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Agustina H, Ayni TN, Azhar Y, Soeriadi EA, Hernowo BS. The ability of anexelekto (AXL) expression and TERT promoter mutation to predict radioiodine-refractory differentiated thyroid carcinoma. Diagn Pathol 2025; 20:46. [PMID: 40241101 PMCID: PMC12004822 DOI: 10.1186/s13000-025-01643-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/01/2025] [Indexed: 04/18/2025] Open
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) generally has a favourable prognosis with standard treatments; however, the risks of local recurrence and distant metastases remain a concern, affecting a substantial proportion of patients. Radioactive iodine (RAI) refractoriness further complicates DTC management, leading to substantially reduced survival rates. In this study, we aimed to identify anexelekto (AXL) expression and TERT promoter mutation as potential predictors of RAI-refractory DTC. METHODS We conducted a retrospective analysis of 81 DTC patients who underwent thyroidectomy and received at least two courses of RAI therapy. After a median follow-up period of 30 months (range: 6-60 months), therapy response was categorized as nonrefractory or refractory. AXL expression and TERT promoter mutation were evaluated in all patients to discern any associations with the development of RAI refractoriness. RESULTS The overall prevalence of refractory RAI in DTC patients was 44.4% (36/81). AXL expression was high in 30/36 patients (83.3%) with RAI-refractory DTC and negative/low in 24/45 patients (53.3%) with non-RAI-refractory DTC (OR adjusted: 44.98, CI 95%: 1.41-1439.03, p = 0.031). TERT promoter mutation occurred in 21/36 (58.3%) RAI-refractory DTCs and in 2/45 (4.4%) non-RAI-refractory DTCs (OR adjusted: 10.95, CI 95%: 1.06-112.92, p = 0.044). Despite similar age, sex, and histological type distributions between the RAI-refractory and non-RAI-refractory groups, significant differences in clinicopathological characteristics emerged. Multivariate analysis confirmed that aggressive subtype, elevated AXL expression, and TERT promoter mutation independently correlated with RAI-refractory status. CONCLUSIONS Our predictive model highlights the association of elevated AXL expression, TERT promoter mutation, and an aggressive tumour subtype with the risk of RAI refractoriness. This information has the potential to aid in making informed treatment decisions. Furthermore, AXL is a potential therapeutic target for RAI-refractory disease.
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Affiliation(s)
- Hasrayati Agustina
- Department of Anatomic Pathology, Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
| | - Tutik Nur Ayni
- Department of Anatomic Pathology, Dr. Hasan Sadikin Hospital, Bandung, Indonesia
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Yohana Azhar
- Department of Surgery Subdivision Oncology Surgery, Dr. Hasan Sadikin Hospital, Bandung, Indonesia
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Erwin Affandi Soeriadi
- Department of Nuclear Medicine and Molecular Theranostic, Dr. Hasan Sadikin Hospital, Bandung, Indonesia
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Bethy Suryawathy Hernowo
- Department of Anatomic Pathology, Dr. Hasan Sadikin Hospital, Bandung, Indonesia
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
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Marongiu A, Nuvoli S, De Vito A, Mura A, Vargiu S, Spanu A, Madeddu G. The Role of Risk Factors for the Progression of Patients with T1b-T2 Papillary Thyroid Carcinoma (PC) during Long-Term Follow-Up. J Clin Med 2024; 13:5373. [PMID: 39336859 PMCID: PMC11431881 DOI: 10.3390/jcm13185373] [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: 08/09/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objectives: Recurrence prediction for patients with PC and tumor sizes ranging between 1 and 4 cm, classified as T1b and T2, remains a controversial problem. We evaluated which risk factors, identified during the primary tumor surgery, might play a prognostic role in predicting disease progression. Methods: We retrospectively enrolled 363 patients with classic PC who were in follow-up (207 T1b, 156 T2), with tissue risk factors at surgery in 209/363 cases. In all cases, an 131I-whole-body scan, SPECT/CT, and US were employed to detect any metastases during follow-up, and histology was used to confirm lesions. In the absence of surgery, metastases were validated by radioisotopic and radiologic procedures, eventually culminating in a needle biopsy and sequential thyroglobulin changes. Results: Metastases occurred in 61/363 (16.8%) patients (24 T1b, 37 T2). In 50/61 cases, the following risk factors were identified: minimal extrathyroid tumor extension (mETE) alone in 12/50 patients, neck lymph node (LN) metastases in 8/50 cases, and