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Bischoff LA, Ganly I, Fugazzola L, Buczek E, Faquin WC, Haugen BR, McIver B, McMullen CP, Newbold K, Rocke DJ, Russell MD, Ryder M, Sadow PM, Sherman E, Shindo M, Shonka DC, Singer MC, Stack BC, Wirth LJ, Wong RJ, Randolph GW. Molecular Alterations and Comprehensive Clinical Management of Oncocytic Thyroid Carcinoma: A Review and Multidisciplinary 2023 Update. JAMA Otolaryngol Head Neck Surg 2024; 150:265-272. [PMID: 38206595 DOI: 10.1001/jamaoto.2023.4323] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 01/12/2024]
Abstract
Importance Oncocytic (Hürthle cell) thyroid carcinoma is a follicular cell-derived neoplasm that accounts for approximately 5% of all thyroid cancers. Until recently, it was categorized as a follicular thyroid carcinoma, and its management was standardized with that of other differentiated thyroid carcinomas. In 2022, given an improved understanding of the unique molecular profile and clinical behavior of oncocytic thyroid carcinoma, the World Health Organization reclassified oncocytic thyroid carcinoma as distinct from follicular thyroid carcinoma. The International Thyroid Oncology Group and the American Head and Neck Society then collaborated to review the existing evidence on oncocytic thyroid carcinoma, from diagnosis through clinical management and follow-up surveillance. Observations Given that oncocytic thyroid carcinoma was previously classified as a subtype of follicular thyroid carcinoma, it was clinically studied in that context. However, due to its low prevalence and previous classification schema, there are few studies that have specifically evaluated oncocytic thyroid carcinoma. Recent data indicate that oncocytic thyroid carcinoma is a distinct class of malignant thyroid tumor with a group of distinct genetic alterations and clinicopathologic features. Oncocytic thyroid carcinoma displays higher rates of somatic gene variants and genomic chromosomal loss of heterozygosity than do other thyroid cancers, and it harbors unique mitochondrial DNA variations. Clinically, oncocytic thyroid carcinoma is more likely to have locoregional (lymph node) metastases than is follicular thyroid carcinoma-with which it was formerly classified-and it develops distant metastases more frequently than papillary thyroid carcinoma. In addition, oncocytic thyroid carcinoma rarely absorbs radioiodine. Conclusions and Relevance The findings of this review suggest that the distinct clinical presentation of oncocytic thyroid carcinoma, including its metastatic behavior and its reduced avidity to radioiodine therapy, warrants a tailored disease management approach. The reclassification of oncocytic thyroid carcinoma by the World Health Organization is an important milestone toward developing a specific and comprehensive clinical management for oncocytic thyroid carcinoma that considers its distinct characteristics.
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Affiliation(s)
- Lindsay A Bischoff
- Department of Medicine, Division of Endocrinology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Fugazzola
- Endocrine Oncology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, The University of Kansas, Kansas City
| | - William C Faquin
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bryan R Haugen
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora
| | - Bryan McIver
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Caitlin P McMullen
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Kate Newbold
- Thyroid Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Daniel J Rocke
- Department of Otolaryngology Head and Neck Surgery, Weill Medical College, Cornell University, New York, New York
| | - Marika D Russell
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
| | - Mabel Ryder
- Division of Endocrinology and Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Peter M Sadow
- Departments of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville
| | - Michael C Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Lori J Wirth
- Departments of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Richard J Wong
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston
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Pozdeyev N, Dighe M, Barrio M, Raeburn C, Smith H, Fisher M, Chavan S, Rafaels N, Shortt JA, Lin M, Leu MG, Clark T, Marshall C, Haugen BR, Subramanian D, Crooks K, Gignoux C, Cohen T. Thyroid Cancer Polygenic Risk Score Improves Classification of Thyroid Nodules as Benign or Malignant. J Clin Endocrinol Metab 2024; 109:402-412. [PMID: 37683082 DOI: 10.1210/clinem/dgad530] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Abstract
CONTEXT Thyroid nodule ultrasound-based risk stratification schemas rely on the presence of high-risk sonographic features. However, some malignant thyroid nodules have benign appearance on thyroid ultrasound. New methods for thyroid nodule risk assessment are needed. OBJECTIVE We investigated polygenic risk score (PRS) accounting for inherited thyroid cancer risk combined with ultrasound-based analysis for improved thyroid nodule risk assessment. METHODS The convolutional neural network classifier was trained on thyroid ultrasound still images and cine clips from 621 thyroid nodules. Phenome-wide association study (PheWAS) and PRS PheWAS were used to optimize PRS for distinguishing benign and malignant nodules. PRS was evaluated in 73 346 participants in the Colorado Center for Personalized Medicine Biobank. RESULTS When the deep learning model output was combined with thyroid cancer PRS and genetic ancestry estimates, the area under the receiver operating characteristic curve (AUROC) of the benign vs malignant thyroid nodule classifier increased from 0.83 to 0.89 (DeLong, P value = .007). The combined deep learning and genetic classifier achieved a clinically relevant sensitivity of 0.95, 95% CI [0.88-0.99], specificity of 0.63 [0.55-0.70], and positive and negative predictive values of 0.47 [0.41-0.58] and 0.97 [0.92-0.99], respectively. AUROC improvement was consistent in European ancestry-stratified analysis (0.83 and 0.87 for deep learning and deep learning combined with PRS classifiers, respectively). Elevated PRS was associated with a greater risk of thyroid cancer structural disease recurrence (ordinal logistic regression, P value = .002). CONCLUSION Augmenting ultrasound-based risk assessment with PRS improves diagnostic accuracy.
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Affiliation(s)
- Nikita Pozdeyev
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Division of Endocrinology Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Manjiri Dighe
- Department of Radiology, University of Washington, Seattle, WA 98195, USA
| | - Martin Barrio
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher Raeburn
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Harry Smith
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Matthew Fisher
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sameer Chavan
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nicholas Rafaels
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jonathan A Shortt
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Meng Lin
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michael G Leu
- Information Technology Services, UW Medicine, Seattle, WA 98195, USA
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
- Division of Hospital Medicine, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Toshimasa Clark
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carrie Marshall
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bryan R Haugen
- Division of Endocrinology Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Kristy Crooks
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher Gignoux
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Trevor Cohen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
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Greca AL, Grau L, Arbet J, Liao LM, Sosa JA, Haugen BR, Kitahara CM. Anthropometric, dietary, and lifestyle factors and risk of advanced thyroid cancer: The NIH-AARP diet and health cohort study. Clin Endocrinol (Oxf) 2023; 99:586-597. [PMID: 37694684 DOI: 10.1111/cen.14970] [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] [Received: 05/02/2023] [Revised: 08/17/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Most patients diagnosed with thyroid cancer have low-risk disease, but some have a higher risk for persistent or recurrent disease and even death from thyroid cancer. Few studies have evaluated potential anthropometric, lifestyle, or dietary risk factors for advanced or aggressive types of thyroid cancer. METHODS Using data from a large US cohort study, we examined associations for high-risk thyroid cancer (HRTC) and, separately, low-risk thyroid cancer (LRTC) in relation to anthropometric factors, diet, smoking, and alcohol consumption. The National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study included 304,122 participants (124,656 women and 179,466 men) without a history of cancer who completed a mailed questionnaire in 1996-1997 and were followed for cancer incidence through 2011 via linkages with state cancer registries. Hazard ratios (HRs) for anthropometric, dietary, and lifestyle factors in relation to HRTC or LRTC, defined using guidance from the American Thyroid Association initial risk of recurrence classification, were calculated using multivariable-adjusted Cox proportional hazards regression models. RESULTS During follow-up (median = 10.1 years), 426 participants were diagnosed with HRTC (n = 95) or LRTC (n = 331). In models combining men and women, baseline waist circumference (per 5 cm, HR = 1.13, 95% confidence interval [CI] 1.01-1.27) and weight gain from age 18 years to baseline age (per 5 kg, HR = 1.14, 95% CI 1.02-1.28) were positively associated with risk of HRTC but not LRTC. In contrast, vegetable intake (per cup equivalents/day, HR = 1.15, 95% CI 1.01-1.30), cigarette smoking (current vs. never, HR = 0.39, 95% CI 0.23-0.68), and alcohol consumption (per drink/day, HR = 0.83, 95% CI 0.70-0.97) were associated with risk of LRTC but not HRTC. The association of LRTC risk with vegetable intake was limited to men, and that of current smoking was more pronounced in women. CONCLUSIONS Our findings suggest that greater waist circumference and adulthood weight gain are associated with thyroid cancers at higher risk for recurrence. These results may have implications for the primary prevention of advanced thyroid cancer.
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Affiliation(s)
- Amanda La Greca
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Laura Grau
- Department of Biostatistics & Informatics, University of Colorado, Aurora, Colorado, USA
| | - Jaron Arbet
- Department of Biostatistics & Informatics, University of Colorado, Aurora, Colorado, USA
| | - Linda M Liao
- Division of Cancer Epidemiology & Genetics, Metabolic Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Julie A Sosa
- Department of Surgery, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Cari M Kitahara
- Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Chiosea S, Hodak SP, Yip L, Abraham D, Baldwin C, Baloch Z, Gulec SA, Hannoush ZC, Haugen BR, Joseph L, Kargi AY, Khanafshar E, Livhits MJ, McIver B, Patel K, Patel SG, Randolph GW, Shaha AR, Sharma J, Stathatos N, van Zante A, Carty SE, Nikiforov YE, Nikiforova MN. Molecular Profiling of 50 734 Bethesda III-VI Thyroid Nodules by ThyroSeq v3: Implications for Personalized Management. J Clin Endocrinol Metab 2023; 108:2999-3008. [PMID: 37071871 PMCID: PMC10583990 DOI: 10.1210/clinem/dgad220] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/29/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT Comprehensive genomic analysis of thyroid nodules for multiple classes of molecular alterations detected in a large series of fine needle aspiration (FNA) samples has not been reported. OBJECTIVE To determine the prevalence of clinically relevant molecular alterations in Bethesda categories III-VI (BCIII-VI) thyroid nodules. METHODS This retrospective analysis of FNA samples, tested by ThyroSeq v3 using Genomic Classifier and Cancer Risk Classifier at UPMC Molecular and Genomic Pathology laboratory, analyzed the prevalence of diagnostic, prognostic, and targetable genetic alterations in a total of 50 734 BCIII-VI nodules from 48 225 patients. RESULTS Among 50 734 informative FNA samples, 65.3% were test-negative, 33.9% positive, 0.2% positive for medullary carcinoma, and 0.6% positive for parathyroid. The benign call rate in BCIII-IV nodules was 68%. Among test-positive samples, 73.3% had mutations, 11.3% gene fusions, and 10.8% isolated copy number alterations. Comparing BCIII-IV nodules with BCV-VI nodules revealed a shift from predominantly RAS-like alterations to BRAF V600E-like alterations and fusions involving receptor tyrosine kinases (RTK). Using ThyroSeq Cancer Risk Classifier, a high-risk profile, which typically included TERT or TP53 mutations, was found in 6% of samples, more frequently BCV-VI. RNA-Seq confirmed ThyroSeq detection of novel RTK fusions in 98.9% of cases. CONCLUSION In this series, 68% of BCIII-IV nodules were classified as negative by ThyroSeq, potentially preventing diagnostic surgery in this subset of patients. Specific genetic alterations were detected in most BCV-VI nodules, with a higher prevalence of BRAF and TERT mutations and targetable gene fusions compared to BCIII-IV nodules, offering prognostic and therapeutic information for patient management.
