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Lu C, Wang G, Si Z, Li F, Liu X, Han N, Wang C, Li J, Wang X. Nomogram Model for Prognosis of Distant Metastatic DTC Based on Inflammatory and Clinicopathological Factors. J Endocr Soc 2025; 9:bvaf037. [PMID: 40182184 PMCID: PMC11965788 DOI: 10.1210/jendso/bvaf037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Indexed: 04/05/2025] Open
Abstract
Context Inflammatory markers may serve as potential biomarkers in predicting prognosis in patients with distant metastasis differentiated thyroid cancer (DM-DTC). Objective This study aimed to evaluate the predictive ability of inflammatory markers and clinicopathological features for disease progression (PD) in patients with DM-DTC. Methods A retrospective analysis was conducted on 230 DM-DTC patients from May 2016 to January 2022. Patients were divided into a training set and a validation set at a 7:3 ratio. Inflammatory markers were obtained within 1 week before the last 131I treatment. The primary outcome was progression-free survival (PFS). Univariable and multivariable Cox proportional hazards models identified significant prognostic factors, and a nomogram based on inflammatory markers and clinicopathological features was constructed and validated using R software. Results Multivariable Cox regression analysis showed that age (hazard ratio [HR] = 2.191; 95% CI, 1.387-3.462), histological type (HR = 2.030; 95% CI, 1.216-3.389), distant metastatic site (HR = 3.379; 95% CI, 1.832-6.233), T stage (HR = 6.061; 95% CI, 2.469-14.925), and LMR (HR = 2.050; 95% CI, 1.194-3.519) were identified as independent risk factors for the progression of DM-DTC. A predictive nomogram was constructed to estimate the probability of DM-DTC progression. The C-index of the PFS model was calculated to be 0.775 (0.749-0.802) for the training set and 0.731 (95% CI, 0.686-0.775) for the validation set. The calibration curve of the validation set closely approached the reference line. The decision curve analysis indicated that when the risk threshold was greater than 0.2, this nomogram model provided clinical net benefit. Conclusion The study identified significant inflammatory markers and clinical factors for predicting PD in DM-DTC patients, providing a robust prognostic model with potential clinical application.
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Affiliation(s)
- Chenghui Lu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Guoqiang Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Zengmei Si
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Fengqi Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Xinfeng Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Na Han
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Congcong Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Jiao Li
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
| | - Xufu Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, PR China
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Sharma S, Nazar AH, Mishra P, Ora M, Arya A, Barai S, Pradhan PK, Gambhir S. A new therapeutic paradigm: radioiodine combined with lenvatinib for radioiodine-avid metastatic well-differentiated thyroid cancer. Nucl Med Commun 2025:00006231-990000000-00416. [PMID: 40165683 DOI: 10.1097/mnm.0000000000001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
PURPOSE Management of metastatic well-differentiated thyroid cancer (WDTC) remains challenging, with significant morbidity and mortality. Multidisciplinary treatment, along with high-dose radioiodine therapy (HDRI), remains a mainstay. Morbidity and mortality benefits are noted, with seldom complete response. The foremost concerns are HDRI side effects, radioiodine refractoriness, macronodular lung, and bone metastasis. Lenvatinib is a standard of care in radioiodine-refractory disease. However, it remains unexplored in radioiodine-avid metastatic WDTC. This study investigates the effect of lenvatinib with HDRI in improving disease control and progression in radioiodine-avid metastatic WDTC. MATERIAL AND METHODS Fifteen patients with metastatic WDTC were enrolled with or without prior HDRI. The disease burden was evaluated with imaging [whole-body radioiodine scan (WBRI), PET-computed tomography (CT), or CT] and serum thyroglobulin (Tg) measurement. After excluding contraindication, lenvatinib was given for 3 months, along with thyroxine suppression. Adverse effects were monitored. Thyroxin was withdrawn, and the patient underwent WBRI followed by HDRI. Treatment response was evaluated based on imaging [response evaluation criteria in solid tumors (RECIST), PET response criteria in solid tumors (PERCIST), and WBRI] and tumor marker (Tg) parameters. RESULTS The mean age was 52.0 ± 14.2 years. Lung and bone metastases were noted in (12, 80%) and 10 (66%) patients. Nine (60%) patients already had HDRI (242.5 ± 140.3 mCi). Lenvatinib was well-tolerated, with two-thirds of patients having grade I toxicities. During follow-up (14.79 ± 5.93 months), one patient died of pneumonia unrelated to WDTC. Tg level fell from 45 800.8 ± 69 283.9 [median: 7094.0, interquartile range (IQR): 988.3-114 397.0] to 10 672.5 ± 18 490.5 (median: 1796.0, IQR: 171.0-17 090.0) ng/ml. Tg fall was not associated (P > 0.05) with age, sex, histopathology, and previous HDRI. Partial response and stable disease were noted in 10 and four patients, respectively, based on imaging (PERSIST and RECIST criteria) and tumor marker levels. One patient had disease progression on Tg and imaging. CONCLUSION HDRI, in combination with lenvatinib, demonstrated potential benefits in radioiodine-avid metastatic WDTC. The combination treatment was well-tolerated. There was an unprecedented fall in tumor marker level and partial response on imaging by a single cycle of the therapy. While a small sample size limited the study, preliminary data suggest that the synergistic effect may improve disease control. Further investigation with a larger cohort is warranted to confirm findings and explore potential response predictors.
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Affiliation(s)
| | | | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
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Howaidi A, Alswailem A, Hakami A, Hadadi A, Alturki D, Abothenain F, Alobaid L, Ewain NS, Murugan AK, Alzahrani AS. Disease-specific Mortality of Differentiated Thyroid Cancer With Distant Metastases. J Endocr Soc 2025; 9:bvaf034. [PMID: 40071068 PMCID: PMC11893527 DOI: 10.1210/jendso/bvaf034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Indexed: 03/14/2025] Open
Abstract
Overview Distant metastases (DM) are the major cause of death in patients with differentiated thyroid cancer (DTC). This study aimed to investigate the predictors of DM-associated mortality. Patients and Methods We identified 154 thyroid cancer (TC) patients with DM from our institution's tumor registry. We excluded anaplastic (n = 21) and medullary TC (n = 32) and patients with inadequate data (n = 15). The remaining 86 patients with DTC were studied. These include 57 females (66.3%) and 29 males (33.7%) with a median age of 53.5 years [interquartile range (IQR) 45-65]. All patients underwent thyroidectomy; 58 (67.4%) had neck dissection, and 81 (94.2%) received radioactive iodine (I-131) ablation/therapy. Results Lung metastases were the most common, occurring in 91.9%; skeletal metastases occurred in 58.1%, brain metastases in 9.3%, and multiple-organ DM in 58%. The management of DM included surgery, 1 or more doses of I-131, external beam radiotherapy, and multikinase inhibitors. Over a median follow-up of 84 months (IQR 35.5-118) for the whole cohort, 47 patients succumbed to their disease (disease-specific mortality 54.7%). Factors associated with mortality were increasing age (P = .001) and bone metastases (P < .0001). These factors remained significant in multivariate analyses [for age, P = .009, hazard ratio (HR) 1.030, 95% confidence interval (CI) 1.007-1.053] and for bone metastases (P = .017, HR 2.58, 95% CI 1.19-5.6). Conclusion DM from DTC are associated with ∼ 55% mortality at a median survival of 47 months. Increasing age and skeletal metastases are predictors of an increased risk of mortality.
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Affiliation(s)
- Ali Howaidi
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
- Department of Pathology, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Anwar Alswailem
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Abdulrhman Hakami
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Afnan Hadadi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Deema Alturki
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Fayha Abothenain
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Lulu Alobaid
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Najla Saleh Ewain
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh 11426, Saudi Arabia
| | - Avaniyapuram Kannan Murugan
- Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
- Department of Molecular Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
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ÖZÇEVİK H, ÖNER TAMAM M, BABACAN GB, ŞENGİZ ERHAN S, ACAR TAYYAR MN, ERTÜRK B. Genetic mutations and prognostic indicators in differentiated thyroid cancer: a molecular perspective. Turk J Med Sci 2024; 55:72-81. [PMID: 40104288 PMCID: PMC11913491 DOI: 10.55730/1300-0144.5944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 02/18/2025] [Accepted: 12/25/2024] [Indexed: 03/20/2025] Open
Abstract
Background/aim The aim of this study was to investigate the relationship between the presence of the BRAF, HRAS, NRAS, and KRAS gene mutations and the development of dedifferentiation (iodine-refractory disease) and extrathyroidal disease in patients with differentiated thyroid carcinoma (DTC). Materials and methods The patient group included 77 adults classified as intermediate or high-risk according to the American Thyroid Association's 2015 guidelines who underwent total thyroidectomy followed by radioiodine I-131 (RAI) therapy between June 2014 and December 2022. Clinical data were collected via the hospital information system, including the number of surgeries and RAI treatments and the levels of thyroglobulin (Tg), anti-thyroglobulin, and thyroid-stimulating hormone. The histopathological subtypes of DTC were reevaluated, and mutation analyses of the BRAF, KRAS, NRAS, and HRAS genes were performed using real-time polymerase chain reaction (PCR). Statistical analyses were conducted using Medcalc software, with p < 0.05 considered significant. Results Of the 77 patients, most had classical papillary thyroid carcinoma, while others represented various subtypes. No mutations were found in BRAF K601E/V600_K601, KRAS G12x-G13D, or NRAS G12-G13; however, NRAS Q61x was found in one patient, HRAS Q61x in 12, and BRAFV600E/Ec in 36. A significant relationship was observed between HRAS Q61x mutation and disease response, alongside a significant association between gene mutations and iodine-refractory disease development (p = 0.0004). A ROC curve analysis indicated a 49.2 ng/mL threshold for Tg with 75% sensitivity and 94.1% specificity. Conclusion The findings suggest that the HRAS Q61x gene mutation is significantly associated with iodine-resistant disease. It may serve as a prognostic biomarker in early-stage thyroid cancer and aid in disease monitoring in metastatic patients.
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Affiliation(s)
- Halim ÖZÇEVİK
- Department of Nuclear Medicine, Hamidiye Medical Faculty, University of Health Sciences, İstanbul,
Turkiye
| | - Müge ÖNER TAMAM
- Department of Nuclear Medicine, Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Gündüzalp Buğrahan BABACAN
- Department of Nuclear Medicine, Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Selma ŞENGİZ ERHAN
- Department of Pathology, Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Merve Nur ACAR TAYYAR
- Department of Nuclear Medicine, Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, İstanbul,
Turkiye
| | - Biray ERTÜRK
- Department of Medical Genetics, Prof. Dr. Cemil Taşcıoğlu City Hospital, University of Health Sciences, İstanbul,
Turkiye
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Ma W, Yu F, Chen B, Yang Z, Kang F, Li X, Yang W, Wang J. Development and validation of a lung metastases-predicting nomogram for intermediate- to high-risk differentiated thyroid carcinoma patients. Future Oncol 2024; 20:1575-1586. [PMID: 38868921 PMCID: PMC11457604 DOI: 10.1080/14796694.2024.2354161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/08/2024] [Indexed: 06/14/2024] Open
Abstract
Aim: This research aimed to construct a clinical model for forecasting the likelihood of lung metastases in differentiated thyroid carcinoma (DTC) with intermediate- to high-risk.Methods: In this study, 375 DTC patients at intermediate to high risk were included. They were randomly divided into a training set (70%) and a validation set (30%). A nomogram was created using the training group and then validated in the validation set using calibration, decision curve analysis (DCA) and receiver operating characteristic (ROC) curve.Results: The calibration curves demonstrated excellent consistency between the predicted and the actual probability. ROC analysis showed that the area under the curve in the training cohort was 0.865 and 0.845 in the validation cohort. Also, the DCA curve indicated that this nomogram had good clinical utility.Conclusion: A user-friendly nomogram was constructed to predict the lung metastases probability with a high net benefit.
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Affiliation(s)
- Wenhui Ma
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
| | - Feng Yu
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
| | - Bowen Chen
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
| | - Zhiping Yang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
| | - Fei Kang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
| | - Xiang Li
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
| | - Weidong Yang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, No. 127, Changle West Road, Xi'an, 710000, Shaanxi, China
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Li Z, Su J, Wang J, Yan L, Zhang H, Li X, Tai Y, Fang Y, Yan T. Ultrasound-guided core needle biopsy combined with immunohistochemistry and molecular testing improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma, two case reports and analyses. Clin Case Rep 2024; 12:e8959. [PMID: 38817707 PMCID: PMC11136645 DOI: 10.1002/ccr3.8959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 06/01/2024] Open
Abstract
Key Clinical Message Ultrasound-guided core needle biopsy combined with immunohistochemistry and molecular testing could improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma, help to predict distant metastasis and prognosis. Abstract Metastatic thyroid follicular carcinoma presenting initially with bone lesion is uncommon, its prime symptom is gradual onset, localized pain. Patient with bone metastasis who were diagnosed before thyroidectomy had a higher rate of mortality, clinician should be cautious in eliciting the clinical history and this insidious symptom in middle age group, carry out further examination. We are presenting two case reports of a follicular thyroid carcinoma with bone metastasis, ultrasound-guided core needle biopsy combined with immunohistochemistry (IHC) were carried out by our clinical team to determine the source and nature of the tumor, relevant literature was reviewed, molecular testing was discussed, we believe core needle biopsy combined with IHC and molecular testing improve the diagnostic accuracy of bone metastases from follicular thyroid carcinoma.
