7 months. Among sorafenib-treated patients, 70% had dose modifications, 35% had a dose reduction, 89% experienced ≥1 treatment-emergent adverse event (TEAE), and 82% experienced ≥1 drug-related TEAE. Conclusions: This real-world study provides valuable insight into outcomes in patients with asymptomatic, progressive RAI-R DTC under observation or receiving MKI treatment. TTSP in the FAS provides insight into the current prognosis for patients with RAI-R DTC in the era of MKIs. Registration: NCT02303444.
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Affiliation(s)
- Marcia S Brose
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Johannes W A Smit
- Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Chia-Chi Lin
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, Tennoujiku, Osaka, Japan
| | - Daniel W Bowles
- Department of Medicine, Division of Medical Oncology, University of Colorado, Aurora, Colorado, USA
| | - Francis Worden
- Department of Medical Oncology, Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Hueng-Yuan Shen
- Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Ming Huang
- Asian Institute of Thyroid Care, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Hui-Jen Tsai
- Asian Institute of Thyroid Care, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - Maria Alevizaki
- Endocrine Unit, Department of Medical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Pavel Rumyantsev
- Department of Nuclear Medicine, Endocrinology Research Center, Moscow, Russian Federation
| | - Rongjin Guan
- Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | | | | | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Fabian Pitoia
- Department of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Livia Lamartina
- Gustave Roussy, Department of Nuclear Medicine and Endocrine Oncology, Villejuif, France
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10
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Kure S, Chiba T, Ebina A, Toda K, Jikuzono T, Motoda N, Mitani H, Sugitani I, Takeuchi K, Ohashi R. Correlation between low expression of protein disulfide isomerase A3 and lymph node metastasis in papillary thyroid carcinoma and poor prognosis: a clinicopathological study of 1,139 cases with long-term follow-up. Endocr J 2022; 69:273-281. [PMID: 34732604 DOI: 10.1507/endocrj.ej21-0394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The incidence of papillary thyroid carcinoma (PTC) is increasing worldwide. The biomarkers to identify aggressive types of PTC are limited, illustrating the need to establish reliable novel biomarkers. Protein disulfide isomerase A3 (PDIA3) is a chaperone protein that modulates the folding of newly synthesized glycoproteins and stress-responsive proteins in the endoplasmic reticulum. Although the role of PDIA3 in various cancers such as breast, uterine cervix, head and neck, and gastrointestinal tract has been examined, its expression in thyroid cancer has not been reported. We retrospectively reviewed accumulated data with long-term follow-up of 1,139 PTC patients, and investigated the correlation between immunohistochemical expression of PDIA3 in PTC patients and clinicopathological features and prognosis. PDIA3 expression was significantly lower in PTCs compared to normal thyroid tissues (NTT; n = 80, p = 0.002). In PTCs, correlation between low PDIA3 expression and lymph node metastasis (p = 0.018) and the number of positive nodes (p = 0.004) was observed. Patients with low PDIA3 expression exhibited worse cause-specific survival compared to those with high PDIA3 expression (p = 0.013). Our findings indicate that low PDIA3 expression is related to poor clinical outcome in PTC patients, and that PDIA3 may potentially be a novel ancillary biomarker. Further clarification of the biological role of PDIA3 in PTC is warranted for the future clinical application.
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Affiliation(s)
- Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo 113-8602, Japan
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Tomohiro Chiba
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Aya Ebina
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Kazuhisa Toda
- Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Norio Motoda
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo 113-8602, Japan
| | - Hiroki Mitani
- Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Kengo Takeuchi
- Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Pathology Project for Molecular Targets, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo 113-8602, Japan
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11
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Jikuzono T, Ishibashi O, Kure S, Itoh C, Yamada T, Sugitani I. VsN, a Reliability-index of Shear-wave Measurement in Sonoelastography, Is Useful for the Diagnosis of Thyroid Tumor Malignancy. In Vivo 2022; 36:264-273. [PMID: 34972724 DOI: 10.21873/invivo.12700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Shear wave measurement (SWM) is a new elastography modality that quantifies the shear wave velocity (Vs) and the percentage of the net effective shear wave velocity (VsN). This study examined whether these parameters could be used to differentiate between malignant and benign thyroid tumors. PATIENTS AND METHODS The study of SWM enrolled 111 patients (133 nodules) who underwent thyroid surgery. Overall, 61 nodules were diagnosed as benign and 72 as malignant, of which 68 nodules were diagnosed as papillary thyroid carcinoma (PTC) and 4 as follicular thyroid carcinoma (FTC). RESULTS A preoperative SWM revealed that Vs was significantly higher and VsN significantly lower in the PTC compared to the benign nodules. The VsN of FTC was significantly lower than that of follicular adenoma. Multivariate analysis revealed that VsN significantly correlated with nodule malignancy. CONCLUSION SWM parameters, especially VsN, can potentially differentiate between benign and malignant thyroid nodules non-invasively.
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Affiliation(s)
- Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan.,Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan; .,Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, Osaka, Japan
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | | | - Tetsu Yamada
- Department of Endocrine Surgery, Kanaji Thyroid Hospital, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
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12
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Okazaki-Hada M, Fukuda I, Nagaoka R, Nagao M, Igarashi T, Kobayashi S, Oba T, Yamaguchi Y, Nagamine T, Sugitani I, Sugihara H. A case of pheochromocytoma associated with liver abscess and intestinal pseudo-obstruction. Ther Adv Endocrinol Metab 2022; 13:20420188221139652. [PMID: 36533183 PMCID: PMC9749039 DOI: 10.1177/20420188221139652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/31/2022] [Indexed: 12/14/2022] Open
Abstract
Pheochromocytomas can present with various symptoms. Nonspecific manifestations of pheochromocytoma include intestinal pseudo-obstruction and weight loss. Here, we present a case of pheochromocytoma in which prolonged intestinal pseudo-obstruction due to excess catecholamines was one of the factors leading to the development of a liver abscess. An 18-year-old male patient with a history of status epilepticus and severe intellectual disability was transferred to our hospital for a thorough examination of fever and constipation that had lasted for 2 months. When admitted to our hospital, he had fever, and his body mass index was 9.5 kg/m2. Upon comprehensive examination of the patient's fever, the blood culture was found positive for Bacteroides. Computed tomography showed findings of intestinal pseudo-obstruction and a low density region in the liver that indicated a liver abscess. Imaging studies also revealed a right adrenal mass and endocrinological test showed elevated plasma norepinephrine and urine normetanephrine levels. In addition, the right adrenal mass showed uptake on 123I-metaiodobenzylguanidine scintigraphy. These findings led to a definite diagnosis of pheochromocytoma. The patient was eventually diagnosed with a pheochromocytoma coexisting with a liver abscess. After treating the liver abscess with antibiotics and ultrasound-guided drainage, an adrenalectomy was performed. The pathological findings were consistent with pheochromocytoma. Postoperatively, the catecholamine excess normalized and intestinal pseudo-obstruction and weight loss improved. We suspected that prolonged intestinal pseudo-obstruction resulted in bacterial translocation and development of a liver abscess. To the best of our knowledge, this is the first report of a pheochromocytoma associated with a liver abscess. Moreover, the clinical presentation of this patient was unusual for pheochromocytoma, as the patient did not have typical symptoms such as hypertension or tachycardia, but rather presented with constipation, intestinal pseudo-obstruction, and weight loss. This case provides valuable insight regarding the impact of catecholamine excess on the intestinal tract and body weight.
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Affiliation(s)
- Mikiko Okazaki-Hada
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | | | - Ryuta Nagaoka
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Mototsugu Nagao
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takehito Igarashi
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Shunsuke Kobayashi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takeshi Oba
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuji Yamaguchi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Tomoko Nagamine
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Sugihara
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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13
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Nagaoka R, Sugitani I, Kazusaka H, Matsui M, Sen M, Saitou M, Jikuzono T, Okamura R, Igarashi T, Shimizu K. Learning curve for endoscopic thyroidectomy using video-assisted neck surgery: retrospective analysis of a single surgeon's experience of 100 cases. J NIPPON MED SCH 2021; 89:277-286. [PMID: 34526468 DOI: 10.1272/jnms.jnms.2022_89-302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy offers excellent cosmetic outcomes, but requires a period of time for surgeons to become proficient. We examined the learning curve for the first 100 cases experienced by a single surgeon using a video-assisted neck surgery (VANS) subclavian approach. METHODS We retrospectively studied 100 patients (99 women, 1 man; mean age, 36.2 years) with both benign and malignant thyroid diseases treated between 2016 and 2020. RESULTS Preoperative diagnosis was papillary thyroid carcinoma (PTC) in 36 cases and other (non-PTC) in 64 cases. All patients underwent lobectomy, with unilateral central node dissection added for patients with PTC. Mean operative time was 125 min for non-PTC cases and 129 min for PTC cases (p = 0.43), with blood loss of 33.8 ml and 7.6 ml, respectively (p = 0.01). Recurrent laryngeal nerve paralysis (RNP) was observed in 12 patients (12%) and hemorrhage in 2 patients (2%). Comparing the first 30 cases with the last 70 cases, no significant differences in operative time or blood loss were evident, although tumor size of non-PTC cases was significantly greater among later cases (32.4 mm vs. 39.5 mm, p = 0.039). RNP was significantly decreased in later cases (26.7% vs. 5.7%, p = 0.003). Multivariate analysis revealed tumor size as a significant risk factor for increased blood loss, and increased experience correlated significantly with the decrease in RNP. CONCLUSIONS In VANS, a certain surgical level was reached after experiencing 30 cases.
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Affiliation(s)
- Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Hiroko Kazusaka
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Mami Matsui
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Masaomi Sen
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Marie Saitou
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Ritsuko Okamura
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Takehito Igarashi
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Kazuo Shimizu
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
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14
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Jin S, Sugitani I. Development of a Rat Model for Evaluating Thyroid-Stimulating Hormone Suppression after Total Thyroidectomy. J NIPPON MED SCH 2021; 88:311-318. [PMID: 32863348 DOI: 10.1272/jnms.jnms.2021_88-409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We developed an animal model for evaluating thyroid-stimulating hormone (TSH) suppression therapy after total thyroidectomy in rats. METHODS Sixty Wistar rats were randomly divided into 6 groups, including a sham-operated group (SO group), a total thyroidectomy group (TD group), and a L-thyroxine (L-T4) treatment I group (TS-I group), II group (TS-II group), III group (TS-III group), and IV group (TS-IV group) (in which rats were treated with 1.4, 1.6, 1.8, and 2.0 μg/100 g body weight, respectively) after total thyroidectomy. RESULTS HE staining in the TD group and all L-T4-treated rats showed that the resected tissue was normal thyroid gland. No residual thyroid tissue was found in neck tissue of the cross-section of the thyroid gland. Serum T3 levels in the TS-II group were not significantly different from those in the SO group, whereas serum T4 levels were slightly higher than those in the SO group, and serum TSH levels were slightly lower. CONCLUSIONS Rats subcutaneously injected with L-T4 1.6 μg/100 g body weight for 15 days after total thyroidectomy were suitable as an animal model for TSH suppression therapy.