multifocality/multicentricity (M/M) in 6/50 cases. In the remaining 24/50 cases, the risk factors were associated with each other. From a Cox regression multivariate analysis, metastasis development was significantly (p < 0.001) influenced by only mETE and LN metastases, with a shorter disease-free survival (log-rank test). Conclusions: The current study proves that mETE and neck LN metastases are associated with aggressive PC. While LN metastasis' role is known, mETE's role is still being debated, and was removed by the AJCC's eighth edition because it was considered to not be associated with an unfavorable prognosis. However, this interpretation is not supported by the present study and, according to comparable studies, we suggest a revision of the mETE classification be considered in the next AJCC edition.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Antonio Mura
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Sonia Vargiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Tran A, Weigel RJ, Beck AC. ATA risk stratification in papillary thyroid microcarcinoma has low positive predictive value when identifying recurrence. Am J Surg 2024; 229:106-110. [PMID: 37968147 DOI: 10.1016/j.amjsurg.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/25/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Rising incidence of papillary thyroid microcarcinomas (PTMC) has raised concerns for overdiagnosis. Utility of the American Thyroid Association Risk Stratification System (ATA-RSS) 2015 in predicting risk of disease recurrence in patients with PTMC was assessed. METHODS Electronic health records of patients who underwent total thyroidectomy were queried. ATA-RSS 2015 risk stratification was performed on those with PTMC, and validity for predicting disease recurrence was calculated. RESULTS With 10-year median follow up, recurrence was higher in PTMC patients with high/intermediate vs low ATA risk (33 % vs 4 %, p = 0.002). Sensitivity of ATA-RSS for detecting recurrence was 60 %, specificity 90 %, PPV 33.3 %, NPV 96.6 %, and accuracy 88 %. When microscopic extrathyroidal extension (ETE) was excluded as an intermediate risk criterion, PPV improved to 50 % and accuracy improved to 92.5 % CONCLUSIONS: ATA-RSS 2015 predicts recurrence in PTMC with high NPV but low PPV. Exclusion of microscopic ETE improved PPV, which may help prevent overtreatment.
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Affiliation(s)
- Andy Tran
- University of Iowa Carver College of Medicine, USA
| | - Ronald J Weigel
- University of Iowa Hospitals and Clinics, Department of Surgery, USA
| | - Anna C Beck
- University of Iowa Hospitals and Clinics, Department of Surgery, USA; University of Wisconsin School of Medicine and Public Health, Department of Surgery, USA.
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Marongiu A, Nuvoli S, De Vito A, Vargiu S, Spanu A, Madeddu G. Minimal Extrathyroid Extension (mETE) as the Only Risk Factor in Patients with Papillary Thyroid Carcinoma (PC): Its Clinical Impact on Recurrence and Outcome during Long-Term Follow-Up. Biomedicines 2024; 12:350. [PMID: 38397952 PMCID: PMC10886778 DOI: 10.3390/biomedicines12020350] [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: 01/04/2024] [Revised: 01/20/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Minimal extrathyroid extension (mETE) effect on papillary thyroid carcinoma (PC) prognosis is still debated even more so now that this factor has been removed in the 8th AJCC Edition, supporting the hypothesis that mETE is not associated with aggressive tumors. We retrospectively enrolled 91 PC patients (Group 1) submitted to total thyroidectomy and radioiodine ablation. At the time of the primary tumor surgery, mETE was ascertained in all patients with no other risk factors, such as multifocality, vascular invasion, neck and distant metastases, and aggressive histological variants. As controls, 205 consecutive matched PC patients (Group 2) without mETE and the aforementioned risk factors were enrolled. During the follow-up (average 8 years), 16/91 (17.58%) Group 1 patients and 15/205 (7.32%) Group 2 patients developed metastases (p = 0.0078). Cox regression analysis showed an increased risk of metastases in patients with mETE (HR: 2.58 (95% CI 1.28-5.22) p = 0.008). Disease-free survival (DFS) was significantly lower in patients with mETE than in controls (p = 0.0059). The present study seems to demonstrate that mETE can be associated with an aggressive PC and can be considered, even alone without other risk factors, an independent factor of unfavorable DFS. Thus, by excluding mETE in the 8th AJCC Edition, patient care and management could be compromised.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy;
| | - Sonia Vargiu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (A.M.); (S.N.); (S.V.); (G.M.)