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Affiliation(s)
- Zhiyuan Li
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jianbin Su
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Jinjing Wang
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Li Yan
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Huiqiang Zhang
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Xinyu Li
- Center for Disease Control and Prevention of Xicheng DistrictBeijingChina
| | - Yanhong Tai
- Department of PathologyFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Yi Fang
- Department of Endocrinology and MetabolismFifth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Tao Yan
- Outpatient DepartmentFifth Medical Center of Chinese PLA General HospitalBeijingChina
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Li W, Li J, Cai J. Development of a nomogram to predict the prognosis of patients with secondary bone tumors in the intensive care unit: a retrospective analysis based on the MIMIC IV database. J Cancer Res Clin Oncol 2024; 150:164. [PMID: 38546896 PMCID: PMC10978606 DOI: 10.1007/s00432-024-05667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/24/2024] [Indexed: 04/01/2024]
Abstract
PURPOSE The present study aimed to develop a nomogram to predict the prognosis of patients with secondary bone tumors in the intensive care unit to facilitate risk stratification and treatment planning. METHODS We used the MIMIC IV 2.0 (the Medical Information Mart for Intensive Care IV) to retrieve patients with secondary bone tumors as a study cohort. To evaluate the predictive ability of each characteristic on patient mortality, stepwise Cox regression was used to screen variables, and the selected variables were included in the final Cox proportional hazard model. Finally, the performance of the model was tested using the decision curve, calibration curve, and receiver operating characteristic (ROC) curve. RESULTS A total of 1028 patients were enrolled after excluding cases with missing information. In the training cohort, albumin, APSIII (Acute Physiology Score III), chemotherapy, lactate, chloride, hepatic metastases, respiratory failure, SAPSII (Simplified Acute Physiology Score II), and total protein were identified as independent risk factors for patient death and then incorporated into the final model. The model showed good and robust prediction performance. CONCLUSION We developed a nomogram prognostic model for patients with secondary bone tumors in the intensive care unit, which provides effective survival prediction information.
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Affiliation(s)
- Weikang Li
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, 430074, China
| | - Jinliang Li
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, 430074, China
| | - Jinkui Cai
- Department of Orthopedics, Wuhan Third Hospital, Tongren Hospital of Wuhan University, Wuhan, 430074, China.
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Kuang HF, Lu WL. Predictive factors for lung metastasis in pediatric differentiated thyroid cancer: a clinical prediction study. J Pediatr Endocrinol Metab 2024; 37:250-259. [PMID: 38332686 DOI: 10.1515/jpem-2023-0425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/18/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVES The objective of this study was to develop and evaluate the efficacy of a nomogram for predicting lung metastasis in pediatric differentiated thyroid cancer. METHODS The SEER database was utilized to collect a dataset consisting of 1,590 patients who were diagnosed between January 2000 and December 2019. This dataset was subsequently utilized for the purpose of constructing a predictive model. The model was constructed utilizing a multivariate logistic regression analysis, incorporating a combination of least absolute shrinkage feature selection and selection operator regression models. The differentiation and calibration of the model were assessed using the C-index, calibration plot, and ROC curve analysis, respectively. Internal validation was performed using a bootstrap validation technique. RESULTS The results of the study revealed that the nomogram incorporated several predictive variables, namely age, T staging, and positive nodes. The C-index had an excellent calibration value of 0.911 (95 % confidence interval: 0.876-0.946), and a notable C-index value of 0.884 was achieved during interval validation. The area under the ROC curve was determined to be 0.890, indicating its practicality and usefulness in this context. CONCLUSIONS This study has successfully developed a novel nomogram for predicting lung metastasis in children and adolescent patients diagnosed with thyroid cancer. Clinical decision-making can be enhanced by assessing clinicopathological variables that have a significant predictive value for the probability of lung metastasis in this particular population.
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Affiliation(s)
- Hou-Fang Kuang
- Department of General Surgery, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Wuhan, P.R. China
| | - Wen-Liang Lu
- Department of Thyroid and Breast Surgery, Maternal and Child Health Hospital of Hubei Province, Wuhan, P.R. China
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Ma Q, Chen Z, Fang Y, Wei X, Wang N, Zhou X, Li S, Ying C. Development and validation of survival nomograms for patients with differentiated thyroid cancer with distant metastases: a SEER Program-based study. J Endocrinol Invest 2024; 47:115-129. [PMID: 37294407 DOI: 10.1007/s40618-023-02129-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/31/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND We aimed to develop a nomogram model of overall survival (OS) and cancer-specific survival (CSS) in patients with differentiated thyroid cancer with distant metastases, and to evaluate and validate the nomogram. Also, its prognostic value was compared with that of the 8th edition of the American Joint Committee on Cancer tumor-node-metastasis staging system (AJCC8SS). METHODS Patients with distant metastatic differentiated thyroid cancer (DMDTC) from 2004 to 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) Program to extract the clinical variables used for analysis. A total of 906 patients were divided into a training set (n = 634) and validation set (n = 272). OS and CSS were selected as the primary end point and secondary end point. LASSO regression analysis and multivariate Cox regression analysis were applied to screen variables for constructing OS and CSS nomograms for survival probability at 3, 5, and 10 years. Nomograms were evaluated and validated using the consistency index (C-index), time-dependent receiver operator characteristic (ROC) curves, area under the ROC curve, calibration curves, and decision curve analysis (DCA). The predictive survival of the nomogram was compared with that of AJCC8SS. Kaplan-Meier curves and log-rank tests were used to evaluate the risk-stratification ability OS and CSS nomograms. RESULTS CS and CSS nomograms included six independent predictors: age, marital status, type of surgical procedure, lymphadenectomy, radiotherapy, and T stage. The C-index for the OS nomogram was 0.7474 (95% CI = 0.7199-0.775), and that for the CSS nomogram was 0.7572 (0.7281-0.7862). The nomogram showed good agreement with the "ideal" calibration curve in the training set and validation sets. DCA confirmed that the survival probability predicted by the nomogram had high clinical predictive value. The nomogram could stratify patients more accurately, and showed more robust accuracy and predictive power, than AJCC8SS. CONCLUSIONS We established and validated prognostic nomograms for patients with DMDTC, which had significant clinical value compared with AJCC8SS.
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Affiliation(s)
- Q Ma
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Z Chen
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Y Fang
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - X Wei
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - N Wang
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - X Zhou
- Laboratory of Morphology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - S Li
- Clinical Research Institute, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - C Ying
- Department of Endocrinology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
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Kanankulam Velliangiri S, Ballal S, Prasad Yadhav M, Tripathi M, Satapathy S, Bal C. A long-term retrospective cohort-based risk-benefit analysis of augmenting total cumulative I-131 activity to 37GBq in differentiated thyroid cancer patients with skeletal metastases. PLoS One 2023; 18:e0294343. [PMID: 37963164 PMCID: PMC10645322 DOI: 10.1371/journal.pone.0294343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Skeletal metastases in differentiated thyroid cancer (DTC) patients are associated with poor prognosis. The objective was to determine the maximum I-131 cumulative activity that could be safely administered without compromising efficacy. The secondary objective was to identify other prognostic factors affecting survival outcomes. MATERIALS AND METHODS This was a retrospective cohort study done at a tertiary-care institution comprising of data from January 1990-June 2020. 489 DTC patients having skeletal metastases with ≥12 months follow-up were included. Ninety-six percent of patients had thyroidectomy followed by radioiodine therapy for skeletal metastases. All patients were on oral suppressive levothyroxine tablets. External beam radiotherapy (EBRT) and oral tyrosine kinase inhibitors were used whenever indicated. The main outcome measures were overall survival (OS), progression-free survival (PFS), and adverse-events. RESULTS There were 347 (71%) females and 324 (66%) had follicular carcinoma thyroid. Median follow-up was 78 (interquartile range, IQR: 37-153) months. 333 patients (68%) received ≤37GBq I-131 cumulative activity (group 1) and 156 patients (32%) received >37GBq cumulative RAI activity (group 2). Overall median OS and PFS were 74 (95% confidence interval (CI): 62.2-85.8) and 48 (95%CI: 40.5-55.4) months, respectively. The 5-, 10-, 15- and 20-year estimated overall survival probabilities were 55.7%, 28.4%, 14% and 8.3%, respectively. On multivariate analysis, age(<55years) (p<0.001), female gender(p = 0.01), cumulative I-131 activity >37GBq (p<0.001) and EBRT(p = 0.001) were favourably associated with OS; no factors were significantly associated with PFS. The median OS for groups 1 & 2 were 51 versus 90 months (p<0.001) & median PFS for groups 1 & 2 were 45 versus 53 months respectively (p = 0.9). However, cumulative activity >37GBq resulted in more adverse events (2.4%), particularly bone marrow suppression (3.5%). CONCLUSION For better survival outcomes, cumulative I-131 activity upto 37GBq could be administered with acceptable toxicity to DTC patients with skeletal metastases.
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Affiliation(s)
| | - Sanjana Ballal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhav Prasad Yadhav
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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11
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Wu XY, Li B, Zhang J, Duan LL, Hu BX, Gao YJ. Analysis of the clinical factors affecting excellent response of Iodine-131 treatment for pulmonary metastases from differentiated thyroid cancer. Heliyon 2023; 9:e20853. [PMID: 37928010 PMCID: PMC10623150 DOI: 10.1016/j.heliyon.2023.e20853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Background Iodiene-131 (131I) treatment is the primary therapeutic approach for imaging 131I-avid pulmonary metastases. The response to radioiodine (RAI) treatment is an important prognostic factor in patients with pulmonary metastases from differentiated thyroid cancer (DTC). Patients who achieve an excellent response (ER) to 131I treatment show significantly reduced disease-related mortality. This study aimed to retrospectively analyse the clinical data and therapeutic effects of 131I treatment in patients with DTC and pulmonary metastases and to screen out the clinical factors affecting ER. Materials and methods The study included a total of 75 patients with exclusively Iodine-131 avid (131I-avid) pulmonary metastases who underwent 131I treatment. Relevant clinical data for these patients were collected. Following treatment, the status of DTC metastatic lesions was categorized as follows: excellent response (ER), biochemical incomplete response (BIR), structural incomplete response (SIR), or indeterminate response (IDR). Gender, age at diagnosis, pathological type, stages (TNM), stimulated thyroglobulin (sTg) value before initial 131I treatment, metastatic nodule size, and type of post-treatment whole body scan (Rx-WBS) were recorded. Mono-factor analysis and binary logistic regression analyses were used to identify the factors that might affect the ER in DTC pulmonary metastases. The receiver operating characteristic (ROC) curve of the sTg value was used to predict the ER of 131I treatment. Results All 75 patients with exclusively 131I-avid pulmonary metastases received 131I treatment and underwent follow-up. Out of the 75 patients, 26 achieved ER, resulting in an excellent response rate of 34.7 % (26/75). Among them, 25 (25/26, 96.2 %) achieved an ER after undergoing two rounds of 131I treatment. Binary logistic regression analysis showed that the factors influencing DTC pulmonary metastases excellent response were lower sTg levels [odds ratio (OR) = 0.998, P < 0.001], micronodular metastases (OR = 0.349, P = 0.001) and focal distribution on Rx-WBS imaging (OR = 0.113, P = 0.001). The area under the ROC curve for sTg value predicting ER was 0.876, and the cut-off value was 26.84 ng/mL, with a sensitivity and specificity of 87.9 % and 80.3 %, respectively. Conclusions 131I treatment is effective for 131I-avid pulmonary metastases of DTC. Some patients who underwent 131I treatment achieved ER. Most patients with ER were obtained after two rounds of 131I treatments. Patients with sTg values before initial 131I treatment lower than 26.84 ng/mL, micronodular metastases, and focal distribution on Rx-WBS imaging were more likely to achieve ER.
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Affiliation(s)
- Xin-Yu Wu
- Department of Nuclear Medicine, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Novel Molecular Probes and Clinical Translation in Nuclear Medicine, Zhengzhou, People's Republic of China
| | - Bo Li
- Department of Nuclear Medicine, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Novel Molecular Probes and Clinical Translation in Nuclear Medicine, Zhengzhou, People's Republic of China
| | - Jie Zhang
- Department of Nuclear Medicine, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - Li-Li Duan
- Department of Nuclear Medicine, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
| | - Bing-Xin Hu
- Department of Nuclear Medicine, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Novel Molecular Probes and Clinical Translation in Nuclear Medicine, Zhengzhou, People's Republic of China
| | - Yong-Ju Gao
- Department of Nuclear Medicine, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, People's Republic of China
- Henan Key Laboratory of Novel Molecular Probes and Clinical Translation in Nuclear Medicine, Zhengzhou, People's Republic of China
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12
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Kato S, Demura S, Yokogawa N, Shimizu T, Kobayashi M, Yamada Y, Murakami H, Tsuchiya H. Metastasectomy of spinal lesions from thyroid carcinomas. Bone Joint J 2023; 105-B:575-582. [PMID: 37121585 DOI: 10.1302/0301-620x.105b5.bjj-2022-1003.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Patients with differentiated thyroid carcinomas (DTCs) have a favourable long-term survival. Spinal metastases (SMs) cause a decline in performance status (PS), directly affecting mortality and indirectly preventing the use of systemic therapies. Metastasectomy is indicated, if feasible, as it yields the best local tumour control. Our study aimed to examine the long-term clinical outcomes of metastasectomy for SMs of thyroid carcinomas. We collected data on 22 patients with DTC (16 follicular and six papillary carcinomas) and one patient with medullary carcinoma who underwent complete surgical resection of SMs at our institution between July 1992 and July 2017, with a minimum postoperative follow-up of five years. The cancer-specific survival (CSS) from the first spinal metastasectomy to death or the last follow-up was determined using Kaplan-Meier analysis. Potential factors associated with survival were evaluated using the log-rank test. We analyzed the clinical parameters and outcome data, including pre- and postoperative disability (Eastern Cooperative Oncology Group PS 3), lung and non-spinal bone metastases, and history of radioiodine and kinase inhibitor therapies. Lung and other bone metastases at the time of surgery were observed in ten and eight patients, respectively. Three patients experienced local tumour recurrences at the operated site. The five- and ten-year CSS rates in the 22 patients with DTC were 77% and 52%, respectively. Pre- and postoperative disability and operative site tumour recurrence were identified as risk factors for short postoperative survival. Metastasectomy for resectable SM from DTC yielded favourable results and has the potential to improve survival.