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Affiliation(s)
- Shan Jin
- Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University.,Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School
| | - Iwao Sugitani
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School
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15
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Konda Y, Minamitani K, Takatani T, Kure S, Sugitani I. A case of "asymmetrical" Graves' disease with lateral radioisotope uptake. Pediatr Int 2021; 63:1137-1139. [PMID: 34227705 DOI: 10.1111/ped.14575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Yutaka Konda
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kanshi Minamitani
- Department of Pediatrics, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Tomozumi Takatani
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shoko Kure
- Department of Diagnostic Pathology, Nippon Medical School, Musashi-Kosugi Hospital, Kanagawa, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
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16
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Horiguchi K, Yoshida Y, Iwaku K, Emoto N, Kasahara T, Sato J, Shimura H, Shindo H, Suzuki S, Nagano H, Furuya F, Makita N, Matsumoto F, Manaka K, Mitsutake N, Miyakawa M, Yokoya S, Sugitani I. Position paper from the Japan Thyroid Association task force on the management of low-risk papillary thyroid microcarcinoma (T1aN0M0) in adults. Endocr J 2021; 68:763-780. [PMID: 33762511 DOI: 10.1507/endocrj.ej20-0692] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The incidence of thyroid carcinoma has been increasing worldwide. This is interpreted as an increase in the incidental detection of papillary thyroid microcarcinomas (PTMCs). However, mortality has not changed, suggesting overdiagnosis and overtreatment. Prospective clinical trials of active surveillance for low-risk PTMC (T1aN0M0) have been conducted in two Japanese institutions since the 1990s. Based on the favorable outcomes of these trials, active surveillance has been gradually adopted worldwide. A task force on the management of PTMC in adults organized by the Japan Thyroid Association therefore conducted a systematic review and has produced the present position paper based on the scientific evidence concerning active surveillance. This paper indicates evidence for the increased incidence of PTMC, favorable surgical outcomes for low-risk PTMC, recommended criteria for diagnosis using fine needle aspiration cytology, and evaluation of lymph node metastasis (LNM), extrathyroidal extension (ETE) and distant metastasis. Active surveillance has also been reported with a low incidence of disease progression and no subsequent recurrence or adverse events on survival if conversion surgery was performed at a slightly advanced stage. Active surveillance is a safe and valid strategy for PTMC, because it might preserve physical quality of life and reduce 10-year medical costs. However, some points should be noted when performing active surveillance. Immediate surgery is needed for PTMC showing high-risk features, such as clinical LNM, ETE or distant metastasis. Active surveillance should be performed under an appropriate medical team and should be continued for life.
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Affiliation(s)
- Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Kenji Iwaku
- Sapporo Thyroid Clinic (Ito Hospital), Sapporo 060-0042, Japan
| | - Naoya Emoto
- Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Sakura 285-0014, Japan
| | | | - Junichiro Sato
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroki Shimura
- Department of Laboratory Medicine, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan
| | - Satoru Suzuki
- Department of Thyroid and Endocrinology, Division of Internal Medicine, Fukushima Medical University Hospital, Fukushima 960-1295, Japan
| | - Hidekazu Nagano
- Department of Molecular Diagnosis, Graduate school of Medicine, Chiba University, Chiba 260-8670, Japan
| | - Fumihiko Furuya
- Third Department of Internal Medicine, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3998, Japan
| | - Noriko Makita
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Fumihiko Matsumoto
- Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan
| | - Katsunori Manaka
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Norisato Mitsutake
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki 852-8523, Japan
| | - Megumi Miyakawa
- Department of Internal Medicine, Miyakawa Hospital, Kawasaki 210-0802, Japan
| | - Susumu Yokoya
- Thyroid and Endocrine Center, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo 113-8603, Japan
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17
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Nagaoka R, Ebina A, Toda K, Jikuzono T, Saitou M, Sen M, Kazusaka H, Matsui M, Yamada K, Mitani H, Sugitani I. Multifocality and Progression of Papillary Thyroid Microcarcinoma During Active Surveillance. World J Surg 2021; 45:2769-2776. [PMID: 34100116 DOI: 10.1007/s00268-021-06185-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prospective trials of active surveillance (AS) have shown low rates of progression in low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0). However, the significance of multifocality as a prognostic factor remains controversial. METHODS Data from 571 patients (mean age, 53.1 years; 495 females) who underwent AS were reviewed. PTMC was unifocal in 457 patients (80.0%) and multifocal in 114 patients (20.0%), with 2-5 lesions each (261 tumors in total). Tumor progression was defined as tumor size enlargement ≥ 3 mm and/or development of clinically evident lymph node metastasis (LNM). RESULTS After a mean duration of AS of 7.6 years, 53 patients (9.3%) showed tumor enlargement and 8 patients (1.4%) developed LNM. The 10-year progression rate was 13.1%. Age, sex, and calcification pattern did not differ significantly between uni- and multifocal diseases. However, anti-thyroglobulin antibody and/or anti-thyroid peroxidase antibody was more frequently positive with multifocal PTMCs (46.7%) than with unifocal disease (34.4%, p = 0.024). Patients with uni- and multifocal disease showed no significant differences in 10-year rate of tumor enlargement (11.4% vs. 14.8%), LNM development (1.1% vs. 2.4%), or progression (12.4% vs 15.9%). Multivariate analysis of predictors for progression showed multifocality was not a significant risk factor (odds ratio, 1.45; 95% confidence interval, 0.79-2.54; p = 0.22). Eventually, 9 patients (7.9%) with multifocal PTMCs underwent surgery and 7 needed total thyroidectomy, although 7 still showed T1N0M0 low-risk cancer. CONCLUSIONS Even patients with multiple PTMCs (T1amN0M0) are good candidates for AS. Many patients can avoid total thyroidectomy and subsequent surgical complications.
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Affiliation(s)
- Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Aya Ebina
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.,Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kazuhisa Toda
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tomoo Jikuzono
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Marie Saitou
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Masaomi Sen
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroko Kazusaka
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Mami Matsui
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Keiko Yamada
- Division of Ultrasonography, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hiroki Mitani
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.,Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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18
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Tahara M, Takami H, Ito Y, Okamoto T, Sugitani I, Sugino K, Takahashi S, Takeyama H, Tsutsui H, Hara H, Mitsuma A, Yamashita H, Ohashi Y, Imai T. Planned drug holiday in a cohort study exploring the effect of lenvatinib on differentiated thyroid cancer. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6070 Background: Lenvatinib is now available for unresectable radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC). However, toxicities are considerable and require frequent dose interruption and modification. Recently, planned drug holidays, which are dose interruptions in accordance with the timing of severe or intolerable adverse events, have been proposed to avoid severe adverse events due to lenvatinib (Tahara M.ESMO Open 2018). Our retrospective study demonstrated that progression-free survival (PFS) and overall survival (OS) were significantly longer in patients who used planned drug holidays than those who did not (Matsuyama C et.al, 2020 Annual Meeting of the Japan Association of Endocrine Surgeons). Methods: In this prospective observational study, patients with curatively unresectable and progressive RAI-refractory DTC were treated with lenvatinib in a real-world clinical setting. Lenvatinib was administered orally at a dose of 24 mg daily. Dose modification for toxicities were permitted. Primary endpoint was OS, and secondary endpoints were time to treatment failure (TTF), time to failure of strategy (TFS), PFS with clinical progressive disease, response rate, quality of life, safety, and patient reports. This study was registered with UMIN Clinical Trials Registry (UMIN000022243). Results: 262 patients were accrued. Of 255 evaluable, 153 were female; median age was 70 (range 27.0-88.0); histology was papillary thyroid carcinoma/follicular thyroid carcinoma/poorly DTC in 204/45/4; previous therapy was surgery/RAI/molecular targeted drug in 246/164/14; reason for initiation of lenvatinib was disease progression/unsuitable for RAI in 241/4. 1-year OS was 85.6% (95%CI: 80.6-89.4%); 1-year TTF rate was 74.9% (95%CI: 69.1-79.8%); 1-year TFS rate was 80.8% (95%CI: 75.4-85.2%); and 1-year PFS rate was 84.4% (95%CI: 79.3-88.4%). Overall response by RECIST was 3 (1.2%) in CR and 151 (61.9%) in PR. Most common grade 3 or 4 toxicities were hypertension (61.4%), hand foot syndrome (10.2%), fatigue (9.1%), anorexia (8.3%) and diarrhea (4.7%). Grade 5 toxicities occurred in 4 patients (fistula, hypoxia, respiratory failure, trachea stenosis). Of 253 patients evaluable for efficacy, 73 used planned drug holidays. TTF, TFS and PFS were significantly longer in patients who used planned drug holiday than those who did not (Table). Conclusions: Planned drug holiday for lenvatinib demonstrated significantly better clinical outcomes, including TTF, TFS and PFS, than daily oral administration. These data further support use of a planned drug holiday in RAI-refractory DTC patients receiving lenvatinib. Clinical trial information: 000022243. [Table: see text]
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Affiliation(s)
- Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Iwao Sugitani
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | | | - Shunji Takahashi
- Department of Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Hisato Hara
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | | | - Yasuo Ohashi
- Department of Integrated Science and Engineering, Chuo University, Tokyo, Japan
| | - Tsuneo Imai
- National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
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Sen M, Nagaoka R, Kazusaka H, Matsui M, Saitou M, Sugitani I, Sakatani T, Kameyama K. Non-functioning oxyphilic parathyroid carcinoma: a case report. Surg Case Rep 2021; 7:119. [PMID: 33978837 PMCID: PMC8116379 DOI: 10.1186/s40792-021-01201-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background Non-functioning parathyroid carcinoma is an extremely rare malignancy among endocrine tumors. We report a case in which non-functional oxyphilic parathyroid carcinoma was diagnosed from clinical symptoms and pathological diagnosis. Case presentation The patient was a 42-year-old man with no medical or family history of note. He had presented to a local hospital with a neck mass 2 months earlier. Medullary thyroid carcinoma was diagnosed and he was referred to our department. A 3.5-cm mass was observed in the left thyroid lobe. Laboratory data for thyroid functions, thyroglobulin, anti-thyroglobulin antibodies, anti-thyroid peroxidase antibodies, serum calcium, and parathyroid hormone (PTH) were all within normal ranges. Ultrasonography revealed a 40-mm irregular, hypoechoic mass throughout the left thyroid lobe. Follicular thyroid tumor was suspected from fine-needle aspiration cytology. Left lobectomy was performed. Pathological features revealed a thick fibrous capsule around the tumor, and a thick fibrous band was observed inside the tumor. Both capsular invasions and vascular invasions were observed. Tumor cells were eosinophilic and displayed solid growth. Immunohistochemically, tumor cells were negative for thyroid transcription factor-1, negative for thyroglobulin, negative for chromogranin A (positive for normal parathyroid tissue within the nodule), positive for PTH, and positive for parafibromin. Ki-67 labeling index was 10%. Based on these findings, non-functional oxyphilic parathyroid carcinoma was diagnosed. One and a half years postoperatively, calcium and PTH were within normal ranges, and he has shown no evidence of recurrence or metastasis. Conclusions Non-functioning oxyphilic parathyroid carcinoma is an extremely rare malignancy, and definitive diagnosis is difficult to obtain preoperatively. Few reports have been made worldwide, and information on the long-term prognosis is scarce. Long-term surveillance by imaging is mandatory, since no indices that can be used as a marker for postoperative recurrence and metastasis have been identified.
