Targeted Mutational Profiling and a Powerful Risk Score as Additional Tools for the Diagnosis of Papillary Thyroid Cancer

Molecular testing in indeterminate thyroid nodules: an additional tool for clinical decision-making

Thyroid nodules are commonly encountered in clinical practice, affecting up to 50% of the population. The large majority of thyroid lumps are benign incidental findings detected by imaging, while approximately 5-15% harbor malignancy. For a target patient's care, it is of paramount importance to identify and treat thyroid malignancy, while preventing unnecessary invasive surgery in patients with benign lesions. Although fine needle aspiration (FNA) associated with cytological examination provides malignant risk information, 20-30% of diagnoses fall into the "indeterminate thyroid nodule" (ITN) category. ITN clinical management remains a challenging issue for physicians since the ITN risk of malignancy varies from 5% to 40% and most thyroid nodules undergo overtreatment with surgery procedures. ITN molecular testing may better define malignant risk in the single nodule and is able to discriminate with accuracy benign from malignant nodules. Nowadays there are different technologies and different molecular panels, each with its own specificity, sensitivity and predictive values. In view of widespread introduction of molecular testing , some outstanding questions remain and are addressed in the present review such as the presence of molecular panels acting as "rule in" or "rule out" tools, the effective impact of testing results in the clinical decision-making process, and the prohibitive cost of commercial assays associated with the lack of test reimbursement in national health systems.

Competing-Risks Model for Predicting the Postoperative Prognosis of Patients with Papillary Thyroid Adenocarcinoma Based on The Surveillance, Epidemiology, and End Results (SEER) Database

Background

The aim of this study was to identify accurate prognostic factors for postoperative papillary thyroid adenocarcinoma (PTAC) using a competing-risks model based on data from the Surveillance, Epidemiology, and End Results (SEER) database.

Material/Methods

Data on patients with PTAC who had received surgery between 2010 and 2015 in the SEER database were extracted. A univariate analysis was performed while considering competing risks using the cumulative incidence function, with Nelson-Aalen cumulative risk curves of the incidence function for PTAC-specific death were calculated and then compared between 2 groups using Gray’s test. To identify the factors that affect the cumulative incidence of PTAC-specific death, a multivariate analysis using the Fine-Gray model was performed.

Results

The 8324 eligible surgical PTAC patients included 101 patients who died from PTAC and 129 patients who died from other causes. The univariate Gray’s test revealed that the cumulative incidence rate for events of interest was significantly affected (P<0.05) by age, sex, marital status, metastasis, differentiation grade, American Joint Committee on Cancer (AJCC) stage, radiation status, chemotherapy status, regional lymph nodes removal, and tumor size. Multivariate competing-risks analyses showed that age, sex, metastasis, differentiation grade, radiation status, chemotherapy status, and tumor size were independent risk factors for the postoperative prognosis of PTAC patients (P<0.05). The results of multivariate Cox regression were different, with marital status also appearing as an independent risk factor.

Conclusions

This study established a competing-risks analysis model to evaluate the risk factors of surgical PTAC patients. Our findings may be useful for improving patient prognoses and decision-making when providing individualized treatments.