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Affiliation(s)
- Satoshi Kato
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Satoru Demura
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Noriaki Yokogawa
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takaki Shimizu
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Motoya Kobayashi
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yohei Yamada
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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13
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Akatani N, Wakabayashi H, Kayano D, Inaki A, Takata A, Hiromasa T, Yamase T, Kunita Y, Watanabe S, Mori H, Saito S, Nakajima K, Kinuya S. Long-term outcomes and prognostic factors of patients with lung metastases from differentiated thyroid cancer after radioiodine therapy in Japan. Endocr J 2023; 70:315-322. [PMID: 36567077 DOI: 10.1507/endocrj.ej22-0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Long-term survival in patients with differentiated thyroid cancer (DTC) and lung metastasis remains unexplored in Japan. This study aimed to investigate the long-term survival and prognostic factors of radioiodine therapy (RIT) in a University Hospital setting. This retrospective study included 62 patients with lung metastases from DTC who received RIT between March 2005 and December 2016. According to the 131I whole-body scan and chest computed tomography results, lung metastases were classified as 131I-avid or non-131I-avid, and miliary, micronodular, or macronodular metastases. The 5- and 10-year overall survival (OS) rates from the initial RIT were calculated by the Kaplan-Meier method, and a proportional hazard fit analysis was performed to determine prognostic factors. With a median follow-up of 7.9 years, the 5- and 10-year OS rates from the initial RIT were 93% and 72%, respectively. Univariable and multivariable analyses of patient subgroups revealed that macronodular lung metastases (defined as nodules >1 cm), older age at initial RIT, and high thyroglobulin values (>400 ng/mL) at initial RIT predicted low OS. The 5- and 10-year OS rates of DTC patients with lung metastases were similar to those in previous Japanese reports, which included a smaller sample size compared with ours. Patients with ≤1 cm lung metastases, aged ≤55 years, and a thyroglobulin level of ≤400 ng/mL at the initial RIT had favorable outcomes.
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Affiliation(s)
- Norihito Akatani
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Daiki Kayano
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Anri Inaki
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Aki Takata
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Tomo Hiromasa
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Takafumi Yamase
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Yuji Kunita
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Satoru Watanabe
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa 920-8641, Japan
| | - Hiroshi Mori
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Shintaro Saito
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University, Kanazawa 920-8641, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa 920-8641, Japan
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14
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Li X, Yan L, Xiao J, Li Y, Zhu Y, Yang Z, Zhang M, Luo Y. Optimal thyrotropin level for low-risk papillary thyroid carcinoma after ultrasound-guided radiofrequency ablation. Int J Hyperthermia 2023; 40:2160880. [PMID: 36599433 DOI: 10.1080/02656736.2022.2160880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Maintaining an optimal thyroid stimulating hormone (TSH) level is important in the postoperative management of papillary thyroid carcinoma (PTC). However, there is little evidence for TSH target levels in patients undergoing radiofrequency ablation (RFA). This study aimed to determine the optimal TSH level for management in low-risk patients who underwent RFA. METHODS This retrospective propensity score-matched cohort study included patients with low-risk PTC who underwent RFA from January 2014 to December 2018. The patients were categorized into two groups based on the range of TSH levels: low (≤2 mU/L) and high (>2 mU/L) TSH levels. Local tumor progression and disease-free survival (DFS) were compared between the low TSH and high TSH groups, using propensity score analyses based on patient- and tumor-level characteristics. Univariate analyses were performed to select risk factors for tumor progression. RESULTS Overall, our study included 516 patients with low-risk PTC who underwent RFA with a long-term follow-up of 5-years. During follow-up, the overall incidence rate of local tumor progression was 4.8% (25/516), with no significant difference between the matched groups (7/106 [6.6%] vs. 5/53 [9.4%], p = 0.524). DFS did not differ between the two groups (p = 0.5). Moreover, TSH level was not regarded as a significant predictor of tumor progression after Cox analysis; primary tumor size was the only relevant risk factor. CONCLUSION This large propensity-matched study revealed no association between TSH levels and tumor progression. Thus, for patients with low-risk PTC who underwent RFA, the optimalTSH level is recommended at the euthyroid range.
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Affiliation(s)
- Xinyang Li
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Lin Yan
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yingying Li
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen Yang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
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15
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Wilhelm A, Conroy PC, Calthorpe L, Shui AM, Kitahara CM, Roman SA, Sosa JA. Disease-Specific Survival Trends for Patients Presenting with Differentiated Thyroid Cancer and Distant Metastases in the United States, 1992-2018. Thyroid 2023; 33:63-73. [PMID: 36413032 PMCID: PMC9885538 DOI: 10.1089/thy.2022.0353] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: Differentiated thyroid cancer (DTC) is associated with an excellent prognosis, but patients with distant metastatic DTC have a 10-year disease-specific survival (DSS) of just 50%. The incidence of distant metastatic DTC has steadily increased in the United States since the 1980s. The aim of this study was to examine trends in survival and treatment for patients with distant metastatic DTC. Methods: In this population-based, retrospective cohort study, patients with distant metastatic DTC were identified from the Surveillance, Epidemiology, and End Results-13 cancer registry program. Multivariable logistic and Cox regression analyses were used to examine factors associated with DSS and management. Annual percentage changes in treatment patterns were calculated using log-linear regression. Results: During 1992-2018, 1991 patients (69.7% white, 58.0% female, 47.5% aged ≥65 years) were diagnosed with distant metastatic DTC. Papillary thyroid cancer was the most common histological type (74.5%). While the 10-year DSS for overall DTC increased over time (95.4% for patients diagnosed in 1992-1998, 96.6% in 1999-2008, and 97.3% in 2009-2018; p < 0.01), 10-year DSS for DTC with distant metastases did not change (50.2%, 47.3%, and 52.4%, respectively; p = 0.48). Ten-year DSS rates were reduced for patients aged ≥65 years (28.1%), patients undergoing nonsurgical treatment with external beam radiation therapy and/or systemic therapy (6.0%), and patients undergoing no/unknown treatment (32.8%). On multivariable analysis, oncocytic carcinoma, age 65-79 and ≥80 years, male sex, node-positive disease, larger tumor size, nonsurgical treatment, and no/unknown treatment were associated with increased risk of thyroid cancer death. Between 1992 and 2018, the rate of nonsurgical treatment increased, on average, 1.3% per year (1992-1998: 22.9% vs. 2009-2018: 25.6%; p = 0.03), and the rate of patients receiving no/unknown treatment increased 1.9% per year (1992-1998: 11.3% vs. 2009-2018: 15.6%; p = 0.01). Patients aged 65-79 and ≥80 years were more likely than younger patients to receive nonsurgical management or no/unknown treatment. Conclusion: Patients diagnosed with distant metastatic DTC have experienced no improvement in DSS over the past three decades. An increasing proportion of patients diagnosed with distant metastatic DTC are receiving nonsurgical treatment or no/unknown treatment over time; the proportion was highest among the oldest patients.
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Affiliation(s)
- Alexander Wilhelm
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
- Department of Surgery, Clarunis – St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Patricia C. Conroy
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
| | - Lucia Calthorpe
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
| | - Amy M. Shui
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Cari M. Kitahara
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Sanziana A. Roman
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
| | - Julie Ann Sosa
- Department of Surgery and University of California, San Francisco, San Francisco, California, USA
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16
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Lee JS, Lee JS, Yun HJ, Chang H, Kim SM, Lee YS, Chang HS, Park CS. Prognosis of Anaplastic Thyroid Cancer with Distant Metastasis. Cancers (Basel) 2022; 14:cancers14235784. [PMID: 36497268 PMCID: PMC9737297 DOI: 10.3390/cancers14235784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Anaplastic thyroid cancer (ATC) is derived from follicular thyroid cells and is associated with high mortality risk. Obtaining information to characterize ATC is difficult because ATC with distant metastasis is extremely rare. This study determined the clinical characteristics of ATC with distant metastasis. The medical records of 152 patients with ATC at Gangnam Severance Hospital were reviewed between January 2004 and March 2022. The primary endpoint was the overall survival of the total patient sample, patients with ATC and distant metastasis, and those with ATC and brain metastasis. Of the 152 patients with ATC, 88 had distant metastasis at diagnosis. The 5-year disease-specific survival was 24% for total ATC and 10% for ATC with distant metastasis. Survival for >1 year was 32% for total ATC and 15% for ATC with distant metastasis. The median survival rate differed significantly between the total ATC and ATC with distant metastasis groups (228.5 vs. 171 days). Among the ATC cases, 11% had brain metastasis; thus, brain MRI or CT is worth considering at diagnosis and follow-up, even if there were no statistical difference in overall survival between patients with ATC with and without brain metastasis.
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Affiliation(s)
- Jin-Seok Lee
- Thyroid Cancer Center, Department of Surgery, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Jun Sung Lee
- Thyroid Cancer Center, Department of Surgery, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hyeok Jun Yun
- Thyroid Cancer Center, Department of Surgery, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hojin Chang
- Thyroid Cancer Center, Department of Surgery, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Seok Mo Kim
- Thyroid Cancer Center, Department of Surgery, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
- Correspondence: ; Tel.: +82-2-2019-3370
| | - Yong Sang Lee
- Thyroid Cancer Center, Department of Surgery, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Hang-Seok Chang
- Thyroid Cancer Center, Department of Surgery, Institute of Refractory Thyroid Cancer, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Goyang-si 10414, Republic of Korea
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17
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Nervo A, Retta F, Ragni A, Piovesan A, Gallo M, Arvat E. Management of Progressive Radioiodine-Refractory Thyroid Carcinoma: Current Perspective. Cancer Manag Res 2022; 14:3047-3062. [PMID: 36275786 PMCID: PMC9584766 DOI: 10.2147/cmar.s340967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with thyroid cancer (TC) usually have an excellent prognosis; however, 5-10% of them develop an advanced disease. The prognosis of this subgroup is still favourable if the lesions respond to radioactive iodine (RAI) treatment. Nearly two-thirds of advanced TC patients become RAI-refractory (RAI-R), and their management is challenging. A multidisciplinary approach in the context of a tumour board is essential to define a personalized strategy. Systemic therapy is not always the best option. In case of slow neoplastic growth and low tumour burden, active surveillance may represent a valuable choice. Local approaches might be considered if the disease progression is limited to a single or few lesions, also in combination and during systemic therapy. Antiresorptive treatment may be started in presence of bone metastases. In case of rapid and/or symptomatic progression involving multiple lesions and/or organs, systemic therapy has to be considered, in absence of contraindications. The multi-kinase inhibitors (MKIs) lenvatinib and sorafenib are currently available as first-line treatment for advanced progressive RAI-R TC. Among second-line options, cabozantinib has been recently approved in RAI-R TC who progressed during MKIs targeting the vascular endothelial growth factor receptor (VEGFR). In the last few years, next-generation sequencing (NGS) assays have been increasingly employed, permitting identification of the genetic alterations harboured by TC, with a significant impact on patients' management. Novel selective targeted therapies have been introduced for the treatment of RAI-R TC in selected cases: REarranged during Transfection (RET) inhibitors (selpercatinib and pralsetinib) and Tropomyosin Receptor Kinase (TRK) inhibitors (larotrectinib and entrectinib) have recently expanded the panorama of the therapeutic options. Moreover, immune checkpoint inhibitors (ICIs) have shown promising results, and they are still under investigation.
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Affiliation(s)
- Alice Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy,Correspondence: Alice Nervo, Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Via Genova 3, Turin, 10126, Italy, Tel +390116336611, Fax +390116334703, Email
| | - Francesca Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
| | - Alberto Ragni
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Alessandro Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
| | - Marco Gallo
- Endocrinology and Metabolic Diseases Unit, AO SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Emanuela Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, University of Turin, Turin, Italy
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18
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Chen YK, Chen YC, Lin WX, Zheng JH, Liu YY, Zou J, Cai JH, Ji ZQ, Chen LZ, Li ZY, Chen YX. Follicular carcinoma of the thyroid with a single metastatic lesion in the lumbar spine: A case report. World J Clin Cases 2022; 10:9493-9501. [PMID: 36159419 PMCID: PMC9477679 DOI: 10.12998/wjcc.v10.i26.9493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/17/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The bone is the second most common site of thyroid cancer metastasis, after the lung. Treatment options for bone metastasis of thyroid cancer include surgery, radioiodine therapy (RAIT), external radiation therapy, thyroid-stimulating hormone (TSH) inhibition, bisphosphonates, and small-molecule targeted therapies. In most cases, thyroid carcinoma is found in the thyroid tissue; reports of follicular thyroid carcinoma with a single metastasis to the lumbar spine are rare.
CASE SUMMARY We report a case of bone metastasis as the only clinical manifestation of thyroid cancer. The patient was a 67-year-old woman with lumbar pain for 7 years and aggravation with intermittent claudication who had previously undergone partial thyroidectomy of a benign thyroid lesion. No abnormal nodules were found in the bilateral thyroid glands. However, imaging studies were consistent with a spinal tumor, and the lesion was diagnosed as a metastatic follicular carcinoma of thyroid origin. We adopted a multidisciplinary collaboration and comprehensive treatment approach. The patient underwent lumbar spine surgery, total resection of the thyroid, postoperative TSH suppression therapy, and RAIT. There were no complications associated with the operation, and the patient had good postoperative recovery. She has experienced no recurrence.
CONCLUSION Follicular thyroid carcinoma is associated with early hematogenous metastasis, and the bone is a typical site of metastasis. Single bone metastasis is not a contraindication to medical procedures, and providing the appropriate therapy can result in better outcomes and quality of life for these patients.