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Affiliation(s)
- Simion Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Steven P Hodak
- NYU Robert I. Grossman School of Medicine, NYU Langone Health, New York, NY 12297, USA
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Devaprabu Abraham
- Division of Endocrinology, Department of Internal Medicine, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Chelsey Baldwin
- Division of Endocrinology & Metabolism, George Washington University, Washington, DC 20037, USA
| | - Zubair Baloch
- Perelman School of Medicine Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA 19103, USA
| | - Seza A Gulec
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Zeina C Hannoush
- Division of Endocrinology, Diabetes and Metabolism. University of Miami, Miller School of Medicine, Miami, FL 33146, USA
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Lija Joseph
- Lowell General Hospital, Boston University and Tufts University, Lowell, MA 01854, USA
| | - Atil Y Kargi
- Division of Endocrinology, Diabetes and Metabolism. University of Miami, Miller School of Medicine, Miami, FL 33146, USA
| | - Elham Khanafshar
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Masha J Livhits
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | | | - Kepal Patel
- NYU Robert I. Grossman School of Medicine, NYU Langone Health, New York, NY 12297, USA
| | - Snehal G Patel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30342, USA
| | | | - Ashok R Shaha
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jyotirmay Sharma
- Department of Surgery, Emory University School of Medicine, Atlanta, GA 30342, USA
| | | | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Sally E Carty
- Division of Endocrine Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Marina N Nikiforova
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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Wahdan-Alaswad RS, Edgerton SM, Kim HM, Tan AC, Haugen BR, Liu B, Thor AD. Thyroid hormone enhances estrogen-mediated proliferation and cell cycle regulatory pathways in steroid receptor-positive breast Cancer. Cell Cycle 2023:1-20. [PMID: 37723865 DOI: 10.1080/15384101.2023.2249702] [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: 01/24/2023] [Accepted: 08/15/2023] [Indexed: 09/20/2023] Open
Abstract
Estrogen receptor (ER) α expression and associated signaling is a major driver of over two-thirds of all breast cancers (BC). ER targeting strategies are typically used as a first-line therapy in patients with steroid receptor positive (SR+) disease. Secondary resistance to anti-estrogenic agents may occur with clonal expansion and disease progression. Mechanisms underlying hormone resistance are an expanding field of significant translational importance. Cross-talk with other nuclear hormones, receptors, and signaling pathways, including thyroid hormones (TH) and their receptors (THRs), have been shown to promote endocrine therapy resistance in some studies. We have shown that TH replacement therapy (THRT) was independently and significantly associated with higher rates of relapse and mortality in SR positive (+), node-negative (LN-) BC patients, whereas it showed no association with outcomes in SR negative (-) patients. LN-, SR+ patients receiving THRT and tamoxifen had the worst outcomes, suggesting a pro-carcinogenic interaction that significantly and independently shortened survival and increased mortality. Using in vivo and in vitro models, we previously showed hormonal cross-talk, altered gene signaling, target gene activation, and resistance to tamoxifen in the presence of TH. In this report, we show TH ± E2 ± tamoxifen inhibits cell cycle control signaling, reduces apoptosis, and enhances cell proliferation, tumor growth, tamoxifen resistance, and clonal expansion. Mechanistically these changes involve numerous genes and pathways, including critical cell cycle regulatory proteins and genes identified using various molecular methods. These studies facilitate a greater mechanistic understanding of the biological and molecular impact of TH on SR+ BC.
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Affiliation(s)
- Reema S Wahdan-Alaswad
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Susan M Edgerton
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Hyun Min Kim
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Aik Choon Tan
- Department of Oncological Sciences and Biomedical Informatics, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Bryan R Haugen
- University of Colorado Cancer Center, Aurora, CO, USA
- Division of Endocrinology, Metabolism, & Diabetes, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | - Bolin Liu
- Department of Genetics, Stanley S. Scott Cancer Center, School of Medicine, Louisiana State University (LSU) Health Sciences Center, New Orleans, LA, USA
| | - Ann D Thor
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
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Barrio M, Raeburn CD, McIntyre R, Albuja-Cruz M, Haugen BR, Pozdeyev N. Computer-Assisted Levothyroxine Dose Selection for the Treatment of Postoperative Hypothyroidism. Thyroid 2023; 33:547-555. [PMID: 37084246 DOI: 10.1089/thy.2023.0033] [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] [Indexed: 04/22/2023]
Abstract
Background: Thyroid hormone replacement with levothyroxine (LT4) is a recommended treatment for patients undergoing thyroidectomy. The starting LT4 dose is frequently calculated based on the patient's weight. However, the weight-based LT4 dosing performs poorly in clinical practice, with only ∼30% of patients achieving target thyrotropin (TSH) levels at the first thyroid function testing after treatment initiation. A better way to calculate the LT4 dose for patients with postoperative hypothyroidism is needed. Methods: In this retrospective cohort study we used demographic, clinical, and laboratory data for 951 patients after thyroidectomy and several regression and classification machine learning methods to develop an LT4 dose calculator for treating postoperative hypothyroidism targeting the desired TSH level. We compared the accuracy with the current standard-of-care practice and other published algorithms and evaluated generalizability with fivefold cross-validation and out-of-sample testing. Results: The retrospective clinical chart review showed that only 285/951 (30%) patients met their postoperative TSH goal. Obese patients were overtreated with LT4. An ordinary least squares regression based on weight, height, age, sex, calcium supplementation, and height:sex interaction predicted prescribed LT4 dose in 43.5% of all patients and 45.3% of patients with normal postoperative TSH (0.45-4.5 mIU/L). The ordinal logistic regression, artificial neural networks regression/classification, and random forest methods achieved comparable performance. LT4 calculator recommended lower LT4 doses to obese patients. Conclusions: The standard-of-care LT4 dosing does not achieve the target TSH in most thyroidectomy patients. Computer-assisted LT4 dose calculation performs better by considering multiple relevant patient characteristics and providing personalized and equitable care to patients with postoperative hypothyroidism. Prospective validation of LT4 calculator performance in patients with various TSH goals is needed.
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Affiliation(s)
- Martin Barrio
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christopher D Raeburn
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Robert McIntyre
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maria Albuja-Cruz
- Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Jeon MJ, Haugen BR. Preclinical Models of Follicular Cell-Derived Thyroid Cancer: An Overview from Cancer Cell Lines to Mouse Models. Endocrinol Metab (Seoul) 2022; 37:830-838. [PMID: 36604954 PMCID: PMC9816502 DOI: 10.3803/enm.2022.1636] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022] Open
Abstract
The overall prognosis of thyroid cancer is excellent, but some patients have grossly invasive disease and distant metastases with limited responses to systemic therapies. Thus, relevant preclinical models are needed to investigate thyroid cancer biology and novel treatments. Different preclinical models have recently emerged with advances in thyroid cancer genetics, mouse modeling and new cell lines. Choosing the appropriate model according to the research question is crucial to studying thyroid cancer. This review will discuss the current preclinical models frequently used in thyroid cancer research, from cell lines to mouse models, and future perspectives on patient-derived and humanized preclinical models in this field.
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Affiliation(s)
- Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bryan R. Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Corresponding author: Bryan R. Haugen. Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 East 17th Avenue, Aurora, CO 80045, USA Tel: +1-303-724-3921, Fax: +1-303-724-3920, E-mail:
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8
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Clark T, Cohen T, Haugen BR, Subramanian D, Pozdeyev N, Dighe M, Barrio M, Leu MG. RF11 | PSAT234 Deep learning analysis of thyroid nodule ultrasound images has high sensitivity and negative predictive value to rule-out thyroid cancer. J Endocr Soc 2022. [PMCID: PMC9628735 DOI: 10.1210/jendso/bvac150.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To evaluate deep learning analysis of thyroid nodule ultrasound images as a rule-out test for thyroid malignancy. Methods Supervised deep learning (DL) classifier of thyroid nodules was trained on 32,545 thyroid US images from 621 nodules representing all major benign and malignant types of thyroid lesions and tested on an independent set of 145 nodules collected at a different healthcare system in the United States. The Big Transfer BiT-M ResNet-50×1 convolutional neural net architecture was modified to contain 3, 4, 6 and 3 PreActBottleneck units per block 1 through 4. Weights pretrained on the ImageNet-21k dataset were loaded and weights for blocks 3 and 4 were fine-tuned for the binary classification task of distinguishing benign and malignant thyroid nodules. Results The deep learning thyroid nodule classifier achieved an area under receiver operating characteristic curve (AUROC) of 0.889 on five-fold cross-validation. The AUROC improved when images were scaled by nodule size and six randomly selected cine clip frames were added to the training set per epoch. GradCAM class activation heatmaps revealed that microcalcifications and spongiform appearance were reliably recognized by the classifier as malignant and benign features, respectively. Spongiform nodules were found to be benign even when microcystic spaces constituted less than 50% of nodule volume. To investigate the clinical relevance of the benign vs. malignant classifier, the binary classification threshold for the probability of malignancy generated by model was set at 7% to achieve sensitivity and negative predictive value (NPV) comparable to that of the fine needle aspiration biopsy (FNA). At this threshold, cross-validated deep-learning model achieved a sensitivity of 90%, specificity of 63%, positive predictive value (PPV) of 46% and negative predictive value of 94%. When tested on an independent image set that includes 18 classic papillary thyroid cancers (PTC), 5 follicular variant PTC, 4 medullary thyroid cancers, 3 follicular thyroid cancers (FTC), and 1 Hurthle cell thyroid cancer, the DL classifier achieved AUROC of 0.88, sensitivity of 97%, specificity of 61%, PPV of 40% and NPV of 99%. A single minimally-invasive FTC that had no suspicious features on thyroid ultrasound was incorrectly classified as benign. Conclusions This study demonstrates that the ultrasound-based deep-learning classifier of thyroid nodules achieves sensitivity and negative predictive value comparable to that of thyroid fine needle aspiration (FNA). Clinicians may use this tool to augment clinical judgment when determining whether to perform FNA procedures. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:06 p.m. - 1:11 p.m.
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Mehta V, Naraparaju A, Liao D, Davies L, Haugen BR, Kopp PA, Mandel SJ, Nikiforov YE, Ross DS, Shin JJ, Tuttle RM, Randolph GW. What's in a Name? A Cost-Effectiveness Analysis of the Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features' Nomenclature Revision. Thyroid 2022; 32:421-428. [PMID: 34915744 PMCID: PMC9469743 DOI: 10.1089/thy.2021.0486] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: The noninvasive subtype of encapsulated follicular variant of papillary thyroid carcinoma (eFVPTC) has been reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in 2016 to reflect the indolent behavior and favorable prognosis of this type of tumor. This terminology change has also de-escalated its management approach from cancer treatment to a more conservative treatment strategy befitting a benign thyroid neoplasm. Objective: To characterize the reduced health care costs and improved quality of life (QOL) from management of NIFTP as a nonmalignant tumor compared with the previous management as eFVPTC. Methods: A cost-effectiveness analysis was performed by creating Markov models to simulate two management strategies for NIFTP: (i) de-escalated management of the tumor as NIFTP involving lobectomy with reduced follow-up, (ii) management of the tumor as eFVPTC involving completion thyroidectomy/radioactive iodine ablation for some patients, and follow-up recommended for carcinoma. The model was simulated for 5 and 20 years following diagnosis of NIFTP. Aggregate costs and quality-life years were measured. One-way sensitivity analysis was performed for all variables. Results: Over a five-year simulation period, de-escalated management of NIFTP had a total cost of $12,380.99 per patient while the more aggressive management of the tumor as eFVPTC had a total cost of $16,264.03 per patient (saving $3883.05 over five years). Management of NIFTP provided 5.00 quality-adjusted life years, whereas management as eFVPTC provided 4.97 quality-adjusted life years. Sensitivity analyses showed that management of NIFTP always resulted in lower costs and greater quality-adjusted life years (QALYs) over the sensitivity ranges for individual variables. De-escalated management for NIFTP is expected to produce ∼$6-42 million in cost savings over a five-year period for these patients, and incremental 54-370 QALYs of increased utility in the United States. Conclusion: The degree of cost savings and improved patient utility of de-escalated NIFTP management compared with traditional management was estimated to be $3883.05 and 0.03 QALYs per patient. We demonstrate that these findings persisted in sensitivity analysis to account for variability in recurrence rate, surveillance approaches, and other model inputs. These findings allow for greater understanding of the economic and QOL impact of the NIFTP reclassification.
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Affiliation(s)
- Vikas Mehta
- Otorhinolaryngology–Head & Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
- Address correspondence to: Vikas Mehta, MD, MPH, Otorhinolaryngology–Head & Neck Surgery, Montefiore Medical Center, 3400 Bainbridge Avenue, 3rd Floor MAP Bldg, Bronx, NY 10467, USA
| | | | - David Liao
- Otolaryngology–Head and Neck Surgery, Mount Sinai Medical Center, New York, New York, USA
| | - Louise Davies
- The VA Outcomes Group, White River Junction Department of Veterans Affairs, White River Junction, Vermont, USA
| | - Bryan R. Haugen
- Division of Endocrinology Metabolism and Diabetes, University of Colorado, Aurora, Colorado, USA
| | - Peter A. Kopp
- Division of Endocrinology Metabolism and Diabetes, University of Lausanne, Lausanne, Switzerland
- Division of Endocrinology Metabolism and Diabetes, Northwestern University, Chicago, Illinois, USA
| | - Susan J. Mandel
- Division of Endocrinology Metabolism and Diabetes, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas S. Ross
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer J. Shin
- Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Gregory W. Randolph
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Bertol BC, Bales ES, Calhoun JD, Mayberry A, Ledezma ML, Sams SB, Orlicky DJ, Donadi EA, Haugen BR, French JD. Lenvatinib Plus Anti-PD-1 Combination Therapy for Advanced Cancers: Defining Mechanisms of Resistance in an Inducible Transgenic Model of Thyroid Cancer. Thyroid 2022; 32:153-163. [PMID: 34641722 PMCID: PMC8861922 DOI: 10.1089/thy.2021.0371] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 02/03/2023]
Abstract
Background: Combination therapy with lenvatinib plus programmed death-1 (PD-1) immune checkpoint blockades (ICBs) is under investigation in many solid tumors, including thyroid cancer. Lenvatinib is known to reduce angiogenesis and may overturn the immunosuppressive effects of vascular endothelial growth factor in the tumor microenvironment. Previous studies investigating the effects of VEGF receptor inhibition on the immune response were performed in rapidly growing tumor models where immune equilibrium is not established before treatment. We hypothesize that physiologically relevant preclinical models are necessary to define mechanisms of resistance to immune-targeted combination therapies. Methods: We utilized the TPO-CreER/BrafV600E/wt/Trp53Δex2-10/Δex2-10 inducible transgenic model of advanced thyroid cancer to investigate lenvatinib treatment in the context of an anti-PD-1 ICB. Following tumor establishment, 3.5 months postinduction, mice were treated with high- (10 mg/kg) or low-dose (2 mg/kg) lenvatinib, anti-PD-1, or combination of lenvatinib with anti-PD-1. Tumor volume and lung metastases were assessed in each group. Immune infiltrate was characterized by flow cytometry and immunohistochemistry, and TCRß sequencing was performed to further investigate the T cell response. Results: Both low- and high-dose lenvatinib reduced tumor volume, while anti-PD-1 had no effect, alone or in combination. Although both low- and high-dose lenvatinib reduced vascular density, low-dose lenvatinib was superior in controlling tumor size. Lung metastases and survival were not improved with therapy despite the effects of lenvatinib on primary tumor size. Low-dose lenvatinib treatment led to a subtle reduction in the dominant Ly6G+CD11b+ myeloid cell population and was associated with increased CD4+ T cell infiltrate and enrichment in 4-1BB+ and granzyme B+ CD4+ T cells and FoxP3+ regulatory T cells. Polyclonal T cell expansion was evident in the majority of mice, suggesting that a tumor-specific T cell response was generated. Conclusions: The effects of lenvatinib on the immune response were most pronounced in mice treated with low-dose lenvatinib, suggesting that dose should be considered in clinical application. While the immune-modulating potential of lenvatinib is encouraging, alterations in the immune milieu and T cell activation status were insufficient to sustain durable tumor regression, even with added anti-PD-1. Additional studies are necessary to develop more effective combination approaches in low-mutation burden tumors, such as thyroid cancer.