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Affiliation(s)
- Masaomi Sen
- Department of Endocrine Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Hiroko Kazusaka
- Department of Endocrine Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Mami Matsui
- Department of Endocrine Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Marie Saitou
- Department of Endocrine Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takashi Sakatani
- Department of Diagnostic Pathology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Kaori Kameyama
- Department of Pathology, Showa University Northern Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama-shi, Kanagawa, Tokyo, 224-8503, Japan
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20
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Jikuzono T, Suzuki S, Ishibashi O, Kure S, Sakanushi A, Nakamizo M, Kawamoto M, Ohashi R, Yamada T, Sugitani I. Clinical Utility of Fine Needle Aspiration Cytology for Adenoid Cystic Carcinoma of the Trachea with Thyroid Invasion: A Case Report. J NIPPON MED SCH 2021; 89:460-465. [PMID: 33867428 DOI: 10.1272/jnms.jnms.2022_89-207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adenoid cystic carcinoma of the trachea (ACCT) is a rare cancer; ACCT with thyroid invasion is particularly rare. We first suspected anaplastic thyroid carcinoma (ATC) but diagnosed ACC after performing fine needle aspiration cytology (FNAC). A tracheal origin was confirmed after operation. CASE DESCRIPTION We report the case of a 77-year-old female presenting to our hospital with acute inspiratory dyspnea requiring emergency tracheotomy. Physical examination revealed a right anterior neck swelling with a hard and unmovable mass. Computed tomography (CT) and ultrasonography (US) showed tumor extension to the right thyroid lobe, and between the first and third tracheal rings, which caused severe stenosis of the lumen. Next, we performed FNAC. Clinical findings were highly suspicious for ACCT with thyroid invasion. Thirty-five days after the first visit to our department, the patient underwent total laryngectomy, cervical esophagectomy, and thyroidectomy with bilateral selective neck dissections at another hospital. The tumor was located in the right posterior wall of the trachea, with extension into the right thyroid gland. Pathological examination showed an infiltrative carcinomatous proliferation with tubular and cribriform patterns. The tumor was classified as pT4N1. A definite diagnosis was made after histopathological analyis of the surgical specimen confirmed ACCT. The tumor was found to be positive for FABP7, a putative prognostic marker of ACC, and metastasized to the lungs 3 years after the surgery. CONCLUSIONS ACCT with thyroid invasion is an extremely rare malignant neoplasm. FNAC was useful for differentiating ACCT from other diagnoses and enabled appropriate surgical treatment.
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Affiliation(s)
| | | | - Osamu Ishibashi
- Department of Endocrine Surgery, Nippon Medical School.,Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University
| | - Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School.,Department of Diagnostic Pathology, Nippon Medical School Musashi Kosugi Hospital
| | - Atsuko Sakanushi
- Department of Otolaryngology, Head and Neck Surgery, Nippon Medical School
| | | | - Masashi Kawamoto
- Department of Diagnostic Pathology, Teikyo University Mizonokuchi Hospital
| | - Ryuji Ohashi
- Department of Integrated Diagnostic Pathology, Nippon Medical School
| | - Tetsu Yamada
- Department of Endocrine Surgery, Nippon Medical School.,Department of Endocrine Surgery, Kanaji Thyroid Hospital
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
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21
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Abstract
Currently, thyroid surgery is the most common and safe operation worldwide. However, thyroidectomy is still not free from the risks of complications and death due to the anatomical structure and physiological function particularity of the thyroid gland. Postoperative complications affect the life quality and life safety of patients after surgery. The common complications include hypoparathyroidism (HP), recurrent laryngeal nerve (RLN) injury, injury to the external branch of the superior laryngeal nerve (EBSLN), postoperative bleeding (PB), thoracic duct injury, laryngeal edema, tracheospasm, tracheal injury, and esophageal injury. A severe complication, such as dyspnea, asphyxia, or thyroid crisis, might cause the death of the patient. Therefore, every thyroid surgeon's responsibility is to remain alert and aware of the occurrence of various intraoperative and postoperative complications and exercise effective prevention and treatment. This is closely related to the advancement in thyroid disease research, the increase in local anatomy knowledge, the standardization of surgical approaches, the improvement in operating skills, the application of new technologies, and the emphasis on specialty training. In addition, many complications that effect patients are much better tolerated if the patient has appropriate expectations of what the complications are and how to treat them. Open communication between surgeon and patient optimizes the potential negative effects that complications may have on patients' quality of life. This paper discusses the prevention, recognition and therapy of intraoperative and postoperative complications in thyroid surgery.
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Affiliation(s)
- Shan Jin
- Department of General Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.,Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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22
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Sugitani I, Ito Y, Takeuchi D, Nakayama H, Masaki C, Shindo H, Teshima M, Horiguchi K, Yoshida Y, Kanai T, Hirokawa M, Hames KY, Tabei I, Miyauchi A. Indications and Strategy for Active Surveillance of Adult Low-Risk Papillary Thyroid Microcarcinoma: Consensus Statements from the Japan Association of Endocrine Surgery Task Force on Management for Papillary Thyroid Microcarcinoma. Thyroid 2021; 31:183-192. [PMID: 33023426 PMCID: PMC7891203 DOI: 10.1089/thy.2020.0330] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The question of how to manage patients with low-risk papillary thyroid microcarcinoma (PTMC; T1aN0M0) has recently become an important clinical issue. Two Japanese centers have conducted prospective clinical trials of active surveillance (AS) for low-risk PTMC since the 1990s, reporting favorable outcomes. This policy has thus seen gradual adoption worldwide to avoid overtreatment. Not all PTMCs are suitable for AS, however, and many physicians still hesitate to apply the management policy in daily clinical practice. A task force on management for PTMC created by the Japan Association of Endocrine Surgery collected and analyzed bibliographic evidence and has produced the present consensus statements regarding indications and concrete strategies for AS to facilitate the management of adult patients diagnosed with low-risk PTMC. Summary: These statements provide indications for AS in adult patients with T1aN0M0 low-risk PTMC. PTMCs with clinical lymph node metastasis, distant metastasis, recurrent laryngeal nerve (RLN) paralysis due to carcinoma invasion, or protrusion into the tracheal lumen warrant immediate surgery. Tumors suspected of aggressive subtypes on cytology are recommended for immediate surgery. Immediate surgery is also recommended for tumors adherent to the trachea or located along the course of the RLN. Practical strategies include diagnosis, decision-making, follow-up, and monitoring related to the implementation of AS. The rate of low-risk PTMC progression is lower in older patients. However, we recommend continuing AS as long as circumstances permit. Future tasks in optimizing management for low-risk PTMC are also described, including molecular markers and patient-reported outcomes. Conclusions: An appropriate multidisciplinary team is necessary to accurately evaluate primary tumors and lymph nodes at the beginning of and during AS, and to adequately reach a shared-decision with individual patients. If appropriately applied, AS of low-risk PTMC is a safe management strategy offering favorable outcomes and preserves quality of life at low cost.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Address correspondence to: Iwao Sugitani, MD, PhD, Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Dai Takeuchi
- Department of Breast and Endocrine Surgery, Nagoya University, Nagoya, Japan
| | | | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo, Japan
| | - Hisakazu Shindo
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka, Japan
| | - Masanori Teshima
- Department of Otolaryngology, Head and Neck Surgery, Kobe University, Kobe, Japan
| | - Kazuhiko Horiguchi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Gunma University, Maebashi, Japan
| | - Yusaku Yoshida
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiharu Kanai
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | - Isao Tabei
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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23
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Koshkina A, Fazelzad R, Sugitani I, Miyauchi A, Thabane L, Goldstein DP, Ghai S, Sawka AM. Association of Patient Age With Progression of Low-risk Papillary Thyroid Carcinoma Under Active Surveillance: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 146:552-560. [PMID: 32297926 DOI: 10.1001/jamaoto.2020.0368] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Active surveillance is sometimes considered as a disease management option for individuals with small, low-risk papillary thyroid carcinoma. Objective To assess whether patient age is associated with progression of low-risk papillary thyroid carcinoma (tumor growth or incident metastatic disease) in adults under active surveillance. Evidence Review Eight electronic databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Emcare, PsycINFO, Web of Science, and ClincalTrials.gov) were searched from inception to March 2019, supplemented with a hand search. Two investigators independently screened citations, reviewed full-text articles, and abstracted data. Additional data were sought from authors. Random-effects meta-analyses were performed using incidence data (statistically adjusted for confounders and crude rates). Findings A total of 1658 unique citations were screened, and 62 full-text articles were reviewed, including 5 studies. Three studies included exclusively microcarcinomas and 2 included tumors up to 2 cm in maximal diameter. The mean age of participants was 51.0 to 55.2 years in 4 studies reporting this value. The mean or median follow-up was 5 years or more in 3 studies and approximately 2 years in 2 studies. The pooled risk ratio for tumor growth of 3 mm or more in maximal diameter in individuals aged 40 to 50 years compared with younger individuals was 0.51 when adjusted for confounders (95% CI, 0.29-0.89; 1619 patients, 2 studies), and the unadjusted risk ratio of this outcome for individuals 40 years or older was 0.55 (95% CI, 0.36-0.82; 2097 patients, 4 studies). In adults aged 40 to 45 years, the unadjusted risk ratio for any tumor volume increase compared with younger individuals was 0.65 (95% CI, 0.51-0.83; 1232 patients, 4 studies). The pooled risk ratio for incident nodal metastases in individuals 40 years or older was 0.22 (95% CI, 0.10-0.47; 1806 patients, 3 studies); however, in a secondary analysis, the risk difference was not significantly different. There was no statistically significant heterogeneity in any of the meta-analyses. There were no thyroid cancer-related deaths nor incident distant metastases. Conclusions and Relevance This study suggests that older age may be associated with a reduced risk of primary papillary thyroid carcinoma tumor growth under active surveillance. Incident metastatic disease is uncommon during active surveillance.
