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Liu Y, Song Y, He Y, Kong Z, Li H, Zhu Y, Liu S. Surgical management and outcomes of T4a papillary thyroid carcinoma: a single-centre study of 602 cases. Endocrine 2024:10.1007/s12020-024-04026-5. [PMID: 39266883 DOI: 10.1007/s12020-024-04026-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 08/28/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVE This study aimed to investigate the clinical characteristics and risk factors associated with the disease progression of T4a papillary thyroid carcinoma (PTC). METHODS In all, 602 patients (230 males; 372 females), aged 8-82 years, with T4a PTC who were admitted for initial surgery between April 2010 and September 2022 were retrospectively analysed. RESULTS Tracheal invasion was observed in 271 (45.0%), oesophageal invasion in 190 (31.6%), recurrent laryngeal nerve (RLN) invasion in 516 (85.7%), and larynx invasion in 22 (3.7%) patients. The 5-year progression-free survival was 89.8%, and disease-specific survival was 96.0%, with a postoperative disease progression rate of 9.6% (54 patients) and mortality rate of 5.17% (29 patients). Disease recurrence was most likely to occur at the initial surgical site. Age ≥55 years, preoperative vocal cord paralysis, microvascular invasion, trachea invasion, and metastases to >5 cervical lymph nodes were independent risk factors for disease progression in patients with M0 stage. Male sex, preoperative vocal cord paralysis, microvascular invasion, specific pathological type, and laryngeal invasion were associated with an increased risk of disease progression for all T4a patients, while lobectomy, total thyroidectomy, tumour shaving on the RLN surface, total RLN resection, and absence of radioactive iodine therapy were not. CONCLUSIONS Surgery was the primary treatment for patients with stage T4a PTC and most patients had a satisfactory prognosis. Surgeons should comprehensively evaluate each patient before deciding the surgical approach.
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Affiliation(s)
- Yang Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 PanjiayuanNanli, Chaoyang District, 100021, Beijing, PR China
| | - Yixuan Song
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 PanjiayuanNanli, Chaoyang District, 100021, Beijing, PR China
| | - Yuqin He
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 PanjiayuanNanli, Chaoyang District, 100021, Beijing, PR China
| | - Ziren Kong
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 PanjiayuanNanli, Chaoyang District, 100021, Beijing, PR China
| | - Han Li
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 PanjiayuanNanli, Chaoyang District, 100021, Beijing, PR China
| | - Yiming Zhu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 PanjiayuanNanli, Chaoyang District, 100021, Beijing, PR China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 PanjiayuanNanli, Chaoyang District, 100021, Beijing, PR China.
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Kravchenko T, Chen V, Hsu D, Manzella A, Kheng M, Laird AM, Simon M, Trooskin S, Beninato T. Which Ultrasound Characteristics Predict Lymphatic Spread of Papillary Thyroid Cancer? J Surg Res 2024; 299:263-268. [PMID: 38781736 DOI: 10.1016/j.jss.2024.04.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 04/02/2024] [Accepted: 04/21/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION The 2015 American Thyroid Association guidelines recommend lymph node mapping US in patients with definitive cytological evidence of thyroid cancer. Suspicious lymph node features on imaging including enlarged size (>1 cm in any dimension), architectural distortion, loss of fatty hilum, and microcalcifications often prompt evaluation with fine needle aspiration. There is no universally agreed upon model for determining which ultrasound characteristics most strongly correlate with metastatic disease. METHODS A retrospective review of patients with confirmed papillary thyroid cancer (PTC) undergoing lymph node mapping ultrasound from 2013 to 2019 was performed. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value were calculated for each individual ultrasound characteristic as well as for characteristic combinations. RESULTS Data from 119 lymph nodes were included. Malignant lymph nodes were more likely to be enlarged (71% versus 61%, P < 0.001) and to have each individual suspicious feature. Loss of fatty hilum had the highest sensitivity (89%) but was not specific (19%) for metastatic disease. Architectural distortion was found to have the highest specificity (87%). A combination of the four features was found to have higher specificity (97%) and PPV (88%) than any individual feature or combination of two/three features. CONCLUSIONS A combination of four sonographic features correlates with metastatic PTC to lymph nodes and has the highest specificity and PPV for malignancy. A risk stratification model based on these features may lead to better classification of ultrasound findings in PTC patients with concern for nodal metastases.
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Affiliation(s)
| | - Vivian Chen
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Daniel Hsu
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Alexander Manzella
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Marin Kheng
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Amanda M Laird
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey; Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Mitchell Simon
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Stanley Trooskin
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Toni Beninato
- Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey; Section of Endocrine Surgery, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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An S, Park J, Kim K, Bae JS, Kim JS. Safety and surgical outcomes of single-port trans-axillary robot-assisted thyroidectomy: Experience from a consecutive series of 300 patients. J Robot Surg 2024; 18:13. [PMID: 38214763 DOI: 10.1007/s11701-023-01810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/23/2023] [Indexed: 01/13/2024]
Abstract
Since the introduction of the single-port (SP) robotic system, SP trans-axillary robot-assisted thyroidectomy (SP-TART) has been performed. We aimed to evaluate the safety and surgical outcomes of SP-TART in a consecutive series of 300 cases. We analyzed 300 patients with thyroid disease who underwent SP-TART from October 2021 to May 2023 in St. Mary's Hospital in Seoul, Korea. We analyzed the patients' clinicopathological characteristics and perioperative outcomes according to surgical extent. Of the 300 cases analyzed, 250 patients underwent less than total thyroidectomy (LTT), 31 patients underwent total thyroidectomy (TT), and 19 patients underwent TT with modified radical neck dissection (TT c mRND). The mean operative times for LTT, TT, and for TT c mRND were 69.8 ± 23.6, 104.2 ± 30.7, and 223.7 ± 72.4 min, respectively. Complications, including postoperative bleeding, transient hypoparathyroidism, and vocal cord palsy, were observed in nine, six, and six LTT, TT, and TT c mRND cases. The SP-TART method is a safe and feasible surgical option with a short operative time, good surgical outcome, and excellent cosmetic results.
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Affiliation(s)
- Solji An
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, 06591, Seoul, Republic of Korea
| | - Joonseon Park
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, 06591, Seoul, Republic of Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, 06591, Seoul, Republic of Korea.
| | - Ja Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, 06591, Seoul, Republic of Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, 06591, Seoul, Republic of Korea
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Cherim A, Petca RC, Dumitrascu MC, Petca A, Candrea E, Sandru F. Thyroid Disorders in Systemic Sclerosis: A Comprehensive Review. J Clin Med 2024; 13:415. [PMID: 38256549 PMCID: PMC10816939 DOI: 10.3390/jcm13020415] [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: 12/06/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Systemic sclerosis, also referred to as scleroderma, is a chronic autoimmune disease that affects both internal organs and the skin. Systemic sclerosis predominantly affects female patients and can coexist with other disorders, including those affecting the thyroid gland. Common symptoms such as fatigue and weight changes can be attributed to either systemic sclerosis or thyroid disease. In this comprehensive review, an extensive analysis is conducted using research from 2002 to 2022, sourced from PubMed. The main focus of this exploration is to understand the intricate relationship between thyroid disorders and systemic sclerosis. We obtained these results by analyzing a number of 32285 patients included in 21 original studies. The existing evidence suggests that there is a higher incidence of elevated TSH levels and hypothyroidism in patients with systemic sclerosis, particularly in females, compared to the general population. This remains true even when comparing patients from iodine-deficient regions. Additionally, there is an increased occurrence of hyperthyroidism in the context of systemic sclerosis, which negatively impacts the prognosis of these patients. Furthermore, thyroid antibodies, predominantly anti-thyroid peroxidase (anti-TPO) antibodies, and autoimmune disorders are more commonly observed in individuals with systemic sclerosis. Although thyroid nodules are not specifically linked to the disease, when considering thyroid volume, it is observed that the thyroid gland in systemic sclerosis patients has a decreased volume, possibly due to fibrosis. Conversely, other studies have revealed that patients without autoimmune thyroid diseases (AITDs) are more likely to have a history of digital ulcers, pulmonary fibrosis detected by computed tomography scan, and a requirement for immunosuppressive medication. The majority of the studies did not establish a connection between thyroid disease in these patients and the occurrence of the limited or diffuse forms of systemic sclerosis, as well as the presence of digital ulcers, calcinosis, pulmonary arterial hypertension, scleroderma renal crisis, Raynaud phenomenon, and various other clinical manifestations.
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Affiliation(s)
- Aifer Cherim
- Department of Dermatovenerology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.); (F.S.)
- Internal Medicine 3rd Department, Colentina Clinical Hospital, 020123 Bucharest, Romania
| | - Răzvan-Cosmin Petca
- Department of Urology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Urology, ‘Prof. Dr. Th. Burghele’ Clinical Hospital, 050659 Bucharest, Romania
| | - Mihai-Cristian Dumitrascu
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, 050098 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Obstetrics and Gynecology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Elisabeta Candrea
- Department of Dermatology, University of Medicine and Pharmacy ‘I. Hatieganu’, 400347 Cluj Napoca, Romania;
| | - Florica Sandru
- Department of Dermatovenerology, ‘Carol Davila’ University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.C.); (F.S.)
- Dermatology Department, “Elias” University Emergency Hospital, 011461 Bucharest, Romania
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Ginzberg SP, Gasior JA, Passman JE, Ballester JMS, Finn CB, Karakousis GC, Kelz RR, Wachtel H. Disparities in Presentation, Treatment, and Survival in Anaplastic Thyroid Cancer. Ann Surg Oncol 2023; 30:6788-6798. [PMID: 37474696 DOI: 10.1245/s10434-023-13945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/27/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Disparities have been previously described in the presentation, management, and outcomes of other thyroid cancer subtypes; however, it is unclear whether such disparities exist in anaplastic thyroid cancer (ATC). METHODS We identified patients with ATC from the National Cancer Database (2004-2020). The primary outcomes were receipt of surgery, chemotherapy, and radiation. The secondary outcome was 1-year survival. Multivariable logistic and Cox proportional hazards regressions were used to assess the associations between sex, race/ethnicity, and the outcomes. RESULTS Among 5359 patients included, 58% were female, and 80% were non-Hispanic white. Median tumor size was larger in males than females (6.5 vs. 6.0 cm; p < 0.001) and in patients with minority race/ethnicity than in white patients (6.5 vs. 6.0 cm; p < 0.001). After controlling for tumor size and metastatic disease, female patients were more likely to undergo surgical resection (odds ratio [OR]: 1.20; p = 0.016) but less likely to undergo chemotherapy (OR: 0.72; p < 0.001) and radiation (OR: 0.76; p < 0.001) compared with males. Additionally, patients from minority racial/ethnic backgrounds were less likely to undergo chemotherapy (OR: 0.69; p < 0.001) and radiation (OR: 0.71; p < 0.001) than white patients. Overall, unadjusted, 1-year survival was 23%, with differences in treatment receipt accounting for small but significant differences in survival between groups. CONCLUSIONS There are disparities in the presentation and treatment of ATC by sex and race/ethnicity that likely reflect differences in access to care as well as patient and provider preferences. While survival is similarly poor across groups, the changing landscape of treatments for ATC warrants efforts to address the potential for exacerbation of disparities.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA.
| | - Julia A Gasior
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jesse E Passman
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Jacqueline M Soegaard Ballester
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlin B Finn
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Korkmaz HA, Ozkan B. Hypoparathyroidism in children and adolescents. Ann Pediatr Endocrinol Metab 2023; 28:159-167. [PMID: 37798892 PMCID: PMC10556444 DOI: 10.6065/apem.2346096.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 10/07/2023] Open
Abstract
Hypoparathyroidism is characterized by insufficient parathyroid hormone (PTH) release from the parathyroid glands to maintain serum calcium level within normal limits and unresponsiveness of target tissues despite normal serum PTH level. Hypoparathyroidism is defined as low or inappropriately normal serum PTH level. In this narrative review, we discuss the etiology of hypoparathyroidism in children.
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Affiliation(s)
- Hüseyin Anıl Korkmaz
- Division of Pediatric Endocrinology, Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
| | - Behzat Ozkan
- Division of Pediatric Endocrinology, Department of Pediatrics, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, İzmir, Turkey
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Benmiloud F, Le Bihan C, Rebaudet S, Marino P, Bousquet PJ, Bouée-Benhamiche E. Hypoparathyroidism-related health care utilization and expenditure during the first postoperative year after total thyroidectomy for cancer: a comprehensive national cohort study. Front Endocrinol (Lausanne) 2023; 14:1193290. [PMID: 37448467 PMCID: PMC10338088 DOI: 10.3389/fendo.2023.1193290] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/09/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives Hypoparathyroidism is the most common complication of total thyroidectomy for cancer, and requires calcium and/or vitamin D supplementation for an unpredictable period of time. The additional cost associated with this complication has not hitherto been assessed. The aim of this study was to assess the economic burden of postoperative hypoparathyroidism after total thyroidectomy for cancer in France. Methods Based on the French national cancer cohort, which extracts data from the French National Health Data System (SNDS), all adult patients who underwent a total thyroidectomy for cancer in France between 2011 and 2015 were identified, and their healthcare resource use during the first postoperative year was compared according to whether they were treated postoperatively with calcium and/or vitamin D or not. Univariate and multivariate cost analyses were performed with the non-parametric Wilcoxon test and generalized linear model (gamma distribution and log link), respectively. Results Among the 31,175 patients analyzed (75% female, median age: 52y), 13,247 (42%) started calcium and/or vitamin D supplementation within the first postoperative month, and 2,855 patients (9.1%) were still treated at 1 year. Over the first postoperative year, mean overall and specific health expenditures were significantly higher for treated patients than for untreated patients: €7,233 vs €6,934 per patient (p<0.0001) and €478.6 vs €332.7 per patient (p<0.0001), respectively. After adjusting for age, gender, Charlson Comorbidity index, ecological deprivation index, types of thyroid resection, lymph node dissection and complications, year and region, the incremental cost of overall health care utilization was €142 (p<0.004). Conclusion Our study found a significant additional cost in respect of health expenditures for patients who had hypoparathyroidism after thyroidectomy for cancer, over the first postoperative year. Five-year follow-up is planned to assess the impact of more severe long-term complications on costs.