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Affiliation(s)
- Yao-Kun Chen
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Yu-Chun Chen
- Department of Bone, Joint and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Wei-Xun Lin
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Jie-Hua Zheng
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Yi-Yuan Liu
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Juan Zou
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Jie-Hui Cai
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Ze-Qi Ji
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Ling-Zhi Chen
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Zhi-Yang Li
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
| | - Ye-Xi Chen
- Department of Thyroid, Breast and Hernia Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515000, Guangdong Province, China
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19
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Sparano C, Moog S, Hadoux J, Dupuy C, Al Ghuzlan A, Breuskin I, Guerlain J, Hartl D, Baudin E, Lamartina L. Strategies for Radioiodine Treatment: What’s New. Cancers (Basel) 2022; 14:cancers14153800. [PMID: 35954463 PMCID: PMC9367259 DOI: 10.3390/cancers14153800] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Radioiodine treatment (RAI) represents the most widespread and effective therapy for differentiated thyroid cancer (DTC). RAI goals encompass ablative (destruction of thyroid remnants, to enhance thyroglobulin predictive value), adjuvant (destruction of microscopic disease to reduce recurrences), and therapeutic (in case of macroscopic iodine avid lesions) purposes, but its use has evolved over time. Randomized trial results have enabled the refinement of RAI indications, moving from a standardized practice to a tailored approach. In most cases, low-risk patients may safely avoid RAI, but where necessary, a simplified protocol, based on lower iodine activities and human recombinant TSH preparation, proved to be just as effective, reducing overtreatment or useless impairment of quality of life. In pediatric DTC, RAI treatments may allow tumor healing even at the advanced stages. Finally, new challenges have arisen with the advancement in redifferentiation protocols, through which RAI still represents a leading therapy, even in former iodine refractory cases. RAI therapy is usually well-tolerated at low activities rates, but some concerns exist concerning higher cumulative doses and long-term outcomes. Despite these achievements, several issues still need to be addressed in terms of RAI indications and protocols, heading toward the RAI strategy of the future.
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Affiliation(s)
- Clotilde Sparano
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Sophie Moog
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Julien Hadoux
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Corinne Dupuy
- UMR 9019 CNRS, Université Paris-Saclay, Gustave Roussy, 94800 Villejuif, France
| | - Abir Al Ghuzlan
- Département de Biologie et Pathologie Médicales, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Ingrid Breuskin
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Joanne Guerlain
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Dana Hartl
- Département Anesthésie Chirurgie et Interventionnel, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Eric Baudin
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
| | - Livia Lamartina
- Service d’oncologie Endocrinienne, Département d’Imagerie Médicale, Gustave Roussy, 112 rue Edouard Vaillant, 94805 Villejuif, France
- Correspondence:
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20
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Jannin A, Lamartina L, Moutarde C, Djennaoui M, Lion G, Chevalier B, Vantyghem MC, Deschamps F, Hadoux J, Baudin E, Schlumberger M, Leboulleux S, Do Cao C. Bone metastases from differentiated thyroid carcinoma: heterogenous tumor response to radioactive Iodine therapy and overall survival. Eur J Nucl Med Mol Imaging 2022; 49:2401-2413. [PMID: 35149914 PMCID: PMC9165254 DOI: 10.1007/s00259-022-05697-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/19/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE Bone metastases (BM) from differentiated thyroid carcinoma (DTC) impact negatively the quality of life and the life expectancy of patients. The aim of the study was (a) to evaluate the overall survival (OS) and prognostic factors of OS and (b) to assess predictive factors of complete BM response (C-BM-R) using radioiodine treatment (RAI) either alone or in association with focal treatment modalities. METHODS A total of 178 consecutive DTC patients harbouring BM, treated between 1989 and 2015, were enrolled in this retrospective study conducted in two tertiary referral centers. OS analysis was performed for the whole cohort, and only the 145 considered non-RAI refractory patients at BM diagnosis were evaluated for C-BM-R following RAI. RESULTS The median OS from BM diagnosis was 57 months (IQR: 24-93). In multivariate analysis, OS was significantly reduced in the case of T4 stage, 18FDG uptake by the BM and RAI refractory status. Among the 145 DTC considered non-RAI refractory patients at BM diagnosis, 46 patients (31.7%) achieved a C-BM-R following RAI treatment, either alone in 32 (18%) patients or in association with focal BM treatment modalities in 14. The absence of extra-skeletal distant metastasis and of 18FDG uptake in BM were predictive for C-BM-R. CONCLUSIONS In nearly one-third of DTC patients with RAI avid BM, RAI alone or in combination with BM focal treatment can induce C-BM-R. The presence of 18FDG uptake in BM is associated with an absence of C-BM-R and with a poor OS. 18FDG PET-CT should be performed when BM is suspected.
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Affiliation(s)
- Arnaud Jannin
- Department of Endocrinology and Metabolism, University Hospital of Lille, Lille, France.
- University of Lille, Lille, France.
| | - Livia Lamartina
- Gustave Roussy, Service d'oncologie Endocrinienne, Département d'Imagerie, University Paris Saclay, Cedex, Villejuif, France
| | - Coralie Moutarde
- Department of Endocrinology and Metabolism, Armentières Hospital, Armentières, France
| | - Mehdi Djennaoui
- Department of Public Health, Valenciennes Hospital, Valenciennes, France
| | - George Lion
- Department of Nuclear Medicine, University Hospital of Lille and Lille University, Lille, France
| | - Benjamin Chevalier
- Department of Endocrinology and Metabolism, University Hospital of Lille, Lille, France
- University of Lille, Lille, France
| | - Marie Christine Vantyghem
- Department of Endocrinology and Metabolism, University Hospital of Lille, Lille, France
- University of Lille, Lille, France
| | - Frédéric Deschamps
- Gustave Roussy, Department of Interventional Radiology, University Paris Saclay, Villejuif Cedex, France
| | - Julien Hadoux
- Gustave Roussy, Service d'oncologie Endocrinienne, Département d'Imagerie, University Paris Saclay, Cedex, Villejuif, France
| | - Eric Baudin
- Gustave Roussy, Service d'oncologie Endocrinienne, Département d'Imagerie, University Paris Saclay, Cedex, Villejuif, France
| | - Martin Schlumberger
- Gustave Roussy, Service d'oncologie Endocrinienne, Département d'Imagerie, University Paris Saclay, Cedex, Villejuif, France
| | - Sophie Leboulleux
- Gustave Roussy, Service d'oncologie Endocrinienne, Département d'Imagerie, University Paris Saclay, Cedex, Villejuif, France
| | - Christine Do Cao
- Department of Endocrinology and Metabolism, University Hospital of Lille, Lille, France
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21
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Nunes KS, Matos LL, Cavalheiro BG, Magnabosco FF, Tavares MR, Kulcsar MA, Hoff AO, Kowalski LP, Leite AK. Risk factors associated with disease-specific mortality in papillary thyroid cancer patients with distant metastases. Endocrine 2022; 75:814-822. [PMID: 34665427 DOI: 10.1007/s12020-021-02901-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Papillary thyroid carcinoma (PTC) is among the most curable cancer types. Even though uncommon, some patients present distant metastatic disease at diagnosis or during the follow-up and most of them have long-term survival. However, there continues to be controversies regarding what clinicopathological features are associated with mortality in these patients. This paper evaluates the factors related to poor disease-specific survival (DSS) in patients with metastatic PTC. METHODS A retrospective cohort study included PTC patients with distant metastasis from a tertiary public oncological center. Clinicopathological features, treatment modalities, and outcome were reviewed. RESULTS Between 1986 and 2014, 108 patients were diagnosed with metastatic PTC. In the multivariate analysis male sex (HR = 2.65; 95%CI: 1.08-6.53; P = 0.033), radioiodine refractory disease (HR = 9.50; 95%CI: 1.23-73.38; P = 0.031) and metastasis at multiple sites (HR = 5.91; 95%CI: 1.80-19.32; P = 0.003) were independent risk factors for death in patients with metastatic PTC. CONCLUSION Male patients with metastatic PTC, with radioiodine refractory disease and metastasis at multiple sites have a high risk of death.
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Affiliation(s)
- Kamilla Schmitz Nunes
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Leandro Luongo Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Beatriz Godoi Cavalheiro
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Ferraz Magnabosco
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Roberto Tavares
- Head and Neck Surgery Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marco Aurélio Kulcsar
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Oliveira Hoff
- Endocrinology Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Kober Leite
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo/Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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22
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Pierre-Alexis A, SCHNEEGANS O, KOCH G, WEISS J, CAUDRELIER J, DALILI D, PEROLAT R, AULOGE P, Luigi CAZZATO R, GANGI A, GARNON J. Technique efficacy and safety following percutaneous cryoablation of extra-spinal thyroid cancer bone metastases with curative intent: single-center experience with a median follow-up of more than 5 years. J Vasc Interv Radiol 2022; 33:797-804. [DOI: 10.1016/j.jvir.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
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23
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Qi L, Zhang W, Ren X, Xu R, Liu C, Tu C, Li Z. Incidence and Predictors of Synchronous Bone Metastasis in Newly Diagnosed Differentiated Thyroid Cancer: A Real-World Population-Based Study. Front Surg 2022; 9:778303. [PMID: 35141273 PMCID: PMC8819693 DOI: 10.3389/fsurg.2022.778303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/03/2022] [Indexed: 12/24/2022] Open
Abstract
Background Clinical and sociodemographic characteristics of differentiated thyroid cancer (DTC) patients with synchronous bone metastasis (SBM) remain unclear. This real-world study aimed to elucidate the incidence and prognosis of DTC patients with SBM using population-based data. Methods Data of patients with newly diagnosed DTC from 2010 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression analysis was utilized to identify predictors of developing SBM in patients with DTC and was further evaluated by receiver operator characteristics (ROC) analysis. Multivariable Cox regression was applied to identify prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS). Results A total of 67,176 patients with DTC were screened from the database, with 0.36% (244/67,176) developed SBM. The age-adjusted incidence of SBM in patients with DTC was relatively stable during the study period with an average annual percentage change (AAPC) of 2.52. Multivariable logistic regression analysis recognized seven factors (older age, male gender, black race, other races, follicular histology, the American Joint Committee on Cancer (AJCC) T2, T3, T4 staging, and N1 staging) as predictors of developing SBM among the entire cohort, with the value of area under the curve (AUC) of 0.931 (95% CI: 0.915–0.947). The median survival time of DTC patients with SBM was 22 months (interquartile range, 7–47 months). The multivariable Cox regression analysis indicated multiple metastatic sites, surgical procedures, and chemotherapy as predictors for the survival of patients. Conclusions Predictors and prognostic factors of SBM in patients with DTC were identified in this study. Patients with risk factors should be given more attention in clinical practice.
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Affiliation(s)
- Lin Qi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Wenchao Zhang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Xiaolei Ren
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Ruiling Xu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
| | - Chaoqian Liu
- Department of General Surgery, Changhai Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Chao Tu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
- *Correspondence: Chao Tu
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Changsha, China
- Zhihong Li
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24
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Feasibility of Recombinant Human TSH as a Preparation for Radioiodine Therapy in Patients with Distant Metastases from Papillary Thyroid Cancer: Comparison of Long-Term Survival Outcomes with Thyroid Hormone Withdrawal. Diagnostics (Basel) 2022; 12:diagnostics12010221. [PMID: 35054388 PMCID: PMC8775305 DOI: 10.3390/diagnostics12010221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
Background: this study was designed to compare the long-term survival outcomes of patients prepared for radioiodine (RAI) therapy using either thyroid hormone withdrawal (THW) or recombinant human thyrotropin (rhTSH) stimulation, by specifically focusing on cases with distant metastases from papillary thyroid cancer (PTC). Methods: A retrospective analysis was performed on 88 patients with distant metastases from PTC. Fifty-one and thirty-seven patients were prepared for RAI treatment by either THW or rhTSH stimulation, respectively. The primary endpoints were progression-free survival (PFS) and disease-specific survival (DSS). Results: The 10-year DSS rates of patients prepared for RAI therapy using either THW or rhTSH stimulation were 62.2% and 73.3%, respectively. Using multivariate analysis, RAI-avid metastases (p = 0.025) and preparation with rhTSH (p = 0.041) were identified as independent prognostic factors for PFS. Notably, PFS in the group of patients with RAI-avid metastases and preparation with rhTSH was significantly better than that in the other groups (p = 0.025). Conclusions: Preparation for RAI therapy using rhTSH stimulation is not inferior to THW preparation in terms of long-term survival outcomes experienced by patients with PTC and distant metastasis. Patients with RAI-avid metastases and preparation with rhTSH had the most favorable PFS.