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Affiliation(s)
- Alexandra Koshkina
- University of Toronto Endocrinology Fellowship, Toronto, Ontario, Canada
| | - Rouhi Fazelzad
- University Health Network Library and Information Services, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan.,Division of Head and Neck, Cancer Institute Hospital of Japanese Foundation of Cancer Research, Tokyo, Japan
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology, Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network-Mount Sinai Hospital-Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anna M Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
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24
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Brose M, Smit J, Lin CC, Tori M, Bowles D, Worden F, Shen DY, Huang SM, Alevizaki M, Peeters R, Takahashi S, Rumyantsev P, Guan R, Babajanyan S, Ozgurdal K, Sugitani I, Pitoia F, Lamartina L. 1918P Final analysis of RIFTOS MKI, a global, non-interventional study assessing the use of multikinase inhibitors (MKIs) for the treatment of patients with asymptomatic radioactive iodine-refractory differentiated thyroid cancer (RAI-R DTC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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25
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Ebina A, Togashi Y, Baba S, Sato Y, Sakata S, Ishikawa M, Mitani H, Takeuchi K, Sugitani I. TERT Promoter Mutation and Extent of Thyroidectomy in Patients with 1-4 cm Intrathyroidal Papillary Carcinoma. Cancers (Basel) 2020; 12:cancers12082115. [PMID: 32751594 PMCID: PMC7464551 DOI: 10.3390/cancers12082115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
There are concerns regarding overtreatment in papillary thyroid carcinoma (PTC). BRAF V600E and TERT promoter mutations play important roles in the development of PTC. However, initial surgical approaches for PTC based on genetic characteristics remain unclear. The present study aimed to identify genetic mutations as predictors of prognosis and to establish proper indications for lobectomy (LT) in patients with 1–4 cm intrathyroidal PTC. Prospectively accumulated data from 685 consecutive patients with PTC who underwent primary thyroid surgery at the Cancer Institute Hospital, Tokyo, Japan, between 2001 and 2012 were retrospectively reviewed. Of the 685 patients examined, 538 (78.5%) had BRAF V600E mutation and 133 (19.4%) had TERT promoter mutations. Patients with TERT promoter mutations displayed significantly worse outcomes than those without mutations (10-year cause-specific survival (CSS): 73.7% vs. 98.1%, p < 0.001; 10-year disease-free survival (DFS): 53.7% vs. 93.3%, p < 0.001). As for extent of thyroidectomy among TERT mutation-negative patients with 1–4 cm intrathyroidal PTC, patients who underwent LT showed no significant differences in 10-year CSS and 10-year DFS compared to patients who had total thyroidectomy (TT) under propensity score-matching. Avoiding TT for those patients indicates a possible pathway to prevent overtreatment and reduce postoperative complications.
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Affiliation(s)
- Aya Ebina
- Department of Endocrine Surgery, Nippon Medical School, Tokyo 113-8603, Japan;
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Correspondence: ; Tel.: +81-3-3822-2131
| | - Yuki Togashi
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Satoko Baba
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Yukiko Sato
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
| | - Seiji Sakata
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Masashi Ishikawa
- Department of Anesthesiology, Nippon Medical School, Tokyo 113-8603, Japan;
| | - Hiroki Mitani
- Division of Head and Neck, Cancer Institute Hospital, Tokyo 135-8550, Japan;
| | - Kengo Takeuchi
- Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (Y.T.); (S.B.); (Y.S.); (S.S.); (K.T.)
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
- Clinical Pathology Center, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, Tokyo 113-8603, Japan;
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26
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Jikuzono T, Ishikawa T, Hirokawa M, Sugitani I, Ishibashi O. Microarray analysis of formalin-fixed, paraffin-embedded follicular thyroid carcinoma samples from patients who developed postoperative distant metastasis. BMC Res Notes 2020; 13:241. [PMID: 32404135 PMCID: PMC7218651 DOI: 10.1186/s13104-020-05080-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/03/2020] [Indexed: 01/22/2023] Open
Abstract
Objective Although follicular thyroid carcinoma (FTC) generally has a good prognosis, it occasionally metastasises, leading to poor prognosis. Unfortunately, minimally invasive FTC (mi-FTC) and encapsulated angioinvasive FTC (ea-FTC) cannot be distinguished cytopathologically from thyroid follicular adenoma (FTA), a benign tumour with a good prognosis. Therefore, a molecular diagnosis to distinguish mi- or ea-FTC from FTA is needed for clinical treatment. Several transcriptomics/proteomics studies have searched for FTC biomarkers. However, the results of these studies were not consistent, which could be partly explained by inaccurate diagnosis of the specimens analysed. Data description We conducted a microarray-based genome-wide transcriptome analysis using formalin-fixed paraffin-embedded mi- or ea-FTC specimens from patients who developed distant metastasis up to 10 years postoperatively, which ensured the accuracy of diagnosis.
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Affiliation(s)
- Tomoo Jikuzono
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, 1‑1 Gakuen‑cho, Sakai, 599‑8531, Japan.,Department of Endocrine Surgery, Kanaji Thyroid Hospital, 1‑5‑6 Nakazato, Kita‑ku, Tokyo, 114‑0015, Japan.,Department of Endocrine Surgery, Nippon Medical School, 1‑1‑5 Sendagi, Bunkyo‑ku, Tokyo, 113‑8602, Japan
| | - Tomoko Ishikawa
- Institute for Human Life Innovation, Ochanomizu University, 2‑1‑1 Otsuka, Bunkyo‑ku, Tokyo, 112‑8610, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, 8‑2‑35 Shimoyamate‑dori, Chuo‑ku, Kobe, 650‑0011, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, 1‑1‑5 Sendagi, Bunkyo‑ku, Tokyo, 113‑8602, Japan
| | - Osamu Ishibashi
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, 1‑1 Gakuen‑cho, Sakai, 599‑8531, Japan. .,Department of Endocrine Surgery, Nippon Medical School, 1‑1‑5 Sendagi, Bunkyo‑ku, Tokyo, 113‑8602, Japan.
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27
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Onoda N, Sugitani I, Ito KI, Suzuki A, Higashiyama T, Fukumori T, Suganuma N, Masudo K, Nakayama H, Uno A, Yane K, Yoshimoto S, Ebina A, Kawasaki Y, Maeda S, Iwadate M, Suzuki S. Evaluation of the 8th Edition TNM Classification for Anaplastic Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12030552. [PMID: 32120853 PMCID: PMC7139873 DOI: 10.3390/cancers12030552] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/21/2020] [Accepted: 02/25/2020] [Indexed: 01/16/2023] Open
Abstract
Background: The tumor–node–metastasis (TNM) classification system to categorized anaplastic thyroid cancer (ATC) was revised. Methods: The revised system was evaluated using a large database of ATC patients. Results: A total of 757 patients were analyzed. The proportion and median overall survival values (OS: months) for each T category were T1 (n = 8, 1.1%, 12.5), T2 (n = 43, 5.7%, 10.9), T3a (n = 117, 15.5%, 5.7), T3b (n = 438, 57.9%, 3.9), and T4 (n = 151, 19.9%, 5.0). The OS of the N0 and N1 patients were 5.9 and 4.3, respectively (log-rank p < 0.01). Sixty-three (58.3%) patients migrated from stage IV A to IV B by revision based on the existence of nodal involvement and 422 patients (55.7%) were stratified into stage IV B, without a worsening of their OS (6.1), leaving 45 patients (5.9%) in stage IV A with fair OS (15.8). The hazard ratios for the survival of the patients of stage IV B compared to stage IV A increased from 1.1 to 2.1 by the revision. No change was made for stage IV C (n = 290, 38.8%, 2.8). Conclusion: The revised TNM system clearly indicated the prognoses of ATC patients by extracting rare patients with fair prognoses as having stage IV A disease and categorized many heterogeneous patients in stage IV B.
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Affiliation(s)
- Naoyoshi Onoda
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Breast & Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Iwao Sugitani
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Endocrine Surgery, Nippon Medical School, Tokyo 113-8603, Japan
| | - Ken-Ichi Ito
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Japan
| | - Akifumi Suzuki
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Takuya Higashiyama
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Tatsuya Fukumori
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Surgery, Kanaji Thyroid Hospital, Tokyo 114-0015, Japan
| | - Nobuyasu Suganuma
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama 241-8515, Japan
| | - Katsuhiko Masudo
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Breast and Endocrine Surgery, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Hirotaka Nakayama
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Surgery, Yokohama City University, Yokohama 236-0004, Japan
| | - Atsuhiko Uno
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Otolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka 558-8558, Japan
| | - Katsunari Yane
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Otolaryngology-Head and Neck Surgery, Kindai University Nara Hospital, Ikoma 630-0293, Japan
| | - Seiichi Yoshimoto
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Aya Ebina
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Head and Neck Surgery, Cancer Institute Hospital, Tokyo 135-8550, Japan
| | - Yukari Kawasaki
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Surgery, Tsuchiya General Hospital, Hiroshima 730-0811, Japan
| | - Shigeto Maeda
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Omura 856-8562, Japan
| | - Manabu Iwadate
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
| | - Shinichi Suzuki
- Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan
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28
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Sugitani I, Ito Y, Miyauchi A, Imai T, Suzuki S. Active Surveillance Versus Immediate Surgery: Questionnaire Survey on the Current Treatment Strategy for Adult Patients with Low-Risk Papillary Thyroid Microcarcinoma in Japan. Thyroid 2019; 29:1563-1571. [PMID: 31441377 PMCID: PMC6862943 DOI: 10.1089/thy.2019.0211] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Two Japanese prospective trials of active surveillance (AS) for adult patients with low-risk papillary thyroid carcinoma (PTC) ≤1 cm (cT1aN0M0 PTMC) have verified the safety of AS in oncological control and its superiority over immediate surgery with respect to unfavorable outcomes. Thus, AS has been accepted as an alternative to immediate surgery for asymptomatic papillary thyroid microcarcinomas (PTMCs). However, the real-world clinical approach for PTMC is unknown. Thus, this study aimed to investigate the current state of management of asymptomatic PTMCs in Japan. Methods: We conducted a questionnaire survey on the actual treatment patterns for adult patients with low-risk PTMCs. The subjects were member institutions of the Japan Association of Endocrine Surgery (JAES) or Japanese Society of Thyroid Surgery (JSTS), including the departments of surgery and head and neck surgery (HNS). Results: Responses were obtained from 134 institutes, where 72.4% of Japanese thyroid cancer cases operated by surgeons were treated. For suspicious tumors on ultrasound, 18 responders (13.4%) conducted cytological examination routinely, while 69 (51.5%) and 40 (27.8%) conducted it only for tumors >5 and >10 mm, respectively. After the diagnosis, 42 responders (31.3%) recommend AS, 35 (26.1%) recommend immediate surgery as the management, and 52 (38.8%) allowed patients to decide the treatment course. The present responders tended to recommend surgery for PTMCs that were located adjacent to the dorsal surface of the thyroid, were multiple, or measured almost 10 mm in size. At these institutions, 1176 patients with PTMC underwent surgery in 2017, accounting for 18.1% of surgeries for PTC. During the succeeding three months, 310 of 576 (53.8%) PTMC patients underwent AS. The treatment strategies did not differ between the departments (Surgery or HNS). The institutions that have six or more surgeons, that were located in metropolitan areas, or that were certified by JAES or JSTS performed AS more actively. Conclusion: More than 50% of low-risk PTMCs are on AS in Japan. However, the indication and recommendation for AS vary significantly between institutions. To improve the implementation of this management modality, physicians and patients should be further educated, and the sociomedical environment should be improved.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Address correspondence to: Iwao Sugitani, MD, PhD, Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yasuhiro Ito
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Akira Miyauchi
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Tsuneo Imai
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Surgery, National Hospital Organization, Higashinagoya National Hospital, Nagoya, Japan
| | - Shinichi Suzuki
- Research Group for the Management of Papillary Thyroid Microcarcinoma, Japan Association of Endocrine Surgery & Japanese Society of Thyroid Surgery, Tokyo, Japan
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
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29
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Namizato D, Iwasaki M, Ishikawa M, Nagaoka R, Genda Y, Kishikawa H, Sugitani I, Sakamoto A. Anesthetic Considerations of Intraoperative Neuromonitoring in Thyroidectomy. J NIPPON MED SCH 2019; 86:263-268. [DOI: 10.1272/jnms.jnms.2019_86-408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Dai Namizato
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Masae Iwasaki
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Masashi Ishikawa
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Ryuta Nagaoka
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School
| | - Yuki Genda
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Hiroaki Kishikawa
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
| | - Iwao Sugitani
- Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School
| | - Atsuhiro Sakamoto
- Department of Anesthesiology and Pain Medicine, Graduate School of Medicine, Nippon Medical School
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30
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Kure S, Ishino K, Kudo M, Wada R, Saito M, Nagaoka R, Sugitani I, Naito Z. Incidence of BRAF V600E mutation in patients with papillary thyroid carcinoma: a single-institution experience. J Int Med Res 2019; 47:5560-5572. [PMID: 31533501 PMCID: PMC6862924 DOI: 10.1177/0300060519873481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Papillary thyroid carcinoma (PTC) accounts for 95% of all thyroid carcinomas. PTC is an epithelial tumor characterized by the proliferation of follicular cells with distinctive nuclear features, and is heterogeneous in terms of its carcinogenesis and behavior. PTC has been associated with several genetic abnormalities, of which the BRAF V600E mutation is the most common. However, reported incidences of this mutation have varied depending on the patient background, population size, or methods. In this study, we investigated the incidence of BRAF V600E mutation and its relationships with clinicopathological characteristics in patients with PTC. Methods Surgical specimens were obtained from 40 patients with PTC who underwent surgery at Nippon Medical School Hospital between 2009 and 2017. DNA from exon 15 of the BRAF gene was extracted and amplified by polymerase chain reaction, followed by direct sequencing. Results The frequency of BRAF V600E mutation increased with age. However, there were no correlations between BRAF V600E mutation and other clinicopathological features including sex, Hashimoto disease, family history of thyroid disease, tumor size, pathological T stage, pathological N stage, lymphovascular invasion, extrathyroidal extension, and metastasis. Conclusions This study demonstrated that PTCs harboring the BRAF V600E mutation increased in an age-dependent manner.