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Affiliation(s)
- Fares Benmiloud
- Department of Endocrine Surgery, Hôpital Privé de Provence, Aix-en-Provence, France
- Department of Endocrine Surgery, Hôpital Européen Marseille, Marseille, France
| | - Christine Le Bihan
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
| | - Stanislas Rebaudet
- Department of Endocrine Surgery, Hôpital Européen Marseille, Marseille, France
- Aix-Marseille Institute of Public Health, Institut des sciences de la santé publique d’Aix-Marseille (ISSPAM), Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM), Aix-Marseille Univ, Institut national de la santé et de la recherche médicale (INSERM), Institut de recherche pour le développement (IRD), Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM UMR) 1252, Institut national de la santé et de la recherche (INSERM), Institut de recherche pour le développement (IRD), Aix Marseille University, Marseille, France
| | - Philippe-Jean Bousquet
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
- Institut Paoli-Calmettes Sciences économiques et sociales de la santé & traitement de l’information médicale Unité mixte de recherche (SESSTIM UMR) 1252, Institut national de la santé et de la recherche (INSERM), Institut de recherche pour le développement (IRD), Aix Marseille University, Marseille, France
| | - Elsa Bouée-Benhamiche
- Department of Health Data and Assessment, French National Cancer Institute (Institut National du Cancer, INCa), Boulogne-Billancourt, France
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Yu WS, Zhou ZP, Zeng JF, Huang ZQ, Qiu CZ. Expression and Clinical Significance of Golgi Phosphoprotein 3 (GOLPH3) in Papillary Thyroid Carcinoma. Appl Immunohistochem Mol Morphol 2023; 31:324-330. [PMID: 36952588 DOI: 10.1097/pai.0000000000001117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 02/05/2023] [Indexed: 03/25/2023]
Abstract
This study aimed to explore the correlation of Golgi phosphoprotein 3 (GOLPH3) levels in papillary thyroid carcinoma (PTC) and papillary thyroid microcarcinoma (PTMC) with clinicopathologic features. GOLPH3 expression was determined by western blotting in solid tumors and the adjacent normal thyroid tissues. Mammalian target of rapamycin (mTOR) and Ki-67 were examined by immunohistochemical staining. Significantly higher levels of GOLPH3 protein were observed in PTC and PTMC compared with the adjacent normal thyroid tissues ( P <0.001). GOLPH3 level was positively associated with lymph node metastasis and clinical stage in PTC ( P <0.05) and utterly related to the clinical stage in PTMC ( P =0.012). No correlation was observed between GOLPH3 level and other clinicopathologic parameters such as sex, local invasion, tumor number, and tumor size. The expression level of GOLPH3 protein in mTOR-positive PTC was significantly higher than in mTOR-negative PTC ( P =0.002 in PTC, P =0.022 in PTMC) and positively correlated with Ki-67 proliferation index in PTC via Pearson correlation analysis ( r =0.353, P =0.007 in PTC; r =0.583, P <0.001 in PTMC). In conclusion, the relative expression level of GOLPH3 protein was significantly higher in PTC and PTMC than in normal thyroid tissues and increased with cancer severity. It may provide adjunctive information for diagnosing and predicting prognosis in patients with PTC or PTMC.
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Affiliation(s)
- Wai-Shi Yu
- Department of General Surgery, The Affiliated Second Hospital, Fujian Medical University, Quanzhou, China
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Luisa Garo M, Deandreis D, Campennì A, Vrachimis A, Petranovic Ovcaricek P, Giovanella L. Accuracy of papillary thyroid cancer prognostic nomograms: a systematic review. Endocr Connect 2023; 12:e220457. [PMID: 36662681 PMCID: PMC10083677 DOI: 10.1530/ec-22-0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023]
Abstract
Objective Current staging and risk-stratification systems for predicting survival or recurrence of patients with differentiated thyroid carcinoma may be ineffective at predicting outcomes in individual patients. In recent years, nomograms have been proposed as an alternative to conventional systems for predicting personalized clinical outcomes. We conducted a systematic review to evaluate the predictive performance of available nomograms for thyroid cancer patients. Design and methods PROSPERO registration (CRD42022327028). A systematic search was conducted without time and language restrictions. PICOT questions: population, patients with papillary thyroid cancer; comparator prognostic factor, single-arm studies; outcomes, overall survival, disease-free survival, cancer-specific survival, recurrence, central lymph node metastases, or lateral lymph node metastases; timing, all periods; setting, hospital setting. Risk of bias was assessed through PROBAST tool. Results Eighteen studies with a total of 20 prognostic models were included in the systematic review (90,969 papillary thyroid carcinoma patients). Fourteen models were at high risk of bias and four were at unclear risk of bias. The greatest concerns arose in the analysis domain. The accuracy of nomograms for overall survival was assessed in only one study and appeared limited (0.77, 95% CI: 0.75-0.79). The accuracy of nomograms for disease-free survival ranged from 0.65 (95% CI: 0.55-0.75) to 0.92 (95% CI: 0.91-0.95). The C-index for predicting lateral lymph node metastasis ranged from 0.72 to 0.92 (95% CI: 0.86-0.97). For central lymph node metastasis, the C-index of externally validated studies ranged from 0.706 (95% CI: 0.685-0.727) to 0.923 (95% CI: 0.893-0.946). Conclusions Our work highlights the extremely high heterogeneity among nomograms and the critical lack of external validation studies that limit the applicability of nomograms in clinical practice. Further studies ideally using commonly adopted risk factors as the backbone to develop nomograms are required. Significance statement Nomograms may be appropriate tools to plan treatments and predict personalized clinical outcomes in patients with papillary thyroid cancer. However, the nomograms developed to date are very heterogeneous, and their results seem to be closely related to the specific samples studied to generate the same nomograms. The lack of rigorous external validation procedures and the use of risk factors that sometimes appear to be far from those commonly used in clinical practice, as well as the great heterogeneity of the risk factors considered, limit the ability of nomograms to predict patient outcomes and thus their current introduction in clinical practice.
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Affiliation(s)
| | - Désirée Deandreis
- Division of Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Alexis Vrachimis
- Department of Nuclear Medicine, German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Petra Petranovic Ovcaricek
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital of Zürich, Zürich, Switzerland
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Powell BH, Turchinovich A, Wang Y, Gololobova O, Buschmann D, Zeiger MA, Umbricht CB, Witwer KW. miR-210 Expression Is Strongly Hypoxia-Induced in Anaplastic Thyroid Cancer Cell Lines and Is Associated with Extracellular Vesicles and Argonaute-2. Int J Mol Sci 2023; 24:4507. [PMID: 36901936 PMCID: PMC10002857 DOI: 10.3390/ijms24054507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 03/03/2023] Open
Abstract
Hypoxia, or low oxygen tension, is frequently found in highly proliferative solid tumors such as anaplastic thyroid carcinoma (ATC) and is believed to promote resistance to chemotherapy and radiation. Identifying hypoxic cells for targeted therapy may thus be an effective approach to treating aggressive cancers. Here, we explore the potential of the well-known hypoxia-responsive microRNA (miRNA) miR-210-3p as a cellular and extracellular biological marker of hypoxia. We compare miRNA expression across several ATC and papillary thyroid cancer (PTC) cell lines. In the ATC cell line SW1736, miR-210-3p expression levels indicate hypoxia during exposure to low oxygen conditions (2% O2). Furthermore, when released by SW1736 cells into the extracellular space, miR-210-3p is associated with RNA carriers such as extracellular vesicles (EVs) and Argonaute-2 (AGO2), making it a potential extracellular marker for hypoxia.
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Affiliation(s)
- Bonita H. Powell
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Andrey Turchinovich
- Division of Cancer Genome Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Biolabs GmbH, 69120 Heidelberg, Germany
| | - Yongchun Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Olesia Gololobova
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Dominik Buschmann
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Martha A. Zeiger
- Center for Cancer Research, National Cancer Institute, National Institute of Health, Bethesda, MD 20892, USA
| | - Christopher B. Umbricht
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kenneth W. Witwer
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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11
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Yu F, Wu W, Zhang L, Li S, Yao X, Wang J, Ni Y, Meng Q, Yang R, Wang F, Shi L. Cervical lymph node metastasis prediction of postoperative papillary thyroid carcinoma before 131I therapy based on clinical and ultrasound characteristics. Front Endocrinol (Lausanne) 2023; 14:1122517. [PMID: 36875475 PMCID: PMC9982841 DOI: 10.3389/fendo.2023.1122517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/07/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The status of lymph nodes is crucial to determine the dose of radioiodine-131(131I) for postoperative papillary thyroid carcinoma (PTC). We aimed to develop a nomogram for predicting residual and recurrent cervical lymph node metastasis (CLNM) in postoperative PTC before 131I therapy. METHOD Data from 612 postoperative PTC patients who underwent 131I therapy from May 2019 to December 2020 were retrospectively analyzed. Clinical and ultrasound features were collected. Univariate and multivariate logistic regression analyses were performed to determine the risk factors of CLNM. Receiver operating characteristic (ROC) analysis was used to weigh the discrimination of prediction models. To generate nomograms, models with high area under the curves (AUC) were selected. Bootstrap internal validation, calibration curves and decision curves were used to assess the prediction model's discrimination, calibration, and clinical usefulness. RESULTS A total of 18.79% (115/612) of postoperative PTC patients had CLNM. Univariate logistic regression analysis found serum thyroglobulin (Tg), serum thyroglobulin antibodies (TgAb), overall ultrasound diagnosis and seven ultrasound features (aspect transverse ratio, cystic change, microcalcification, mass hyperecho, echogenicity, lymphatic hilum structure and vascularity) were significantly associated with CLNM. Multivariate analysis revealed higher Tg, higher TgAb, positive overall ultrasound and ultrasound features such as aspect transverse ratio ≥ 2, microcalcification, heterogeneous echogenicity, absence of lymphatic hilum structure and abundant vascularity were independent risk factors for CLNM. ROC analysis showed the use of Tg and TgAb combined with ultrasound (AUC = 0.903 for "Tg+TgAb+Overall ultrasound" model, AUC = 0.921 for "Tg+TgAb+Seven ultrasound features" model) was superior to any single variant. Nomograms constructed for the above two models were validated internally and the C-index were 0.899 and 0.914, respectively. Calibration curves showed satisfied discrimination and calibration of the two nomograms. DCA also proved that the two nomograms were clinically useful. CONCLUSION Through the two accurate and easy-to-use nomograms, the possibility of CLNM can be objectively quantified before 131I therapy. Clinicians can use the nomograms to evaluate the status of lymph nodes in postoperative PTC patients and consider a higher dose of 131I for those with high scores.
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Affiliation(s)
- Fei Yu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wenyu Wu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Liuting Zhang
- Department of Functional Examination, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shaohua Li
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaochen Yao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yudan Ni
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qingle Meng
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rui Yang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Liang Shi, ; Feng Wang,
| | - Liang Shi
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- *Correspondence: Liang Shi, ; Feng Wang,
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12
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Clinical significance of sentinel lymph node biopsy in differentiated thyroid cancer. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns3.6390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Differentiated thyroid cancers are the most common endocrine malignancy and include three main entities: papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and Hürthle cell carcinoma (HCC). Papillary thyroid cancer (PTC) is the most common histologic subtype. Was to review different sentinel lymph node biopsy (SLNB) techniques in patients with differentiated thyroid cancer. We also will compare the detection rates and sensitivity of the different detection methods in these patients and assessment of feasibility and side effects of the different techniques. This study was a cross sectional study, Surgical Oncology Department of National Cancer Institute, Cairo University and Damietta Cancer Center, Ministry of Health and Population. Radionuclide technique (lymphoscintigraphy and gamma probe scanning) was successful in 94.6 % (35/37) of the patients as shown in table 4 and relation between SLN and identification by gamma probe. In the 37 patients, the intraoperative frozen biopsy indicated that 22 patients were experiencing SLN metastases, while post-operative routine pathological examination was able to diagnose three additional patients with lymph node metastases.