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Affiliation(s)
- Bruna C. Bertol
- Postgraduate Program of Basic and Applied Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Aurora, Colorado, USA
| | - Elise S. Bales
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Aurora, Colorado, USA
| | - Jacob D. Calhoun
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Aurora, Colorado, USA
| | - Alanna Mayberry
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Aurora, Colorado, USA
| | - Melissa L. Ledezma
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Aurora, Colorado, USA
| | - Sharon B. Sams
- Department of Pathology; University of Colorado, Aurora, Colorado, USA
| | - David J. Orlicky
- Department of Pathology; University of Colorado, Aurora, Colorado, USA
| | - Eduardo A. Donadi
- Postgraduate Program of Basic and Applied Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Division of Clinical Immunology, Department of Medicine; Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Bryan R. Haugen
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Aurora, Colorado, USA
| | - Jena D. French
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, Aurora, Colorado, USA
- Address correspondence to: Jena D. French, PhD, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12801 E. 17th Avenue, RC1 South, 7401D, Campus Box 8106, Aurora, CO 80045, USA
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11
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Figge JJ, Gooding WE, Steward DL, Yip L, Sippel RS, Yang SP, Scheri RP, Sipos JA, Mandel SJ, Mayson SE, Burman KD, Folek JM, Haugen BR, Sosa JA, Parameswaran R, Tan WB, Nikiforov YE, Carty SE. Do Ultrasound Patterns and Clinical Parameters Inform the Probability of Thyroid Cancer Predicted by Molecular Testing in Nodules with Indeterminate Cytology? Thyroid 2021; 31:1673-1682. [PMID: 34340592 PMCID: PMC8917891 DOI: 10.1089/thy.2021.0119] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further inform the risk of thyroid cancer in nodules predicted to be positive or negative by MT remains unknown. The aim of this study was to test if clinical parameters, including patient age, sex, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] vs. American College of Radiology Thyroid Image Reporting and Data System [TI-RADS] systems), radiation exposure, or family history of thyroid cancer can modify the probability of thyroid cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) predicted by MT. Methods: We studied 257 thyroid nodules in 232 patients from 10 study centers with indeterminate fine needle aspiration cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression was used for data analysis. Results: The presence of cancer/NIFTP was associated with positive TSv3 results (odds ratio 61.39, p < 0.0001). On univariate regression, patient sex, age, and Bethesda category were associated with cancer/NIFTP probability (p < 0.05 for each). Although ATA (p = 0.1211) and TI-RADS (p = 0.1359) US categories demonstrated positive trends, neither was significantly associated with cancer/NIFTP probability. A multivariate regression model incorporating the four most informative non-MT covariates (sex, age, Bethesda category, and ATA US pattern; Model No. 1) yielded a C index of 0.653; R2 = 0.108. When TSv3 was added to Model number 1, the C index increased to 0.888; R2 = 0.572. However, age (p = 0.341), Bethesda category (p = 0.272), and ATA US pattern (p = 0.264) were nonsignificant, and other than TSv3 (p < 0.0001), male sex was the only non-MT parameter that potentially contributed to cancer/NIFTP risk (p = 0.095). The simplest and most efficient clinical model (No. 3) incorporated TSv3 and sex (C index = 0.889; R2 = 0.588). Conclusions: In this multicenter study of thyroid nodules with indeterminate cytology and MT, neither the ATA nor TI-RADS US scoring systems further informed the risk of cancer/NIFTP beyond that predicted by TSv3. Although age and Bethesda category were associated with cancer/NIFTP probability on univariate analysis, in sequential nomograms they provided limited incremental value above the high predictive ability of TSv3. Patient sex may contribute to cancer/NIFTP risk in thyroid nodules with indeterminate cytology.
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Affiliation(s)
- James J. Figge
- Diabetes & Endocrine Care, St. Peter's Health Partners/Trinity Health, Rensselaer, New York, USA
- Address correspondence to: James J. Figge, MD, MBA, Diabetes & Endocrine Care, St. Peter's Health Partners/Trinity Health, 279 Troy Road, Rensselaer, NY 12144, USA
| | - William E. Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - David L. Steward
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
- Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Randall P. Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jennifer A. Sipos
- Division of Endocrinology, Diabetes, and Metabolism, Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Susan J. Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah E. Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth D. Burman
- Endocrinology Section, Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | - Bryan R. Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie A. Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Boon Tan
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sally E. Carty
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Sally E. Carty, MD, Division of Endocrine Surgery, University of Pittsburgh, 101 Kauffmann, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
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12
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Abstract
The treatment of differentiated thyroid cancer continues to move away from a 'one size fits all' approach to a process of tailored therapeutic decision-making that incorporates disease-specific factors and individual patient preferences. Management options range from active surveillance to thyroid lobectomy to total thyroidectomy with or without the use of postoperative radioactive iodine (RAI). RAI may be administered for one or more reasons: Thyroid remnant ablation, adjuvant therapy, or therapy for persistent structural disease. It is important to be cognizant of the therapeutic intent of RAI and weigh the risks and benefits of treatment for each individual patient. Risk stratification should be used to identify those patients who are most likely to benefit from RAI and guide therapeutic choices. Available data suggest that RAI can be safely deferred for most patients considered at low risk for structural recurrence, while adjuvant RAI is associated with improved disease-free survival in patients with higher-risk disease. Although progress has been made, many areas of uncertainty related to the use of RAI remain. These include: (1) The appropriate selection of intermediate-risk patients to receive adjuvant RAI, (2) the superiority or inferiority of different RAI dosing activities, (3) the optimal approach to the use of RAI in special populations, including patients with end-stage renal disease and children, and (4) the management of patients with RAI-refractory disease.
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Affiliation(s)
- Sarah E Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christine M Chan
- Section of Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
- University of Colorado Cancer Center, Aurora, Colorado, USA
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13
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Wahdan-Alaswad RS, Edgerton SM, Salem H, Kim HM, Tan AC, Finlay-Schultz J, Wellberg EA, Sartorius CA, Jacobsen BM, Haugen BR, Liu B, Thor AD. Exogenous Thyroid Hormone Is Associated with Shortened Survival and Upregulation of High-Risk Gene Expression Profiles in Steroid Receptor-Positive Breast Cancers. Clin Cancer Res 2021; 27:585-597. [PMID: 33097494 DOI: 10.1158/1078-0432.ccr-20-2647] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Thyroid disease is a frequent comorbidity in women with breast cancer, and many require thyroid hormone replacement therapy (THRT). We postulated that THRT has a deleterious clinical effect mechanistically through hormonal interactions, nuclear receptor cross-talk, and upregulation of high-risk breast cancer genes. EXPERIMENTAL DESIGN Observational studies of patients with lymph node-negative (LN-) breast cancer (n = 820 and n = 160) were performed to test interactions between THRT and clinical, histologic, outcome, and treatment variables. Differences between the two cohorts include but are not limited to patient numbers, decades of treatment, duration of follow-up/treatment, tumor sizes, incidence, and type and dose/regimen of antihormonal and/or chemotherapeutic agents. In vivo and vitro models, in silico databases, and molecular methods were used to study interactions and define mechanisms underlying THRT effects. RESULTS THRT significantly and independently reduced disease-free and breast cancer-specific overall survival of only the steroid receptor (SR)-positive (as compared with SR-negative) node-negative patients in both long-term observational studies. Patients with SR+ LN- breast cancer who received THRT and tamoxifen experienced the shortest survival of all treatment groups. A less potent interaction between THRT and aromatase inhibitors was noted in the second patient cohort. Using in vivo and in vitro models, TH administration enhanced estrogen and TH-associated gene expression and proliferation, nuclear colocalization of estrogen receptor and thyroid hormone receptor, and activation of genes used clinically to predict tumor aggression in SR+ breast cancer, including the IGF-IR, WNT, and TGFβ pathways. CONCLUSIONS We show clinically significant adverse interactions between THRT, estrogenic, and oncogenic signaling in patients with SR+ LN- breast cancer.
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Affiliation(s)
- Reema S Wahdan-Alaswad
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Susan M Edgerton
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Hiba Salem
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Hyun Min Kim
- University of Colorado Cancer Center, Aurora, Colorado
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Aik Choon Tan
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Jessica Finlay-Schultz
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Elizabeth A Wellberg
- Department of Pathology, University of Oklahoma Health and Sciences, Oklahoma City, Oklahoma
| | - Carol A Sartorius
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Britta M Jacobsen
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Bryan R Haugen
- University of Colorado Cancer Center, Aurora, Colorado
- Division of Endocrinology, Metabolism, & Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Bolin Liu
- Department of Genetics, Stanley S. Scott Cancer Center, School of Medicine, Louisiana State University (LSU) Health Sciences Center, New Orleans, Louisiana
| | - Ann D Thor
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
- University of Colorado Cancer Center, Aurora, Colorado
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Sawka AM, Alexander EK, Bianco AC, Chou R, Haugen BR, Kopp PA, Pearce EN, Ross DS, Smallridge RC, Jonklaas J. Challenges in Developing Recommendations Based on Low-Quality Evidence in Thyroid Guidelines. Thyroid 2021; 31:3-7. [PMID: 32900277 DOI: 10.1089/thy.2020.0448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/17/2022]
Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, University Health Network, University of Toronto, Toronto, Canada
| | - Erik K Alexander
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Antonio C Bianco
- Section of Endocrinology and Metabolism, University of Chicago, Chicago, Illinois, USA
| | - Roger Chou
- Department of Medicine, and Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Bryan R Haugen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter A Kopp
- Division of Endocrinology, University of Lausanne, Lausanne, Switzerland
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth N Pearce
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Douglas S Ross
- Division of Endocrinology, Harvard University and Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, District of Columbia, USA
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Abstract
Background: Despite advances in targeted kinase inhibitor development for patients with medullary thyroid cancer (MTC), most patients develop resistance and would benefit from alternative approaches. Immune-based therapies are now considered for patients with progressive MTC. This study is the first comprehensive assessment of the immune milieu, immune-suppressive molecules, and potential tumor antigens in patients with MTC. Methods: Primary and/or regionally metastatic tumor tissues from 46 patients with MTC were screened for immune infiltrates by using standard immunohistochemistry (IHC) and further analyzed by multispectral imaging for T cell and myeloid markers. RNASeq expression profiling was performed in parallel. RNASeq, targeted sequencing, and IHC techniques identified cancer-associated mutations and MTC-enriched proteins. Results: Organized immune infiltration was observed in 49% and 90% of primary and metastatic tumors, respectively. CD8+ cells were the dominant T cell subtype in most samples, while CD163+ macrophages were most frequent among myeloid infiltrates. PD-1+ T cells were evident in 24% of patients. Myeloid subsets were largely major histocompatibility complex II (MHCII-), suggesting a dysfunctional phenotype. Expression profiling confirmed enrichment in T cell, macrophage, and inflammatory profiles in a subset of samples. PD-L1 was expressed at low levels in a small subset of patients, while the immune regulatory molecules CD155 and CD47 were broadly expressed. Calcitonin, GRP, HIST1H4E, NOMO3, and NPIPA2 were highly and specifically expressed in MTC. Mutations in tumor suppressors, PTEN and p53, and mismatch repair genes, MSH2 and MSH6, may be relevant to disease progression and antigenicity. Conclusions: This study suggests that MTC is a more immunologically active tumor that has been previously reported. Patients with advanced MTC should be screened for targetable antigens and immune checkpoints to determine their eligibility for current clinical trials. Additional studies are necessary to fully characterize the antigenic potential of MTC and may encourage the development of adoptive T cells therapies for this rare tumor.