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Affiliation(s)
- Shoko Kure
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.,Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Kousuke Ishino
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Mitsuhiro Kudo
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
| | - Ryuichi Wada
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.,Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Marie Saito
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Zenya Naito
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan.,Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
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Abstract
BACKGROUND Prospective trials of active surveillance for asymptomatic papillary microcarcinoma (T1aN0M0) since the 1990s have shown progression rates of only 5-10%. Late rescue surgery after progression had no deleterious effects on mortality and morbidity. The 2015 American Thyroid Association guidelines approved active surveillance for very low-risk papillary thyroid carcinoma (PTC) as an alternative method to immediate surgery. However, there is no study that evaluates long-term active surveillance for T1b tumors. METHODS A prospective trial of active surveillance with 360 very low-risk PTC (T1aN0M0) patients has been conducted since 1995. Of the 392 T1bN0M0 patients, 61 selected active surveillance over surgery and eventually participated in this trial, while the remaining 331 patients underwent surgery. To find an appropriate management strategy for patients with T1bN0M0 PTC, the outcomes of active surveillance for T1bN0M0 to T1aN0M0 PTC were investigated and compared, and the outcomes of surgery for T1bN0M0 PTC were studied. RESULTS After a mean of 7.4 years of active surveillance, 29 (8%) T1aN0M0 tumors and four (7%) T1bN0M0 tumors had increased in size (p = 0.69). Development of lymph node metastasis was seen in three (0.8%) patients and two (3%) patients, respectively (p = 0.10). No significant difference in progression rate was seen between groups. Among T1bN0M0 tumors, weak calcification and rich vascularity were risk factors for tumor-size increase, and younger age was a predictor for the development of lymph node metastasis. Mean initial tumor size was significantly greater in T1bN0M0 patients who underwent immediate surgery (14.5 ± 2.8 mm) than it was in patients who chose observation (11.7 ± 1.1 mm; p < 0.0001). No postoperative recurrence was seen in patients with tumor <15 mm in diameter. CONCLUSIONS Active surveillance is an option for selected patients with T1bN0M0 PTC.
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Affiliation(s)
- Toshihiko Sakai
- 1 Division of Head and Neck, Cancer Institute Hospital, Tokyo, Japan
| | - Iwao Sugitani
- 1 Division of Head and Neck, Cancer Institute Hospital, Tokyo, Japan
- 2 Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
| | - Aya Ebina
- 1 Division of Head and Neck, Cancer Institute Hospital, Tokyo, Japan
| | - Osamu Fukuoka
- 3 Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Kazuhisa Toda
- 1 Division of Head and Neck, Cancer Institute Hospital, Tokyo, Japan
| | - Hiroki Mitani
- 1 Division of Head and Neck, Cancer Institute Hospital, Tokyo, Japan
| | - Keiko Yamada
- 4 Department of Ultrasonography, Cancer Institute Hospital, Tokyo, Japan
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32
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Tahara M, Takami H, Ito Y, Sugino K, Takahashi S, Takeyama H, Tsutsui H, Hara H, Mitsuma A, Yamashita H, Okamoto T, Sugitani I, Ohashi Y, Imai T. Cohort study exploring the effect of lenvatinib on differentiated thyroid cancer. Endocr J 2018; 65:1071-1074. [PMID: 30369531 DOI: 10.1507/endocrj.ej18-0261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lenvatinib is a molecular-targeting agent that was recently approved in Japan for treatment of curatively unresectable, radioactive iodine-refractory, progressive differentiated thyroid cancer (DTC). Because only a few Japanese patients have received lenvatinib in clinical trials, there are limited domestic data on its safety and efficacy or prognostic factors. Therefore, a prospective observational study has been designed to collect safety and efficacy data in at least 300 patients with curatively unresectable DTC receiving lenvatinib therapy (24 mg/day), in order to find predictors of antitumor activity and survival. Patients with progressive curatively unresectable DTC refractory to radioiodine therapy will be enrolled and the primary endpoint will be overall survival. This study is designed to estimate the 95% confidence intervals of the 1-year and 2-year survival rates with a two-sided width of less than 10%. Secondary endpoints will be the time to treatment failure, time to strategy failure, progression-free survival time with clinical progressive disease, response rate, quality of life, safety, and patient reports. The ultimate goal is to obtain information for developing evidence-based guidelines for treatment of DTC, including recommendations on patient selection, dosages, and duration of treatment. This study has been registered with the UMIN Clinical Trials Registry (UMIN000022243).
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Affiliation(s)
- Makoto Tahara
- Department of Head and Neck Cancer Oncology, National Cancer Center Hospital East, Kashiwa, Chiba 277-8577, Japan
| | - Hiroshi Takami
- Department of Surgery, Ito Hospital, Shibuya-ku, Tokyo 150-8308, Japan
| | - Yasuhiro Ito
- Department of Clinical Trial, Department of Surgery, Kuma Hospital, Kobe, Hyogo 650-0011, Japan
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, Shibuya-ku, Tokyo 150-8308, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Hiroshi Takeyama
- Department of Breast and Endocrine Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan
| | - Hidemitsu Tsutsui
- Department of Thoracic and Thyroid Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Hisato Hara
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Ayako Mitsuma
- Department of Clinical Oncology and Chemotherapy, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
| | - Hiroyuki Yamashita
- Department of Surgery, Yamashita Thyroid Hospital, Fukuoka 812-0034, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University Hospital, Shinjuku-ku, Tokyo 162-8666, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Bunkyo-ku, Tokyo 112-8551, Japan
| | - Tsuneo Imai
- National Hospital Organization, Higashinagoya National Hospital, Nagoya, Aichi 465-8620, Japan
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33
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Jikuzono T, Horikawa A, Ishikawa T, Hirokawa M, Sugitani I, Inui T, Ishibashi O. Proteinase K treatment improves RNA recovery from thyroid cells fixed with liquid-based cytology solution. BMC Res Notes 2018; 11:822. [PMID: 30454013 PMCID: PMC6245812 DOI: 10.1186/s13104-018-3914-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/09/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Fine-needle aspiration biopsy (FNAB), an important diagnostic tool given its simplicity, safety, and cost-effectiveness, is fast becoming a popular procedure in the diagnosis of thyroid diseases. Generally, cells isolated from biopsies are transferred directly to microscope slides to prepare smears for cytopathological examination; however, the technical difficulties of this procedure often cause poor reproducibility, which limits the accuracy of diagnostic results. Liquid-based cytology (LBC), in which isolated cells are collected in a fixative solution, is advantageous in that it facilitates the preparation of homogenous cytological specimens. However, LBC has not been applied to molecular diagnoses, such as RNA expression-based diagnosis, mainly because of difficulties in cell recovery and RNA isolation. This study was aimed to improve RNA extraction from papillary cancer-derived K1 cells and thyroid FNAB specimens suspended in LBC solutions. RESULTS K1 cells suspended in CytoRich-Red and CytoRich-Blue, fixatives for LBC, were efficiently recovered by trapping to glass-fiber filters. Importantly, subsequent Proteinase K treatment was essential for efficient RNA extraction from the fixed cells. This finding was also applicable to RNA extraction from CytoRich-Red-fixed thyroid FNAB specimens processed in the same way. Consistently, U6 small nuclear RNA was detected in these RNA samples by reverse transcription-polymerase chain reaction.
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Affiliation(s)
- Tomoo Jikuzono
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, 1-1 Gakuen-cho, Sakai, 599-8531, Japan.,Department of Endocrine Surgery, Kanaji Thyroid Hospital, 1-5-6 Nakazato, Kita-ku, Tokyo, 114-0015, Japan.,Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Aya Horikawa
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, 1-1 Gakuen-cho, Sakai, 599-8531, Japan
| | - Tomoko Ishikawa
- Institute for Human Life Innovation, Ochanomizu University, 2-1-1 Otsuka, Bunkyo-ku, Tokyo, 112-8610, Japan
| | - Mitsuyoshi Hirokawa
- Department of Diagnostic Pathology and Cytology, Kuma Hospital, 8-2-35 Shimoyamate-dori, Chuo-ku, Kobe, 650-0011, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan
| | - Takashi Inui
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, 1-1 Gakuen-cho, Sakai, 599-8531, Japan
| | - Osamu Ishibashi
- Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, 1-1 Gakuen-cho, Sakai, 599-8531, Japan. .,Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8602, Japan.