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25
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Parvathareddy SK, Siraj AK, Qadri Z, DeVera F, Siddiqui K, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Microscopic Extrathyroidal Extension Results in Increased Rate of Tumor Recurrence and Is an Independent Predictor of Patient's Outcome in Middle Eastern Papillary Thyroid Carcinoma. Front Oncol 2021; 11:724432. [PMID: 34926245 PMCID: PMC8671701 DOI: 10.3389/fonc.2021.724432] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/15/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Papillary Thyroid Cancer (PTC) is the most common endocrine malignancy, with recurrence rate as high as 30%. A great deal of controversy surrounds the significance of microscopic extrathyroidal extension (m-ETE) as a prognostic factor. The most recent edition (8th) of American Joint Committee on Cancer (AJCC) staging system has removed m-ETE from the definition of pT3, which suggests that m-ETE may lack prognostic impact in PTC patients. Moreover, data about m-ETE prevalence and clinical impact on Middle Eastern PTC remains unknown. We therefore investigate the prevalence of m-ETE and its clinico-pathological correlation and prognostic impact in Middle Eastern PTC. We also compared the AJCC 7th and 8th staging systems and their prognostic performance. METHODS PTCs from 1430 consecutive adult (> 18 years) patients from single tertiary care hospital were included in this study. A retrospective analysis of PTC patients' survival and recurrence were compared between AJCC 8th and AJCC 7th staging systems using Proportion of Variation Explained (PVE) and Harrell's C-index. RESULTS Median follow up of the study cohort was 9.3 years. 31.2% (446/1430) of patients had m-ETE. In the overall cohort, m-ETE was associated with multiple adverse features such as older age (p < 0.0001), male sex (p = 0.0245), tall cell variant (p < 0.0001), bilateral tumors (p < 0.0001), multifocality (p < 0.0001), lymphovascular invasion (p < 0.0001), lymph node metastasis (p < 0.0001), distant metastasis (p = 0.0166), tumor recurrence (p < 0.0001), radioactive iodine refractoriness (p < 0.0001), BRAF mutation (p < 0.0001) and reduced recurrence-free survival (RFS; HR = 1.75; 95% CI = 1.30 - 2.35; p < 0.0001) irrespective of tumor size. Of the 611 patients with T3 disease based on AJCC 7th edition, 359 (58.8%) were down-staged in AJCC 8th edition classification. Overall, the prognostic performance of AJCC 8th edition was inferior to AJCC 7th on the basis of lower PVE (3.04% vs. 3.73%) and lower C-index (0.40 vs. 0.48). CONCLUSIONS In Middle Eastern PTC, m-ETE is significantly associated with compromised survival and acts as an independent predictor of RFS. Given these findings, m-ETE should be included in the thyroid cancer treatment guidelines.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zeeshan Qadri
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Felisa DeVera
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology-Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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26
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Dhanani R, Faisal M, Akram M, Shakeel O, Zahid MT, Hassan A, Hussain R. Differentiated Thyroid Carcinoma: Distant Metastasis as an Unusual Sole Initial Manifestation. Turk Arch Otorhinolaryngol 2021; 59:188-192. [PMID: 34713003 PMCID: PMC8527540 DOI: 10.4274/tao.2021.2021-2-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/25/2021] [Indexed: 01/11/2023] Open
Abstract
Objective: The objective of this study was to identify the characteristic features of patients with distant metastasis as the only manifestation of well-differentiated thyroid cancers and to analyze the treatment outcomes Methods: A retrospective review of all patients with well-differentiated thyroid cancers and distant metastasis as the sole initial presentation was carried out. Data regarding age, gender, tumor histology, site, symptoms, and treatment outcomes were collected. Results: There were 10 patients who presented with distant metastasis as the only presentation. The mean age was 56.1 years. Eight (80%) patients had osseous metastasis, one (10%) had pulmonary and one (10%) had both. Follicular thyroid carcinoma was more common and seen in six (60%) patients. Seven (77.8%) out of nine patients had demised within five years of initial presentation. Conclusion: Distant metastases without a neck lump as the initial presentation of well-differentiated thyroid cancers are extremely rare. No specific guidelines are available to manage such patients due to lack of relevant data in the literature.
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Affiliation(s)
- Rahim Dhanani
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Mahir Akram
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Osama Shakeel
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muhammad Toqeer Zahid
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Aamna Hassan
- Department of Nuclear Medicine, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
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27
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Kato S, Demura S, Shinmura K, Yokogawa N, Shimizu T, Tsuchiya H. Current Management of Bone Metastases from Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13174429. [PMID: 34503240 PMCID: PMC8431580 DOI: 10.3390/cancers13174429] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC) can live longer than those with BMs from other cancers. BMs from DTC create destructive lesions and easily cause intractable pain and neurological symptoms, including paralysis. These symptoms related to BMs affect mortality directly and indirectly by hampering the application of systemic therapies. Therefore, long-term local control of BMs in patients with DTC is desired, especially in patients with single or a small number of metastases. Local treatments for BMs have recently become advanced and sophisticated in surgery, radiotherapy, and percutaneous procedures. These therapies, either alone or in combination with other treatments, can effectively improve, or prevent the deterioration of, the performance status and quality of life of patients with DTC-BM. Among local therapies, complete surgical resection and stereotactic radiosurgery are the mainstay for achieving long-term control of DTC-BM. Abstract After the lung, the skeleton is the second most common site of distant metastases in differentiated thyroid carcinoma (DTC). Patients with osteolytic bone metastases (BMs) from thyroid carcinoma often have significantly reduced performance status and quality of life. Recent advancements in cancer therapy have improved overall survival in multiple cancer subtypes, including thyroid cancer. Therefore, long-term local control of thyroid BMs is desired, especially in patients with a single metastasis or oligometastases. Here, we reviewed the current management options for DTC-BMs and especially focused on local treatments for long-term local tumor control from an orthopedic tumor surgeon’s point of view. Metastasectomy and stereotactic radiosurgery can be performed either alone or in combination with radioiodine therapy and kinase inhibitors to cure skeletal lesions in selected patients. Percutaneous procedures have been developed in recent years, and they can also have a curative role in small BMs. Recent advancements in local therapies have the potential to provide not only long-term local tumor control but also a better prognosis.
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Fung R, Fasen M, Warda F, Natter P, Nedrud S, Fernandes R, Alkhasawneh A, Gandhi GY. Clavicular Metastasis as an Initial Presentation of Papillary Thyroid Cancer. Case Rep Endocrinol 2021; 2021:6662071. [PMID: 34484842 PMCID: PMC8413079 DOI: 10.1155/2021/6662071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE We present the case of a 44-year-old man with a large neck mass to highlight the unique presentation of papillary thyroid carcinoma (PTC) metastatic to the clavicle. METHODS We reviewed the medical record for a detailed history and physical examination findings. Our radiology colleagues examined the diagnostic imaging studies performed. The pathology team reviewed the neck mass biopsy and the confirmatory surgical pathology after total resection of the mass. RESULTS A 44-year-old man presented with an enlarging neck mass. Initial X-rays revealed a large soft tissue density mass that extended to the midline of the right clavicle. A neck ultrasound established a 5.4 × 3.6 cm mass with increased vascularity and calcification extending from the thyroid. A CT scan noted the extension of the mass into the adjacent sternoclavicular junction with osteolysis of the middle third of the clavicle and the superior aspect of the sternal body. Fine-needle aspiration revealed a thyroid neoplasm with follicular features and positive immunostaining consistent with thyroid carcinoma. The patient underwent a composite resection of the tumor, including a segmental osteotomy of approximately two-thirds of the medial clavicle. The pathology report confirmed PTC with extrathyroidal extension and clavicle involvement (staged pT4a pN0), with further genomic findings showing positive KRAS mutation. CONCLUSION Clavicular metastasis from differentiated thyroid cancer is rare. While the prognosis is generally favorable, various factors, including age greater than 45 years, poor differentiation, follicular thyroid carcinoma, Hurthle cell variant, and extrapulmonary metastasis, have typically been associated with poorer cancer-specific survival.
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Affiliation(s)
- Russell Fung
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Madeline Fasen
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Firas Warda
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Patrick Natter
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Stacey Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Ahmad Alkhasawneh
- Department of Pathology and Laboratory Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Gunjan Y. Gandhi
- Division of Endocrinology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
- Department of Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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Siraj AK, Poyil PK, Parvathareddy SK, Alobaisi K, Ahmed SO, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Loss of ZNF677 Expression Is an Independent Predictor for Distant Metastasis in Middle Eastern Papillary Thyroid Carcinoma Patients. Int J Mol Sci 2021; 22:ijms22157833. [PMID: 34360599 PMCID: PMC8346014 DOI: 10.3390/ijms22157833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 01/08/2023] Open
Abstract
Thyroid cancer incidence has increased in recent decades. Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Approximately 30% of PTC patients develop recurrence or distant metastasis and tend to have poor prognosis. Therefore, the identification of targetable biomarkers in this subset of patients is of great importance. Accumulating evidence indicates that zinc finger protein 677 (ZNF677), which belongs to the zinc finger protein family, is an important effector during the progression of multiple malignancies. However, its role in Middle Eastern PTC patients has not been fully illustrated. Here, we uncovered the molecular mechanism and the clinical impact of ZNF677 expression in a large cohort of more than 1200 Middle Eastern PTC and 15 metastatic tissues. We demonstrated that ZNF677 is frequently downregulated in primary PTC (13.6%, 168/1235) and showed that complete loss of expression of ZNF677 is significantly associated with aggressive clinico-pathological markers such as extrathyroidal extension (p = 0.0008) and distant metastases (p < 0.0001). We also found a significantly higher incidence of ZNF677 loss in primary tumors with distant metastases (33.3%; p < 0.0001) as well as in distant metastatic tissues (46.7%; p = 0.0002) compared to the overall cohort (13.6%). More importantly, PTC with loss of ZNF677 expression showed significantly lower metastasis-free survival (p = 0.0090). Interestingly, on multivariate logistic regression analysis, ZNF677 loss was an independent predictor of distant metastasis in PTC (Odds ratio = 2.60, 95% Confidence interval = 1.20–5.62, p = 0.0155). In addition, we found a significant association between ZNF677 loss and phospho-AKT expression (p < 0.0001). Our functional molecular results suggest that ZNF677 acts as a tumor suppressor, mediating its effect by inhibiting AKT phosphorylation. Taken together, our results highlight the pivotal role played by ZNF677 during carcinogenesis and metastasis formation in Middle Eastern PTC patients.
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Affiliation(s)
- Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (P.K.P.); (S.K.P.); (K.A.); (S.O.A.)
| | - Pratheesh Kumar Poyil
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (P.K.P.); (S.K.P.); (K.A.); (S.O.A.)
| | - Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (P.K.P.); (S.K.P.); (K.A.); (S.O.A.)
| | - Khadija Alobaisi
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (P.K.P.); (S.K.P.); (K.A.); (S.O.A.)
| | - Saeeda O. Ahmed
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (P.K.P.); (S.K.P.); (K.A.); (S.O.A.)
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (P.K.P.); (S.K.P.); (K.A.); (S.O.A.)
- Correspondence: ; Tel.: +966-11-205-5167
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Toraih EA, Hussein MH, Zerfaoui M, Attia AS, Marzouk Ellythy A, Mostafa A, Ruiz EML, Shama MA, Russell JO, Randolph GW, Kandil E. Site-Specific Metastasis and Survival in Papillary Thyroid Cancer: The Importance of Brain and Multi-Organ Disease. Cancers (Basel) 2021; 13:cancers13071625. [PMID: 33915699 PMCID: PMC8037301 DOI: 10.3390/cancers13071625] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction-heterogeneity in clinical outcomes and survival was observed in patients with papillary thyroid cancer (PTC) and distant metastases. Here, we investigated the effect of distant metastases sites on survival in PTC patients. Methods-patients with a diagnosis of PTC and known metastases were identified using the Surveillance, Epidemiology, and End Results database (1975-2016). Univariate and multivariate Cox regression analyses were performed to analyze the effect of distant metastases sites on thyroid cancer-specific survival (TCSS) and overall survival (OS). Results-from 89,694 PTC patients, 1819 (2%) developed distant metastasis at the initial diagnosis, of whom 26.3% presented with the multiple-organ disease. The most common metastatic sites were lung (53.4%), followed by bone (28.1%), liver (8.3%), and brain (4.7%). In metastatic patients, thyroid cancer-specific death accounted for 73.2%. Kaplan-Meier curves showed decreased OS in patients with metastases to the brain (median OS = 5 months) and liver (median OS = 6 months) compared to lung (median OS = 10 months) and bone (median OS = 23 months). Moreover, multiple organ metastasis had a higher mortality rate (67.4%) compared to single organ metastasis (51.2%, p < 0.001). Using multivariate analysis, risk factors that significantly influence TCSS and OS were male gender (HR = 1.86, 95% CI = 1.17-2.94, p < 0.001, and HR = 1.90, 95% CI = 1.40-2.57, p = 0.009), higher tumor grade (HR = 7.31, 95% CI = 2.13-25.0, p < 0.001 and HR = 4.76, 95% CI = 3.93-5.76, p < 0.001), multiple organ involvement (HR = 6.52, 95% CI = 1.50-28.39, p = 0.026 and HR = 5.08, 95% CI = 1.21-21.30, p = 0.013), and brain metastasis (HR = 1.82, 95% CI = 1.15-2.89, p < 0.001 and HR = 4.21, 95% CI = 2.20-8.07, p = 0.010). Conclusion-the pattern of distant metastatic organ involvement was associated with variability in OS in PTC. Multi-organ metastasis and brain involvement are associated with lower survival rates in PTC. Knowledge of the patterns of distant metastasis is crucial to personalize the treatment and follow-up strategies.
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Affiliation(s)
- Eman A. Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
- Genetics Unit, Department of Histology and Cell Biology, Suez Canal University, Ismailia 41522, Egypt
- Correspondence: (E.A.T.); (E.K.); Tel.: +1-504-988-7407 (E.A.T.); Fax: +1-504-988-4762 (E.A.T.)
| | - Mohammad H. Hussein
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Mourad Zerfaoui
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Abdallah S. Attia
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | | | - Arwa Mostafa
- Tulane University School of Medicine, New Orleans, LA 70112, USA; (A.M.E.); (A.M.)
| | - Emmanuelle M. L. Ruiz
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Mohamed Ahmed Shama
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
| | - Jonathon O. Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, Baltimore, MD 21287, USA;
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA 02115, USA;
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA; (M.H.H.); (M.Z.); (A.S.A.); (E.M.L.R.); (M.A.S.)
- Correspondence: (E.A.T.); (E.K.); Tel.: +1-504-988-7407 (E.A.T.); Fax: +1-504-988-4762 (E.A.T.)