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Affiliation(s)
- Nikita Pozdeyev
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Timothy A. Erickson
- Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, Oregon, USA
| | - Lian Zhang
- Department of Pathology, University of Colorado Denver, Aurora, Colorado, USA
| | - Kim Ellison
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Christopher J. Rivard
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Sharon Sams
- Department of Pathology, University of Colorado Denver, Aurora, Colorado, USA
| | - Fred R. Hirsch
- Department of Pathology, University of Colorado Denver, Aurora, Colorado, USA
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, Colorado, USA
| | - Bryan R. Haugen
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, Colorado, USA
| | - Jena D. French
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Denver, Aurora, Colorado, USA
- University of Colorado Cancer Center, University of Colorado Denver, Aurora, Colorado, USA
- Address correspondence to: Jena D. French, PhD, Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, 12801 East 17th Avenue, RC1 South, 7401D, Campus Box 8106, Aurora, CO 80045, USA
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16
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Davis SN, Haugen BR. Ultrasound-Guided Orthotopic Injections of Thyroid Cancer Cell Lines in Mice. VideoEndocrinology 2020. [DOI: 10.1089/ve.2020.0185] [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: 11/13/2022] Open
Affiliation(s)
- Stephanie N. Davis
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Bryan R. Haugen
- Division of Endocrinology, Metabolism, and Diabetes, Departments of Medicine and Pathology, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, Colorado, USA
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17
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Sawka AM, Gagliardi AR, Haymart MR, Sturgeon C, Bernet V, Hoff K, Angelos P, Brito JP, Haugen BR, Kim B, Kopp PA, Mandel SJ, Ross DS, Samuels M, Sarne D, Sinclair C, Jonklaas J. A Survey of American Thyroid Association Members Regarding the 2015 Adult Thyroid Nodule and Differentiated Thyroid Cancer Clinical Practice Guidelines. Thyroid 2020; 30:25-33. [PMID: 31830853 DOI: 10.1089/thy.2019.0486] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The 2015 American Thyroid Association (ATA) clinical practice guidelines (CPGs) on management of thyroid nodules (TNs) and differentiated thyroid cancer (DTC) in adults were developed to inform clinicians, patients, researchers, and health policy makers about the best available evidence, and its limitations, relating to management of these conditions. Methods: We conducted a cross-sectional electronic survey of ATA members' perspectives of these CPGs, using a standardized survey (Clinician Guidelines Determinant Questionnaire) developed by the Guidelines International Network. A survey link was electronically mailed to members in February of 2019, with reminders sent to nonrespondents 2 and 5 weeks later. Data were descriptively summarized, after excluding missing responses. Results: The overall response rate was 19.8% (348/1761). The effective response rate was 20.2% (348/1720), after excluding a recently deceased member and individuals who had either invalid e-mail addresses or whose e-mails were returned. Of the respondents, 37.9% (132/348) were female, 60.4% (209/346) were endocrinologists, 27.5% (95/346) were surgeons, and 3.5% (12/346) were nuclear medicine specialists. The majority of respondents (71.9%; 250/348) were at a mid- or advanced-career level, and more than half were in academia (57.5%; 195/339). The majority (69.8%; 243/348) practiced in North America. The vast majority of respondents indicated that the CPGs explained the underlying evidence (92.3%; 298/323) and 92.9% (300/323) agreed or strongly agreed with the content. Most respondents stated that they regularly used the CPGs in their practice (83.0%; 268/323). Most respondents (83.0%; 268/323) also agreed or strongly agreed that the recommendations were easy to incorporate in their practice. The most popular CPG format was an electronic desktop file (78.8%; 252/320). Shorter more frequent CPGs were favored by 55.0% (176/320) of respondents, and longer traditional CPGs were favored by 39.7% (127/320). Conclusions: The clinical content and evidence explanations in the adult TN and DTC CPGs are widely accepted and applied among ATA survey respondents. Future ATA CPG updates need to be optimized to best meet users' preferences regarding format, frequency, and length.
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Affiliation(s)
- Anna M Sawka
- Division of Endocrinology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Megan R Haymart
- Division of Endocrinology, University of Michigan, Ann Arbor, Michigan
| | - Cord Sturgeon
- Division of Endocrine Surgery, Northwestern University, Chicago, Illinois
| | - Victor Bernet
- Division of Endocrinology, Mayo Clinic, Jacksonville, Florida
| | - Kelly Hoff
- American Thyroid Association, Falls Church, Virginia
| | - Peter Angelos
- Division of Endocrine Surgery, General Surgery, University of Chicago, Chicago, Illinois
| | - Juan P Brito
- Division of Endocrinology and Knowledge Evaluation and Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Bryan R Haugen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian Kim
- Division of Endocrinology, Rush University, Chicago, Illinois
| | - Peter A Kopp
- Division of Endocrinology, University of Lausanne, Lausanne, Switzerland
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Chicago, Illinois
| | - Susan J Mandel
- Division of Endocrinology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Douglas S Ross
- Division of Endocrinology, Harvard Medical School, Boston, Massachusetts
| | - Mary Samuels
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health Sciences University, Portland, Oregon
| | - David Sarne
- Division of Endocrinology, University of Chicago, Chicago, Illinois
| | - Catherine Sinclair
- Department of Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jacqueline Jonklaas
- Division of Endocrinology, Georgetown University Medical Center, Washington, District of Columbia
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18
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Steward DL, Carty SE, Sippel RS, Yang SP, Sosa JA, Sipos JA, Figge JJ, Mandel S, Haugen BR, Burman KD, Baloch ZW, Lloyd RV, Seethala RR, Gooding WE, Chiosea SI, Gomes-Lima C, Ferris RL, Folek JM, Khawaja RA, Kundra P, Loh KS, Marshall CB, Mayson S, McCoy KL, Nga ME, Ngiam KY, Nikiforova MN, Poehls JL, Ringel MD, Yang H, Yip L, Nikiforov YE. Performance of a Multigene Genomic Classifier in Thyroid Nodules With Indeterminate Cytology: A Prospective Blinded Multicenter Study. JAMA Oncol 2019; 5:204-212. [PMID: 30419129 PMCID: PMC6439562 DOI: 10.1001/jamaoncol.2018.4616] [Citation(s) in RCA: 259] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Question Can the diagnosis of benign disease or cancer in thyroid nodules with indeterminate cytology be established by molecular testing instead of diagnostic surgery? Findings This prospective, blinded, multicenter cohort study of a multigene genomic classifier (ThyroSeq v3) test included 257 indeterminate cytology thyroid nodules with informative test results. It demonstrated a high sensitivity (94%) and reasonably high specificity (82%), with 61% of the nodules yielding a negative test result and only 3% residual cancer risk in these nodules. Meanings Up to 61% of patients with indeterminate cytology thyroid nodules may avoid diagnostic surgery by undergoing multigene genomic classifier testing. Importance Approximately 20% of fine-needle aspirations (FNA) of thyroid nodules have indeterminate cytology, most frequently Bethesda category III or IV. Diagnostic surgeries can be avoided for these patients if the nodules are reliably diagnosed as benign without surgery. Objective To determine the diagnostic accuracy of a multigene classifier (GC) test (ThyroSeq v3) for cytologically indeterminate thyroid nodules. Design, Setting, and Participants Prospective, blinded cohort study conducted at 10 medical centers, with 782 patients with 1013 nodules enrolled. Eligibility criteria were met in 256 patients with 286 nodules; central pathology review was performed on 274 nodules. Interventions A total of 286 FNA samples from thyroid nodules underwent molecular analysis using the multigene GC (ThyroSeq v3). Main Outcomes and Measures The primary outcome was diagnostic accuracy of the test for thyroid nodules with Bethesda III and IV cytology. The secondary outcome was prediction of cancer by specific genetic alterations in Bethesda III to V nodules. Results Of the 286 cytologically indeterminate nodules, 206 (72%) were benign, 69 (24%) malignant, and 11 (4%) noninvasive follicular thyroid neoplasms with papillary-like nuclei (NIFTP). A total of 257 (90%) nodules (154 Bethesda III, 93 Bethesda IV, and 10 Bethesda V) had informative GC analysis, with 61% classified as negative and 39% as positive. In Bethesda III and IV nodules combined, the test demonstrated a 94% (95% CI, 86%-98%) sensitivity and 82% (95% CI, 75%-87%) specificity. With a cancer/NIFTP prevalence of 28%, the negative predictive value (NPV) was 97% (95% CI, 93%-99%) and the positive predictive value (PPV) was 66% (95% CI, 56%-75%). The observed 3% false-negative rate was similar to that of benign cytology, and the missed cancers were all low-risk tumors. Among nodules testing positive, specific groups of genetic alterations had cancer probabilities varying from 59% to 100%. Conclusions and Relevance In this prospective, blinded, multicenter study, the multigene GC test demonstrated a high sensitivity/NPV and reasonably high specificity/PPV, which may obviate diagnostic surgery in up to 61% of patients with Bethesda III to IV indeterminate nodules, and up to 82% of all benign nodules with indeterminate cytology. Information on specific genetic alterations obtained from FNA may help inform individualized treatment of patients with a positive test result.
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Affiliation(s)
- David L Steward
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Sally E Carty
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennslyvania
| | | | - Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Julie A Sosa
- Section of Endocrine Surgery, Department of Surgery, Duke Cancer Institute and Duke Clinical Research Institute, Duke University, Durham, North Carolina.,Department of Surgery, University of California, San Francisco
| | - Jennifer A Sipos
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University School of Medicine, Columbus
| | - James J Figge
- Diabetes & Endocrine Care, St Peter's Health Partners, Rensselaer, New York
| | - Susan Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora
| | - Kenneth D Burman
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Zubair W Baloch
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ricardo V Lloyd
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison
| | - Raja R Seethala
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Simion I Chiosea
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Cristiane Gomes-Lima
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Robert L Ferris
- Departments of Otolaryngology and Immunology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania
| | - Jessica M Folek
- Diabetes & Endocrine Care, St Peter's Health Partners, Rensselaer, New York
| | - Raheela A Khawaja
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University School of Medicine, Columbus
| | - Priya Kundra
- Department of Medicine, Endocrinology Section, MedStar Washington Hospital Center, Washington, DC
| | - Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora
| | - Kelly L McCoy
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennslyvania
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore
| | - Kee Yuan Ngiam
- Department of General Surgery, University Surgical Cluster, National University Hospital, Singapore
| | | | - Jennifer L Poehls
- Division of Endocrinology, Diabetes & Metabolism, University of Wisconsin, Madison
| | - Matthew D Ringel
- Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University School of Medicine, Columbus
| | - Huaitao Yang
- Department Pathology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennslyvania
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
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19
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Landa I, Pozdeyev N, Knauf JA, Haugen BR, Fagin JA, Schweppe RE. Genetics of Human Thyroid Cancer Cell Lines-Response. Clin Cancer Res 2019; 25:6883-6884. [PMID: 31732665 DOI: 10.1158/1078-0432.ccr-19-2531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/05/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Iñigo Landa
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Division of Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,University of Colorado Cancer Center, Aurora, Colorado
| | - Jeffrey A Knauf
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,University of Colorado Cancer Center, Aurora, Colorado
| | - James A Fagin
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca E Schweppe
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,University of Colorado Cancer Center, Aurora, Colorado
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20
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Abstract
The historical management approach for many patients with indeterminate thyroid nodule fine needle aspiration cytology is a diagnostic lobectomy or thyroidectomy. However, the majority of patients undergo surgery unnecessarily, because most are proven to have benign disease on histology. Molecular testing is a diagnostic tool that can be used to help guide the clinical management of thyroid nodules with indeterminate cytology results. Testing has evolved substantially over the last decade with significant advances in testing methodology and improvements in our understanding of the genetic basis of thyroid cancer.
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Affiliation(s)
- Sarah E Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, MS 8106, 12801 East 17th Avenue, Aurora, CO 80045, USA.