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34
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Nagaoka R, Sugitani I, Sanada M, Jikuzono T, Okamura R, Igarashi T, Akasu H, Shimizu K. The Reality of Multiple Endocrine Neoplasia Type 2B Diagnosis: Awareness of Unique Physical Appearance Is Important. J NIPPON MED SCH 2018; 85:178-182. [PMID: 30135345 DOI: 10.1272/jnms.jnms.2018_85-26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple endocrine neoplasia type 2B (MEN2B) is an extremely rare syndrome mainly caused by RET918 germline mutations. MEN2B typically causes medullary thyroid carcinoma (MTC), pheochromocytoma, and unique physical characteristics including mucosal neuroma, distinctive facial appearance, and Marfanoid habitus. Most patients have abdominal symptoms such as bloating, intermittent constipation, and diarrhea. MTC is the most important determinant of mortality in patients with MEN2B. Establishing the diagnosis of MEN2B at a curative stage of MTC is crucial. CASE PRESENTATION We have encountered four patients with MEN2B. Two were hereditary cases from the same family, and two were considered de novo cases with phenotypically normal parents. Mean age at diagnosis was 25.5 years (range, 13-39 years). Although all patients had shown mucosal neuroma on the lips and tongue, in addition to gastrointestinal symptoms from infancy, diagnoses were made from symptomatic MTC even for the hereditary patients (our index case was a 14-year-old girl, whose mother was subsequently diagnosed with advanced MTC). Genetic tests for RET mutations revealed the M918T mutation in all patients. Two patients developed pheochromocytoma, two died from distant metastases of MTC, and two received treatment for multiple metastases of MTC (one with vandetanib). CONCLUSIONS In our patients with MEN2B, prophylactic or early thyroidectomy could not be performed. The characteristic phenotype associated with MEN2B is almost always seen prior to detection of MTC or pheochromocytoma. Knowledge about the non-endocrine manifestations of MEN2B needs to be shared among pediatricians and gastroenterologists.
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Affiliation(s)
- Ryuta Nagaoka
- Department of Endocrine Surgery, Nippon Medical School
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School
| | - Marie Sanada
- Department of Endocrine Surgery, Nippon Medical School
| | | | | | | | - Haruki Akasu
- Department of Endocrine Surgery, Nippon Medical School
| | - Kazuo Shimizu
- Department of Endocrine Surgery, Nippon Medical School
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Abstract
Anaplastic thyroid carcinoma (ATC) accounts for only 1 to 2% of all thyroid carcinomas, but it is one of the most lethal neoplasms in humans. To obtain further insights into this "orphan disease," we have established the ATC Research Consortium of Japan (ATCCJ) in 2009. It represents a multicenter registry for ATC that have been treated in Japan. To date, 67 institutions have taken part in the collaborative research system and over 1,200 cases have been accumulated in its database. Using this big data, several retrospective studies were carried out to evaluate 1) prognostic factors to determine initial treatment policy, 2) significance of extended radical surgery for Stage IVB cases, 3) characteristics of ATC incidentally found on pathological examination and 4) pathological features of ATC with long-term survival. Moreover, the ATCCJ has conducted an investigator-initiated, nationwide, prospective clinical trial since 2012; namely, the feasibility, safety and efficacy study of weekly paclitaxel administration for patients with ATC (UMIN: 000008574). Revised Japanese guidelines for treatment of thyroid tumors are going to adopt the recommendations from the results of this research. Since 2016, the ATCCJ has started the phase II study assessing the efficacy and safety of lenvatinib, a newly developed tyrosine kinase inhibitor for ATC (UMIN: 000020773). Our nationwide clinical trial network will strengthen the activity to recruit orphan disease patients and may discover new strategies to conquer this dismal malignancy in the near future.
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Affiliation(s)
- Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine
| | - Ken-Ichi Ito
- Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine
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36
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Davies L, Sugino K, Sugitani I, Tomoda C. Re: "High Thyroid Cancer Mortality Rate in Japan: A Result of Nonaggressive Treatment Strategy, or Just an Aging Population?" By Magner (Thyroid 2018;28:818-819). Thyroid 2018; 28:820-822. [PMID: 29644937 DOI: 10.1089/thy.2018.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Iwao Sugitani
- 3 Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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37
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Brose MS, Pitoia F, Smit JWA, Lin CC, Fellous MM, Bayh I, Sugitani I, Schlumberger M. Second interim analysis of RIFTOS MKI, a global non-interventional study assessing the use of multikinase inhibitors (MKIs) in the treatment of patients with asymptomatic radioactive iodine-refractory differentiated thyroid cancer (RAI-R DTC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.6081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Marcia S. Brose
- Department of Otorhinolaryngology, Head and Neck Surgery and the Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | - Fabian Pitoia
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Johannes WA Smit
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Chia-Chi Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Inga Bayh
- Bayer AG, SBU Oncology, Pharmaceuticals, Wuppertal, Germany
| | - Iwao Sugitani
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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38
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Kawabata H, Azuma K, Ikeda K, Sugitani I, Kinowaki K, Fujii T, Osaki A, Saeki T, Horie-Inoue K, Inoue S. Abstract P3-07-06: TRIM44 is a possible poor prognostic factor for breast cancer patients and positively regulates NF-κB signaling pathway. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-07-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
[Background]
Many of the tripartite motif (TRIM) proteins, like Efp/TRIM25 which was identified by our group previously (Nature 417, 871-875, 2002), function as E3 ubiquitin ligases, and are thought to be involved in various physiological and pathological processes such as immunity and oncogenesis. In regard to tripartite motif containing 44 (TRIM44), which is an atypical TRIM family protein lacking RING finger domain, some evidences suggest that it is implicated in the progression of several human malignancies. But its pathophysiological significance in breast cancer remains unknown.
[Methods]
In the present study, immunohistochemical analysis using anti-TRIM44 antibody was performed in clinical breast cancer tissues from 129 patients with the approval of institutional ethical committees (approval number: 845). We then explored the pathophysiological role of TRIM44 in breast cancer by modulating TRIM44 expression in MCF-7 and MDA-MB-231 breast cancer cells.
[Results]
TRIM44 strong immunoreactivity was significantly associated with nuclear grade, distant disease-free survival and overall survival of the breast cancer patients. With multivariate analysis it was shown that the TRIM44 status was an independent prognostic factor for distant disease-free survival and overall survival. The proliferation of MCF-7 and MDA-MB-231 cells was significantly decreased by siRNA-mediated TRIM44 knockdown. TRIM44 knockdown also suppressed migration of MDA-MB-231 cells. Microarray analysis and qRT-PCR revealed that TRIM44 knockdown upregulated CDK19 (Cyclin Dependent Kinase 19), which is reported to be a tumor suppressor gene, whereas downregulated MMP1 (Matrix Metallopeptidase 1) in MDA-MB-231 cells. Notably, TRIM44 knockdown impaired nuclear factor-kappa B (NF-κB)-mediated transcriptional activity stimulated by tumor necrosis factor α (TNFα). Moreover, TRIM44 knockdown substantially attenuated the TNFα-dependent phosphorylation of p65 subunit of NF-κB and IκBα in both MCF-7 and MDA-MB-231 cells.
[Discussion]
Our clinical study showed that prognosis of breast cancer patients is correlated with the immunoreactivity detected by anti-TRIM44 antibody. This result suggested that expression of TRIM44 protein could be used as a potential biomarker of breast cancer. We demonstrated that NF-κB signaling pathway is modulated by TRIM44. Since NF-κB augmentation is shown to be related to aggressive character of breast cancer, stimulation of NF-κB signaling with TRIM44 might be underlying mechanism of poor prognosis. Our in vitro study showed TRIM44 knockdown caused attenuated proliferation and migration of breast cancer cells, raising the possibility of TRIM44 as a potential therapeutic target for breast cancer. These findings provide new clues to develop alternative effective strategies for breast cancer management.
Citation Format: Kawabata H, Azuma K, Ikeda K, Sugitani I, Kinowaki K, Fujii T, Osaki A, Saeki T, Horie-Inoue K, Inoue S. TRIM44 is a possible poor prognostic factor for breast cancer patients and positively regulates NF-κB signaling pathway [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-07-06.
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Affiliation(s)
- H Kawabata
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - K Azuma
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - K Ikeda
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - I Sugitani
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - K Kinowaki
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - T Fujii
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - A Osaki
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - T Saeki
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - K Horie-Inoue
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
| | - S Inoue
- Tokyo Metropolitan Institue of Gerontology, Tokyo, Itabashi-ku, Japan; Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan; Saitama Medical University International Medical Center, Hidaka, Saitama, Japan; Toranomon Hospital, Minato-ku, Tokyo, Japan
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Todo M, Ueda S, Osaki S, Sugitani I, Takahashi T, Takahashi M, Makabe H, Saeki T, Itoh Y. Improvement of treatment outcomes after implementation of comprehensive pharmaceutical care in breast cancer patients receiving everolimus and exemestane. Pharmazie 2018; 73:110-114. [PMID: 29442014 DOI: 10.1691/ph.2018.7837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
Combination therapy with everolimus and an aromatase inhibitor such as exemestane is an effective treatment option for advanced or recurrent breast cancer. However, the therapy is often limited because of the occurrence of severe adverse events (AEs), including oral mucositis, interstitial lung disease, diarrhea, and rash. Therefore, early management of AEs is extremely important to obtain maximum treatment outcome. We investigated here the effects of comprehensive pharmaceutical care for prevention of severe AEs on patient's quality-of-life (QOL) and continuation of therapy. QOL was assessed every month based on the five-level version of EuroQol-5-Dimension (EQ-5D-5L). AEs were graded according to the Common Terminology Criteria for Adverse Events (ver 4.0). Implementation of comprehensive pharmaceutical care remarkably reduced the incidence of severe oral mucositis as compared with those without such interventions. EQ-5D-5L health states were almost constant during 6 months after intervention, ranging from 0.850 to 0.889. Median time to treatment failure (TTF) was significantly longer after intervention than before [224.0 days, 95% confidence interval (CI): 117-331 days versus 34 days, 21-47 days, hazard ratio (HR): 0.027, 95% CI: 0.005 - 0.154, p<0.001]. These findings suggest that our comprehensive pharmaceutical care is highly effective for enhancing treatment outcome by maintaining patient's QOL.