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13
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FDG-PET/CT in indeterminate thyroid nodules: cost-utility analysis alongside a randomised controlled trial. Eur J Nucl Med Mol Imaging 2022; 49:3452-3469. [PMID: 35435497 PMCID: PMC9308600 DOI: 10.1007/s00259-022-05794-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/03/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate cost-effectiveness of an [18F]FDG-PET/CT-driven diagnostic workup as compared to diagnostic surgery, for thyroid nodules with Bethesda III/IV cytology. [18F]FDG-PET/CT avoids 40% of futile diagnostic surgeries for benign Bethesda III/IV nodules. METHODS Lifelong societal costs and quality-adjusted life years (QALYs) were assessed for 132 patients participating in a randomised controlled multicentre trial comparing [18F]FDG-PET/CT to diagnostic surgery. The observed 1-year trial results were extrapolated using a Markov model. The probability of cost-effectiveness was estimated using cost-effectiveness acceptability curves, taking uncertainty about sampling, imputation, and parameters into account. RESULTS The observed 1-year cost difference of [18F]FDG-PET/CT as compared to diagnostic surgery was - €1000 (95% CI: - €2100 to €0) for thyroid nodule-related care (p = 0.06). From the broader societal perspective, the 1-year difference in total societal costs was - €4500 (- €9200 to €150) (p = 0.06). Over the modelled lifelong period, the cost difference was - €9900 (- €23,100 to €3200) (p = 0.14). The difference in QALYs was 0.019 (- 0.045 to 0.083) at 1 year (p = 0.57) and 0.402 (- 0.581 to 1.385) over the lifelong period (p = 0.42). For a willingness to pay of €50,000 per QALY, an [18F]FDG-PET/CT-driven work-up was the cost-effective strategy with 84% certainty. CONCLUSION Following the observed reduction in diagnostic surgery, an [18F]FDG-PET/CT-driven diagnostic workup reduced the 1-year thyroid nodule-related and societal costs while sustaining quality of life. It is very likely cost-effective as compared to diagnostic surgery for Bethesda III/IV nodules. TRIAL REGISTRATION NUMBER This trial is registered with ClinicalTrials.gov: NCT02208544 (5 August 2014), https://clinicaltrials.gov/ct2/show/NCT02208544 .
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14
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Abdullah AM, Ali RM, Salih KM, Mohammed KK, Kakamad FH, Salih AM. Synchronous occurrence of papillary thyroid microcarcinoma, medullary thyroid carcinoma and Hashimoto thyroiditis in a single thyroid: A case report with literature review. Int J Surg Case Rep 2022; 93:106888. [PMID: 35318184 PMCID: PMC8935503 DOI: 10.1016/j.ijscr.2022.106888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/02/2022] Open
Abstract
Introduction Case report Discussion Conclusion Thyroid malignancies are less common than other types of cancer. The interactions between medullary and papillary carcinomas are of particular interest. Synchronous development of medullary and papillary carcinoma has been reported very rarely. In this paper, the occurrence of Hashimoto thyroiditis with papillary carcinoma and medullary carcinoma is reported.
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Seeing Is Not Believing: Intraoperative Nerve Monitoring (IONM) in the Thyroid Surgery. Indian J Surg Oncol 2022; 13:121-132. [PMID: 35462673 PMCID: PMC8986933 DOI: 10.1007/s13193-021-01348-y] [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: 10/12/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022] Open
Abstract
Ensuring the integrity of the recurrent laryngeal nerve (RLN), the external branch of superior laryngeal nerve (EBSLN) and preservation of normal voice are the prime 'functional' goals of thyroid surgery. More in-depth knowledge of neuronal mechanisms has revealed that anatomical integrity does not always translate into functional integrity. Despite meticulous dissection, neural injuries are not always predictable or visually evident. Intraoperative nerve monitoring (IONM) is designed to aid in nerve identification and early detection of functional impairment. With the evolution of technique, intermittent monitoring has given way to continuous-IONM. Over the years, IONM gathered both support and flak. Despite numerous randomised studies, systematic reviews, and meta-analyses, there still prevails a state of clinical equipoise concerning the utility of IONM and its cost-effectiveness. This article inspects the true usefulness of IONM, elaborates on the optimal way to practice it, and presents a critical literature review.
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Garg S, Mouli S, Singh KR, Ramakant P, Mishra AK, Rana C. Revisiting Combination Chemotherapy as a Single Modality Palliative Therapy for Advanced Anaplastic Thyroid Carcinoma-a Single Institution Experience. Indian J Surg Oncol 2022; 13:208-215. [PMID: 35462645 PMCID: PMC8986910 DOI: 10.1007/s13193-021-01401-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/26/2021] [Indexed: 01/18/2023] Open
Abstract
Anaplastic thyroid carcinoma (ATC) is an aggressive malignancy with dismal outcome especially in metastatic setting. Consensus for ideal treatment of advanced and metastatic ATC remains elusive. This study aimed to analyze the impact of palliative chemotherapy versus supportive care on overall survival in patients with metastatic anaplastic thyroid carcinoma. Patients diagnosed with ATC between the period January 2018 and December 2019 were prospectively followed. The patients opting for palliative chemotherapy received 3 weekly Paclitaxel (175 mg/m2) and Carboplatin (AUC-5). Out of the 31 patients diagnosed with ATC, clinicopathological profile of 29 patients was analyzed (2 patients who underwent upfront surgical resection with curative intent were excluded), out of which 20 patients were included in the survival analysis. The median age of presentation was 55.8 years with male:female ratio 1.9:1. Seventeen out of the total 29 patients presented with anaplastic transformation in long-standing goiter. Nineteen out of 20 (95%) patients presented with distant metastasis with lungs being the most common site. Nodal metastasis was present in all patients. Invasion of the strap muscles (90%) and trachea (80%) was the most common peri-thyroidal tissue invasion followed by invasion of the esophagus (40%), internal jugular vein (30%), and carotid artery (5%). Twelve out of the 20 patients opted for palliative chemotherapy. Overall, median survival from the time of diagnosis was 2.6 months, with median survival in patients receiving chemotherapy 3.1 months and those opting for supportive care 1.6 months (p=0.004). Out of all the factors analyzed, male sex (HR 6.521, 95% CI 1.143-37.206, p value 0.03) and vascular invasion (HR 0.066, 95% CI 0.009-0.499, p value 0.008) were poor prognostic indicators. Palliative chemotherapy showed increased survival benefit in patients with metastatic ATC. Male sex and vascular invasion were found to be significant factors associated with poor outcomes on Cox regression analysis.
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Affiliation(s)
- Surabhi Garg
- Department of Endocrine Surgery, King George’s Medical University, Lucknow, UP India
| | - Sasi Mouli
- Department of Endocrine Surgery, King George’s Medical University, Lucknow, UP India
| | - Kul Ranjan Singh
- Department of Endocrine Surgery, King George’s Medical University, Lucknow, UP India
| | - Pooja Ramakant
- Department of Endocrine Surgery, King George’s Medical University, Lucknow, UP India
| | - Anand K. Mishra
- Department of Endocrine Surgery, King George’s Medical University, Lucknow, UP India
| | - Chanchal Rana
- Department of Endocrine Surgery, King George’s Medical University, Lucknow, UP India
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Zhang H, Zhang Y, Xia T, Lu L, Luo M, Chen Y, Liu Y, Li Y. The Role of Keratin17 in Human Tumours. Front Cell Dev Biol 2022; 10:818416. [PMID: 35281081 PMCID: PMC8912659 DOI: 10.3389/fcell.2022.818416] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
Keratins are a group of proteins that can constitute intermediate fibers. It is a component of the cytoskeleton and plays an important role in cell protection and structural support. Keratin 17, a Type I keratin, is a multifunctional protein that regulates a variety of biological processes, including cell growth, proliferation, migration, apoptosis and signal transduction. Abnormal expression of KRT17 is associated with a variety of diseases, such as skin diseases. In recent years, studies have shown that KRT17 is abnormally expressed in a variety of malignant tumours, such as lung cancer, cervical cancer, oral squamous cell carcinoma and sarcoma. These abnormal expressions are related to the occurrence, development and prognosis of malignant tumors. In this review, we summarized the expression patterns of KRT17 in a variety of malignant tumours, the role of KRT17 in the development and prognosis of different malignant tumors and its molecular mechanisms. We also discuss the potential clinical application of KRT17 as a valuable therapeutic target.
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Affiliation(s)
- Hanqun Zhang
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Yun Zhang
- Department of Pathology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Tingting Xia
- Department of Nephrology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Liang Lu
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Min Luo
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Yanping Chen
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
| | - Yuncong Liu
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
- *Correspondence: Yuncong Liu, ; Yong Li,
| | - Yong Li
- Department of Oncology, Guizhou Provincial People’s Hospital, Guizhou, China
- *Correspondence: Yuncong Liu, ; Yong Li,
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18
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Kim JK, Choi SH, Choi SM, Choi HR, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY. Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method. Surg Endosc 2021; 36:2688-2696. [PMID: 34741206 PMCID: PMC8921151 DOI: 10.1007/s00464-021-08837-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022]
Abstract
Background This study aims to report the results of a pioneering clinical study using the single-port transaxillary robotic thyroidectomy (START) for 200 patients with thyroid tumor and to introduce our novel two-step retraction method. Methods START was performed on consecutive 200 patients using the da Vinci Single-Port (SP) robot system from January 2019 to September 2020 at the Yonsei University Health System, Seoul, Korea. The novel two-step retraction technique, in which a 3.5 cm long incision is made along the natural skin crease, was used for the latter 164 patients. The surgical outcome and invasiveness of the SP two-step retraction method were analyzed. Results Among the 200 cases who underwent START, 198 were female and 2 were male, with a mean age of 34.7 (range: 13–58 years). Thyroid lobectomy was performed for 177 patients and total thyroidectomy was performed for 23 patients. Ten patients had benign thyroid nodules, whereas the other 190 had thyroid malignancy. The mean body mass index (BMI) was 22.2 ± 3.7 kg/m2 (range: 15.9–37.0 kg/m2). All of the operations were performed successfully without any open conversions, and patients were discharged on postoperative day 3 or 4 without significant complication. The mean operative time for thyroid lobectomy with the two-step retraction method was 116.69 ± 23.23 min, which was similar to that in the conventional robotic skin flap method (115.33 ± 17.29 min). We could minimize the extent of the robotic skin flap dissection with the two-step retraction method. Conclusions START is a practical surgical method. By employing the new two-step retraction method, we can maximize the cosmetic and functional benefits for patients and reduce the workload fatigue of surgeons by increasing robotic dependency. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08837-9.
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Affiliation(s)
- Jin Kyong Kim
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Sun Hyung Choi
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Soon Min Choi
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Hye Ryeon Choi
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Cho Rok Lee
- Department of Surgery, Yongin Severance Hospital, Gyeonggi-do, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Woong Youn Chung
- Department of Surgery, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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Jin M, Kim ES, Kim BH, Kim HK, Kang YE, Jeon MJ, Kim TY, Kang HC, Kim WB, Shong YK, Kim M, Kim WG. Clinicopathological Characteristics and Disease-Free Survival in Patients with Hürthle Cell Carcinoma: A Multicenter Cohort Study in South Korea. Endocrinol Metab (Seoul) 2021; 36:1078-1085. [PMID: 34731935 PMCID: PMC8566133 DOI: 10.3803/enm.2021.1151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hürthle cell carcinoma (HCC), a type of thyroid carcinoma, is rare in South Korea, and few studies have investigated its prognosis. METHODS This long-term multicenter retrospective cohort study evaluated the clinicopathological features and clinical outcomes in patients with HCC who underwent thyroid surgery between 1996 and 2009. RESULTS The mean age of the 97 patients included in the study was 50.3 years, and 26.8% were male. The mean size of the primary tumor was 3.2±1.8 cm, and three (3.1%) patients had distant metastasis at initial diagnosis. Ultrasonographic findings were available for 73 patients; the number of nodules with low-, intermediate-, and high suspicion was 28 (38.4%), 27 (37.0%), and 18 (24.7%), respectively, based on the Korean-Thyroid Imaging Reporting and Data System. Preoperatively, follicular neoplasm (FN) or suspicion for FN accounted for 65.2% of the cases according to the Bethesda category, and 13% had malignancy or suspicious for malignancy. During a median follow-up of 8.5 years, eight (8.2%) patients had persistent/recurrent disease, and none died of HCC. Older age, gross extrathyroidal extension (ETE), and widely invasive types of tumors were significantly associated with distant metastasis (all P<0.01). Gross ETE (hazard ratio [HR], 27.7; 95% confidence interval [CI], 2.2 to 346.4; P=0.01) and widely invasive classification (HR, 6.5; 95% CI, 1.1 to 39.4; P=0.04) were independent risk factors for poor disease-free survival (DFS). CONCLUSION The long-term prognosis of HCC is relatively favorable in South Korea from this study, although this is not a nation-wide data, and gross ETE and widely invasive cancer are significant prognostic factors for DFS. The diagnosis of HCC by ultrasonography and cytopathology remains challenging.