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, MS 8106, 12801 East 17th Avenue, Aurora, CO 80045, USA
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21
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Landa I, Pozdeyev N, Korch C, Marlow LA, Smallridge RC, Copland JA, Henderson YC, Lai SY, Clayman GL, Onoda N, Tan AC, Garcia-Rendueles MER, Knauf JA, Haugen BR, Fagin JA, Schweppe RE. Comprehensive Genetic Characterization of Human Thyroid Cancer Cell Lines: A Validated Panel for Preclinical Studies. Clin Cancer Res 2019; 25:3141-3151. [PMID: 30737244 DOI: 10.1158/1078-0432.ccr-18-2953] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/26/2018] [Accepted: 02/06/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Thyroid cancer cell lines are valuable models but have been neglected in pancancer genomic studies. Moreover, their misidentification has been a significant problem. We aim to provide a validated dataset for thyroid cancer researchers. EXPERIMENTAL DESIGN We performed next-generation sequencing (NGS) and analyzed the transcriptome of 60 authenticated thyroid cell lines and compared our findings with the known genomic defects in human thyroid cancers. RESULTS Unsupervised transcriptomic analysis showed that 94% of thyroid cell lines clustered distinctly from other lineages. Thyroid cancer cell line mutations recapitulate those found in primary tumors (e.g., BRAF, RAS, or gene fusions). Mutations in the TERT promoter (83%) and TP53 (71%) were highly prevalent. There were frequent alterations in PTEN, PIK3CA, and of members of the SWI/SNF chromatin remodeling complex, mismatch repair, cell-cycle checkpoint, and histone methyl- and acetyltransferase functional groups. Copy number alterations (CNA) were more prevalent in cell lines derived from advanced versus differentiated cancers, as reported in primary tumors, although the precise CNAs were only partially recapitulated. Transcriptomic analysis showed that all cell lines were profoundly dedifferentiated, regardless of their derivation, making them good models for advanced disease. However, they maintained the BRAFV600E versus RAS-dependent consequences on MAPK transcriptional output, which correlated with differential sensitivity to MEK inhibitors. Paired primary tumor-cell line samples showed high concordance of mutations. Complete loss of p53 function in TP53 heterozygous tumors was the most prominent event selected during in vitro immortalization. CONCLUSIONS This cell line resource will help inform future preclinical studies exploring tumor-specific dependencies.
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Affiliation(s)
- Iñigo Landa
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Division of Biomedical Informatics and Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Laura A Marlow
- Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida
| | - Robert C Smallridge
- Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida.,Division of Endocrinology, Internal Medicine Department, Mayo Clinic, Jacksonville, Florida
| | - John A Copland
- Department of Cancer Biology, Mayo Clinic, Jacksonville, Florida
| | - Ying C Henderson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Naoyoshi Onoda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Aik Choon Tan
- University of Colorado Cancer Center, Aurora, Colorado
| | | | - Jeffrey A Knauf
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - James A Fagin
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rebecca E Schweppe
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado. .,Department of Medicine, Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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22
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Schweppe RE, Pozdeyev N, Pike LA, Korch C, Zhou Q, Sams SB, Sharma V, Pugazhenthi U, Raeburn C, Albuja-Cruz MB, Reigan P, LaBarbera DV, Landa I, Knauf JA, Fagin JA, Haugen BR. Establishment and Characterization of Four Novel Thyroid Cancer Cell Lines and PDX Models Expressing the RET/PTC1 Rearrangement, BRAFV600E, or RASQ61R as Drivers. Mol Cancer Res 2019; 17:1036-1048. [PMID: 30733375 DOI: 10.1158/1541-7786.mcr-18-1026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/12/2018] [Accepted: 02/04/2019] [Indexed: 01/04/2023]
Abstract
Cancer cell lines are critical models to study tumor progression and response to therapy. In 2008, we showed that approximately 50% of thyroid cancer cell lines were redundant or not of thyroid cancer origin. We therefore generated new authenticated thyroid cancer cell lines and patient-derived xenograft (PDX) models using in vitro and feeder cell approaches, and characterized these models in vitro and in vivo. We developed four thyroid cancer cell lines, two derived from 2 different patients with papillary thyroid cancer (PTC) pleural effusions, CUTC5, and CUTC48; one derived from a patient with anaplastic thyroid cancer (ATC), CUTC60; and one derived from a patient with follicular thyroid cancer (FTC), CUTC61. One PDX model (CUTC60-PDX) was also developed. Short tandem repeat (STR) genotyping showed that each cell line and PDX is unique and match the original patient tissue. The CUTC5 and CUTC60 cells harbor the BRAF (V600E) mutation, the CUTC48 cell line expresses the RET/PTC1 rearrangement, and the CUTC61 cells have the HRAS (Q61R) mutation. Moderate to high levels of PAX8 and variable levels of NKX2-1 were detected in each cell line and PDX. The CUTC5 and CUTC60 cell lines form tumors in orthotopic and flank xenograft mouse models. IMPLICATIONS: We have developed the second RET/PTC1-expressing PTC-derived cell line in existence, which is a major advance in studying RET signaling. We have further linked all cell lines to the originating patients, providing a set of novel, authenticated thyroid cancer cell lines and PDX models to study advanced thyroid cancer.
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Affiliation(s)
- Rebecca E Schweppe
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado. .,University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nikita Pozdeyev
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura A Pike
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christopher Korch
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Qiong Zhou
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sharon B Sams
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Vibha Sharma
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Umarani Pugazhenthi
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Christopher Raeburn
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maria B Albuja-Cruz
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Philip Reigan
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel V LaBarbera
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Iñigo Landa
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jeffrey A Knauf
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - James A Fagin
- Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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23
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Meltzer CJ, Irish J, Angelos P, Busaidy NL, Davies L, Dwojak S, Ferris RL, Haugen BR, Harrell RM, Haymart MR, McIver B, Mechanick JI, Monteiro E, Morris JC, Morris LGT, Odell M, Scharpf J, Shaha A, Shin JJ, Shonka DC, Thompson GB, Tuttle RM, Urken ML, Wiseman SM, Wong RJ, Randolph G. American Head and Neck Society Endocrine Section clinical consensus statement: North American quality statements and evidence-based multidisciplinary workflow algorithms for the evaluation and management of thyroid nodules. Head Neck 2018; 41:843-856. [PMID: 30561068 DOI: 10.1002/hed.25526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/28/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Care for patients with thyroid nodules is complex and multidisciplinary, and research demonstrates variation in care. The objective was to develop clinical guidelines and quality metrics to reduce unwarranted variation and improve quality. METHODS Multidisciplinary expert consensus and modified Delphi approach. Source documents were workflow algorithms from Kaiser Permanente Northern California and Cancer Care of Ontario based on the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. RESULTS A consensus-based, unified preoperative, perioperative, and postoperative workflow was developed for North American use. Twenty-one panelists achieved consensus on 16 statements about workflow-embedded process and outcomes metrics addressing safety, access, appropriateness, efficiency, effectiveness, and patient centeredness of care. CONCLUSION A panel of Canadian and United States experts achieved consensus on workflows and quality metric statements to help reduce unwarranted variation in care, improving overall quality of care for patients diagnosed with thyroid nodules.
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Affiliation(s)
- Charles J Meltzer
- The Permanente Medical Group, Kaiser Permanente, Santa Rosa, California
| | - Jonathan Irish
- Department of Otolaryngology, Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - Peter Angelos
- Department of Surgery, MacLean Center for Clinical Ethics, The University of Chicago Medicine, Chicago, Illinois
| | - Naifa L Busaidy
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Louise Davies
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.,Section of Otolaryngology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Sunshine Dwojak
- Northwest Permanente Medicine, Kaiser Permanente, Portland, Oregon
| | - Robert L Ferris
- Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Bryan R Haugen
- Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Richard M Harrell
- Departments of Integrative Endocrine Surgery and Pathology, Memorial Healthcare System, Hollywood, Florida
| | - Megan R Haymart
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bryan McIver
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jeffrey I Mechanick
- Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, Mount Sinai School of Medicine, New York, New York
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John C Morris
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Scharpf
- Department of Otolaryngology-Head and Neck Surgery, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ashok Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jennifer J Shin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia
| | | | - R Michael Tuttle
- Department of Medicine, Endocrinology Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark L Urken
- Department of Otolaryngology Head and Neck Surgery, Mount Sinai Beth Israel, New York, New York.,Icahn School of Medicine, Mount Sinai, New York, New York.,Thyroid, Head and Neck Cancer Foundation, New York, New York
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts General Hospital, Boston, Massachusetts
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24
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Deaver KE, Haugen BR, Pozdeyev N, Marshall CB. Outcomes of Bethesda categories III and IV thyroid nodules over 5 years and performance of the Afirma gene expression classifier: A single-institution study. Clin Endocrinol (Oxf) 2018; 89:226-232. [PMID: 29791966 DOI: 10.1111/cen.13747] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The second edition Bethesda System for Reporting Thyroid Cytology estimates 6%-18% malignancy rate of category III (B3) and 10%-40% for category IV (B4) nodules; however, reported malignancy rates have considerable variability among institutions. Use of molecular classifiers (including Afirma Gene Expression Classifier, GEC) can be utilized in management of thyroid nodules. Our objective was to analyse malignancy rates of B3 and B4 nodules and determine clinical outcomes of GEC Benign nodules. METHODS A retrospective analysis of 2019 thyroid FNAs was performed at the University of Colorado from 2011 to 2015, including molecular, surgical and clinical follow-up. RESULTS Of 2019 FNAs analysed, 231 (11.4%) were diagnosed as B3 and 80 (4.0%) as B4. GEC was obtained in 54.1% of B3 cases, with nearly half (48.8%) having a Benign result. Surgery was performed in 40.7% B3 cases with a 24.5% malignancy rate, ranging 8%-38% by year. In the B4 group, 52.5% underwent molecular testing with 28.6% as GEC Benign. About 68.8% of B4 cases underwent surgery with a 20% malignancy rate, ranging 0%-42% by year. Seventy-three GEC Benign cases were reviewed: 5 (6.8%) underwent surgery, with none demonstrating malignancy in the target nodule. Size remained stable for most GEC Benign nodules: 75.9% (B3) and 71.4% (B4) with no malignancy on repeat FNA. CONCLUSIONS Our 5-year review demonstrated that malignancy rates of B3 and B4 nodules showed year-to-year variability. We suggest that clinicians use a multi-year average of their institution's malignancy rates to optimally manage patients. Follow-up for GEC Benign cases thus far supports their indolent nature.
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Affiliation(s)
- Kelsi E Deaver
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Nikita Pozdeyev
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carrie B Marshall
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
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Pozdeyev N, Gay LM, Sokol ES, Hartmaier R, Deaver KE, Davis S, French JD, Borre PV, LaBarbera DV, Tan AC, Schweppe RE, Fishbein L, Ross JS, Haugen BR, Bowles DW. Genetic Analysis of 779 Advanced Differentiated and Anaplastic Thyroid Cancers. Clin Cancer Res 2018; 24:3059-3068. [PMID: 29615459 PMCID: PMC6030480 DOI: 10.1158/1078-0432.ccr-18-0373] [Citation(s) in RCA: 311] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 01/25/2023]
Abstract
Purpose: To define the genetic landscape of advanced differentiated and anaplastic thyroid cancer (ATC) and identify genetic alterations of potential diagnostic, prognostic, and therapeutic significance.Experimental Design: The genetic profiles of 583 advanced differentiated and 196 ATCs generated with targeted next-generation sequencing cancer-associated gene panels MSK-IMPACT and FoundationOne were analyzed.Results: ATC had more genetic alterations per tumor, and pediatric papillary thyroid cancer had fewer genetic alterations per tumor when compared with other thyroid cancer types. DNA mismatch repair deficit and activity of APOBEC cytidine deaminases were identified as mechanisms associated with high mutational burden in a subset of differentiated thyroid cancers and ATCs. Copy number losses and mutations of CDKN2A and CDKN2B, amplification of CCNE1, amplification of receptor tyrosine kinase genes KDR, KIT, and PDGFRA, amplification of immune evasion genes CD274, PDCD1LG2, and JAK2, and activating point mutations in small GTPase RAC1 were associated with ATC. An association of KDR, KIT, and PDGFRA amplification with the sensitivity of thyroid cancer cells to lenvatinib was shown in vitro Three genetically distinct types of ATCs are proposed.Conclusions: This large-scale analysis describes genetic alterations in a cohort of thyroid cancers enriched in advanced cases. Many novel genetic events previously not seen in thyroid cancer were found. Genetic alterations associated with anaplastic transformation were identified. An updated schematic of thyroid cancer genetic evolution is proposed. Clin Cancer Res; 24(13); 3059-68. ©2018 AACR.