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Samargandy SA, Qorban GN, Aljadani AK, Almufarji SS, Azab AM, Merdad MA, Al-Hajeili MR, Samargandy SJ. Course and predictors of excellent response to therapy in patients with differentiated thyroid cancer at long-term follow-up. Saudi Med J 2024; 45:139-146. [PMID: 38309729 PMCID: PMC11115420 DOI: 10.15537/smj.2024.45.2.20230596] [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: 08/15/2023] [Accepted: 01/04/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES To investigate the long-term outcomes of differentiated thyroid cancer (DTC) and the predictive factors for excellent and incomplete responses to therapy on long-term follow-up of patients. METHODS A retrospective chart review and analysis was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Demographic, histological, and therapeutic data were collected from patients older than 13 years at the time of diagnosis, with a minimum follow-up of 18 months. Outcomes were divided into excellent, indeterminate, biochemically incomplete, and structurally incomplete responses. Odds ratios (ORs) for predictors of incomplete response at the last visit were determined. We first tested associations univariately with incomplete responses, and then variables with significant associations were included in a multivariable logistic model. RESULTS Among 230 patients with DTC, 61.7% had excellent responses to therapy on long-term follow-up, and 24.3% had incomplete biochemical and structural responses. The median follow-up was 4.6 years. Factors significantly associated with incomplete response to therapy in the multivariate analysis (p<0.05) were age >55 years (OR=5) and lymph node (OR=3.4) and distant metastases (OR=29). Older age did not affect the outcome in low-risk patients with DTC but was significantly associated with incomplete responses in those with intermediate risk (p=0.04) and high risk (p=0.003). CONCLUSION We strongly advocate incorporating age into recurrence risk assessment for patients with DTC.
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Affiliation(s)
- Shaza A. Samargandy
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Ghofran N. Qorban
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Arwa K. Aljadani
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Salihah S. Almufarji
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Abdulrahman M. Azab
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Mazin A. Merdad
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Marwan R. Al-Hajeili
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | - Saad J. Samargandy
- From the Department of Medicine (A. Samargandy, Qorban, Aljadani, Almufarji, Azab), Endocrinology Unit; form the Department of Otorhinolaryngology (Merdad); from the Department of Medicine (Al-Hajeili), Oncology Unit; and from the Department of Community Medicine (J. Samargandy), King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
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Li X, Yan L, Xiao J, Li Y, Yang Z, Zhang M, Luo Y. Follow-up strategy of radiofrequency ablation for papillary thyroid microcarcinoma: defining a response-to-ablation system. Eur Radiol 2024; 34:761-769. [PMID: 37597031 DOI: 10.1007/s00330-023-10022-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/24/2023] [Accepted: 06/12/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To define a response-to-ablation system based on dynamic risk stratification proposed by the 2015 American Thyroid Association guidelines for predicting clinical outcomes and guiding follow-up strategies for patients with low-risk papillary thyroid microcarcinoma (PTMC) who underwent radiofrequency ablation (RFA). METHODS This retrospective study reviewed patients with low-risk PTMC who underwent RFA between 2014 and 2018. We classified patients into three groups based on their response to therapy at the 1-year follow-up: complete, indeterminate, and incomplete. The primary endpoints were local tumor progression (LTP) and disease-free survival (DFS). RESULTS Among the 748 patients (mean age, 43.7 years ± 9.8; 586 women), 4.0% (30/748) had LTP during a median follow-up of 5 years. The response was complete in 80.2% (600/748) of the patients, indeterminate in 18.1% (135/748), and incomplete in 1.7% (13/748). The LTP rate in the final follow-up was 1% (6/600), 8.1% (11/135), and 100% (13/13), respectively. The risk of LTP was significantly different in the incomplete response group (HR, 1825.82; 95% CI: 458.27, 7274.36; p < 0.001) and indeterminate response group (HR, 8.12; 95% CI: 2.99, 22.09; p < 0.001) than in the complete response group. There were significant differences in DFS among groups (p < 0.001). The proportion of variation explained and C-index of the system was high (27.66% and 0.79, respectively). CONCLUSIONS We defined a response-to-ablation system that provides a new paradigm for the management of patients with PTMC who underwent RFA. Our data confirm that the system can effectively predict the risk of LTP and guide ongoing follow-up recommendations. KEY POINTS • The response-to-ablation system can classify patients with low-risk PTMC who underwent RFA into complete, indeterminate, or incomplete response categories. • Results suggest that, in this population, this system can identify three separate cohorts of patients who have significantly different clinical outcomes. • The response-to-ablation system will help better tailor the ongoing follow-up recommendations.