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Affiliation(s)
- Meihua Jin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Sook Kim
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Bo Hyun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yea Eun Kang
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Min Ji Jeon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Won Bae Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mijin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
- Mijin Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeokro, Seo-gu, Busan 49241, Korea Tel: +82-51-240-7738, Fax: +82-51-254-3237, E-mail:
| | - Won Gu Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Corresponding authors: Won Gu Kim Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-3010-5883, Fax: +82-2-3010-6962, E-mail:
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Characteristics of patients with chronic hypoparathyroidism not adequately controlled with conventional treatment and management patterns in Spain. ENDOCRINOL DIAB NUTR 2021; 68:304-311. [PMID: 34556260 DOI: 10.1016/j.endien.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The current guidelines on hypoparathyroidism offer a model for treating patients but do not cover real-world situations or patient diversity. Given the lack of data regarding hypoparathyroidism, a Delphi panel was convened in Spain to establish consensus in defining the characteristics of patients with chronic hypoparathyroidism not adequately controlled with conventional treatment, as well as to investigate patterns of management. MATERIAL AND METHODS A presentation matrix provided a framework for characterizing inadequately controlled chronic hypoparathyroidism, based on four predefined patient groups: group 1 (normal biochemical levels and the patient feeling well); group 2 (abnormal biochemical levels and the patient feeling well); group 3 (normal biochemical levels and the patient feeling unwell); and group 4 (abnormal biochemical levels and the patient feeling unwell). Based on Likert scales (scored 1-9), the experts were asked to state their agreement/disagreement with the characteristics of patients with chronic hypoparathyroidism, including demographic data, family history, comorbidities, biochemical values, symptoms and quality of life. Consensus was achieved when ≥66% of the respondents were in agreement. RESULTS Consensus was achieved on the importance of assessing demographic data and comorbidities (e.g., renal complications) in groups 2, 3 and 4; family medical history in groups 2 and 3; biochemical parameters (e.g., calcemia/urinary calcium excretion) in groups 2 and 4; and clinical symptoms and quality of life in groups 3 and 4. Consensus was also reached regarding the maintenance of several biochemical parameters and the need for personalized treatment and training in symptoms and complications. CONCLUSIONS The Spanish expert panel reached consensus defining key disease parameters and factors of importance for characterizing and treating patients with inadequately controlled chronic hypoparathyroidism.
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Zhu Y, Che Y, Gao S, Ren S, Tong M, Wang L, Yang F. Long-term follow-up results of PTMC treated by ultrasound-guided radiofrequency ablation: a retrospective study. Int J Hyperthermia 2021; 38:1225-1232. [PMID: 34402363 DOI: 10.1080/02656736.2021.1963850] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To confirm the long-term efficacy and safety of radiofrequency ablation (RFA) for low-risk papillary thyroid microcarcinoma (PTMC). METHODS We retrospectively reviewed data of 102 primary papillary thyroid carcinoma patients (82 women, 20 men; mean age: 43 [19] years) treated with radiofrequency ablation and thyroid-stimulating hormone (TSH) suppression therapy before December 2018. All patients were at high surgical risk or refused surgery. They were followed up at 1, 3, 6, 9, and 12 months and every 6-12 months thereafter using ultrasound and contrast-enhanced ultrasound. The volume and volume reduction ratio was calculated. Recurrence and lymph node or distant metastasis were evaluated. RESULTS The mean initial tumor diameter was 0.50 (0.29) cm; the mean initial volume was 0.06 (0.09) mL. At 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after RFA, complete resorption rates were 0, 0, 9.8 (10/102), 33.3 (34/102), 91.2 (93/102), 96.1 (98/102), 99 (101/102), 100, and 100%, respectively. Two patients had developed ipsilateral neck lymph node metastasis in regions IV and VI at 30- and 18-month follow-ups, respectively. After RFA, 3/102 patients (2.9%) developed hoarseness-the main side effect. No life-threatening or delayed complications occurred. The TSH value in the initial period was 0.06 (0.02) µIU/mL; the rate of reaching the TSH target was 85.7%. The TSH value at follow-up was 1.47 (0.91) µIU/mL; the compliance rate was 99.3%. CONCLUSIONS Ultrasound-guided RFA for PTMC is highly effective and safe. RFA can serve as a minimally invasive treatment for PTMC patients who refuse surgery or active surveillance.
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Affiliation(s)
- Yalin Zhu
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ying Che
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuhang Gao
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuangsong Ren
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengying Tong
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lina Wang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fang Yang
- Department of Ultrasound, The First Affiliated Hospital of Dalian Medical University, Dalian, China
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22
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Cao YM, Zhang TT, Li BY, Qu N, Zhu YX. Prognostic evaluation model for papillary thyroid cancer: a retrospective study of 660 cases. Gland Surg 2021; 10:2170-2179. [PMID: 34422588 DOI: 10.21037/gs-21-100] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023]
Abstract
Background Prognostic evaluation model for papillary thyroid cancer is very important for guiding the personalized treatment and follow-up strategy. There are imperfections in the system existed, and there is no suitable prognostic model for Chinese population. Methods This study was based on the clinic and follow-up data of 660 patients received surgical treatments in the Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center from 2000 to 2005. Cox univariate/multivariate analysis was used to explore the influence factors of prognosis, and nomogram model was performed to establish a prognostic prediction system. Results Totally, 660 patients for initial treatment were included in our analysis with a median follow-up of 113.5 months. Five-, 10- and 15-year disease-free survival rate was 95.5%, 90.2% and 89.2%. Five-, 10- and 15-year overall survival rate was 99.7%, 99.2% and 99.1%. Residual tumor was associated with overall survival [hazard ratio (HR) 20.9, 95% confidence interval (CI): 2.3-187.6, P<0.05]. Age of onset (HR 2.00, 95% CI: 1.17-3.42, P<0.05) and the dimension of lymph nodes involved (0.2-3 cm: HR 3.67, 95% CI: 1.13-11.87, P<0.05; >3 cm: HR 5.20, 95% CI: 1.31-20.65, P<0.05) were independent influence factors of disease-free survival. The nomogram model for predicting prognosis of papillary thyroid cancer was established with a moderate predictive value (c-index 0.71, 95% CI: 0.57-0.84). Conclusions The prognosis of papillary thyroid cancer is very good after appropriate treatment. Age and the dimension of lymph nodes involved were independent influence factors of disease-free survival for papillary thyroid cancer. A prognostic prediction model for Chinese population was established with moderate predictive value. A study with larger samples and including more factors of prognosis is necessary to increase the predictive value of model.
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Affiliation(s)
- Yi-Ming Cao
- Department of Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ting-Ting Zhang
- Department of Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bao-Yuan Li
- Department of thyroid, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Ning Qu
- Department of Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yong-Xue Zhu
- Department of Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Kim E, Ramonell KM, Mayfield N, Lindeman B. Parathyroid allotransplantation for the treatment of permanent hypoparathyroidism: A systematic review. Am J Surg 2021; 223:652-661. [PMID: 34304848 DOI: 10.1016/j.amjsurg.2021.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hypoparathyroidism is the most common complication of bilateral operations in the central neck. No formal guidelines exist for the management of permanent hypoparathyroidism. Current treatment involving medical supplementation increases resource utilization and patient morbidity while decreasing quality of life. Parathyroid allotransplant (PA) offers a promising therapy; however, the optimal technique and role of immunosuppression (IS) in PA remain unclear. METHODS We performed a systematic search of the Embase, MEDLINE, and Cochrane Library databases to identify studies investigating PA for treatment of hypoparathyroidism. RESULTS A total of 24 studies including 186 individual allograft transplants in 146 patients were identified. Pooled graft survival for allotransplants in transplant-naïve vs prior transplant recipients was 29.9% and 80%, respectively. CONCLUSIONS PA using normocellular, fresh parathyroid donor tissue that is ABO-compatible, with induction and, at minimum, short-term maintenance IS presents a potentially safe and effective therapeutic option for permanent hypoparathyroidism in patients tolerating IS.
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Affiliation(s)
- Eric Kim
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Kimberly M Ramonell
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Nicolas Mayfield
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
| | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of Surgery, Division of Breast and Endocrine Surgery, Birmingham, AL, USA.
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24
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Gršić K, Bumber B, Curić Radivojević R, Leović D. Prophylactic Central Neck Dissection in Well-differentiated Thyroid Cancer. Acta Clin Croat 2021; 59:87-95. [PMID: 34219889 PMCID: PMC8212603 DOI: 10.20471/acc.2020.59.s1.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Well-differentiated cancers, both papillary and follicular, account for 90% of all diagnosed thyroid cancers. They have an indolent disease course with a 20-year disease-specific survival over 90%. According to current guidelines, the therapy of choice for well-differentiated thyroid carcinoma is total thyroidectomy or lobectomy. The indication for prophylactic central neck dissection is still a controversial issue and the subject of unfinished and ongoing debate. There is no indication for prophylactic central neck dissection in follicular thyroid carcinomas, which primarily metastasize hematogenously. In small solitary papillary thyroid carcinomas (T1 and T2), prophylactic central neck dissection is not indicated as it does not bring benefits in terms of improved patient survival and at the same time significantly increases the risk of temporary and permanent postoperative complications. Prophylactic central neck dissection is indicated in advanced papillary thyroid cancers (T3 and T4) and all other high-risk well-differentiated thyroid cancer, as well as in the presence of metastatic lymph nodes in the lateral neck.
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Affiliation(s)
| | - Boris Bumber
- 1Department of Otorhinolaryngology and head and neck surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Department of Anaesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia; 4Department of Dental Medicine, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Renata Curić Radivojević
- 1Department of Otorhinolaryngology and head and neck surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Department of Anaesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia; 4Department of Dental Medicine, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Dinko Leović
- 1Department of Otorhinolaryngology and head and neck surgery, Zagreb University Hospital Centre, Zagreb, Croatia; 2Department of Anaesthesiology, Resuscitation and Intensive Care, Zagreb University Hospital Centre, Zagreb, Croatia; 3Department of Otorhinolaryngology and Maxillofacial Surgery, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia; 4Department of Dental Medicine, Faculty of Dental Medicine and Health, J. J. Strossmayer University of Osijek, Osijek, Croatia
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25
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Park J, Lee S, Park J, Park H, Ki CS, Oh YL, Shin JH, Kim JS, Kim SW, Chung JH, Kim K, Kim TH. Proposal of a New Prognostic Model for Differentiated Thyroid Cancer with TERT Promoter Mutations. Cancers (Basel) 2021; 13:cancers13122943. [PMID: 34208345 PMCID: PMC8231155 DOI: 10.3390/cancers13122943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
The role of telomerase reverse transcriptase (TERT) promoter mutations as an independent poor prognostic factor in differentiated thyroid cancer (DTC) patients is well known, but there is no prognostic system that combines the TERT promoter mutation status with tumor-node-metastasis (TNM) stage to predict cancer-specific survival (CSS). A total of 393 patients with pathologically confirmed DTC after thyroidectomy were enrolled. After incorporating wild-type TERT and mutant TERT with stages I, II, and III/IV of the AJCC TNM system 8th edition (TNM-8), we generated six combinations and calculated 10-year and 15-year CSS and adjusted hazard ratios (HRs) for cancer-related death using Cox regression. Then, a new mortality prediction model termed TNM-8T was derived based on the CSS and HR of each combination in the four groups. Of the 393 patients, there were 27 (6.9%) thyroid cancer-related deaths during a median follow-up of 14 years. Patients with a more advanced stage had a lower survival rate (10-year CSS for TNM-8T stage 1, 2, 3, and 4: 98.7%, 93.5%, 77.3%, and 63.0%, respectively; p < 0.001). TNM-8T showed a better spread of CSS (p < 0.001) than TNM-8 (p = 0.002) in the adjusted survival curves. The C-index for mortality risk predictability was 0.880 (95% CI, 0.665-0.957) in TNM-8T and 0.827 (95% CI, 0.622-0.930) in TNM-8 (p < 0.001). TNM-8T, a new prognostic system that incorporates the TERT mutational status into TNM-8, showed superior predictability to TNM-8 in the long-term survival of DTC patients.
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Affiliation(s)
- Jun Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
- Division of Endocrinology, Department of Medicine, Sahmyook Medical Center, Seoul 02500, Korea
| | - Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jiyun Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Hyunju Park
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | | | - Young-Lyun Oh
- Samsung Medical Center, Department of Pathology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jung-Hee Shin
- Samsung Medical Center, Department of Radiology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jee-Soo Kim
- Samsung Medical Center, Department of Surgery, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Sun-Wook Kim
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Jae-Hoon Chung
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Statistics and Data Center, Samsung Medical Center, Research Institute for Future Medicine, Seoul 06355, Korea
- Correspondence: (K.K.); (T.-H.K.); Tel.: +82-2-3410-6049 (T.-H.K.)
| | - Tae-Hyuk Kim
- Thyroid Center, Samsung Medical Center, Division of Endocrinology and Metabolism, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.P.); (J.P.); (H.P.); (S.-W.K.); (J.-H.C.)
- Correspondence: (K.K.); (T.-H.K.); Tel.: +82-2-3410-6049 (T.-H.K.)
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Robotic transaxillary lateral neck dissection for thyroid cancer: learning experience from 500 cases. Surg Endosc 2021; 36:2436-2444. [PMID: 34046713 DOI: 10.1007/s00464-021-08526-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Differentiated thyroid carcinoma with lateral neck lymph node metastasis requires aggressive operative intervention, including lateral neck dissection. Although several robotic approaches have made precise surgery for thyroid cancer possible, few centers have expanded the technique for application to lateral neck dissections. This study aimed to demonstrate the technical feasibility, cosmetic effectiveness, and safety of robotic transaxillary lateral neck dissection (RTLND) using the da Vinci system. METHODS From January 2008 to July 2019, 500 patients diagnosed with thyroid cancer with lateral neck node metastasis underwent RTLND. The clinicopathologic characteristics and surgical outcomes were retrospectively reviewed. RESULTS All operations were performed successfully without open conversion. As the primary operation for thyroid cancer, 476 (95.2%) patients underwent unilateral or bilateral RTLND, including robotic total thyroidectomy. The remaining 24 patients (4.8%), all of whom had a recurrence, also underwent RTLND with additional procedures, if needed. The mean operation time for the 500 operations was 293.71 ± 67.22 min. Only five cases had recurrence and required further treatment. CONCLUSIONS RTLND is technically feasible and safe through the precise manipulation of robotic instruments. While this method is thorough and provides safe and effective surgical outcomes, it also offers the additional advantage of being minimally invasive.