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Affiliation(s)
- Nikita Pozdeyev
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laurie M Gay
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ethan S Sokol
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan Hartmaier
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kelsi E Deaver
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie Davis
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- University of Colorado Cancer Center, Aurora, Colorado
| | - Jena D French
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Pierre Vanden Borre
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel V LaBarbera
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Foundation Medicine Inc., Cambridge, Massachusetts
| | - Aik-Choon Tan
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca E Schweppe
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Lauren Fishbein
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jeffrey S Ross
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Departments of Pathology and Urology, Upstate Medical University, Syracuse, New York
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel W Bowles
- Department of Pharmaceutical Sciences, Skaags School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Sawka AM, Carty SE, Haugen BR, Hennessey JV, Kopp PA, Pearce EN, Sosa JA, Tufano RP, Jonklaas J. American Thyroid Association Guidelines and Statements: Past, Present, and Future. Thyroid 2018; 28:692-706. [PMID: 29698130 DOI: 10.1089/thy.2018.0070] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 02/06/2023]
Abstract
BACKGROUND The American Thyroid Association (ATA) is continually striving to improve the quality of its publications. The ATA Guidelines Policies and Procedures Task Force was active during 2017. It recently recommended convening a formal standing committee to review and update policies and procedures for the development of clinical practice guidelines (CPGs) and Statements on an ongoing basis. OBJECTIVE This statement reviews the history of official ATA publications and discusses the challenges and findings identified by the Task Force. We also wish to present our "work in progress" and propose future directions for the new ATA Guidelines and Statements Committee (ATA GSC). METHODS Our Task Force reviewed the publication record of the ATA with respect to CPGs. We also reviewed existing ATA policies for CPGs and other official statements, examined policies of other organizations, solicited input from external experts and organizations, and convened five conference calls and two in-person meetings. RESULTS The ATA has a rich history of developing official publications that have been influential based on download and citation records as well as changes in practice trends. Key future issues to be further addressed by the ATA GSC include the following: (i) striving to improve the methodologic rigor of development of CPGs while balancing considerations of feasibility and timeliness and the role of transparently communicated expert opinion; (ii) formalizing a framework and process for development of new Statements; (iii) increasing stringency and transparency of management of competing interests of individuals being considered for CPG/Statement panel membership; (iv) encouraging consideration of equity and diversity in CPG/Statement development group composition; (v) increasing relevant stakeholder representation (including patient representatives) in development of CPGs/Statements; and (vi) expanding future guideline implementation strategies. CONCLUSIONS As shown by the completed literature search, the ATA has a long history of producing CPGs and Statements with global impact on informing clinical management, education, and research in thyroid diseases. The ATA remains committed to a process of continual improvement of its publications and to meeting stakeholder information needs. Based on the work of our Task Force, we have identified many elements that are needed to achieve this goal and areas of challenge for our new committee.
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Affiliation(s)
- Anna M Sawka
- 1 University Health Network, University of Toronto , Toronto, Ontario, Canada
| | - Sally E Carty
- 2 Division of Endocrine Surgery, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Bryan R Haugen
- 3 Division of Endocrinology, University of Colorado School of Medicine , Aurora, Colorado
| | - James V Hennessey
- 4 Division of Endocrinology, Harvard Medical School , Division of Endocrinology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peter A Kopp
- 5 Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University , Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth N Pearce
- 6 Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine , Boston, Massachusetts
| | - Julie A Sosa
- 7 Departments of Surgery and Medicine, Duke Cancer Institute and Duke Clinical Research Institute, Duke University Medical Center , Durham, North Carolina
| | - Ralph P Tufano
- 8 Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine , Baltimore, Maryland
| | - Jacqueline Jonklaas
- 9 Division of Endocrinology, Georgetown University Medical Center , Washington, DC
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Giordano TJ, Haugen BR, Sherman SI, Shah MH, Caoili EM, Koenig RJ. Pioglitazone Therapy of PAX8-PPARγ Fusion Protein Thyroid Carcinoma. J Clin Endocrinol Metab 2018; 103:1277-1281. [PMID: 29373711 PMCID: PMC6456920 DOI: 10.1210/jc.2017-02533] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/19/2018] [Indexed: 01/17/2023]
Abstract
CONTEXT A subset of thyroid carcinomas expresses an oncogenic paired box 8 (PAX8) and peroxisome proliferator activated receptor γ (PPARγ) fusion protein (PPFP). The PPARγ/PPFP ligand pioglitazone is highly therapeutic in a transgenic mouse model of PPFP thyroid carcinoma, but whether pioglitazone is therapeutic in patients with PPFP thyroid carcinoma is unknown. CASE DESCRIPTION Tumor blocks from 40 patients with progressive thyroid cancer despite standard-of-care therapy were screened for PPFP, and the tumor from only one patient (2.5%) was positive. The patient had a 6.0-cm acetabular soft tissue metastasis from Hürthle cell carcinoma that caused severe pain on weight bearing and had a serum thyroglobulin level of 1974 ng/mL. After 24 weeks of therapy with pioglitazone, the metastatic lesion was 3.9 cm, the thyroglobulin level was 49.4 ng/mL, and the patient was pain-free. Thirteen months after discontinuation of pioglitazone, the metastatic lesion was 3.6 cm, the thyroglobulin level was 4.7 ng/mL, and the patient remained pain-free. CONCLUSIONS Pioglitazone may be therapeutic in patients with PPFP thyroid cancer. However, thyroid cancers that are progressive despite standard-of-care therapy appear to only rarely express PPFP.
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Affiliation(s)
- Thomas J Giordano
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bryan R Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Manisha H Shah
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio
| | - Elaine M Caoili
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Ronald J Koenig
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- Correspondence and Reprint Requests: Ronald J. Koenig, MD, PhD, University of Michigan, 5560 MSRB-2, 1150 West Medical Center Drive, Ann Arbor, Michigan 48109. E-mail:
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Affiliation(s)
- Jena D French
- Department of Medicine, Division of Endocrinology, University of Colorado Cancer Center, University of Colorado School of Medicine, 12801 E. 17th Avenue, Campus Box 8106, Aurora, Colorado 80045, USA
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, University of Colorado Cancer Center, University of Colorado School of Medicine, 12801 E. 17th Avenue, Campus Box 8106, Aurora, Colorado 80045, USA
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French JD, Haugen BR. Thyroid-Specific T Cells in Patients With Differentiated Thyroid Cancer: Implications for Immune-Based Therapies? J Clin Endocrinol Metab 2017; 102:2131-2132. [PMID: 28899074 PMCID: PMC5505208 DOI: 10.1210/jc.2017-00058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/28/2017] [Indexed: 12/30/2022]
Abstract
This editorial reviews the recent paper by Ehlers et al and provides a perspective on thyroid cancer immunology.
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Affiliation(s)
- Jena D French
- Department of Medicine, Division of Endocrinology, University of Colorado Cancer Center, University of Colorado School of Medicine, Denver, Colorado 80045
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, University of Colorado Cancer Center, University of Colorado School of Medicine, Denver, Colorado 80045
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French JD, Bible K, Spitzweg C, Haugen BR, Ryder M. Leveraging the immune system to treat advanced thyroid cancers. Lancet Diabetes Endocrinol 2017; 5:469-481. [PMID: 27773653 DOI: 10.1016/s2213-8587(16)30277-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [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] [Received: 07/01/2016] [Revised: 09/02/2016] [Accepted: 09/05/2016] [Indexed: 12/20/2022]
Abstract
Inflammation has long been associated with the thyroid and with thyroid cancers, raising seminal questions about the role of the immune system in the pathogenesis of advanced thyroid cancers. With a growing understanding of dynamic tumour-immune cell interactions and the mechanisms by which tumour cells evade antitumour immunity, the field of cancer immunotherapy has been revolutionised. In this Review, we provide evidence to support the presence of an antitumour immune response in advanced thyroid cancers linked to cytotoxic T cells and NK cells. This antitumour response, however, is likely blunted by the presence of immunosuppressive pathways within the microenvironment, facilitated by tumour-associated macrophages or increased expression of negative regulators of cytotoxic T-cell function. Current and future efforts to incorporate immune-based therapies into existing tumour cell or endothelial-derived therapies-eg, with kinase inhibitors targeting tumour-associated macrophages or antibodies blocking negative regulators on T cells-could provide improved and durable responses for patients with disease that is otherwise refractory to treatment.
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Affiliation(s)
- Jena D French
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Denver, Aurora, CO, USA; University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, USA
| | - Keith Bible
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Christine Spitzweg
- Department of Internal Medicine II, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Denver, Aurora, CO, USA; Department of Pathology, University of Colorado Denver, Aurora, CO, USA; University of Colorado Cancer Center, University of Colorado Denver, Aurora, CO, USA
| | - Mabel Ryder
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA.
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Haugen BR, Sawka AM, Alexander EK, Bible KC, Caturegli P, Doherty GM, Mandel SJ, Morris JC, Nassar A, Pacini F, Schlumberger M, Schuff K, Sherman SI, Somerset H, Sosa JA, Steward DL, Wartofsky L, Williams MD. American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features. Thyroid 2017; 27:481-483. [PMID: 28114862 DOI: 10.1089/thy.2016.0628] [Citation(s) in RCA: 205] [Impact Index Per Article: 29.3] [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: 02/05/2023]
Abstract
American Thyroid Association (ATA) leadership asked the ATA Thyroid Nodules and Differentiated Thyroid Cancer Guidelines Task Force to review, comment on, and make recommendations related to the suggested new classification of encapsulated follicular variant papillary thyroid carcinoma (eFVPTC) without capsular or vascular invasion to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The task force consists of members from the 2015 guidelines task force with the recusal of three members who were authors on the paper under review. Four pathologists and one endocrinologist were added for this specific review. The manuscript proposing the new classification and related literature were assessed. It is recommended that the histopathologic nomenclature for eFVPTC without invasion be reclassified as a NIFTP, given the excellent prognosis of this neoplastic variant. This is a weak recommendation based on moderate-quality evidence. It is also noted that prospective studies are needed to validate the observed patient outcomes (and test performance in predicting thyroid cancer outcomes), as well as implications on patients' psychosocial health and economics.
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Affiliation(s)
- Bryan R Haugen
- 1 University of Colorado School of Medicine , Aurora, Colorado
| | - Anna M Sawka
- 2 University Health Network, University of Toronto , Toronto, Canada
| | - Erik K Alexander
- 3 Brigham and Women's Hospital , Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Susan J Mandel
- 7 Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | | | | | | | | | - Kathryn Schuff
- 11 Oregon Health and Science University , Portland, Oregon
| | - Steven I Sherman
- 12 University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Hilary Somerset
- 1 University of Colorado School of Medicine , Aurora, Colorado
| | - Julie Ann Sosa
- 13 Duke University School of Medicine , Durham, North Carolina
| | - David L Steward
- 14 University of Cincinnati Medical Center , Cincinnati, Ohio
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Abstract
OBJECTIVE Thyroid hormone extract is used for the treatment of thyroid disorders, but limited data exist on adverse events commonly noted by the physicians associated with this use. The purpose of this survey was to report adverse events observed by expert physicians managing patients treated for thyroid disease with thyroid hormones. METHODS Members of the American Thyroid Association, The Endocrine Society, and the American Association of Clinical Endocrinologists developed a survey instrument modeled on the U.S. Food and Drug Administration (FDA)'s reported adverse events for levothyroxine that would effectively assess the clinical experience of frequent prescribers of thyroid hormone. Survey links were emailed to physicians, and the websites of each society provided links to the data collection form. RESULTS A total of 174 reports of adverse events occurring in patients on thyroid hormone extract were received. Ninety-one of these reports were accompanied by alterations in thyrotropin values and were further analyzed. Of these, 62 (68%) subjects had developed new symptoms associated with altered thyroid-stimulating hormone (TSH). A majority of TSH changes and symptoms described were consistent with thyrotoxicosis (65%), and 2 patients had developed arrhythmias. Reporters noted difficulty in dose adjustment by primary care providers due to confusion in interpreting thyroid function test results while on thyroid extract, which often necessitated subspecialty referrals. CONCLUSION These adverse event reports should stimulate consideration by the FDA to regulate and monitor thyroid hormone extract use and consider standardizing these extracts to meet current standards of manufacture, hormone content, availability, and shelf-life, like the rigor with which preparations such as levothyroxine are monitored. ABBREVIATIONS AE = adverse event ATA = American Thyroid Association FDA = Food and Drug Administration LT3 = liothyronine LT4 = levothyroxine PTF = Pharmacovigilance Task Force T3 = triiodothyronine TSH = thyroid-stimulating hormone.
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Haugen BR. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: What is new and what has changed? Cancer 2016; 123:372-381. [PMID: 27741354 DOI: 10.1002/cncr.30360] [Citation(s) in RCA: 353] [Impact Index Per Article: 44.1] [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: 06/22/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 01/13/2023]
Abstract
Thyroid nodules are very common, and thyroid cancer is currently the fifth leading cancer diagnosis in women. The American Thyroid Association has led the development and revision of guidelines for the management of patients with thyroid nodules and differentiated thyroid cancer (DTC). The most current revision was published in the January 2016 issue of the journal Thyroid. The current guidelines have 101 recommendations, with 8 figures and 17 tables that are hopefully helpful to those treating patients with thyroid nodules and cancer. The primary goals of the American Thyroid Association Guidelines Task Force were to use the current evidence to guide recommendations and yet be as helpful and practical as possible within the scope and strength of the evidence. The current review focuses on new and significantly revised recommendations that may very well change clinical practice. The author notes 3 new basic principles that have emerged in this guidelines revision: 1) the management of thyroid nodules, including the decision to perform a fine-needle aspiration biopsy as well as follow-up decision making, will be heavily influenced by the newly developed sonographic risk pattern; 2) the long-term management of DTC along with thyroid-stimulating hormone target goals will be heavily influenced by the 4 categories of "response to therapy"; and 3) the management of patients with radioactive iodine-refractory DTC will be divided into 4 basic decision-making groups: patients who should undergo monitoring, patients who should undergo directed therapies, patients who should undergo systemic therapies, and patients who should be offered entry into clinical trials. Cancer 2017;123:372-381. © 2016 American Cancer Society.