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Jaffar S, Jayasekara J, Aniss AM, Tsang VHM, Learoyd DL, Clifton-Bligh R, Gill AJ, Glover AR, Sidhu SB, Robinson B, Sywak M. Predicting distant metastatic disease in differentiated thyroid cancer: a matched case-control study. ANZ J Surg 2021; 91:716-723. [PMID: 33590959 DOI: 10.1111/ans.16652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/17/2021] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The occurrence of distant metastasis (DM) is the most important prognostic factor influencing survival outcomes in differentiated thyroid cancer (DTC). Identifying patients who are likely to develop DM and offering these cases more aggressive surgical approaches and I-131 therapy, is paramount to achieving the best possible outcomes. DM on presentation in DTC are uncommon, with an incidence of 1-9%. However, the incidence of DTC is rising and the disease affects a relatively young cohort of patients. The aims of this study were to investigate predictive factors in the development of DM by comparing a homogenous group of DTC patients with and without DM, and to illustrate the overall and disease-specific survival (DSS) rates of DTC patients presenting with DM. METHODS A matched case-control study of patients with DTC and DM was undertaken. The study group comprised a consecutive series of cases with DM treated in the period 1968-2014. Patients with DM at initial presentation were identified (DTC-DM group). A control group of patients without DM were matched based on age, gender, tumour size and histological subtype. The primary outcome measures were overall and disease-free survival. Secondary outcome measures were lymph node involvement (LNI), extra-thyroidal extension (ETE) of tumour and presence of BRAFV600E mutation identified on immunohistochemistry. RESULTS A total of 2547 patients with DTC were reviewed and of these 83 (3.26%) had DM at initial presentation. At 5 and 10 years, the overall survival rates for DTC-DM patients were 89.6% and 64%, respectively. The 5 and 10 year DSS rates for DTC-DM cases were 90.2% and 67.3%, respectively. When compared to the DTC group, the DTC-DM group had significantly higher rates of ETE (63% vs. 29.5%, P < 0.0001) and LNI (32.5% vs. 18.8%, P = 0.044). Among patients with papillary thyroid cancer (PTC), the presence of BRAFV600E mutation was significantly associated with DM (62.2% vs. 36.8%, P = 0.028). CONCLUSION ETE, LNI and BRAFV600E mutation in PTC are significant predictors for the development of distant metastatic disease.
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Affiliation(s)
- Sukaina Jaffar
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jayani Jayasekara
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ahmad M Aniss
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Venessa H M Tsang
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Diana L Learoyd
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Roderick Clifton-Bligh
- Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Cancer Genetics Laboratory, Kolling Institute of Medical Research, Univerisity of Sydney and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony J Gill
- NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, University of Sydney and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anothony R Glover
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stan B Sidhu
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Bruce Robinson
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Mark Sywak
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Wang X, Zheng X, Zhu J, Li Z, Wei T. Radioactive iodine therapy may not improve disease-specific survival in follicular variant papillary thyroid cancer without distant metastasis: A propensity score-matched analysis. Head Neck 2021; 43:1730-1738. [PMID: 33559196 PMCID: PMC8248087 DOI: 10.1002/hed.26637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/20/2020] [Accepted: 01/21/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Whether radioactive iodine (RAI) therapy is effective in improving disease-specific survival (DSS) in patients with follicular variant papillary thyroid cancer (FVPTC) without distant metastasis remains unclear. METHODS Patients with FVPTC were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The Kaplan-Meier method and the Cox proportional hazards regression model were used to evaluate DSS. Propensity score-matched analysis was performed to reduce the influence of confounding bias. RESULTS RAI did not improve DSS, even in patients with aggressive features such as T4 classification (p = 0.658), extrathyroidal extension (p = 0.083), lateral lymph node metastasis (p = 0.544), and ≥5 metastatic lymph nodes (p = 0.599). CONCLUSION RAI did not affect DSS in patients with FVPTC without distant metastases in this SEER database study. Multicenter, prospective studies including recurrence and molecular information should be conducted to comprehensively evaluate the effects of RAI on FVPTC.
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Affiliation(s)
- Xiaofei Wang
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Zheng
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jingqiang Zhu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihui Li
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Wei
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Analysis of disease progression and prognosis in differentiated thyroid
cancer with pulmonary metastases: a retrospective study. INTERNATIONAL JOURNAL OF SURGERY: ONCOLOGY 2020. [DOI: 10.1097/ij9.0000000000000104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhou L, Li Q, Chen S, Huang Y, Wei W, Zhang C, Wang M, Zhou W, Zeng W, Liu Z, Guo L. Synergic effects of histology subtype, lymph node metastasis, and distant metastasis on prognosis in differentiated thyroid carcinoma using the SEER database. Gland Surg 2020; 9:907-918. [PMID: 32953600 DOI: 10.21037/gs-20-273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Differentiated thyroid carcinoma (DTC) is the most common clinical type of thyroid carcinoma. There are rare reports on the synergic effects of the different clinicopathological risk factors on the prognosis of it. Methods We retrospectively reviewed data on 86,032 DTC patients from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were conducted to evaluate the correlation between clinicopathological factors and the prognosis of DTC. Relative excess risk (RERI) of synergic effect, attributable proportion (AP) of synergic effect, and synergy index (SI) were calculated to assess synergic effects. Kaplan-Meier analyses with log-rank tests was used to plot the survival curve affected by different risk factors. Results Histology subtype, lymph node metastasis (LNM) status, and distant metastasis (DM) were independent risk factors for cancer-specific survival (CSS) and all-cause survival (ACS) in the multivariate analysis (all, P<0.001). Patients' age at diagnosis, sex, extrathyroidal extension, and radiation also influenced prognosis (all, P<0.001). The cancer-specific mortality (CSM) and all-cause mortality (ACM) rates per 1,000 person-years were higher in patients with follicular thyroid carcinoma (FTC) and in those with N1 stage and M1 stage disease. Furthermore, we observed a significant synergic effect between histology subtype and N stage, as well as histology subtype and M stage for the CSM of DTC (RERI =48.806, AP =0.853, SI =7.565; RERI =37.889, AP =0.430, SI =1.771, respectively). However, no synergic effect was observed in the case of the N stage and M stage for the CSM of DTC (RERI =7.928, AP =0.084, SI =1.093). Conclusions Patients with histology subtype of FTC and N1 stage, histology subtype of FTC and M1 stage had significant additive synergic effects on DTC prognosis for CSM.
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Affiliation(s)
- Ling Zhou
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qianqian Li
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Sichao Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yihui Huang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Wei
- Department of Pediatrics, St. John Hospital and Medical Center, Detroit, MI, USA
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Wang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Zhou
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zeming Liu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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Matsuzu K, Sugino K, Masudo K, Mori K, Ono R, Yamazaki H, Masaki C, Akaishi J, Kiyomi Yamada H, Tomoda C, Suzuki A, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Takami H, Ito K. Clinical outcomes and risk stratification for papillary thyroid carcinoma presenting with distant metastasis before the era of tyrosine kinase inhibitors. Endocr J 2020; 67:869-876. [PMID: 32350192 DOI: 10.1507/endocrj.ej20-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Radioactive iodine (RAI) therapy has been the mainstay of treatment for papillary thyroid carcinoma (PTC) patients with distant metastasis (DM). Although tyrosine kinase inhibitors (TKIs) were introduced for the treatment of RAI refractory metastatic thyroid carcinoma several years ago, clinical outcomes for PTC patients with DM treated using RAI therapy remain unclear. We retrospectively examined 64 PTC patients (9 men, 55 women) with DM at diagnosis treated using RAI therapy without administration of any kind of chemotherapy or TKIs. Median age of patients was 58 years. Site of DM was the lungs (n = 59), bone (n = 3), and pleural dissemination (n = 2). No patients showed multiple-organ metastases at diagnosis. By the end of the study period, 21 patients had died of PTC. Cause-specific survival rates at 10, 15, and 20 years after initial surgery were 68.2%, 63.6% and 61.1%, respectively. Uni- and multivariate analyses identified age ≥55 years (HR 3.1, p = 0.023), site of DM other than the lungs (HR 13.4, p < 0.0001), and DM with no RAI avidity (HR 5.1, p = 0.0098) as factors independently associated with disease-related death. When analyses were restricted to patients with lung metastasis (n = 59), surgical non-curability was another independent risk factor (HR 5.2, p = 0.0047) in addition to age and RAI avidity. According to risk stratification analysis based on these risk factors, patients with site of DM other than the lungs or with lung metastasis showing ≥2 risk factors among age ≥55 years, DM with no RAI avidity, and surgical non-curability are expected to show higher mortality rates.
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Affiliation(s)
| | | | - Katsuhiko Masudo
- Department of Surgery, Yokohama City University Hospital, Kanagawa 236-0004, Japan
| | - Kazunori Mori
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Reiko Ono
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Haruhiko Yamazaki
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
- Department of Surgery, Yokohama City University Hospital, Kanagawa 236-0004, Japan
| | - Chie Masaki
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Junko Akaishi
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | | | - Chisato Tomoda
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Akifumi Suzuki
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Takashi Uruno
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | | | | | - Hiroshi Takami
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan
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Broome DT, Gadre GB, Fayazzadeh E, Bena JF, Nasr C. Pleural effusion as a novel prognostic factor in metastatic thyroid carcinoma. Endocr Connect 2020; 9:812-823. [PMID: 32738128 PMCID: PMC7487194 DOI: 10.1530/ec-20-0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify novel prognostic risk factors and compare them with other known prognostic risk factors in follicular-cell-derived thyroid carcinoma (FDTC) with distant metastases. METHODS A retrospective review was conducted of adult patients with metastatic FDTC seen at a tertiary care center between January 1990 and December 2010. A 15-year Kaplan-Meier survival estimate was created for overall survival (OS) and cancer-specific survival (CSS). Hazard ratios (HR) and P values from Cox proportional hazard models were used with a 95% CI. RESULTS There were 143 patients (60.1% male, 39.9% female), of whom 104 (72.7%) patients had papillary, 30 (21.0%) had follicular, 5 (3.5%) had poorly differentiated, and 4 (2.8%) had Hürthle cell cancers. Median length of follow-up was 80.0 months (range 1.0-564.0). The 15-year mortality rate was 32.2% and cancer-specific mortality was 25.2%, with OS and CSS having the same risk factors. Lung was the most common site of metastases in 53 patients (37.1%), and patients with pleural effusions had significantly lower CSS (HR = 5.21, CI = 1.79-15.12). Additional risk factors for a decreased CSS included: older age upon diagnosis (>45 years, HR = 4.15, CI = 1.43-12.02), multiple metastatic locations (HR = 3.75, CI = 1.32-10.67), and incomplete/unknown tumor resection (HR = 2.35, CI = 1.18-4.67). CONCLUSION This study is the first to demonstrate that pleural effusion is a poor prognostic sign in patients with FDTC with distant metastases and compare this risk with other accepted prognostic variables.
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Affiliation(s)
- David T Broome
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gauri B Gadre
- Department of Internal Medicine, Scripps Clinic, La Jolla, California, USA
| | - Ehsan Fayazzadeh
- Department of Radiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - James F Bena
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Christian Nasr
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Correspondence should be addressed to C Nasr:
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van Velsen EFS, Stegenga MT, van Kemenade FJ, Kam BLR, van Ginhoven TM, Visser WE, Peeters RP. Evaluation of the 2015 ATA Guidelines in Patients With Distant Metastatic Differentiated Thyroid Cancer. J Clin Endocrinol Metab 2020; 105:dgz137. [PMID: 31665318 PMCID: PMC7112972 DOI: 10.1210/clinem/dgz137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/19/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Current American Thyroid Association (ATA) Management Guidelines for the treatment of differentiated thyroid cancer (DTC) stratify patients to decide on additional radioiodine (RAI) therapy after surgery, and to predict recurring/persisting disease. However, studies evaluating the detection of distant metastases and how these guidelines perform in patients with distant metastases are scarce. OBJECTIVE To evaluate the 2015 ATA Guidelines in DTC patients with respect to 1) the detection of distant metastases, and 2) the accuracy of its Risk Stratification System in patients with distant metastases. PATIENTS AND MAIN OUTCOME MEASURES We retrospectively included 83 DTC patients who were diagnosed with distant metastases around the time of initial therapy, and a control population of 472 patients (312 low-risk, 160 intermediate-risk) who did not have a routine indication for RAI therapy. We used the control group to assess the percentage of distant metastases that would have been missed if no RAI therapy was given. RESULTS Two hundred forty-six patients had no routine indication for RAI therapy of which 4 (1.6%) had distant metastases. Furthermore, among the 83 patients with distant metastases, 14 patients (17%) had excellent response, while 55 (67%) had structural disease after a median follow-up of 62 months. None of the 14 patients that achieved an excellent response had a recurrence. CONCLUSIONS In patients without a routine indication for RAI therapy according to the 2015 ATA Guidelines, distant metastases would initially have been missed in 1.6% of the patients. Furthermore, in patients with distant metastases upon diagnosis, the 2015 ATA Guidelines are an excellent predictor of both persistent disease and recurrence.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/prevention & control
- Adenocarcinoma, Follicular/secondary
- Adult
- Aged
- Aged, 80 and over
- Endocrinology/methods
- Endocrinology/standards
- Female
- Follow-Up Studies
- Humans
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Organizations, Nonprofit/standards
- Patient Selection
- Practice Guidelines as Topic
- Radiotherapy, Adjuvant/methods
- Radiotherapy, Adjuvant/standards
- Retrospective Studies
- Risk Assessment/methods
- Risk Assessment/standards
- Risk Factors
- Societies, Medical/standards
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/epidemiology
- Thyroid Cancer, Papillary/prevention & control
- Thyroid Cancer, Papillary/secondary
- Thyroid Gland/pathology
- Thyroid Gland/surgery
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
- Thyroidectomy/standards
- United States/epidemiology
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Affiliation(s)
- Evert F S van Velsen
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, CE Rotterdam, The Netherlands
| | - Merel T Stegenga
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, CE Rotterdam, The Netherlands
| | - Folkert J van Kemenade
- Academic Center for Thyroid Diseases, Department of Pathology, Erasmus Medical Center, CE Rotterdam, The Netherlands
| | - Boen L R Kam
- Academic Center for Thyroid Diseases, Department of Nuclear Medicine, Erasmus Medical Center, CE Rotterdam, The Netherlands
| | - Tessa M van Ginhoven
- Academic Center for Thyroid Diseases, Department of Surgery, Erasmus Medical Center, CE Rotterdam, The Netherlands
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, CE Rotterdam, The Netherlands
| | - Robin P Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, CE Rotterdam, The Netherlands
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38
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Qiu ZL, Shen CT, Sun ZK, Song HJ, Xi C, Zhang GQ, Wang Y, Luo QY. Long-Term Outcomes and Prognoses of Elderly Patients (≥65-Years-Old) With Distant Metastases From Well-Differentiated Thyroid Cancer During Radioiodine Therapy and Follow-Up. Front Endocrinol (Lausanne) 2020; 11:588024. [PMID: 33716950 PMCID: PMC7947854 DOI: 10.3389/fendo.2020.588024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the clinicopathological characteristics, long-term outcomes, and prognostic factors of elderly patients with distant metastases at initial diagnosis from well-differentiated thyroid cancer (WDTC) during radioactive iodine (131I) treatment and follow-up. METHODS A retrospective review of medical records identified 183 elderly patients with DTC who underwent 131I treatment at our institution between 2006 and 2019. RESULTS In total, 57 elderly WDTC patients with distant metastases were enrolled in this study. After 131I treatment, 32 (56.14%) patients had 131I avidity and 25 (43.86%) had non-131I avidity; 35 (61.40%) cases were classified as radioiodine refractory (RR)-WDTC and 22 (38.60%) as non-RR-WDTC. At the end of follow-up, 25 (43.86%) patients had died and 32 (56.14%) were alive. The 5- and 10-year overall survival (OS) rates were 71.50% and 30.49%, respectively, while the 5- and 10-year disease-specific survival (DSS) rates were 76.89% and 48.71%, respectively. Multivariate analyses showed that gross extrathyroidal extension and RR-DTC were independent prognostic factors for poor OS (P=0.04 and P=0.03, respectively), while gross extrathyroidal extension, extrapulmonary distant metastases, and RR-WDTC were independent prognostic factors for poor DSS at the end of follow-up (P=0.02, P=0.03, and P=0.02, respectively). CONCLUSIONS WDTC with distant metastases at initial diagnosis accounted for 31.15% of all elderly patients with DTC. Gross extrathyroidal extension and RR-DTC were the major factors associated with poor OS; gross extrathyroidal extension, extrapulmonary distant metastases, and RR-DTC were independent prognostic factors for poor DSS in elderly DTC patients with distant metastases.