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Matsumoto F, Ikeda K. Surgical Management of Tracheal Invasion by Well-Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13040797. [PMID: 33672929 PMCID: PMC7918429 DOI: 10.3390/cancers13040797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/25/2023] Open
Abstract
Simple Summary Tracheal invasion is a poor prognostic factor in well-differentiated thyroid cancer. Appropriate resection can improve the prognosis and maintain the patient’s quality of life. Shaving resection for superficial tracheal invasion is minimally invasive because it does not involve the tracheal lumen, despite the problematic risk of local recurrence. Window resection for tracheal mucosal and luminal invasion provides good tumor control and does not cause postoperative airway obstruction; however, the need for surgical closure of the tracheocutaneous fistula is a disadvantage of this method. Circumferential (sleeve) resection and end-to-end anastomosis are highly curative, but the risk of fatal complications, such as anastomosis dehiscence, is a concern. Abstract Well-differentiated thyroid carcinoma (WDTC) is a slow-growing cancer with a good prognosis, but may show extraglandular progression involving the invasion of tumor-adjacent tissues, such as the trachea, esophagus, and recurrent laryngeal nerve. Tracheal invasion by WDTC is infrequent. Since this condition is rare, relevant high-level evidence about it is lacking. Tracheal invasion by a WDTC has a negative impact on survival, with intraluminal tumor development constituting a worse prognostic factor than superficial tracheal invasion. In WDTC, curative resection is often feasible with a small safety margin, and complete resection can ensure a good prognosis. Despite its resectability, accurate knowledge of the tracheal and peritracheal anatomy and proper selection of surgical techniques are essential for complete resection. However, there is no standard guideline on surgical indications and the recommended procedure in trachea-invading WDTC. This review discusses the indications for radical resection and the three currently available major resection methods: shaving, window resection, and sleeve resection with end-to-end anastomosis. The review shows that the decision for radical resection should be based on the patient’s general condition, tumor status, expected survival duration, and the treating facility’s strengths and weaknesses.
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Burillo E, Vila J, Oguiza A. Characteristics of patients with chronic hypoparathyroidism not adequately controlled with conventional treatment and management patterns in Spain. ACTA ACUST UNITED AC 2021; 68:304-311. [PMID: 33582034 DOI: 10.1016/j.endinu.2020.10.008] [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: 02/26/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE The current guidelines on hypoparathyroidism offer a model for treating patients but do not cover real-world situations or patient diversity. Given the lack of data regarding hypoparathyroidism, a Delphi panel was convened in Spain to establish consensus in defining the characteristics of patients with chronic hypoparathyroidism not adequately controlled with conventional treatment, as well as to investigate patterns of management. MATERIAL AND METHODS A presentation matrix provided a framework for characterizing inadequately controlled chronic hypoparathyroidism, based on 4 predefined patient groups: group 1 (normal biochemical levels and the patient feeling well); group 2 (abnormal biochemical levels and the patient feeling well); group 3 (normal biochemical levels and the patient feeling unwell); and group 4 (abnormal biochemical levels and the patient feeling unwell). Based on Likert scales (scored 1-9), the experts were asked to state their agreement / disagreement with the characteristics of patients with chronic hypoparathyroidism, including demographic data, family history, comorbidities, biochemical values, symptoms and quality of life. Consensus was achieved when ≥ 66% of the respondents were in agreement. RESULTS Consensus was achieved on the importance of assessing demographic data and comorbidities (e.g., renal complications) in groups 2, 3 and 4; family medical history in groups 2 and 3; biochemical parameters (e.g., calcemia / urinary calcium excretion) in groups 2 and 4; and clinical symptoms and quality of life in groups 3 and 4. Consensus was also reached regarding the maintenance of several biochemical parameters and the need for personalized treatment and training in symptoms and complications. CONCLUSIONS The Spanish expert panel reached consensus defining key disease parameters and factors of importance for characterizing and treating patients with inadequately controlled chronic hypoparathyroidism.
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Affiliation(s)
- Elena Burillo
- Shire Pharmaceuticals Ibérica SL, miembro del grupo empresarial Takeda, Madrid, España
| | - Juan Vila
- Shire Pharmaceuticals Ibérica SL, miembro del grupo empresarial Takeda, Madrid, España
| | - Ainhoa Oguiza
- Shire Pharmaceuticals Ibérica SL, miembro del grupo empresarial Takeda, Madrid, España.
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Park J, Lee S, Kim K, Park H, Ki CS, Oh YL, Shin JH, Kim JS, Kim SW, Chung JH, Kim TH. TERT Promoter Mutations and the 8th Edition TNM Classification in Predicting the Survival of Thyroid Cancer Patients. Cancers (Basel) 2021; 13:cancers13040648. [PMID: 33562809 PMCID: PMC7915040 DOI: 10.3390/cancers13040648] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary In a cohort study involving 393 patients with differentiated thyroid cancer, TERT promoter mutations were found to act as an independent poor prognostic factor based on the American Joint Committee on Cancer (AJCC) tumor-node-metastasis 8th edition (TNM-8) in differentiated thyroid carcinoma (DTC) patients, regardless of the histological types or stage at diagnosis. Since the current AJCC TNM-8 is insufficient to distinguish the risk of mortality in patients with differentiated thyroid cancer, a proposal for a new survival prediction model that includes the TERT promoter mutational state is required. Abstract Our research group has previously shown that the presence of TERT promoter mutations is an independent prognostic factor, by applying the TERT mutation status to the variables of the AJCC 7th edition. This study aimed to determine if TERT mutations could be independent predictors of thyroid cancer-specific mortality based on the AJCC TNM 8th edition, with long-term follow-up. This was a retrospective study of 393 patients with pathologically confirmed differentiated thyroid carcinoma (DTC) after thyroidectomy at a tertiary Korean hospital from 1994 to 2004. The thyroid cancer-specific mortality rate was 6.9% (5.2% for papillary and 15.2% for follicular cancers). TERT promoter mutations were identified in 10.9% (43/393) of DTC cases (9.8% of papillary and 16.7% of follicular cancer) and were associated with older age (p < 0.001), the presence of extrathyroidal invasion (p < 0.001), distant metastasis (p = 0.001), and advanced stage at diagnosis (p < 0.001). The 10-year survival rate in mutant TERT was 67.4% for DTC patients (vs. 98% for wild-type; adjusted hazard ratio (HR) of 9.93, (95% CI: 3.67–26.90)) and 75% for patients with papillary cancer (vs. 99%; 18.55 (4.83–71.18)). In addition, TERT promoter mutations were related to poor prognosis regardless of histologic type (p < 0.001 for both papillary and follicular cancer) or initial stage (p < 0.001, p = 0.004, and p = 0.086 for stages I, II, and III and IV, respectively). TERT promoter mutations comprise an independent poor prognostic factor after adjusting for the clinicopathological risk factors of the AJCC TNM 8th edition, histologic type, and each stage at diagnosis, which could increase prognostic predictability for patients with DTC.
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Affiliation(s)
- Jun Park
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | - Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.L.); (K.K.)
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (S.L.); (K.K.)
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06355, Korea
| | - Hyunju Park
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | | | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Jung Hee Shin
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Jee Soo Kim
- Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea;
| | - Sun Wook Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | - Jae Hoon Chung
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
| | - Tae Hyuk Kim
- Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Korea; (J.P.); (H.P.); (S.W.K.); (J.H.C.)
- Correspondence: ; Tel.: +82-2-3410-6049
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Sitges-Serra A. Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy. J Clin Med 2021; 10:jcm10030543. [PMID: 33540657 PMCID: PMC7867256 DOI: 10.3390/jcm10030543] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 12/19/2022] Open
Abstract
Postoperative parathyroid failure is the commonest adverse effect of total thyroidectomy, which is a widely used surgical procedure to treat both benign and malignant thyroid disorders. The present review focuses on the scientific gap and lack of data regarding the time period elapsed between the immediate postoperative period, when hypocalcemia is usually detected by the surgeon, and permanent hypoparathyroidism often seen by an endocrinologist months or years later. Parathyroid failure after thyroidectomy results from a combination of trauma, devascularization, inadvertent resection, and/or autotransplantation, all resulting in an early drop of iPTH (intact parathyroid hormone) requiring replacement therapy with calcium and calcitriol. There is very little or no role for other factors such as vitamin D deficiency, calcitonin, or magnesium. Recovery of the parathyroid function is a dynamic process evolving over months and cannot be predicted on the basis of early serum calcium and iPTH measurements; it depends on the number of parathyroid glands remaining in situ (PGRIS)—not autotransplanted nor inadvertently excised—and on early administration of full-dose replacement therapy to avoid hypocalcemia during the first days/weeks after thyroidectomy.
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Czarniecka A, Zeman M, Wozniak G, Maciejewski A, Stobiecka E, Chmielik E, Oczko-Wojciechowska M, Krajewska J, Handkiewicz-Junak D, Jarzab B. Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma - Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015. Front Endocrinol (Lausanne) 2021; 12:718833. [PMID: 34552559 PMCID: PMC8450606 DOI: 10.3389/fendo.2021.718833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Optimal therapeutic strategy in low advanced papillary thyroid carcinoma (PTC) is still a matter of debate. The management differs depending on the country. A prospective non-randomized study was performed to evaluate whether less extensive surgery could be a safe, acceptable, and sufficient therapeutic option in PTC cT1N0M0 patients. The present paper summarizes the results of over a 5-year follow-up. MATERIAL Our prospective group (PG) treated between 2011 and 2015 consisted of 139 patients with cT1aN0M0 PTC who underwent lobectomy (LT) as initial surgical treatment (PGcT1aN0M0 group) and 102 cT1bN0M0 patients in whom total thyroidectomy (TT) with unilateral central neck dissection (CND) was performed (PGcT1bN0M0). PG was compared with the retrospective group (RG) of patients who underwent TT with bilateral CND between 2004 and 2006: 103 cT1aN0M0 patients (RGcT1aN0M0) and 91cT1bN0M0 (RGcT1bN0M0). The risks of reoperation, cancer relapse and postoperative complications were analyzed. RESULTS Only 12 cT1aN0M0 patients (7.6%) withdrew from the trial and underwent TT with bilateral CND. Over 90% of patients accepted less extensive surgery. In 4 cT1aN0M0 cases, TT with CND was performed due to lymph node metastases found intraoperatively. The initial clinical stage according to the TNM/AJCC 7th edition was confirmed histologically in 77% of cases in PGT1aN0M0 and in 72% in PGT1bN0M0, respectively. 24 PGcT1aN0M0 patients were reoperated on. In this group, cancer lesions in the postoperative histological specimens were found in 8 cases (32%). Five-year disease-free survival (DFS) was excellent. However, no statistically significant differences were found between PG and RG groups (99.3% in PGcT1aN0M0 and 99.0%, in RGcT1aN0M0; p = 0.41 and 98%, in PGcT1bN0M0 and 94.4% in RGcT1bN0M0; p=0.19). No significant differences were observed in the incidence of early paresis of the recurrent laryngeal nerves between PG and RG. However, as predicted, LT completely eliminated the risk of postoperative hypoparathyroidism. SUMMARY The results of the prospective clinical trial confirm that less extensive surgery in adequately selected low-advanced PTC patients is both safe and sufficient.
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Affiliation(s)
- Agnieszka Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland
- *Correspondence: Agnieszka Czarniecka,
| | - Marcin Zeman
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Grzegorz Wozniak
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Adam Maciejewski
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research, Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Ewa Stobiecka
- Tumor Pathology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Ewa Chmielik
- Tumor Pathology Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Malgorzata Oczko-Wojciechowska
- Genetic and Molecular Diagnostics of Cancer Department, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Jolanta Krajewska
- Department of Nuclear Medicine and Endocrine Oncology, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Barbara Jarzab
- Department of Nuclear Medicine and Endocrine Oncology, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
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Alzahrani AS, Albalawi L, Mazi S, Mukhtar N, Aljamei H, Moria Y, Elsayed T, Amer L, Alanazi F, Alnasser L, Alqarni B, Fadel R, AlMatar A, Alqahtani A, Tuttle RM. How Does The AJCC/TNM Staging System Eighth Edition Perform in Thyroid Cancer at A Major Middle Eastern Medical Center? Endocr Pract 2020; 27:607-613. [PMID: 34120701 DOI: 10.1016/j.eprac.2020.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/24/2020] [Accepted: 11/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The American Joint Committee on Cancer tumor node metastasis (TNM) staging system eighth edition (TNM-8) for differentiated thyroid cancer (DTC) has been introduced as a replacement for tumor node metastasis staging system seventh edition (TNM-7). We present the first study from a Middle Eastern population comparing these 2 versions of the TNM staging system. METHODS We compared TNM-8 with TNM-7 in 701 patients with DTC seen during a 3-year period with a median age of 37 years (6-83) and a female-to-male ratio of 558 (79.6%) to 143 (20.4%). RESULTS The number (%) of patients within each stage in TNM-7 and TNM-8, respectively, are as follows: stage I = 503 (71.6%) and 583 (83.2%), stage II = 52 (7.4%) and 81 (11.4%), stage III = 53 (7.6%) and 6 (0.9%), and stage IV = 93 (13.2%) and 31 (4.6%). Overall, 172 patients (24.5%) were downstaged in TNM-8 compared to that in TNM-7, as follows: 26, 30, and 24 patients from stages II, III, and IV in TNM-7 to stage I in TNM-8; 23 and 32 patients from TNM-7 stages III and IV to TNM-8 stage II; 6 patients from stage IVa in TNM-7 to stage III in TNM-8; and 31 patients from stage IVc in TNM-7 to stage IVb in TNM-8. TNM-7 and TNM-8 predicted the long-term outcome well (median follow-up, 7.9 years), but Kaplan-Meier analysis showed better separation of cancer-specific survival in TNM-8 compared to TNM-7. CONCLUSIONS Compared with TNM-7, TNM-8 approximately downstaged a quarter of DTC patients and was more robust in separating the outcome of different stages over time.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
| | - Lina Albalawi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Department of Medicine, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Sedra Mazi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Noha Mukhtar
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hadeel Aljamei
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Yosra Moria
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Tarek Elsayed
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Lama Amer
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Faisal Alanazi
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Department of Medicine, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Layla Alnasser
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Bayan Alqarni
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Roqyah Fadel
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ahmed AlMatar
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ashwag Alqahtani
- Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - R Michael Tuttle
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
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Airway management, symptom relief and best supportive care in anaplastic thyroid cancer. Curr Opin Otolaryngol Head Neck Surg 2020; 28:74-78. [PMID: 32022733 DOI: 10.1097/moo.0000000000000619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer that is associated with significant morbidity and mortality. Because ATC is locally invasive, airway management is a critical component of treating these patients. Timely decisions regarding airway interventions can contribute to symptom relief and supportive care for patients. Over the last decade, there has been a paradigm shift in our recommendations for airway management. The purpose of this review is to summarize airway management, symptom relief and best supportive care for patients with ATC. RECENT FINDINGS More recent literature discusses the morbidities associated with tracheostomy and instead focuses on the benefits of supportive care and surgical resection. The multidisciplinary treating team should initiate early discussions for airway management, end-of-life care and palliative goals for patients with ATC. Tracheostomy should be offered to patients with careful thought and preoperative planning. SUMMARY Our goal in symptom relief and airway management is to improve the quality of life of patients with ATC and avoid the unnecessary morbidity of tracheostomy until clinically indicated.