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Ito Y, Onoda N, Ito KI, Sugitani I, Takahashi S, Yamaguchi I, Kabu K, Tsukada K. Sorafenib in Japanese Patients with Locally Advanced or Metastatic Medullary Thyroid Carcinoma and Anaplastic Thyroid Carcinoma. Thyroid 2017; 27. [PMID: 28635560 PMCID: PMC5646744 DOI: 10.1089/thy.2016.0621] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Therapeutic options for treating advanced or metastatic medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC) are still limited in Japan, even though vandetanib for MTC and lenvatinib for MTC and ATC have been approved. Sorafenib is an oral multikinase inhibitor approved for the treatment of patients with radioactive iodine-refractory differentiated thyroid cancer (DTC). An uncontrolled, open-label, multicenter, single-arm, Phase 2 clinical study was conducted to evaluate the safety and efficacy of sorafenib in Japanese patients with MTC and ATC. METHODS Japanese patients with histologically confirmed ATC and locally advanced or metastatic MTC were enrolled from April to September 2014. The primary endpoint was to evaluate the safety of sorafenib. Treatment efficacy variables including progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and maximum reduction in tumor size were evaluated as secondary endpoints. Patients received sorafenib 400 mg orally twice daily on a continuous basis and then continued treatment until the occurrence of disease progression, unacceptable toxicity, or withdrawal of consent. RESULTS A total of 20 patients were screened, and 18 (8 with MTC and 10 with ATC) were enrolled. The most common drug-related adverse events were palmar-plantar erythrodysesthesia (72%), alopecia (56%), hypertension (56%), and diarrhea (44%). In the ATC patients, median PFS was 2.8 months [confidence interval 0.7-5.6], and median OS was 5.0 months [confidence interval 0.7-5.7]; ORR and DCR were 0% and 40%, respectively. In the MTC population, neither median PFS nor OS had been reached at the time of this analysis; ORR was 25% and DCR was 75%. CONCLUSIONS The toxicities reported in this study were consistent with the known safety profile of sorafenib. Sorafenib seems to be effective in the treatment of advanced MTC but not ATC, and could be a new treatment option for locally advanced or metastatic MTC and radioactive iodine-refractory DTC.
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Affiliation(s)
- Yasuhiro Ito
- Clinical Trial Management Center, Kuma Hospital, Kobe, Japan
| | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ken-ichi Ito
- Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery II, Nippon Medical School, Tokyo, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Iku Yamaguchi
- Product Development, Clinical Statistics, Bayer Yakuhin Ltd., Osaka, Japan
| | - Koki Kabu
- Medical Affairs/KI Oncology, Bayer Yakuhin Ltd., Tokyo, Japan
| | - Katsuya Tsukada
- Medical Affairs, Oncology and Hematology, and Clinical Development, Specialty Medicine, Bayer Yakuhin Ltd., Tokyo, Japan
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41
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Smit J, Brose M, Pitoia F, Lin CC, Sugitani I, Alevizaki M, Godbert Y, Aller J, Peeters R, Pazaitou-Panayiotou K, Leenhardt L, Fellous M, De Sanctis Y, Schlumberger M. Interim baseline characteristics from RIFTOS MKI, a global non-interventional study assessing the use of multikinase inhibitors (MKIs) in the treatment of patients with asymptomatic radioactive iodine-refractory differentiated thyroid cancer (RAI-R DTC): A European subgroup analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx368.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Brose MS, Pitoia F, Smit JWA, Lin CC, Fellous MM, De Sanctis Y, Sugitani I, Schlumberger M. Interim baseline characteristics from RIFTOS MKI, a global non-interventional study assessing the use of multikinase inhibitors (MKIs) in the treatment of patients with asymptomatic radioactive iodine-refractory differentiated thyroid cancer (RAI-R DTC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6084 Background: RIFTOS MKI was designed to compare the time to symptomatic progression from study entry in patients with RAI-R DTC for whom there was a decision to treat or not to treat with an MKI in the real-life setting. Here, we report interim baseline characteristics for the first 274 patients enrolled in the study. Methods: RIFTOS MKI is a non-interventional study enrolling patients with asymptomatic RAI-R DTC. The decision to initiate MKIs at study entry was at the discretion of the treating physician. Final analysis will be performed once 700 patients have been enrolled and the last enrolled patient has been followed for 24 months. Results: Of 274 patients, the median duration of observation was 169.5 days. Patients have been enrolled from USA (n = 74), Japan (n = 55), Europe (n = 80), and rest of the world (n = 65); 54% were female and the median age was 68 years. Most patients had an ECOG performance status of 0 or 1 (97%) and distant metastases (81%). The most frequent histology was papillary (73%). The median time from initial diagnosis of DTC to study entry was 7 years. RAI refractoriness was mainly due to lack of RAI uptake (60%), primarily in Japan (80%). Japan also had the shortest median time from RAI classification to initial visit (2 months) vs other regions, and the average dose per RAI treatment and median cumulative activity of RAI were lower in Japanese patients (3.4 and 3.7 GBq, respectively) (Table). Conclusions: The RIFTOS MKI study is the largest non-interventional study in RAI-R DTC. The regional differences in treatment history observed in the RIFTOS MKI study reflect differences in accessibility and treatment practice. The study is ongoing. Clinical trial information: NCT02303444. [Table: see text]
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Affiliation(s)
| | - Fabian Pitoia
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Johannes WA Smit
- Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Chia-Chi Lin
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Iwao Sugitani
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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Brose MS, Smit J, Lin CC, Pitoia F, Fellous M, DeSanctis Y, Schlumberger M, Tori M, Sugitani I. Timing of multikinase inhibitor initiation in differentiated thyroid cancer. Endocr Relat Cancer 2017; 24:237-242. [PMID: 28270435 PMCID: PMC5446590 DOI: 10.1530/erc-17-0016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/07/2017] [Indexed: 12/14/2022]
Abstract
There are limited treatment options for patients with radioactive iodine refractory, progressive differentiated thyroid cancer. Although there is consensus that multikinase inhibitor therapy should be considered in patients with progressive disease with considerable tumor load or symptomatic disease, uncertainty exists on the optimal timing to treat with a multikinase inhibitor, especially for asymptomatic patients. RIFTOS MKI is an international, prospective, open-label, multicenter, noninterventional study with the primary objective to compare the time to symptomatic progression from study entry in asymptomatic patients with radioactive iodine refractory, progressive differentiated thyroid cancer for whom there is a decision to initiate multikinase inhibitors at study entry (cohort 1) with those for whom there is a decision to not initiate multikinase inhibitors at study entry (cohort 2). Secondary endpoints are overall survival and progression-free survival, which will be compared between cohorts 1 and 2. Additional secondary endpoints are postprogression survival from time of symptomatic progression, duration of and response to each systemic treatment regimen and dosing of sorafenib throughout the treatment period. Asymptomatic, multikinase inhibitor-naive patients aged ≥18 years with histologically/cytologically documented differentiated thyroid cancer that is radioactive iodine refractory are eligible. Patients may receive any therapy for differentiated thyroid cancer, including sorafenib or other multikinase inhibitors if indicated and decided on by the treating physician. In total, 700 patients are estimated to be enrolled from >20 countries. Final analysis will be performed once the last enrolled patient has been followed up with for 24 months (ClinicalTrials.gov identifier: Nbib2303444).
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Affiliation(s)
- Marcia S Brose
- Department of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Stellar-Chance Laboratories Mezzanine, Philadelphia, Pennsylvania, USA
| | - Johannes Smit
- Department of Internal MedicineRadboud University Nijmegen Medical Center, 463 General Internal Medicine, Nijmegen, Netherlands
| | - Chia-Chi Lin
- Department of OncologyNational Taiwan University Hospital, Taipei, Taiwan
| | - Fabian Pitoia
- Division of EndocrinologyHospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marc Fellous
- Bayer HealthCare PharmaceuticalsWhippany, New Jersey, USA
| | | | - Martin Schlumberger
- Department of Nuclear Medicine and Endocrine OncologyInstitut Gustave Roussy and Université Paris Saclay, Villejuif, France
| | - Masayuki Tori
- Department of Endocrine SurgeryOsaka Police Hospital, Tennoujiku, Osaka, Japan
| | - Iwao Sugitani
- Department of Endocrine SurgeryNippon Medical School Graduate School of Medicine, Bunkyo-Ku, Tokyo, Japan
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Ohashi R, Kawahara K, Namimatsu S, Okamura R, Igarashi T, Sugitani I, Naito Z. Expression of MRP1 and ABCG2 is associated with adverse clinical outcomes of papillary thyroid carcinoma with a solid component. Hum Pathol 2017; 67:11-17. [PMID: 28411177 DOI: 10.1016/j.humpath.2017.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/25/2017] [Accepted: 03/18/2017] [Indexed: 12/12/2022]
Abstract
Solid variant of papillary thyroid carcinoma (PTC) is characterized by a solid component (SC) retaining classical cytological features of PTC. Despite some controversies, PTC with SC (PTCSC) cases have poor prognosis compared with well-differentiated PTC. We investigated if cancer stem cells (CSCs) may have a role in pathogenesis of PTCSC. PTCSC tumors (n=27) were histologically represented by a mixture of papillary component (PC) and varying degrees of SC involving 10% to 85% of the tumor. Immunohistochemical expression of CSC markers ABCG2 and MRP1, and HBME1 and CK19 was compared between SC and PC within each tumor in association with clinicopathological parameters. ABCG2 and MRP1 were highly expressed in SC, whereas their expression was limited or absent in PC (P=.04 and .002, respectively). In contrast, expression of HBME1 and CK19 appeared higher in PC than in SC (P=.08 and .02, respectively). Higher expression of ABCG2 was associated with higher incidence of large-sized SC (P=.01). Higher expression of MRP1 was associated with higher incidence of lymphovascular invasion (P=.049). Higher expression of ABCG2 and MRP1, and lower expression of CK19 in SC were associated with higher tumor recurrence rate (P=.02, .01, and .02, respectively), and shorter disease-free survival (P<.001 for all the variables). Our findings indicate that the tumor cells harboring CSC-like characteristics in SC could contribute to the pathogenesis of PTCSC and might account for the poor disease prognosis.