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Affiliation(s)
| | | | | | | | | | | | - Yang Wang
- *Correspondence: Quan-Yong Luo, ; Yang Wang,
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39
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Zhang XY, Sun JW, Qiu ZL, Wang Y, Chen XY, Zhao JH, Luo QY. Clinical outcomes and prognostic factors in patients with no less than three distant organ system metastases from differentiated thyroid carcinoma. Endocrine 2019; 66:254-265. [PMID: 31317522 DOI: 10.1007/s12020-019-01999-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/29/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES For patients with differentiated thyroid carcinoma (DTC), distant metastases are commonly identified in the lungs and bones. However, they are relatively rare in other distant organs, such as the liver, kidneys, or brain. The aim of the current study was to describe the clinical outcomes and evaluate the prognostic factors of patients with no less than three different distant organ system metastases from DTC. METHODS This study retrospectively identified 717 patients diagnosed with DTC with distant metastases between January 2005 and December 2017. Patient response to radioactive iodine (RAI) therapy was monitored by changes in serum thyroglobulin levels and imaging changes. Five-year and 10-year overall survival (OS) rates were calculated by the Kaplan-Meier methods and Cox proportional hazards. RESULTS Among the 717 participants, 37 (5.16%) patients had no less than three different distant organ system metastases from DTC. Five-year and 10-year OS were 45.9% and 37.8% in patients with three or more distant organ system metastases while 74.5% and 64.9% in individuals with one or two distant organ system metastases, respectively. RAI avidity and RAIR-DTC were main independent prognostic factors influencing the clinical outcomes for both groups of patients. The presence of 3 or more different distant organ system metastases was the only independent prognostic factors for 10-year OS by multivariate analysis. CONCLUSIONS Patients with no less than three distant organ system metastases from DTC had poor prognosis. RAI avidity and RAIR-DTC were main factors influencing overall survival for patients with distant metastases from DTC in both groups.
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Affiliation(s)
- Xin-Yun Zhang
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Wen Sun
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhong-Ling Qiu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yang Wang
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiao-Yue Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jin-Hua Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Quan-Yong Luo
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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40
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Liu Z, Chen S, Huang Y, Hu D, Zeng W, Wang M, Zhou W, Chen D, Feng H, Wei W, Zhang C, Zhou L, Guo L. Synergic effects of histology subtype, tumor size, and lymph node metastasis on distant metastasis in differentiated thyroid cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:533. [PMID: 31807515 DOI: 10.21037/atm.2019.09.137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Detection of distant metastasis (DM) is important in differentiated thyroid cancer (DTC). This study aimed to investigate the synergic effects of histology subtype, tumor size, and lymph node metastasis (LNM) status on the occurrence of DM in DTC. Methods We collected data of 96,788 patients with DTC. Univariate and multivariate analyses were conducted to identify the risk factors of DM. Relative excess risk of synergic effect, attributable proportion of synergic effect, and synergy index were then calculated to assess synergic effects. Further, Kaplan-Meier method using the log-rank test and receiver operating characteristic (ROC) curves were utilized. Results Age at diagnosis (P<0.001), sex (P<0.001), race (P<0.01), tumor size (P<0.001), N stage (P < 0.001), histology subtype (P<0.001), and extrathyroidal extension (P<0.001) were risk factors for DM in both univariate and multivariate analyses. We also found a significant additive synergic effect between histology subtype and LNM, and between tumor size and LNM on DM in the DTC patients. In addition, patients with follicular thyroid cancer and N1 stage had the sharpest decline in cancer-specific survival curves (P<0.001) and all-cause survival curves (P<0.001) compared to patients with other combinations of histology subtype and N stage. Similar results were obtained in patients with larger tumors (≥10 mm) and N1 stage. The areas under the curve of histology subtype, tumor size, and LNM status were 0.569, 0.744, and 0.681, respectively. Conclusions Age at diagnosis, sex, race, tumor size, N stage, histology subtype, and extrathyroidal extension are risk factors for DM in DTC patients. LNM has a synergic effect with either follicular thyroid histology or larger tumor size for higher risk of DM which is important for diagnosing DM.
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Affiliation(s)
- Zeming Liu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Sichao Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yihui Huang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Di Hu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Min Wang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wei Zhou
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Danyang Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Haifeng Feng
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Wei Wei
- Department of Pediatrics, St John Hospital and Medical Center, Detroit, MI, USA
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430033, China
| | - Ling Zhou
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Jiao X, Ye J, Wang X, Yin X, Zhang G, Cheng X. KIAA1199, a Target of MicoRNA-486-5p, Promotes Papillary Thyroid Cancer Invasion by Influencing Epithelial-Mesenchymal Transition (EMT). Med Sci Monit 2019; 25:6788-6796. [PMID: 31501407 PMCID: PMC6752488 DOI: 10.12659/msm.918682] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background KIAA1199 has been reported to be associated with malignant progression and poor clinical outcomes in various human malignancies. However, its clinical role and molecular function remain unknown in papillary thyroid cancer (PTC). Material/Methods The Cancer Genome Atlas (TCGA) was used to investigate the expression profiles of KIAA1199 and miR-486-5p in PTC. Immunohistochemistry was used to validate the protein expression of KIAA1199 in PTC. The Weighted Gene Co-expression Network Analysis (WGCNA) and Gene Set Enrichment Analysis (GSEA) were used to explore the potential pathway underling KIAA1199 in PTC. In vitro and in vivo experiments were performed to investigate the biological role of KIAA1199 in PTC progression. Luciferase reporter assays and Western blot analysis were performed to determine whether KIAA1199 is a downstream target of miR-486-5p. Results We found that KIAA1199 was aberrantly elevated in PTC tissues compared with normal tissues, and upregulation of KIAA1199 was positively correlated with more advanced clinical variables. Additionally, bioinformatic analysis indicated that KIAA1199 was involved in cell migration and invasion. KIAA1199 silencing inhibited the invasive ability of PTC cells by affecting epithelial-mesenchymal transition (EMT) in vitro and in vivo. Furthermore, miR-486-5p was identified as an upstream microRNA that directly targets the 3′-UTR region of KIAA1199. Conclusions The miR-486-5p/KIAA1199/EMT axis might play a critical role in PTC invasion and metastasis and offers a potential therapeutic strategy for PTC.
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Affiliation(s)
- Xuehua Jiao
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Department of Endocrinology, The First People's Hospital of Wujiang District, Suzhou, Jiangsu, China (mainland)
| | - Jiandong Ye
- Department of General Surgery, The First People's Hospital of Wujiang District, Suzhou, Jiangsu, China (mainland)
| | - Xiujie Wang
- Department of Endocrinology, The First People's Hospital of Wujiang District, Suzhou, Jiangsu, China (mainland)
| | - Xueyan Yin
- Department of Endocrinology, The First People's Hospital of Wujiang District, Suzhou, Jiangsu, China (mainland)
| | - Guodong Zhang
- Department of Endocrinology, Suzhou Yongding Hospital, Suzhou, Jiangsu, China (mainland)
| | - Xingbo Cheng
- Department of Endocrinology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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42
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Kondraciuk JD, Rice SL, Zhou X, Gharzeddine K, Knezevic A, Spratt DE, Sabra M, Larson SM, Grewal RK, Osborne JR. Thyroid Cancer Bone Metastasis: Survival and Genomic Characteristics of a Large Tertiary Care Cohort. Clin Nucl Med 2019; 44:e465-e471. [PMID: 31274625 PMCID: PMC6621602 DOI: 10.1097/rlu.0000000000002626] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bone metastasis (BM) in differentiated thyroid cancer (DTC) is the second most common site of metastasis after lung. Bone metastases are associated with worse prognosis in DTC. In this study, we examined risk factors for overall survival in patients with BM and for the first time explore the pattern of genomic alterations in DTC BM. PATIENTS AND METHODS A Health Insurance Portability and Accountability Act (HIPAA) compliant, institutional review board-approved retrospective evaluation of the medical record was performed for all patients treated at a single institution for thyroid cancer over a 16-year period. Seventy-four patients met inclusion criteria. Multiple prognostic factors including age, sex, genes, radioactive iodine, and radiation or kinase inhibitor therapies were analyzed. Univariate and multivariate analyses were performed. RESULTS Treatment with external beam radiation was found to significantly increase survival (P = 0.03). The 5-year survival rate was 59% and median survival was 92 months. Patients who developed bone metastasis earlier tend to live longer (P = 0.06). The presence of TERT and BRAF mutations did not significantly worsen the prognosis (P = 0.10). CONCLUSION Patients with DTC can benefit from early treatment with external beam radiation therapy, especially those who develop bone metastasis within 3 years of primary TC diagnosis. Kinase inhibitor treatment tended to prolong survival but not in a statistically significant manner. Sex, age, and TERT or BRAF genetic mutations did not significantly affect the prognosis.
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Affiliation(s)
| | - Samuel L. Rice
- Department of Radiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, NL
| | - Xiaosun Zhou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karem Gharzeddine
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Mona Sabra
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
- Molecular Pharmacology Program, Sloan Kettering Institute, New York, NY
- Center for Targeted Radioimmunotherapy and Theranostics, Ludwig Center for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
| | - Ravinder K. Grewal
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
| | - Joseph R. Osborne
- Department of Radiology, Weill Medical College of Cornell University, New York, NY
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Su DH, Chang TC, Chang SH. Prognostic factors on outcomes of follicular thyroid cancer. J Formos Med Assoc 2019; 118:1144-1153. [DOI: 10.1016/j.jfma.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 02/02/2023] Open
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Wu D, Gomes Lima CJ, Moreau SL, Kulkarni K, Zeymo A, Burman KD, Wartofsky L, Van Nostrand D. Improved Survival After Multimodal Approach with 131I Treatment in Patients with Bone Metastases Secondary to Differentiated Thyroid Cancer. Thyroid 2019; 29:971-978. [PMID: 31017051 DOI: 10.1089/thy.2018.0582] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The objective of this study was to evaluate the overall survival (OS) of radioiodine (131I) treatments alone or combined with non-131I treatments in patients with bone metastases (BM) of differentiated thyroid cancer (DTC). Methods: This was a retrospective study of patients who were evaluated between 2001 and 2018 at MedStar Washington Hospital Center and who had DTC, BM, and at least one 131I treatment after the diagnosis of BM. The OS was analyzed by Kaplan-Meier survival curves and was compared by log-rank test between two groups: patients who received 131I treatments alone and those who received treatments combining 131I with non-131I treatments (CombTx). Non-131I treatments include surgery, radiofrequency ablation, cryotherapy, arterial embolization, external beam radiation, Cyberknife, systemic targeted therapy, and anti-resorptive medication. Results: A total of 77 patients met the above criteria and were followed up to 41 years. Thirty percent (23/77) of patients received 131I treatment alone, and 70% (54/77) received CombTx. For 131I treatment alone, the median survival was 3.9 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 86%, 81%, 61%, 35%, and 23%, respectively. For CombTx, the median survival was 7.7 years, and the 1-, 2-, 3-, 5-, and 10-year OS rates were 96%, 92%, 86%, 69%, and 30%, respectively. Patients who had undergone initial 131I therapy within six months post thyroidectomy demonstrated a better median survival after BM diagnosis than those whose initial 131I therapy was six months or more after thyroidectomy (6.5 vs. 0.5 years; p < 0.001). Patients who received external beam radiation therapy demonstrated a better median survival than those who did not (7.8 vs. 4.4 years; p = 0.016). Patients who received denosumab demonstrated a better median survival than those who did not (7.7 vs. 5.2 years; p = 0.03). Patients who were <55 years of age at the initial diagnosis of DTC or at the initial diagnosis of BM had a better median OS than those diagnosed at ≥55 years of age (both p = 0.01). In the multivariate analysis, only age at initial diagnosis of DTC and initial 131I therapy within six months post thyroidectomy, and multiple 131I treatments were independent prognostic factors. Conclusions: In patients with DTC with BM, 131I treatment in combination with one or more non-131I direct and systemic treatments was associated with a significant increase in OS compared with those patients who were treated by 131I treatment alone.