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Póvoa AA, Teixeira E, Bella-Cueto MR, Melo M, Oliveira MJ, Sobrinho-Simões M, Maciel J, Soares P. Clinicopathological Features as Prognostic Predictors of Poor Outcome in Papillary Thyroid Carcinoma. Cancers (Basel) 2020; 12:cancers12113186. [PMID: 33138175 PMCID: PMC7693726 DOI: 10.3390/cancers12113186] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Thyroid cancer incidence is increasing, with overdiagnosis being the major driver of the thyroid cancer “epidemic”. Papillary thyroid carcinoma, usually with excellent prognosis, sometimes has an aggressive metastatic pattern. This heterogeneity in progression makes it difficult to tailor treatment strategies for an individual patient. We aimed to identify clinicopathological factors associated with papillary thyroid carcinoma recurrence, persistence, and specific mortality. Our study supports that both pre-surgical factors, such as male gender, presence of psammoma bodies, gross extra-thyroidal extension, and lateral compartment lymph node metastases, as well as lymph vessel invasion, venous invasion, presence of necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of PTC patients. The same is true when analysis is restricted to stage I patients. The importance of this report is to emphasize clinical and imaging pre-surgical thyroid cancer patients’ evaluation for an appropriate surgical treatment and patient prognosis. Abstract Papillary thyroid cancer (PTC) has an indolent nature and usually excellent prognosis. Some PTC clinicopathological features may contribute to the development of aggressive metastatic disease. In this work, we want to evaluate PTC clinicopathological features that are presurgical prognostic predictors of patients’ outcomes and find which indicators are more adequate for tailoring surgical procedures and follow-up. We studied a series of 241 PTC patients submitted to surgery. All patients’ files and histological tumor samples were reviewed. The 8th edition AJCC/UICC (American Joint Committee on Cancer/Union for International Cancer) Controlstaging system and the 2015 American Thyroid Association risk stratification system were used. Total thyroidectomy was performed in 228 patients, lymphadenectomy in 28 patients. Gross extrathyroidal extension (ETE) was present in 10 patients and 31 tumor resection margins were incomplete. Cervical lymph node metastases (LNMs) were present in 34 patients and distant metastases at diagnosis in four patients. In multivariate analysis, male gender (OR = 15.4, p = 0.015), venous invasion (OR = 16.7, p = 0.022), and lateral compartment LNM (OR = 26.7, p = 0.004) were predictors of mortality; psammoma bodies (PBs) (OR = 4.5, p = 0.008), lymph vessel invasion (OR = 6.9, p < 0.001), and gross ETE (OR = 16.1, p = 0.001) were predictors of structural disease status; male gender (OR = 2.9, p = 0.011), lymph vessel invasion (OR = 2.8, p = 0.006), and incomplete resection margins (OR = 4.6, p < 0.001) were predictors of recurrent/persistent disease. Our study supports that the factors helping to tailor patient’s surgery are male gender, presence of PBs, gross ETE, and lateral compartment LNM. Together with pathological factors, lymph vessel invasion, venous invasion, necrosis, and incomplete surgical resection, should be taken into consideration regarding treatment and follow-up of patients.
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Affiliation(s)
- Antónia Afonso Póvoa
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Correspondence: (A.A.P.); (P.S.); Tel.: +351-969-813-884 (A.A.P.)
| | - Elisabete Teixeira
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
| | - Maria Rosa Bella-Cueto
- Department of Pathology, Parc Taulí Sabadell Hospital Universitari-Institut d’Investigació i Innovació Parc Taulí-I3PT-Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | - Miguel Melo
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Endocrinology, Centro Hospitalar Universitário de Coimbra, 3004-561 Coimbra, Portugal
| | - Maria João Oliveira
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
| | - Manuel Sobrinho-Simões
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Department of Pathology, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
| | - Jorge Maciel
- Department of General Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/E), 4434-502 Gaia, Portugal;
- Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
| | - Paula Soares
- IPATIMUP-Instituto de Patologia e Imunologia Molecular, Universidade do Porto, 4200-135 Porto, Portugal; (E.T.); (M.M.); (M.S.-S.)
- Cancer Signaling and Metabolism, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- Departamento de Patologia, Faculdade de Medicina da Universidade do Porto, 4200-319 Porto, Portugal
- Correspondence: (A.A.P.); (P.S.); Tel.: +351-969-813-884 (A.A.P.)
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Kim HJ, Han JJ, Maeng CH, Baek SK. Lenvatinib-Induced Acute Pancreatitis in a Patient with Metastatic Thyroid Cancer: A Case Report. Int J Gen Med 2020; 13:699-704. [PMID: 33061538 PMCID: PMC7522403 DOI: 10.2147/ijgm.s272375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background Lenvatinib, a novel multi-target tyrosine kinase inhibitor, has been approved for treating differentiated thyroid cancer. Herein, we describe a rare case of acute pancreatitis that developed during lenvatinib treatment in a 65-year-old man with recurrent thyroid cancer. Case Presentation The patient was admitted to our department following a complaint of acute-onset epigastric pain and indigestion. He had been receiving lenvatinib since 34 days. Although his serum amylase and lipase levels were normal, he had acute-onset persistent epigastric pain and typical computed tomography findings, which were consistent with those of acute pancreatitis. As other common etiologies were excluded, it was concluded that the patient had lenvatinib-induced acute pancreatitis. On admission day 14, he could consume food orally, after conservative care, including drug cessation, intravenous hydration, and pain control. Conclusion Physicians should consider acute pancreatitis as a differential diagnosis for patients complaining of abdominal pain while on lenvatinib, regardless of hyperamylasemia or hyperlipasemia. Systematic collection of data on acute pancreatitis development during lenvatinib treatment should be considered, and further research is warranted to identify the mechanism of acute pancreatitis associated with multi-target tyrosine kinase inhibitors such as lenvatinib.
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Affiliation(s)
- Hong Jun Kim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jae Joon Han
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Chi Hoon Maeng
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Sun Kyung Baek
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Study of Effectiveness of Serum Phosphate as a Predictor of Temporary Hypocalcaemia Following Total Thyroidectomy. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02160-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Norwood TA, Buajitti E, Lipscombe LL, Stukel TA, Rosella LC. Incidental detection, imaging modalities and temporal trends of differentiated thyroid cancer in Ontario: a population-based retrospective cohort study. CMAJ Open 2020; 8:E695-E705. [PMID: 33139390 PMCID: PMC7608946 DOI: 10.9778/cmajo.20200095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Incidence rates of thyroid cancer in Ontario have increased more rapidly than those of any other cancer, whereas mortality rates have remained relatively stable. We evaluated the extent to which incidental detection of differentiated thyroid cancer during unrelated prediagnostic imaging procedures contributed to Ontario's incidence rates. METHODS We conducted a retrospective cohort study involving Ontarians who received a diagnosis of differentiated thyroid cancer from 1998 to 2017 using linked health care administrative databases. We classified cases as incidentally detected if a nonthyroid diagnostic imaging test (e.g., computed tomography [CT]) preceded an index event (e.g., prediagnostic fine-needle aspiration biopsy); all other cases were nonincidentally detected cases. We used Joinpoint and negative binomial regressions to characterize sex-specific rates of differentiated thyroid cancer by incidentally detected status and to quantify potential age, diagnosis period and birth cohort effects. RESULTS The study included 36 531 patients with differentiated thyroid cancer, of which 78.7% were female. Incidentally detected cases increased from 7.0% to 11.0% of female patients and from 13.5% to 18.2% of male patients over the study period. Age-standardized incidence rates increased more rapidly for incidentally detected cases (4.2-fold for female and 3.7-fold for male patients) than for nonincidentally detected cases (2.6-fold for female and 3.0-fold for male patients; p < 0.001). Diagnosis period was the primary factor associated with increased incidence rates of differentiated thyroid cancer, adjusting for other factors. Within each period, incidentally detected rates increased faster than nonincidentally detected rates, adjusting for age. Our results showed that CT was the most common imaging procedure preceding incidentally detected diagnoses. INTERPRETATION Incidentally detected cases represent a large and increasing component of the observed increases in differentiated thyroid cancer in Ontario over the past 20 years, and CT scans are primarily associated with these cases despite the modality having similar, increasing rates of use compared with magnetic resonance imaging (1993-2004). Recent increases in rates of differentiated thyroid cancer among males and incidentally detected cases among females in Ontario appear to be unrelated to birth cohort effects.
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Affiliation(s)
- Todd A Norwood
- Dalla Lana School of Public Health (Norwood, Buajitti, Rosella), University of Toronto; Cancer Care Ontario (Norwood); Women's College Hospital (Lipscombe); Institute of Health Policy, Management and Evaluation (Lipscombe, Stukel), University of Toronto; ICES Central (Stukel, Rosella), Toronto, Ont.
| | - Emmalin Buajitti
- Dalla Lana School of Public Health (Norwood, Buajitti, Rosella), University of Toronto; Cancer Care Ontario (Norwood); Women's College Hospital (Lipscombe); Institute of Health Policy, Management and Evaluation (Lipscombe, Stukel), University of Toronto; ICES Central (Stukel, Rosella), Toronto, Ont
| | - Lorraine L Lipscombe
- Dalla Lana School of Public Health (Norwood, Buajitti, Rosella), University of Toronto; Cancer Care Ontario (Norwood); Women's College Hospital (Lipscombe); Institute of Health Policy, Management and Evaluation (Lipscombe, Stukel), University of Toronto; ICES Central (Stukel, Rosella), Toronto, Ont
| | - Thérèse A Stukel
- Dalla Lana School of Public Health (Norwood, Buajitti, Rosella), University of Toronto; Cancer Care Ontario (Norwood); Women's College Hospital (Lipscombe); Institute of Health Policy, Management and Evaluation (Lipscombe, Stukel), University of Toronto; ICES Central (Stukel, Rosella), Toronto, Ont
| | - Laura C Rosella
- Dalla Lana School of Public Health (Norwood, Buajitti, Rosella), University of Toronto; Cancer Care Ontario (Norwood); Women's College Hospital (Lipscombe); Institute of Health Policy, Management and Evaluation (Lipscombe, Stukel), University of Toronto; ICES Central (Stukel, Rosella), Toronto, Ont
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Lim YS, You BH, Kim HB, Lim SH, Song JG, Bae MG, Han HK, Choi YH, Choi HS. A New Therapeutic Approach Using a Calcilytic (AXT914) for Postsurgical Hypoparathyroidism in Female Rats. Endocrinology 2020; 161:5898117. [PMID: 32852547 DOI: 10.1210/endocr/bqaa145] [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: 05/22/2020] [Accepted: 08/26/2020] [Indexed: 11/19/2022]
Abstract
Postsurgical hypoparathyroidism is the most common complication of thyroid surgery. Conventional therapy with high-dose calcium and vitamin D can correct hypocalcemia but can increase the risk of hypercalciuria, renal stones, or ectopic calcification. The aim of the present study was to investigate the efficacy of a calcium-sensing receptor antagonist, also called a calcilytic (AXT914), in rat models of postsurgical hypoparathyroidism. Two postsurgical hypoparathyroidism rat models were made by hemi-parathyroidectomy or total parathyroidectomy with autotransplantation in 10-week-old female Wistar rats. AXT914 or vehicle was administered orally for 2 to 3 weeks. Serum PTH, calcium, and phosphorus levels, and the urinary excretion of calcium were measured. Autotransplanted parathyroid tissues were collected and examined histologically. In the hemi-parathyroidectomy model, the oral administration of the calcilytic AXT914 (5 and 10 mg/kg) for 2 weeks increased serum PTH and calcium levels and decreased serum phosphorus levels and urinary calcium excretion. In the total parathyroidectomy with autotransplantation model, the oral administration of AXT914 (10 mg/kg) for 3 weeks increased serum PTH and calcium levels and decreased serum phosphorus levels. The serum PTH and calcium levels increased by AXT914 were maintained for 1 week, even after discontinuation of the drug. In conclusion, AXT914 increased PTH secretion in rat models of postsurgical hypoparathyroidism, thereby correcting abnormal calcium and phosphorus homeostasis. Furthermore, AXT914 improved the functional recovery of autotransplanted parathyroid tissues.