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Affiliation(s)
- Bryan R Haugen
- Division of Endocrinology, Metabolism, and Diabetes, Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, Colorado
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Pozdeyev N, Yoo M, Mackie R, Schweppe RE, Tan AC, Haugen BR. Integrating heterogeneous drug sensitivity data from cancer pharmacogenomic studies. Oncotarget 2016; 7:51619-51625. [PMID: 27322211 PMCID: PMC5239501 DOI: 10.18632/oncotarget.10010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/29/2016] [Indexed: 01/22/2023] Open
Abstract
The consistency of in vitro drug sensitivity data is of key importance for cancer pharmacogenomics. Previous attempts to correlate drug sensitivities from the large pharmacogenomics databases, such as the Cancer Cell Line Encyclopedia (CCLE) and the Genomics of Drug Sensitivity in Cancer (GDSC), have produced discordant results. We developed a new drug sensitivity metric, the area under the dose response curve adjusted for the range of tested drug concentrations, which allows integration of heterogeneous drug sensitivity data from the CCLE, the GDSC, and the Cancer Therapeutics Response Portal (CTRP). We show that there is moderate to good agreement of drug sensitivity data for many targeted therapies, particularly kinase inhibitors. The results of this largest cancer cell line drug sensitivity data analysis to date are accessible through the online portal, which serves as a platform for high power pharmacogenomics analysis.
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Affiliation(s)
- Nikita Pozdeyev
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Minjae Yoo
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan Mackie
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca E. Schweppe
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Aik Choon Tan
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Bryan R. Haugen
- Department of Medicine, University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
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Bastman JJ, Serracino HS, Zhu Y, Koenig MR, Mateescu V, Sams SB, Davies KD, Raeburn CD, McIntyre RC, Haugen BR, French JD. Tumor-Infiltrating T Cells and the PD-1 Checkpoint Pathway in Advanced Differentiated and Anaplastic Thyroid Cancer. J Clin Endocrinol Metab 2016; 101:2863-73. [PMID: 27045886 PMCID: PMC4929840 DOI: 10.1210/jc.2015-4227] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Five to 10% of patients with differentiated thyroid cancers (DTC) develop invasive and/or distant metastatic disease that is marginally improved with standard therapies. Prognosis is poor for patients with anaplastic thyroid cancer, with a median survival of 3-5 months. We suggest that a paradigm shift is necessary in the treatment of advanced cases. OBJECTIVE We hypothesized that a T-cell response is generated in advanced thyroid cancer and may be a viable therapeutic target. DESIGN Primary DTCs were analyzed by quantitative RT-PCR (n = 92) for expression of CD3, CD8, forkhead box (Fox)-P3, programmed death (PD)-1, PD-1 ligand-1, and PD-1 ligand-2 and biopsied for cellular analysis by flow cytometry (n = 11). Advanced pT4 cases (n = 22) and metastases (n = 5) were analyzed by immunohistochemistry. SETTING The study was conducted at the University of Colorado Hospital. PATIENTS Thyroid cancer patients undergoing thyroidectomy or completion surgery for advanced disease between 2002 and 2013 participated in the study. INTERVENTION There were no interventions. MAIN OUTCOME MEASURE Immune markers were analyzed for association with disease severity. RESULTS Immune markers were commonly expressed at the RNA level. PD-L1 was higher (P = .0443) in patients with nodal metastases. FoxP3(+) (P < .0001), PD-1(+)CD8(+) (P = .0058), and PD-1(+)CD4(+) (P = .0104) T cells were enriched in DTC biopsies. CD8(+) and FoxP3(+) T cells were detected by immunohistochemistry in all pT4 tumors and a subset of metastases. PD-1(+) lymphocytes were found in 50% of DTCs. PD-L1 was expressed by tumor and associated leukocytes in 13 of 22 cases, and expression was more diffuse in anaplastic thyroid cancer (P = .0373). BRAF(V600E) mutation was associated with higher frequencies of tumor-associated lymphocytes (P = .0095) but not PD-L1 expression. CONCLUSIONS PD-1 checkpoint blockades may have therapeutic efficacy in patients with aggressive forms of thyroid cancer.
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Affiliation(s)
- Jill J Bastman
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Hilary S Serracino
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Yuwen Zhu
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Michelle R Koenig
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Valerica Mateescu
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Sharon B Sams
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Kurtis D Davies
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Christopher D Raeburn
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Robert C McIntyre
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Bryan R Haugen
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
| | - Jena D French
- Department of Medicine (J.J.B., B.R.H., J.D.F.), Division of Endocrinology, Metabolism, and Diabetes, Departments of Pathology (H.S.S., V.M., S.B.S., K.D.D., B.R.H.) and Surgery (Y.Z., M.R.K., R.C.M., C.D.R.), and University of Colorado Cancer Center (B.R.H., J.D.F.), University of Colorado Denver, Aurora, Colorado 80045
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Sinclair CF, Bumpous JM, Haugen BR, Chala A, Meltzer D, Miller BS, Tolley NS, Shin JJ, Woodson G, Randolph GW. Laryngeal examination in thyroid and parathyroid surgery: An American Head and Neck Society consensus statement: AHNS Consensus Statement. Head Neck 2016; 38:811-9. [PMID: 26970554 DOI: 10.1002/hed.24409] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 11/09/2022] Open
Abstract
This American Head and Neck Society (AHNS) consensus statement discusses the techniques of laryngeal examination for patients undergoing thyroidectomy and parathyroidectomy. It is intended to help guide all clinicians who diagnose or manage adult patients with thyroid disease for whom surgery is indicated, contemplated, or has been performed. This consensus statement concludes that flexible transnasal laryngoscopy is the optimal laryngeal examination technique, with other techniques including laryngeal ultrasound and stroboscopy being useful in selected scenarios. © 2016 Wiley Periodicals, Inc. Head Neck 38: 811-819, 2016.
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Affiliation(s)
- Catherine F Sinclair
- Department of Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jeffrey M Bumpous
- Department of Otolaryngology, University of Louisville, Louisville, Kentucky
| | | | - Andres Chala
- University of Caldas, Manizales, Caldas, Colombia, South America
| | | | - Barbra S Miller
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Neil S Tolley
- Department of Surgery, Imperial College of London, London, United Kingdom
| | | | - Gayle Woodson
- Department of Otolaryngology, Southern Illinois University School of Medicine, Carbondale, Illinois
| | - Gregory W Randolph
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Patel NU, McKinney K, Kreidler SM, Bieker TM, Russ P, Roberts K, Glueck DH, Albuja-Cruz M, Klopper J, Haugen BR. Ultrasound-based clinical prediction rule model for detecting papillary thyroid cancer in cervical lymph nodes: A pilot study. J Clin Ultrasound 2016; 44:143-151. [PMID: 26402153 DOI: 10.1002/jcu.22309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 08/06/2015] [Accepted: 08/22/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To identify sonographic features of cervical lymph nodes (LNs) that are associated with papillary thyroid cancer (PTC) and to develop a prediction model for classifying nodes as metastatic or benign. METHODS This retrospective study included the records of postthyroidectomy patients with PTC who had undergone cervical ultrasound and LN biopsy. LN location, size, shape, hilum, echopattern, Doppler flow, and microcalcifications were assessed. Model selection was used to identify features associated with malignant LNs and to build a predictive, binary-outcome, generalized linear mixed model. A cross-validated receiver operating characteristic analysis was conducted to assess the accuracy of the model for classifying metastatic nodes. RESULTS We analyzed records from 71 LNs (23 metastatic) in 44 patients (16 with PTC). The predictive model included a nonhomogeneous echopattern (odds ratio [OR], 5.73; 95% confidence interval [CI], 1.07-30.74; p = 0.04), microcalcifications (OR, 4.91; 95% CI, 0.91-26.54; p = 0.06), and volume (OR, 2.57; 95% CI, 0.66-9.99; p = 0.16) as predictors. The model had an area under the curve of 0.74 (95% CI, 0.60-0.85), sensitivity of 65% (95% CI, 50% to 78%), and specificity of 85% (95% CI, 73% to 94%) at the Youden optimal cut point of 0.38. CONCLUSIONS Nonhomogeneous echopattern, microcalcifications, and node volume were predictive of malignant LNs in patients with PTC. A larger sample is needed to validate this model.
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Affiliation(s)
- Nayana U Patel
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Kristin McKinney
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Sarah M Kreidler
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | | | - Paul Russ
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Katherine Roberts
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, 80045
| | - Deborah H Glueck
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, 80045
| | - Maria Albuja-Cruz
- Department of GI Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, 80045
| | - Joshua Klopper
- Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, 80045
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, University of Colorado School of Medicine and University of Colorado Cancer Center, Aurora, CO, 80045
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8252] [Impact Index Per Article: 1031.5] [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: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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39
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Albuja-Cruz MB, Pozdeyev N, Robbins S, Chandramouli R, Raeburn CD, Klopper J, Haugen BR, McIntyre R. A “safe and effective” protocol for management of post-thyroidectomy hypocalcemia. Am J Surg 2015; 210:1162-8; discussion 1168-9. [DOI: 10.1016/j.amjsurg.2015.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/08/2015] [Accepted: 07/16/2015] [Indexed: 11/27/2022]
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40
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McLeod DS, Jonklaas J, Brierley JD, Ain KB, Cooper DS, Fein HG, Haugen BR, Ladenson PW, Magner J, Ross DS, Skarulis MC, Steward DL, Xing M, Litofsky DR, Maxon HR, Sherman SI. Reassessing the NTCTCS Staging Systems for Differentiated Thyroid Cancer, Including Age at Diagnosis. Thyroid 2015. [PMID: 26203804 PMCID: PMC4589102 DOI: 10.1089/thy.2015.0148] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 01/19/2023]
Abstract
BACKGROUND Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. OBJECTIVE This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. METHODS A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R(2)). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. RESULTS The best five alternate papillary cancer systems had age cut-points of 45-50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50-55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003-0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). CONCLUSIONS No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation.
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Affiliation(s)
- Donald S.A. McLeod
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Australia
- School of Medicine, University of Queensland, Herston, Australia
| | - Jacqueline Jonklaas
- Division of Endocrinology, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - James D. Brierley
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Canada
| | - Kenneth B. Ain
- Department of Internal Medicine, Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky
| | - David S. Cooper
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Henry G. Fein
- Division of Endocrinology and Metabolism, Sinai Hospital, Baltimore, Maryland
| | - Bryan R. Haugen
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul W. Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James Magner
- Genzyme, a Sanofi Company, Cambridge, Massachusetts
| | - Douglas S. Ross
- Thyroid Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Monica C. Skarulis
- Diabetes, Endocrinology, Obesity Branch, National Institutes of Health, Bethesda, Maryland
| | - David L. Steward
- Department of Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Mingzhao Xing
- Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Danielle R. Litofsky
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Harry R. Maxon
- Department of Nuclear Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Steven I. Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Carhill AA, Litofsky DR, Ross DS, Jonklaas J, Cooper DS, Brierley JD, Ladenson PW, Ain KB, Fein HG, Haugen BR, Magner J, Skarulis MC, Steward DL, Xing M, Maxon HR, Sherman SI. Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987-2012. J Clin Endocrinol Metab 2015; 100:3270-9. [PMID: 26171797 PMCID: PMC5393522 DOI: 10.1210/jc.2015-1346] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Initial treatments for patients with differentiated thyroid cancer are supported primarily by single-institution, retrospective studies, with limited follow-up and low event rates. We report updated analyses of long-term outcomes after treatment in patients with differentiated thyroid cancer. OBJECTIVE The objective was to examine effects of initial therapies on outcomes. DESIGN/SETTING This was a prospective multi-institutional registry. PATIENTS A total of 4941 patients, median follow-up, 6 years, participated. INTERVENTION Interventions included total/near-total thyroidectomy (T/NTT), postoperative radioiodine (RAI), and thyroid hormone suppression therapy (THST). MAIN OUTCOME MEASURE Main outcome measures were overall survival (OS) and disease-free survival using product limit and proportional hazards analyses. RESULTS Improved OS was noted in NTCTCS stage III patients who received RAI (risk ratio [RR], 0.66; P = .04) and stage IV patients who received both T/NTT and RAI (RR, 0.66 and 0.70; combined P = .049). In all stages, moderate THST (TSH maintained subnormal-normal) was associated with significantly improved OS (RR stages I-IV: 0.13, 0.09, 0.13, 0.33) and disease-free survival (RR stages I-III: 0.52, 0.40, 0.18); no additional survival benefit was achieved with more aggressive THST (TSH maintained undetectable-subnormal). This remained true, even when distant metastatic disease was diagnosed during follow-up. Lower initial stage and moderate THST were independent predictors of improved OS during follow-up years 1-3. CONCLUSIONS We confirm previous findings that T/NTT followed by RAI is associated with benefit in high-risk patients, but not in low-risk patients. In contrast with earlier reports, moderate THST is associated with better outcomes across all stages, and aggressive THST may not be warranted even in patients diagnosed with distant metastatic disease during follow-up. Moderate THST continued at least 3 years after diagnosis may be indicated in high-risk patients.