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Affiliation(s)
- Di Wu
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 2Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, DC
| | - Cristiane J Gomes Lima
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Shari L Moreau
- 4Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Kanchan Kulkarni
- 4Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Alexander Zeymo
- 5Department of Biostatistics and Biomedical Informatics, MedStar Health Research Institute, Hyattsville, Maryland
| | - Kenneth D Burman
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Leonard Wartofsky
- 3Division of Endocrinology, MedStar Washington Hospital Center, Washington, DC
| | - Douglas Van Nostrand
- 1MedStar Clinical Research Center, MedStar Health Research Institute, Hyattsville, Maryland
- 2Nuclear Medicine Research, MedStar Washington Hospital Center, Washington, DC
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Clinicopathologic and Molecular Features of Metastatic Follicular Thyroid Carcinoma in Patients Presenting With a Thyroid Nodule Versus a Distant Metastasis. Am J Surg Pathol 2019; 43:514-522. [DOI: 10.1097/pas.0000000000001208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee YK, Kim D, Shin DY, Lee CR, Lee EJ, Kang SW, Lee J, Jeong JJ, Nam KH, Chung WY, Park CS. The Prognosis of Papillary Thyroid Cancer with Initial Distant Metastasis is Strongly Associated with Extensive Extrathyroidal Extension: A Retrospective Cohort Study. Ann Surg Oncol 2019; 26:2200-2209. [PMID: 30895495 DOI: 10.1245/s10434-019-07314-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extensive extrathyroidal extension (ETE) has a significant role in the prognosis of papillary thyroid cancer (PTC) without distant metastasis, but its role in PTC with initial distant metastasis has never been studied. This study aimed to evaluate the prognostic significance of extensive ETE regarding disease progression, survival, and remission in PTC patients with initial distant metastasis. METHODS This retrospective cohort study included PTC patients with initial distant metastasis who underwent total thyroidectomy with a median follow-up period of 6.7 years. The prognostic significance of extensive ETE was assessed in terms of time to tumor progression (TTP), cancer-specific survival (CSS), and cumulative incidence of remission with all-cause death as the competing event. RESULTS The study enrolled 64 patients. Of these patients, 21 (32.8%) had extensive ETE, which was associated with a shorter TTP (adjusted hazard ratio [HR], 4.10; p = 0.015) and a lower CSS rate (p = 0.002, log-rank), particularly for patients 55 years of age or older with stage 4b disease (10-year CSS rate: 33.3% in those with and 92.3% in those without extensive ETE; p = 0.017). Additionally, remission was observed only in patients without extensive ETE (10-year cumulative incidence of remission: 0.0% in those with and 29.3% in those without extensive ETE; p = 0.013). CONCLUSIONS Extensive ETE of the primary lesion results in poorer prognoses for PTC patients with initial distant metastasis. The high CSS rate for patients with stage 4b PTC but no extensive ETE indicates that the prognosis of this patient population should be distinguished from that of other stage 4 cases.
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Affiliation(s)
- Young Ki Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Center for Thyroid Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Daham Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Yeob Shin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Cho Rok Lee
- Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Eun Jig Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Kang
- Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jandee Lee
- Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Ju Jeong
- Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee-Hyun Nam
- Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woong Youn Chung
- Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheong Soo Park
- Division of Thyroid and Endocrine Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Albano D, Panarotto MB, Durmo R, Rodella C, Bertagna F, Giubbini R. Clinical and prognostic role of detection timing of distant metastases in patients with differentiated thyroid cancer. Endocrine 2019; 63:79-86. [PMID: 30112608 DOI: 10.1007/s12020-018-1713-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Distant metastases (DM) from DTC occur in 5-25% of cases and are correlated to lower survival; the prognostic significance of the temporal onset of DM is unclear. Our aim was to retrospectively analyze the prevalence of DM and to assess the prognostic role of the timing of manifestation of DM regarding the outcome. MATERIALS AND METHODS We included 174 patients (mean age 64 years). According to the time of manifestation, DM were divided in two groups: synchronous DM (SDM, n = 108) defined as metastases present at initial diagnosis and metachronous DM (MDM, n = 66) as diagnosed during follow-up. SDM were further sub grouped in pre-RAIT when diagnosed during pre-surgery work-up (n = 35) and baseline-RAIT when detected by first whole body scan after RAIT (n = 73). Disease-specific survival (DSS) was analyzed using the Kaplan-Meier method. RESULTS Total RAI activities and number of treatments were significantly higher in MDM, also loss of RAI avidity was more frequent in MDM. Forty-four patients died during follow-up, of which 41 were DTC-related deaths, 5-year and 10-year DSS were 80% and 56%. On univariate analysis MDM had significantly shorter DSS; also histotype and RAI avidity were significant risk factors of impaired survival. On multivariate analysis, only loss of RAI avidity remained as independent negative predictor (p = 0.043). Considering SDM, DSS was significantly shorter in pre-RAIT group than baseline-RAIT (p = 0.004). Instead there was no significant difference between pre-RAIT-SDM and MDM in survival outcome (p = 0.875). CONCLUSIONS In DTC with DM, loss of RAI uptake has an important role in survival. No significant difference in survival outcome was discovered between SDM and MDM; but, among SDM, pre-RAIT had significant shorter DSS than baseline-RAIT.
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Affiliation(s)
| | | | - Rexhep Durmo
- Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy
| | - Carlo Rodella
- Health Physics Department, Spedali Civili, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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Choi JH, Lim I, Lee I, Byun BH, Kim BI, Choi CW, Lim SM. An enhanced treatment effect can be expected from a higher serum thyroglobulin level after radioactive iodine therapy. Ann Nucl Med 2018; 33:128-134. [PMID: 30382500 DOI: 10.1007/s12149-018-1313-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to investigate if increased serum thyroglobulin (Tg) levels after radioactive iodine (RAI) showed more therapeutic effects in patients with differentiated thyroid cancer (DTC). METHODS Data of 65 patients with DTC who underwent RAI from June 2014 to September 2016 were reviewed. Serum thyroglobulin was measured immediately before (Tg1) and 48 h (Tg2) after RAI under TSH stimulation. Differences and ratios between serum Tg measurements (DeltaTg = Tg2 - Tg1 and RatioTg = Tg2/Tg1) were calculated. The treatment response of distant metastasis was assessed using the RECIST criteria. RESULTS There was no difference in the median values of Tg1 and Tg2 (2.6 [range, 0.7-1957.5] ng/mL vs. 7.4 [range, 0.7-5276.0] ng/mL, p = 0.240) in all patients (73 scans, 65 patients). In subgroup analysis, Tg levels increased slightly in patients with distant metastasis (8 scans, 7 patients) (Tg1 vs. Tg2; 48.9 [range, 2.4-1957.5] ng/mL vs. 63.2 [range, 4.4-5276.0] ng/mL, p = 0.408). Among patients with distant metastasis, one patient with a partial response to treatment had a more than 4000fold increase in Tg levels and one patient with stable disease showed a 20fold increase in Tg levels. In contrast, five patients with disease progression showed only two to eightfold increase or more than 100fold decrease in Tg levels at 48 h after RAI. However, there was a significant increase in serum Tg levels in patients without distant metastasis (65 scans, 58 patients) after RAI (Tg1 vs. Tg2; 2.0 [range, 0.7-141.9] ng/mL vs. 6.8 [range, 0.7-577.7] ng/mL, p = 0.026). CONCLUSIONS A higher elevation of Tg levels after RAI may be associated with a better treatment outcome in DTC patients with distant metastasis. An increase in Tg levels after RAI may reflect the destruction of cancer and thyroid cells.
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Affiliation(s)
- Joon Ho Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea
| | - Ilhan Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea.
- Department of Radiological and Medico-Oncological Sciences, University of Science and Technology, 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea.
| | - Inki Lee
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea
| | - Byung Hyun Byun
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea
| | - Byung Il Kim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea
| | - Chang Woon Choi
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea
| | - Sang Moo Lim
- Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75, Nowon-ro, Nowon-gu, Seoul, 139-706, Republic of Korea
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Saito Y, Sugino K, Takami H, Matsuzu K, Uruno T, Ohkuwa K, Kitagawa W, Nagahama M, Kawakubo H, Ito K, Kitagawa Y. Clinical Status and Treatment of Liver Metastasis of Differentiated Thyroid Cancer Using Tyrosine Kinase Inhibitors. World J Surg 2018; 42:3632-3637. [PMID: 29766229 DOI: 10.1007/s00268-018-4676-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Treatment of patients with liver metastasis of differentiated thyroid carcinoma (DTC) has not been sufficiently defined, because liver metastasis of DTC has been described mostly as case reports. Additionally, such patients are considered end-of-treatment responders. A relatively new approach using tyrosine kinase inhibitors (TKIs) may provide opportunities to manage systemic metastasis. This study aims to define the clinical features of DTC patients with liver metastasis and evaluate the benefits of TKIs. METHODS We retrospectively analyzed clinical features of 29 patients (mean age 67.8 years) diagnosed with liver metastasis of DTC at our institution between January 1981 and May 2017. RESULTS All patients had distant metastasis at other organ sites upon diagnosis of liver metastasis; 41% of them developed new metastasis afterward. Management after diagnosis of liver metastasis comprised palliative care (48%), radioactive iodine therapy (28%), and TKI therapy (24%). The median survival after diagnosis of liver metastasis was only 4.8 months. Survival rates were significantly better in patients with performance statuses between 0 and 2 on the Eastern Cooperative Oncology Group scale at diagnosis of liver metastasis (n = 22, 76%) treated with TKI compared to those who were not (P = 0.017; log-rank test; hazard ratio 0.19). One-year survival rates were 71.4 and 26.7% for patients treated with or without TKI, respectively. CONCLUSIONS Patients with liver metastasis had poor clinical prognosis. When other distant metastases existed at diagnosis of liver metastasis, TKI therapy was considered an effective therapeutic option for patients with liver metastasis of DTC.
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MESH Headings
- Aged
- Aged, 80 and over
- Carcinoma, Papillary, Follicular/drug therapy
- Carcinoma, Papillary, Follicular/mortality
- Carcinoma, Papillary, Follicular/pathology
- Female
- Humans
- Liver Neoplasms/drug therapy
- Liver Neoplasms/mortality
- Liver Neoplasms/secondary
- Male
- Middle Aged
- Phenylurea Compounds/therapeutic use
- Protein-Tyrosine Kinases/therapeutic use
- Quinolines/therapeutic use
- Retrospective Studies
- Thyroid Cancer, Papillary/drug therapy
- Thyroid Cancer, Papillary/mortality
- Thyroid Cancer, Papillary/pathology
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
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Affiliation(s)
- Yoshiyuki Saito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kiminori Sugino
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan.
| | - Hiroshi Takami
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Kenichi Matsuzu
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Takashi Uruno
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Keiko Ohkuwa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Wataru Kitagawa
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Mitsuji Nagahama
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Koichi Ito
- Department of Surgery, Ito Hospital, 4-3-6 Jingumae, Shibuya-ku, Tokyo, 150-8308, Japan
| | - Yuko Kitagawa
- Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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50
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Hedman C, Djärv T, Strang P, Lundgren CI. Fear of Recurrence and View of Life Affect Health-Related Quality of Life in Patients with Differentiated Thyroid Carcinoma: A Prospective Swedish Population-Based Study. Thyroid 2018; 28:1609-1617. [PMID: 30244657 DOI: 10.1089/thy.2018.0388] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Differentiated thyroid cancer (DTC) has a good prognosis but a remaining risk of recurrence and need for lifelong follow-up. The aim was to study changes in health-related quality of life (HRQoL) from diagnosis to one year of follow-up. METHODS In this prospective population-based study, patients were identified from all the Swedish departments of oncology treating DTC. In total, 487 patients diagnosed with DTC between 2012 and 2017 were invited to answer the Swedish version of the Short Form-36 Health Survey (SF-36) and a study-specific questionnaire at diagnosis and after one year. RESULTS In total, 349 (72%) patients responded. Of these, 235 (67%) had reached one year of follow-up and also answered the questionnaire after one year. Of those, 23% had a negative view of life, and 75% had a fear of recurrence at diagnosis. These patients had a significantly lower HRQoL on eight and five of the SF-36 domains, respectively (p < 0.05). A negative view of life and a fear of recurrence also affected HRQoL negatively after one year of follow-up, with a significantly lower HRQoL on seven SF-36 domains for those reporting a negative view of life or fear of recurrence often (p < 0.05). Thyrotropin suppression did not affect HRQoL negatively. In regression models, HRQoL at diagnosis was the most important predictive factor for HRQoL at the one-year follow-up. CONCLUSIONS Despite a good prognosis, HRQoL was substantially affected at the time of diagnosis, with some improvements after one year. As fear of recurrence and a negative view of life substantially affect HRQoL, these patients should be given additional attention.
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Affiliation(s)
- Christel Hedman
- 1 Department of Molecular Medicine and Surgery, Solna, Karolinska Institutet , Stockholm, Sweden
- 2 Stockholms Sjukhem Foundation's R&D Department , Stockholm, Sweden
| | - Therese Djärv
- 3 Department of Medicine, Solna, Karolinska Institutet , Stockholm, Sweden
- 4 Karolinska University Hospital , Stockholm, Sweden
| | - Peter Strang
- 2 Stockholms Sjukhem Foundation's R&D Department , Stockholm, Sweden
- 5 Department of Oncology-Pathology, and Solna, Karolinska Institutet , Stockholm, Sweden
| | - Catharina Ihre Lundgren
- 1 Department of Molecular Medicine and Surgery, Solna, Karolinska Institutet , Stockholm, Sweden
- 4 Karolinska University Hospital , Stockholm, Sweden
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