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Affiliation(s)
- Yun-Sung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Byung Hoon You
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Hee-Bok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
| | - So Hyun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Jae Geun Song
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Min Goo Bae
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Hyo-Kyung Han
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Young Hee Choi
- College of Pharmacy and Integrated Research Institute for Drug Development, Dongguk University-Seoul, Koyang-si, Gyeonggi-do, Republic of Korea
| | - Han Seok Choi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Koyang-si, Gyeonggi-do, Republic of Korea
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Chen KS, Gosmanova EO, Curhan GC, Ketteler M, Rubin M, Swallow E, Zhao J, Wang J, Sherry N, Krasner A, Bilezikian JP. Five-year Estimated Glomerular Filtration Rate in Patients With Hypoparathyroidism Treated With and Without rhPTH(1-84). J Clin Endocrinol Metab 2020; 105:5879689. [PMID: 32738041 PMCID: PMC7470469 DOI: 10.1210/clinem/dgaa490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Chronic hypoparathyroidism (HypoPT) is conventionally managed with oral calcium and active vitamin D. Recombinant human parathyroid hormone (1-84) (rhPTH[1-84]) is a therapy targeting the pathophysiology of HypoPT by replacing parathyroid hormone. OBJECTIVE To compare changes in the estimated glomerular filtration rate (eGFR) in patients with chronic HypoPT receiving or not receiving rhPTH(1-84) during a 5-year period. DESIGN/SETTING A retrospective analysis of patients with chronic HypoPT treated with or without rhPTH(1-84). PATIENTS Sixty-nine patients with chronic HypoPT from 4 open-label, long-term trials (NCT00732615, NCT01268098, NCT01297309, and NCT02910466) composed the rhPTH(1-84) cohort and 53 patients with chronic HypoPT not receiving rhPTH(1-84) from the Geisinger Healthcare Database (01/2004-06/2016) composed the historical control cohort. INTERVENTIONS The rhPTH(1-84) cohort (N = 69) received rhPTH(1-84) therapy; the historical control cohort (N = 53) did not receive rhPTH(1-84). MAIN OUTCOME MEASURES Changes in eGFR from baseline during a 5-year follow-up were examined in multivariate regression analyses. RESULTS At baseline, demographic characteristics and eGFR were similar between cohorts, though the proportions with diabetes and cardiac disorders were lower in the rhPTH(1-84) cohort. At the end of follow-up, mean eGFR increased by 2.8 mL/min/1.73 m2 in the rhPTH(1-84) cohort, while mean eGFR fell by 8.0 mL/min/1.73 m2 in the control cohort. In the adjusted model, the difference in the annual eGFR change between the rhPTH(1-84) cohort and the control cohort was 1.7 mL/min/1.73 m2 per year (P = 0.009). CONCLUSIONS Estimated glomerular filtration rate was preserved for over 5 years among patients with chronic HypoPT receiving rhPTH(1-84) treatment, contrasting with an eGFR decline among those not receiving rhPTH(1-84).
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Affiliation(s)
- Kristina S Chen
- Shire Human Genetic Therapies, Inc., Cambridge, Massachusetts (a Takeda company)
- Correspondence and Reprint Requests: Kristina S. Chen, PharmD, MS, Arena Pharmaceuticals, 1 Beacon Street, Suite 2800, Boston, MA 02108, USA. E-mail: . Currently at Arena Pharmaceuticals, 1 Beacon Street, Suite 2800, Boston, Massachusetts, 02108
| | - Elvira O Gosmanova
- Division of Nephrology, Albany Medical College and Nephrology Section, Stratton VA Medical Center, Albany, New York
| | - Gary C Curhan
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
- Department of Medicine Program, University of Split School of Medicine, Split, Croatia
| | - Mishaela Rubin
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Jing Zhao
- Analysis Group Inc., Boston, Massachusetts
| | | | - Nicole Sherry
- Shire Human Genetic Therapies, Inc., Cambridge, Massachusetts (a Takeda company)
| | - Alan Krasner
- Shire Human Genetic Therapies, Inc., Cambridge, Massachusetts (a Takeda company)
| | - John P Bilezikian
- Columbia University College of Physicians and Surgeons, New York, New York
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Tuncel M, Kılıçkap S, Süslü N. Clinical impact of 68Ga-DOTATATE PET-CT imaging in patients with medullary thyroid cancer. Ann Nucl Med 2020; 34:663-674. [PMID: 32602032 DOI: 10.1007/s12149-020-01494-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Medullary thyroid cancer (MTC) arises from neuroendocrine C cells of the thyroid. There is no single diagnostic imaging method that can reveal all MTC recurrences or metastases. 68Ga-DOTATATE is an alternative PET radiotracer that showed acceptable efficacy in the detection of MTC. In this study, we aimed to reveal the clinical efficacy and impact of this radiotracer on the management of patients with MTC. METHODS The 68Ga-DOTATATE PET-CT records of 38 patients with confirmed MTC were included in the study. The demographic data, clinical indication for the scan, previous therapies, and tumor marker levels were recorded. The site and SUVmax of the lesions were also noted. A consensus was reached on the additional value of 68Ga-DOTATATE PET-CT, and sites with discordant results on conventional imaging (CI). Finally, changes in management after the scan were evaluated. RESULTS 68Ga-DOTATATE PET-CT outperformed CI in 14/38 (37%) patients. In these 14 patients, metastatic lymph nodes were detected in 8, bone metastases in 4, and both bone and lymph nodes metastases in 2 patients. In 16/38 (42%) patients, 68Ga-DOTATATE PET-CT performed equally well as CI. In 5/38 (13%) patients, CI outperformed PET-CT. Most of the patients (4/5) in this group had hepatic metastases. 68Ga-DOTATATE PET-CT positivity was also correlated with tumor marker expression [median calcitonin; PET-positive: 743 ± 5439 vs PET-negative: 45 ± 17 (p:0.012), median CEA; PET-positive: 41 ± 162 vs PET-negative: 2.6 ± 1.4 (p:0.015)]. 68Ga-DOTATATE PET-CT changed the clinical management of 13/38 (34%) patients. The information provided by PET-CT resulted in neck surgery in 5/13 patients, external radiotherapy in 3/13 and both in one patient. Four of these thirteen patients were found to be eligible for peptide receptor radionuclide therapy. CONCLUSION 68 Ga-DOTATATE is an essential part of the work-up for patients with MTC. This modality outperformed CI in 14/38 (37%) patients and changed the clinical management in 13/38 (34%) patients. Prospective randomized studies with image-guided therapy decisions are needed to further reveal the impact of PET imaging in patients with MTC.
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Affiliation(s)
- Murat Tuncel
- Department of Nuclear Medicine, Faculty of Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| | - Saadettin Kılıçkap
- Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilda Süslü
- Department of Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Abstract
Given the long-term survival of most patients with thyroid cancer, it is very important to distinguish patients who need aggressive treatment from those who do not. Conventional clinicopathological prognostic parameters could not completely predict the final outcome of each patient. Recently, molecular marker-based risk stratification of thyroid cancer has been proposed to better estimate the cancer risk. Although BRAF mutation has drawn much attention based on its high prevalence, its association with recurrence or mortality is not clear. Recently, telomerase reverse transcriptase (TERT) promoter mutation has been identified in thyroid cancer. It increases telomerase activity, which allows cancer cells to immortalize. It was found in 10 to 20% of differentiated thyroid carcinoma and 40% of dedifferentiated thyroid carcinoma. It is highly prevalent in old age, large tumor, aggressive histology, advanced stages, and distant metastasis. It is associated with increased recurrence and mortality. Concomitant BRAF and TERT promoter mutations worsen the survival rate. Inclusion of TERT promoter mutation analysis with conventional clinicopathological evaluation can lead to better prognostication and management for individual patients.
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Affiliation(s)
- Jae Hoon Chung
- Division of Endocrinology and Metabolism, Department of Medicine and Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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Is Less More? A Microsimulation Model Comparing Cost-effectiveness of the Revised American Thyroid Association's 2015 to 2009 Guidelines for the Management of Patients With Thyroid Nodules and Differentiated Thyroid Cancer. Ann Surg 2020; 271:765-773. [PMID: 30339630 DOI: 10.1097/sla.0000000000003074] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess relative clinical and economic performance of the revised American Thyroid Association (ATA) thyroid cancer guidelines compared to current standard of care. BACKGROUND Diagnosis of thyroid cancer in the United States has tripled whereas mortality has only marginally increased. Most patients present with small papillary carcinomas and have historically received at least a total thyroidectomy as a treatment. In 2015, the ATA released the revised guidelines recommending an option for active surveillance (AS) of small papillary thyroid carcinoma and thyroid lobectomy for larger unifocal tumors. METHODS We created a Markov microsimulation model to evaluate the performance of the ATA's 2015 guidelines compared to the ATA's 2009 guidelines. We modeled a cohort of simulated patients with demographic and thyroid nodule characteristics representative of those presenting clinically in the United States. Outcome measures include life expectancy, quality-adjusted life years, costs, and frequency of surgical adverse events. RESULTS In our base case analysis, the ATA 2015 strategy dominates the ATA 2009 strategy. The ATA 2015 strategy delivers greater discounted average quality-adjusted life years (13.09 vs 12.43) at a lower discounted average cost ($14,752 vs $20,126). Deaths due to thyroid cancer under the 2015 strategy are higher than the 2009 strategy but this is offset by a reduction in surgical deaths, leading to greater average life expectancy under the ATA 2015 strategy. The optimal strategy is sensitive to patients who experience a greater decrement in quality of life while undergoing AS. CONCLUSIONS The ATA 2015 Guidelines represent a cost-effective strategy regarding AS and extent of surgery.
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Yumuşakhuylu AC, Asya O, Gündoğdu Y, Oysu Ç. Clinicopathologic Results of the Surgical Management of Thyroid Gland Pathologies. Turk Arch Otorhinolaryngol 2020; 58:93-98. [PMID: 32783035 DOI: 10.5152/tao.2020.5276] [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: 03/09/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study is to share our surgical approach and results in patients with benign and malignant thyroid diseases. Methods All patients who underwent thyroid gland surgery at our University Hospital Ear, Nose, and Throat Department between 2012 and 2017 were retrospectively analyzed. The study included 293 patients. Results Of the 293 patients included in the study, 76 (25.9%) were male and 217 (74.1%) were female. Mean follow-up period was 47.1 months. Patients' ages ranged from 4 to 77 years. In terms of the pathology, 160 patients had benign and 133 had neoplastic thyroid diseases. None of the patients who underwent thyroid surgery due to benign diseases required revision surgery. Recurrence occurred in 15 out of the 116 patients that were operated on for well-differentiated thyroid cancer. Out of these 15 patients with disease recurrence, 11 had biochemically incomplete responses and four had structurally recurrent diseases. Conclusion Thyroidectomy, when performed safely and correctly, is a very effective way of treating both benign and malignant thyroid diseases. Total thyroidectomy or total lobectomy and isthmectomy are the gold-standard surgical approaches to prevent recurrence. A national form is needed regarding thyroid surgery for following up on patients and for the regular and systematic collection of data.
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Affiliation(s)
- Ali Cemal Yumuşakhuylu
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Orhan Asya
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Yavuz Gündoğdu
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Çağatay Oysu
- Department of Otolaryngology, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
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Bogović Crnčić T, Ilić Tomaš M, Girotto N, Grbac Ivanković S. Risk Factors for Thyroid Cancer: What Do We Know So Far? Acta Clin Croat 2020; 59:66-72. [PMID: 34219886 PMCID: PMC8212601 DOI: 10.20471/acc.2020.59.s1.08] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Thyroid cancer (TC) is the most common endocrine cancer today. The rising incidence of the differentiated papillary type cannot be entirely explained by early and meticulous diagnosis, since a proportion of large tumors has also been reported. In this review, we present the results of numerous investigations focused on possible factors causing increased TC incidence, such as chromosomal and genetic alterations, iodine intake, TSH level, autoimmune thyroid disease, gender, estrogen, obesity, lifestyle changes, and environmental pollutants. Up to now, only childhood exposure to ionizing radiation has been fully recognized as a risk factor. There is also a possibility that yet undiscovered carcinogens, especially during intrauterine life or early childhood, might be responsible for increased TC incidence as well as epigenetic changes. Therefore, more studies are necessary in order to further investigate the potential risk factors for TC and their mechanisms of action.