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Affiliation(s)
- Aubrey A Carhill
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Danielle R Litofsky
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Douglas S Ross
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Jacqueline Jonklaas
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - David S Cooper
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - James D Brierley
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Paul W Ladenson
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Kenneth B Ain
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Henry G Fein
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Bryan R Haugen
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - James Magner
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Monica C Skarulis
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - David L Steward
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Mingxhao Xing
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Harry R Maxon
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
| | - Steven I Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders (A.A.C., D.R.L., S.I.S.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Thyroid Unit (D.S.R.), Massachusetts General Hospital, Boston, Massachusetts 02114; Division of Endocrinology (J.J.), Department of Medicine, Georgetown University Medical Center, Washington, DC 20057; Division of Endocrinology and Metabolism (D.S.C., P.W.L., M.X.), The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205; Department of Radiation Oncology (J.D.B.), Princess Margaret Hospital, Toronto, ON M5G 2M9, Canada; Department of Internal Medicine (K.B.A.), Veterans Affairs Medical Center and University of Kentucky, Lexington, Kentucky 40502; Division of Endocrinology and Metabolism (H.G.F.), Sinai Hospital, Baltimore, Maryland 21215; Division of Endocrinology, Metabolism, and Diabetes (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045; Genzyme (J.M.), a Sanofi Company, Cambridge, Massachusetts 02142; Diabetes, Endocrinology, Obesity Branch (M.C.S.), National Institutes of Health, Bethesda, Maryland 20892; Departments of Head and Neck Surgery (D.L.S.) and Nuclear Medicine (H.R.M.), University of Cincinnati Medical Center, Cincinnati, Ohio 45219
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Pozdeyev N, Berlinberg A, Zhou Q, Wuensch K, Shibata H, Wood WM, Haugen BR. Targeting the NF-κB Pathway as a Combination Therapy for Advanced Thyroid Cancer. PLoS One 2015; 10:e0134901. [PMID: 26263379 PMCID: PMC4532464 DOI: 10.1371/journal.pone.0134901] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/10/2015] [Indexed: 11/21/2022] Open
Abstract
NF-κB signaling plays an important role in tumor cell proliferation, cell survival, angiogenesis, invasion, metastasis and drug/radiation resistance. Combination therapy involving NF-κB pathway inhibition is an attractive strategy for the treatment of advanced forms of thyroid cancer. This study was designed to test the efficacy of NF-κB pathway inhibition in combination with cytotoxic chemotherapy, using docetaxel and ionizing radiation in in vitro models of thyroid cancer. We found that while both docetaxel and ionizing radiation activated NF-κB signaling in thyroid cancer cells, there was no synergistic effect on cell proliferation and/or programmed cell death with either genetic (transduction of a dominant negative mutant form of IκBα) or pharmacologic (proteasome inhibitor bortezomib and IKKβ inhibitor GO-Y030) inhibition of the NF-κB pathway in thyroid cancer cell lines BCPAP, 8505C, THJ16T and SW1736. Docetaxel plus bortezomib synergistically decreased in vitro invasion of 8505C cells, but not in the other cell lines. Screening of a panel of clinically relevant targeted therapies for synergy with genetic NF-κB inhibition in a proliferation/cytotoxicity assay identified the histone deacetylase (HDAC) inhibitor suberoylanilide hydroxamic acid (SAHA) as a potential candidate. However, the synergistic effect was confirmed only in the BCPAP cells. These results indicate that NF-κB inhibitors are unlikely to be beneficial as combination therapy with taxane cytotoxic chemotherapy, external radiation therapy or radioiodine therapy. There may be unique circumstances where NF-κB inhibitors may be considered in combination with docetaxel to reduce tumor invasion or in combination with HDAC inhibitors to reduce tumor growth, but this does not appear to be a combination therapy that could be broadly applied to patients with advanced thyroid cancer. Further research may identify which subsets of patients/tumors may respond to this therapeutic approach.
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Affiliation(s)
- Nikita Pozdeyev
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Adam Berlinberg
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Qiong Zhou
- Department of Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Kelsey Wuensch
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Hiroyuki Shibata
- Department of Clinical Oncology, Faculty of Medicine, Akita University, Akita, Japan
| | - William M. Wood
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
| | - Bryan R. Haugen
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States of America
- University of Colorado Cancer Center, Anschutz Medical Campus, Aurora, CO, United States of America
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Severson JJ, Serracino HS, Mateescu V, Raeburn CD, McIntyre RC, Sams SB, Haugen BR, French JD. PD-1+Tim-3+ CD8+ T Lymphocytes Display Varied Degrees of Functional Exhaustion in Patients with Regionally Metastatic Differentiated Thyroid Cancer. Cancer Immunol Res 2015; 3:620-30. [PMID: 25701326 DOI: 10.1158/2326-6066.cir-14-0201] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/10/2015] [Indexed: 01/11/2023]
Abstract
Regional metastatic differentiated thyroid cancer (mDTC) provides a unique model in which to study the tumor-immune interface. These lymph node metastases persist for years, generally without progression to distant metastases. Although the immune system likely impedes disease progression, it is unsuccessful in eliminating disease. Our previous studies revealed that programmed death-1 (PD-1)(+) T cells were enriched in tumor-involved lymph nodes (TILN). Tumor-associated leukocytes and tumor cells were collected from grossly involved lymph nodes from 12 patients to further characterize the phenotype and functional potential of mDTC-associated PD-1(+) T cells. PD-1(+)CD4(+) and PD-1(+)CD8(+) T cells were enriched in 8 of 12 TILN samples. PD-1(+) T cells coexpressed Tim-3 and CD69 and failed to downregulate CD27. CD8(+) T cells, but not CD4(+) T cells, from these samples were variably deficient in their ability to produce effector cytokines when compared with control TILNs that lacked resident PD-1(+) T cells. PD-1(+)CD8(+) T cells were capable of exocytosis but lacked intracellular perforin. Surprisingly, T-cell proliferative capacity was largely maintained in all samples. Thus, although PD-1 expression by mDTC-associated CD8(+) T cells was associated with dysfunction, exhaustion was not complete. Notably, molecular markers of exhaustion did not translate to dysfunction in all samples or in CD4(+) T cells. Regulatory T cells (Treg), PD-L1, and galectin-9 were commonly found in mDTC and likely contributed to the initiation of T-cell exhaustion and disease progression. Therapies that release the effects of PD-1 and Tim-3 and reduce the suppressive effects of Tregs may encourage tumor elimination in patients with mDTC.
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Affiliation(s)
- Jill J Severson
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Hilary S Serracino
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Valerica Mateescu
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Christopher D Raeburn
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. University of Colorado Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Robert C McIntyre
- Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. University of Colorado Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Sharon B Sams
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. University of Colorado Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Bryan R Haugen
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. University of Colorado Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Jena D French
- Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. University of Colorado Cancer Center, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
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Henderson YC, Ahn SH, Ryu J, Chen Y, Williams MD, El-Naggar AK, Gagea M, Schweppe RE, Haugen BR, Lai SY, Clayman GL. Development and characterization of six new human papillary thyroid carcinoma cell lines. J Clin Endocrinol Metab 2015; 100:E243-52. [PMID: 25427145 PMCID: PMC4318904 DOI: 10.1210/jc.2014-2624] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Cell lines are a widely used tool in cancer research. However, despite the relatively high incidence of papillary thyroid carcinoma (PTC), there are only four PTC cell lines available for international research audience. OBJECTIVE The objective of this study was to establish and characterize new PTC cell lines that represent primary tumor biology. Surgical specimens were obtained to generate PTC cell lines. Short tandem repeat profiling was used to confirm the uniqueness of the cell lines against databases of known cell lines and mutations were assessed using Sequenom. The expression of thyroid-specific genes was examined using real-time PCR. Tumorigenicity was determined using an orthotopic thyroid xenograft tumor mouse model. RESULTS Six PTC cell lines (five conventional PTCs and one follicular variant of PTC) were generated and found to be unique when compared by short tandem repeat profiling against databases of all existing cell lines. The five conventional PTC cell lines carry the BRAF V600E mutation and the follicular variant of PTC cell line had an NRAS mutation. Five of the six cell lines had a mutation in the promoter of the human telomerase reverse transcriptase gene. None of the cell lines have RET/PTC rearrangements. Three cell lines were tumorigenic in the orthotopic thyroid xenograft tumor mouse model. CONCLUSIONS These five characterized conventional PTC cell lines and the unique follicular variant of PTC cell line should be valuable reagents for thyroid cancer research. The three tumorigenic cell lines can be used for in vivo testing of targeted therapeutic and novel agents.
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Affiliation(s)
- Ying C Henderson
- Departments of Head and Neck Surgery (Y.C.H., Y.C., S.Y.L., G.L.C.), Pathology (M.D.W., A.K.E-N.), Veterinary Medicine and Surgery (M.G.), Molecular and Cellular Oncology (S.Y.L.), and Cancer Biology (G.L.C.), The University of Texas MD Anderson Cancer Center, Houston, Texas 77030; Department of Otolaryngology-Head and Neck Surgery (S.H.A), College of Medicine, Seoul National University Bundang Hospital, Kyunggi-do, 463-707 Korea; Center for Thyroid Cancer (J.R), National Cancer Center, Goyang-si, Gyeonggi-do, 410-769 Korea; Department of Endocrinology (R.E.S., B.R.H.), University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado 80045
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Haugen BR, Wartofsky L. In memoriam, Dr. E. Chester Ridgway, 1942-2014. Endocr Rev 2014; 35:715-6. [PMID: 25247379 DOI: 10.1210/er.2014-1064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bryan R Haugen
- University of Colorado School of Medicine (B.R.H.), Denver, Colorado 80045 and MedStar Washington Hospital Center (L.W.), Georgetown University School of Medicine, Washington, DC 20010
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Olson AC, Haugen BR, Walter J, Kwak JJ, Bagrosky BM, Koo PJ. SPECT/CT and I131 therapy of brain metastases from follicular variant papillary thyroid carcinoma (FVPTC). J Clin Endocrinol Metab 2014; 99:3511-2. [PMID: 25057877 DOI: 10.1210/jc.2014-1875] [Citation(s) in RCA: 2] [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: 11/19/2022]
MESH Headings
- Adolescent
- Brain Neoplasms/diagnosis
- Brain Neoplasms/radiotherapy
- Brain Neoplasms/secondary
- Carcinoma/diagnosis
- Carcinoma/pathology
- Carcinoma, Papillary
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/radiotherapy
- Carcinoma, Papillary, Follicular/secondary
- Female
- Humans
- Iodine Radioisotopes
- Multimodal Imaging/methods
- Thyroid Cancer, Papillary
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
- Tomography, Emission-Computed, Single-Photon/methods
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Andrew C Olson
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging (A.C.O., J.W., J.J.K., B.M.B., P.J.K.), and Department of Medicine, Division of Endocrinology and Metabolism (B.R.H.), University of Colorado School of Medicine, Aurora, Colorado 80045
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Haugen BR, Wartofsky L. In Memoriam, Dr. E. Chester Ridgway, 1942–2014. Mol Endocrinol 2014; 28:1587-8. [DOI: 10.1210/me.2014-1247] [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: 11/19/2022] Open
Affiliation(s)
- Bryan R. Haugen
- University of Colorado School of Medicine (B.R.H.), Denver, Colorado 80045
| | - Leonard Wartofsky
- MedStar Washington Hospital Center (L.W.), Georgetown University School of Medicine, Washington, DC 20010
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Haugen BR, Wartofsky L. In memoriam, Dr. E. Chester Ridgway, 1942-2014. J Clin Endocrinol Metab 2014; 99:3487-8. [PMID: 25279569 DOI: 10.1210/jc.2014-3181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/13/2023]
Affiliation(s)
- Bryan R Haugen
- University of Colorado School of Medicine (B.R.H.), Denver, Colorado 80045 and MedStar Washington Hospital Center (L.W.), Georgetown University School of Medicine, Washington, DC 20010
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Haugen BR, Wartofsky L. In memoriam, Dr. E. Chester Ridgway, 1942-2014. Endocrinology 2014; 155:3727-8. [PMID: 25238132 DOI: 10.1210/en.2014-1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/19/2022]
Affiliation(s)
- Bryan R Haugen
- University of Colorado School of Medicine (B.R.H.), Denver, Colorado 80045 and MedStar Washington Hospital Center (L.W.), Georgetown University School of Medicine, Washington, DC 20010
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Haugen BR, Wartofsky L. In memoriam, Dr. E. Chester Ridgway, 1942- 2014. Horm Cancer 2014; 5:263-264. [PMID: 25200857 DOI: 10.1007/s12672-014-0200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Bryan R Haugen
- Department of Endocrinology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, 80045, USA
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