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Affiliation(s)
- Ryuji Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo 113-8603, Japan.
| | - Kiyoko Kawahara
- Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo 113-8603, Japan
| | - Shigeki Namimatsu
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Ritsuko Okamura
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Takehito Igarashi
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo 113-8603, Japan
| | - Zenya Naito
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo 113-8603, Japan; Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo 113-8603, Japan
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45
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Ohashi R, Murase Y, Matsubara M, Watarai Y, Igarashi T, Sugitani I, Naito Z. Fine needle aspiration cytology of the papillary thyroid carcinoma with a solid component: A cytological and clinical correlation. Diagn Cytopathol 2017; 45:391-398. [PMID: 28224716 DOI: 10.1002/dc.23679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/02/2017] [Accepted: 01/23/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Solid variant of papillary thyroid carcinoma is a rare subtype of papillary thyroid carcinoma (PTC) containing a solid component (SC), and thus its cytological and clinicopathological features remain elusive. We examined fine needle aspiration (FNA) cytological features of PTC with variable degrees of SC (20-80% of the tumor)(PTCSC) in comparison to well-differentiated PTC (WPTC). METHODS Twenty-six cases of PTCSC were histologically stratified into major-SC (SC >50% of the tumor) and minor-SC (<49%) groups. Pre-operative FNA smears were compared between major-SC (n = 11) and minor-SC (n = 15) groups, and between PTCSC and WPTC (n = 39) groups. RESULTS In FNA smears of PTCSC, the presence of cohesive solid nests, trabecular patterns, overlapping, enlarged nuclei, pleomorphism, and distinct nucleolus, and the absence of colloid and psammoma bodies were noted more often than in WPTC, while classical cytological features of PTC, such as nuclear grooves and/or pseudo-nuclear inclusions, were preserved. There was no significant difference in FNA findings between the major-SC and minor-SC groups. The presence of either solid nests or trabecular patterns, and overlapping in FNA smears of PTCSC was associated with a higher recurrence rate of the tumor (P = 0.007 and P < 0.001, respectively). CONCLUSION PTCSC may pre-operatively be identified by detecting its characteristic cytological features in FNA smears, regardless of the proportion of SC within the tumor. Because clinical outcomes of PTCSC remain undetermined, it is imperative to postulate PTCSC as a differential diagnosis, even when classical nuclear features of PTC are present. Diagn. Cytopathol. 2017;45:391-398. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ryuji Ohashi
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yukihiro Murase
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Miyuki Matsubara
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuhiko Watarai
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Takehito Igarashi
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Hospital, Tokyo, Japan
| | - Zenya Naito
- Department of Diagnostic Pathology, Nippon Medical School Hospital, Tokyo, Japan.,Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan
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46
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Ohashi R, Kawahara K, Namimatsu S, Igarashi T, Sakatani T, Sugitani I, Naito Z. Clinicopathological significance of a solid component in papillary thyroid carcinoma. Histopathology 2017; 70:775-781. [DOI: 10.1111/his.13132] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Ryuji Ohashi
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
| | - Kiyoko Kawahara
- Department of Integrated Diagnostic Pathology; Nippon Medical School; Tokyo Japan
| | - Shigeki Namimatsu
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
| | - Takehito Igarashi
- Department of Endocrine Surgery; Nippon Medical School Hospital; Tokyo Japan
| | - Takashi Sakatani
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
- Department of Integrated Diagnostic Pathology; Nippon Medical School; Tokyo Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery; Nippon Medical School Hospital; Tokyo Japan
| | - Zenya Naito
- Department of Diagnostic Pathology; Nippon Medical School Hospital; Tokyo Japan
- Department of Integrated Diagnostic Pathology; Nippon Medical School; Tokyo Japan
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Tahara M, Sugitani I, Ito Y, Okayama Y, Kawakami Y, Sunaya T, Sakaguchi T, Minami H, Imai T. Post-marketing surveillance of all patients treated with sorafenib for unresectable DTC in Japan: Interim report. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw521.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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48
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Fukuoka O, Sugitani I, Ebina A, Toda K, Kawabata K, Yamada K. Natural History of Asymptomatic Papillary Thyroid Microcarcinoma: Time-Dependent Changes in Calcification and Vascularity During Active Surveillance. World J Surg 2016; 40:529-37. [PMID: 26581368 DOI: 10.1007/s00268-015-3349-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Prospective trials of non-surgical observation have shown progression rates of only 5-10% in patients with asymptomatic papillary microcarcinoma (PMC). This study investigated time-dependent changes in calcification patterns and tumor vascularity on ultrasonography (US) to clarify the natural course of PMC. METHODS We examined calcification patterns and tumor vascularity for 480 lesions in 384 patients. Calcification patterns were classified as: (A) none; (B) micro; (C) macro; or (D) rim. Tumor vascularity was classified as rich or poor via color Doppler US. RESULTS After a mean of 6.8 years of observation, 29 lesions (6.0%) had increased in size. Mean age for initial calcification pattern was 52.1 years for A (n = 135), 54.2 years for B (n = 235), 56.3 years for C (n = 96), and 60.1 years for D (n = 14), and the incidence rates of tumor enlargement were 9.6, 5.5, 3.2, and 0%, respectively. The cumulative rate of upgrade in calcification pattern was 51.8% at 10 years. Lesions with initially rich vascularity (n = 70) had significantly higher rate of tumor enlargement than those with poor vascularity (n = 410); however, the majority of tumor (61.4%) with initially rich vascularity had decreased their blood supply during the follow-up. Multivariate analysis showed that strong calcification (C or D) and poor vascularity at last examination correlated significantly with non-progressive disease. CONCLUSIONS PMCs in older patients showed significantly stronger calcification patterns and poorer vascularity. Both consolidation of calcification and loss of vascularity occurred in a time-dependent manner during observation and were significant indicators for non-progressive disease.
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Affiliation(s)
- Osamu Fukuoka
- Division of Head and Neck, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Iwao Sugitani
- Division of Head and Neck, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. .,Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Aya Ebina
- Division of Head and Neck, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kazuhisa Toda
- Division of Head and Neck, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Kazuyoshi Kawabata
- Division of Head and Neck, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keiko Yamada
- Department of Ultrasonography, Cancer Institute Hospital of JFCR, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Onoda N, Sugino K, Higashiyama T, Kammori M, Toda K, Ito KI, Yoshida A, Suganuma N, Nakashima N, Suzuki S, Tsukahara K, Noguchi H, Koizumi M, Nemoto T, Hara H, Miyauchi A, Sugitani I. The Safety and Efficacy of Weekly Paclitaxel Administration for Anaplastic Thyroid Cancer Patients: A Nationwide Prospective Study. Thyroid 2016; 26:1293-9. [PMID: 27484330 DOI: 10.1089/thy.2016.0072] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Anaplastic thyroid cancer (ATC) is a rare and extremely aggressive malignancy, with a median survival of less than 6 months due to rapid progression and resistance to multimodal therapies. Effective treatment strategies have not been identified. A prospective clinical study was performed to objectively evaluate outcomes of treatment with paclitaxel. METHODS An investigator-initiated, multicenter, nonrandomized, open-label, single-arm study to evaluate the feasibility and efficacy of weekly paclitaxel (80 mg/m(2)) administration for patients with pathologically confirmed ATC was conducted in a nationwide organization. RESULTS Feasibility was analyzed in 56 patients. More than one course of treatment was performed in 52 (93%) patients retaining sufficient dose intensity (>84%). No patient had to terminate the treatment because of an adverse event. The median overall survival was 6.7 months [confidence interval 4.4-9.0]. The 6-month survival was 54%. Among the 42 patients with an evaluable lesion, none demonstrated complete remission, 9 (21%) showed partial remission, 22 (52%) achieved stable disease, and 8 (19%) exhibited progressive disease; 3 did not complete the initial treatment course. The objective response rate was 21%, and the clinical benefit rate was 73%. The median time to progression was 1.6 months. Statistically, no additional effect of concomitant radiation was demonstrated in 6 patients receiving combined therapy. Eight patients, in whom a complete post-treatment surgical removal of the tumor was feasible, survived significantly longer (median 7.6 months [CI 8.1-23.0]) than the other 34 patients in whom the tumor could not be completely removed after chemotherapy (5.4 months [CI 3.0-7.8], p = 0.018). SUMMARY The study demonstrates objective and accurate information concerning the feasibility and efficacy of a standardized treatment with weekly paclitaxel administration for ATC patients. CONCLUSIONS Weekly paclitaxel administration for ATC patients can be of clinical benefit in a neo-adjuvant setting.
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Affiliation(s)
- Naoyoshi Onoda
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 2 Department of Surgical Oncology, Osaka City University Graduate School of Medicine , Osaka, Japan
| | - Kiminori Sugino
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 3 Department of Surgery, Ito Hospital , Tokyo, Japan
| | - Takuya Higashiyama
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 4 Department of Surgery, Kuma Hospital , Kobe, Japan
| | - Makoto Kammori
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 5 Department of Surgery, Kanaji Thyroid Hospital , Tokyo, Japan
| | - Kazuhisa Toda
- 6 Division of Head and Neck, Cancer Institute Hospital , Tokyo, Japan
| | - Ken-Ichi Ito
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 7 Department of Surgery II, Shinshu University , Matsumoto, Japan
| | - Akira Yoshida
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 8 Department of Breast and Endocrine Surgery, Kanagawa Cancer Center , Yokohama, Japan
| | | | - Noriaki Nakashima
- 10 Department of Breast and Endocrine Surgery, Tohoku University , Sendai, Japan
| | - Shinichi Suzuki
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 11 Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine , Fukushima, Japan
| | - Kiyoaki Tsukahara
- 12 Department of Otolaryngology, Tokyo Medical University , Tokyo, Japan
| | - Hitoshi Noguchi
- 13 Noguchi Thyroid Clinic and Hospital Foundation , Oita, Japan
| | | | - Toshimitsu Nemoto
- 15 Department of Otorhinolaryngology, Japanese Red Cross Narita Hospital , Chiba, Japan
| | - Hisato Hara
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 16 Department of Breast and Endocrine Surgery, Tsukuba University , Tsukuba, Japan
| | - Akira Miyauchi
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 4 Department of Surgery, Kuma Hospital , Kobe, Japan
| | - Iwao Sugitani
- 1 Prospective Clinical Study Committee of Anaplastic Thyroid Carcinoma Research Consortium of Japan , Tokyo, Japan
- 6 Division of Head and Neck, Cancer Institute Hospital , Tokyo, Japan
- 17 Department of Endocrine Surgery, Nippon Medical School , Tokyo, Japan
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Ito Y, Suzuki S, Ito KI, Imai T, Okamoto T, Kitano H, Sugitani I, Sugino K, Tsutsui H, Hara H, Yoshida A, Shimizu K. Tyrosine-kinase inhibitors to treat radioiodine-refracted, metastatic, or recurred and progressive differentiated thyroid carcinoma [Review]. Endocr J 2016; 63:597-602. [PMID: 27210070 DOI: 10.1507/endocrj.ej16-0064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Differentiated thyroid carcinoma (DTC) is generally indolent in nature and, even though it metastasizes to distant organs, the prognosis is normally excellent. In contrast, the overall survival (OS) of patients with radioactive iodine (RAI)-refractory and progressive metastases is dire, because no effective therapies have been available to control the metastatic lesions. However, recently, administration of tyrosine-kinase inhibitors (TKIs) has become a new line of therapy for RAI-refractory and progressive metastases. Previous studies have reported significant improvement regarding the progression-free survival rates of patients with metastatic lesions. However, TKIs cause various severe adverse events (AEs) that damage patients' quality of life and can even be life-threatening. Additionally, metastatic lesions may progress significantly after stopping TKI therapy. Therefore, it is difficult to determine who is a candidate for TKI therapy, as well as how and when physicians start and stop the therapy. The present review, created by Committee of pharmacological therapy for thyroid cancer of the Japanese Society of Thyroid Surgery (JSTS) and the Japan Association of Endocrine Surgeons (JAES) describes how to appropriately use TKIs by describing what we do and do not know about treatment using TKIs.
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Affiliation(s)
- Yasuhiro Ito
- Committee of Pharmacological Therapy for Thyroid Cancer of Japan Association of Endocrine Surgery (JAES) and Japanese Society of Thyroid Surgery (JSTS), Japan
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