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Affiliation(s)
| | - Maja Ilić Tomaš
- Department of Nuclear Medicine, University of Rijeka Faculty of Medicine, Clinical Department of Nuclear Medicine, Rijeka Clinical Hospital Centre, Rijeka, Croatia
| | - Neva Girotto
- Department of Nuclear Medicine, University of Rijeka Faculty of Medicine, Clinical Department of Nuclear Medicine, Rijeka Clinical Hospital Centre, Rijeka, Croatia
| | - Svjetlana Grbac Ivanković
- Department of Nuclear Medicine, University of Rijeka Faculty of Medicine, Clinical Department of Nuclear Medicine, Rijeka Clinical Hospital Centre, Rijeka, Croatia
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Vogel T, Wendler J, Frank-Raue K, Kreissl MC, Spitzweg C, Fassnacht M, Raue F, Kroiss M. Bone Metastases in Medullary Thyroid Carcinoma: High Morbidity and Poor Prognosis Associated With Osteolytic Morphology. J Clin Endocrinol Metab 2020; 105:5740219. [PMID: 32072159 DOI: 10.1210/clinem/dgaa077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/18/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT The clinical relevance of bone metastases (BM) in advanced medullary thyroid carcinoma (MTC) is poorly described. OBJECTIVE The objectives of this work are to describe the prevalence of BM, frequency of skeletal related events (SREs), and impact of BM morphology and SREs on prognosis, and to assess the role of antiresorptive treatment (ART). DESIGN A retrospective cohort study was conducted. SETTING This study was conducted at 4 German referral centers. PATIENTS A total of 1060 MTC patients were included. MAIN OUTCOME MEASURE Main outcome measures include descriptive statistics, overall survival (OS) by the Kaplan-Meier method, and risk factors by Cox proportional hazards modeling. RESULTS A total of 120 of 416 patients (29%) with metastatic MTC had BM, of which 97% had concurrent nonosseous metastases. BM occurred 2.1 years (median, range -0.1 to 20.6 years) after initial diagnosis, were multifocal in 79%, and were located preferentially in the spine (86%) and pelvis (60%). BM morphology was osteolytic in 32%, osteoblastic in 25%, and mixed in 22% of cases (unknown: 21%). Within a median observation period of 26.6 months (range, 0-188 months) after BM diagnosis, 47% of patients experienced one or more SREs (bone radiation 50%, pathological fractures 32%), of which 42% occurred in osteolytic and 17% in osteoblastic BM (P = .047). Presence of osteolytic metastases (hazard ratio 3.85, 95% CI 1.52-9.77, P = .005) but not occurrence of SREs was associated with impaired OS. Among the 36 patients who received ART (no ART: n = 71), SREs were significantly less frequent than in untreated patients (P = .04). CONCLUSION BM are common in metastatic MTC and most often with an osteolytic morphology and an unfavorable prognosis. The majority of SREs occur in osteolytic metastases and may be prevented by ART.
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Affiliation(s)
- Theresa Vogel
- University Hospital, University of Würzburg, Department of Internal Medicine I, Division of Endocrinology/Diabetology, Würzburg, Germany
| | - Julia Wendler
- University Hospital, University of Würzburg, Department of Internal Medicine I, Division of Endocrinology/Diabetology, Würzburg, Germany
| | | | - Michael C Kreissl
- University Hospital, University of Magdeburg, Department of Nuclear Medicine, Magdeburg, Germany
| | - Christine Spitzweg
- University Hospital, Ludwig-Maximilians University of Munich, Department of Internal Medicine IV, Munich, Germany
| | - Martin Fassnacht
- University Hospital, University of Würzburg, Department of Internal Medicine I, Division of Endocrinology/Diabetology, Würzburg, Germany
- University Hospital, University of Würzburg, Comprehensive Cancer Center Mainfranken, Würzburg, Germany
| | | | - Matthias Kroiss
- University Hospital, University of Würzburg, Department of Internal Medicine I, Division of Endocrinology/Diabetology, Würzburg, Germany
- University Hospital, University of Würzburg, Comprehensive Cancer Center Mainfranken, Würzburg, Germany
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Pardal-Refoyo JL, Pardal-Peláez B, Ochoa-Sangrador C, Estévez-Alonso JS. Laryngeal paralysis detected in preoperative laryngoscopy in malignant and benign thyroid disease. Systematic review and meta-analysis. ACTA ACUST UNITED AC 2019; 67:364-373. [PMID: 31879254 DOI: 10.1016/j.endinu.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/29/2019] [Accepted: 09/25/2019] [Indexed: 11/29/2022]
Abstract
There is controversy regarding the performance of preoperative laryngoscopy (LP) in thyroid surgery, with different recommendations being made, based on observational studies, in various publications. The aim of the study was to know the prevalence of laryngeal paralysis found in the LPs of patients who underwent thyroidectomy in benign and malignant pathology. A systematic review was carried out with 29 articles included for the qualitative study and a meta-analysis of 13 articles in which the data could be obtained to evaluate the same effect (in all patients in which an LP was carried out, those with preoperative laryngeal paralysis were included, and assigned to malignant or benign postoperative histology groups). The pooled prevalence of preoperative paralysis in benign pathology was 1.1% (95% CI 0.7 to 1.7%, 71% I2) and in 6.3% malignant pathology (95% CI 3.8 to 9.4%; I2 85%). The prevalence was significantly higher among patients with malignant pathology with an estimated effect RR 5.66, 95% CI, 2.48, 12.88. The studies analyzed present biases that will need to be corrected in future research, eliminating blinding biases in the selection and allocation of patients or in the laryngoscopy technique used. The LP in thyroid surgery evaluates possible disorders of laryngeal motility. The prevalence of laryngeal paralysis in thyroid pathology found in LPs in patients with a postoperative diagnosis of malignant pathology was higher than in the benign pathology group. This information is necessary for interpreting the intraoperative neuromonitoring signal and for making informed decisions.
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Affiliation(s)
- José Luis Pardal-Refoyo
- Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, IBSAL (Instituto de Investigación Biomédica de Salamanca), Salamanca, España.
| | - Beatriz Pardal-Peláez
- Facultad de Medicina y Clínica Odontológica, Departamento de Cirugía, Universidad de Salamanca, Salamanca, España
| | - Carlos Ochoa-Sangrador
- Servicio de Pediatría, Complejo Asistencial de Zamora, Apoyo en Investigación en Epidemiología Clínica, Zamora, España
| | - José Santiago Estévez-Alonso
- Servicio de Otorrinolaringología, Hospital Universitario de Salamanca, IBSAL (Instituto de Investigación Biomédica de Salamanca), Salamanca, España
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Hakeem AH, Javaid H, Hakeem IH, Wani FJ. Near-Total Laryngectomy for Extranodal Infiltration from Papillary Cancer to Larynx and Hypopharynx. Indian J Surg Oncol 2019; 10:614-617. [DOI: 10.1007/s13193-019-00932-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/02/2019] [Indexed: 11/28/2022] Open
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Baerbock N, Mittelstädt A, Jähne J. Morbidity and long-term survival in patients with cervical re-exploration for papillary thyroid carcinoma. Innov Surg Sci 2019; 4:91-99. [PMID: 31709300 PMCID: PMC6817731 DOI: 10.1515/iss-2018-0023] [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] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/05/2019] [Indexed: 01/15/2023] Open
Abstract
Background Papillary thyroid carcinoma (PTC) has a favorable prognosis following one-stage surgical therapy, whereas two-stage resections bear the risk of increased morbidity and possibly impaired prognosis. To further elucidate the value of surgical re-exploration in PTC, a retrospective study was performed. Methods The study involved 187 patients with PTC who underwent total thyroidectomy with central lymph node dissection between 2001 and 2011. The number of two-stage surgeries, the rates of recurrent laryngeal nerve paralysis (RLNP) as well as hypocalcemia, and the long-term survival were assessed. Results Two-stage surgeries were performed in 43%. No statistically significant difference was seen between the one- and two-stage resection groups regarding the rate of RLNP (transient 5.6% vs. 6.3%, permanent 2.6% vs. 0%) nor for hypocalcemia (transient 25.2% vs. 18.8%, permanent 14.0% vs. 22.5%). The 10-year recurrence-free survival was 95.5% and the 10-year disease-specific survival was 98.9% with no difference between groups. Conclusion Even though two-stage surgeries do not lead to a higher incidence of RLNP and hypocalcemia, optimal preoperative and intraoperative diagnostics have to be carried out to reduce the amount of completion surgeries.
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Affiliation(s)
- Nenia Baerbock
- Clinic of Anaesthesiology and Intensive Care, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Anke Mittelstädt
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Joachim Jähne
- Clinic for General and Digestive Surgery, Center for Endocrine, Oncologic and Metabolic Surgery, DIAKOVERE Henriettenstift, Hannover, Germany
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Gopi G, Sarkar S, Nayak A. Extra-laryngeal branching of recurrent laryngeal nerve: a possibility thyroid surgeons need to keep in mind to prevent inadvertent nerve injury. BMJ Case Rep 2019; 12:12/11/e231305. [PMID: 31704798 DOI: 10.1136/bcr-2019-231305] [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: 11/04/2022] Open
Abstract
A 45-year-old woman presented with a neck swelling since the past 6 years. The swelling was painless but slowly and progressively increasing in size. On examination, a thyroid swelling of size approximately 6×4 cm was seen on the left side. Ultrasonography revealed the size to be 6×5 cm with microcalcifications. Fine needle aspiration cytology revealed the mass to be papillary carcinoma. She was planned for total thyroidectomy with central compartment clearance. Preoperative assessment including thyroid hormone profile was normal and the patient was taken for surgery after proper anaesthesia clearance. During the surgery, it was found that there was a branching of the left recurrent laryngeal nerve. The branching was confirmed with nerve monitor and careful dissection was done to prevent injuries. The surgery was completed successfully without any nerve damage and the postoperative period was uneventful. Follow-up assessments revealed no signs of nerve injury like hoarseness of voice. Possibility of abnormal branches and duplication of nerves though uncommon should not be underestimated and extra vigilance and caution must be exercised when operating near a nerve, even by an experienced surgeon familiar with the local anatomy. Any doubts arising during the surgery must be clarified immediately, and nerve monitors should be used to check suspected branching and duplications before proceeding further.
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Affiliation(s)
- Gokul Gopi
- All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Saurav Sarkar
- ENT and Head Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
| | - Anindya Nayak
- ENT and Head Neck Surgery, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India
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Díez JJ, Anda E, Sastre J, Pérez Corral B, Álvarez-Escolá C, Manjón L, Paja M, Sambo M, Santiago Fernández P, Blanco Carrera C, Galofré JC, Navarro E, Zafón C, Sanz E, Oleaga A, Bandrés O, Donnay S, Megía A, Picallo M, Sánchez Ragnarsson C, Baena-Nieto G, García JCF, Lecumberri B, de la Vega MS, Romero-Lluch AR, Iglesias P. Prevalence and risk factors for hypoparathyroidism following total thyroidectomy in Spain: a multicentric and nation-wide retrospective analysis. Endocrine 2019; 66:405-415. [PMID: 31317524 DOI: 10.1007/s12020-019-02014-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The prevalence of postoperative hypoparathyroidism has been studied in registries and in surgical series with highly variable and imprecise results. However, the frequency of this hormonal deficiency in the clinical practice of endocrinologists is not known with accuracy. We aimed to assess the prevalence and risk factors of hypoparathyroidism in patients undergoing total thyroidectomy in Spain. METHODS We designed a retrospective, multicentre and nation-wide protocol including all patients with total thyroidectomy who were seen in the endocrinology clinic of the participant centers from January to March 2018. Prevalence of hypoparathyroidism was evaluated at discharge of surgery, 3-6 months after surgery, 12 months after surgery and at last visit. Twenty hospitals participated in the study. RESULTS Of 1792 patients undergoing total thyroidectomy, 866 (48.3%) developed postoperative hypoparathyroidism at discharge of surgery. Most of them recover parathyroid function over time. Prevalence of hypoparathyroidism at 3-6 months, 12 months and at last visit was 22.9%, 16.7% and 14.5%, respectively. The risk of developing definitive hypoparathyroidism was related to the presence of parathyroid tissue at histology, lymph node dissection, and two-stage thyroidectomy. Patients with thyroid cancer, with higher postoperative calcium levels and treated by expert surgical teams exhibited lower risk of developing permanent hypoparathyroidism. CONCLUSIONS Although most patients with postsurgical hypoparathyroidism recover parathyroid function, the prevalence of permanent disease in clinical practice is non negligible (14.5%). Postoperative calcium, extent and timing of surgery, the presence of cancer, expert surgical team, and parathyroid tissue at histology are predictors of permanent hypoparathyroidism.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
| | - Emma Anda
- Department of Endocrinology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Julia Sastre
- Department of Endocrinology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Begoña Pérez Corral
- Department of Endocrinology, Complejo Asistencial Universitario de León, León, Spain
| | | | - Laura Manjón
- Department of Endocrinology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Miguel Paja
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
| | - Marcel Sambo
- Department of Endocrinology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Concepción Blanco Carrera
- Department of Endocrinology, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Juan C Galofré
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Elena Navarro
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carles Zafón
- Department of Endocrinology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eva Sanz
- Department of Endocrinology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Amelia Oleaga
- Department of Endocrinology, Hospital Universitario de Basurto, Bilbao, Spain
| | - Orosia Bandrés
- Department of Endocrinology, Hospital Royo Villanova, Zaragoza, Spain
| | - Sergio Donnay
- Department of Endocrinology, Fundación Hospital de Alcorcón, Alcorcón, Madrid, Spain
| | - Ana Megía
- Department of Endocrinology, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Ciberdem, Tarragona, Spain
| | - María Picallo
- Department of Endocrinology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Gloria Baena-Nieto
- Department of Endocrinology, Hospital de Jerez, Jerez de la Frontera, Cádiz, Spain
| | | | - Beatriz Lecumberri
- Department of Endocrinology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Ana R Romero-Lluch
- Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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