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Affiliation(s)
- Xinyang Li
- School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, 300071, Tianjin, China
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Lin Yan
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Jing Xiao
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Yingying Li
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Zhen Yang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China
| | - Mingbo Zhang
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
| | - Yukun Luo
- School of Medicine, Nankai University, No.94 Weijin Road, Nankai District, 300071, Tianjin, China.
- Department of Ultrasound, the First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, 100853, Beijing, China.
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Wang H, Zhao S, Yao J, Yu X, Xu D. Factors influencing extrathyroidal extension of papillary thyroid cancer and evaluation of ultrasonography for its diagnosis: a retrospective analysis. Sci Rep 2023; 13:18344. [PMID: 37884592 PMCID: PMC10603168 DOI: 10.1038/s41598-023-45642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023] Open
Abstract
Pathologists usually explore extrathyroidal extensions (ETEs) in thyroid cancer; however, sonographers are often not concerned with ETEs. We investigated factors influencing ETEs and the efficacy of ultrasound evaluation of thyroid capsule invasion. We retrospectively analysed 1933 papillary thyroid carcinoma patients who underwent thyroidectomy during 2018-2021. Patients were divided into three groups: no ETE, minor ETE (mETE), and gross ETE. Clinical characteristic differences were assessed using binary logistic regression analysis to identify ETE predictors, and the kappa test was performed to analyse consistency between ultrasonographic and pathological diagnoses of ETE. The mETE group was more likely to have larger tumour diameters and more extensive lymph node metastasis (LNM) than the no ETE group and more likely to be diagnosed in the isthmus. In the multivariate logistic regression analysis, longest tumour diameter, lesion site, LNM extent, and thyroglobulin concentration were significant mETE predictors. Minimal consistency existed between pathological and ultrasonographic examinations for neighbouring tissue invasion. Many clinical differences were observed between the no ETE and mETE groups, suggesting the importance of considering mETE. Therefore, sonographers should pay more attention to relationships between nodules and capsule and indicate these on ultrasound reports to provide more accurate preoperative ETE information for surgeons.
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Affiliation(s)
- Hui Wang
- Department of Ultrasound, Joint Service Support Force 903 Hospital, Hangzhou, China
| | - Shanshan Zhao
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Jincao Yao
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Xiuhua Yu
- Department of Ultrasound, Joint Service Support Force 903 Hospital, Hangzhou, China.
| | - Dong Xu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China.
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Popović Krneta M, Šobić Šaranović D, Mijatović Teodorović L, Krajčinović N, Avramović N, Bojović Ž, Bukumirić Z, Marković I, Rajšić S, Djorović BB, Artiko V, Karličić M, Tanić M. Prediction of Cervical Lymph Node Metastasis in Clinically Node-Negative T1 and T2 Papillary Thyroid Carcinoma Using Supervised Machine Learning Approach. J Clin Med 2023; 12:jcm12113641. [PMID: 37297835 DOI: 10.3390/jcm12113641] [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: 04/27/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is generally considered an indolent cancer. However, patients with cervical lymph node metastasis (LNM) have a higher risk of local recurrence. This study evaluated and compared four machine learning (ML)-based classifiers to predict the presence of cervical LNM in clinically node-negative (cN0) T1 and T2 PTC patients. The algorithm was developed using clinicopathological data from 288 patients who underwent total thyroidectomy and prophylactic central neck dissection, with sentinel lymph node biopsy performed to identify lateral LNM. The final ML classifier was selected based on the highest specificity and the lowest degree of overfitting while maintaining a sensitivity of 95%. Among the models evaluated, the k-Nearest Neighbor (k-NN) classifier was found to be the best fit, with an area under the receiver operating characteristic curve of 0.72, and sensitivity, specificity, positive and negative predictive values, F1 and F2 scores of 98%, 27%, 56%, 93%, 72%, and 85%, respectively. A web application based on a sensitivity-optimized kNN classifier was also created to predict the potential of cervical LNM, allowing users to explore and potentially build upon the model. These findings suggest that ML can improve the prediction of LNM in cN0 T1 and T2 PTC patients, thereby aiding in individual treatment planning.
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Affiliation(s)
- Marina Popović Krneta
- Department of Nuclear Medicine, Institute for Oncology and Radiology of Serbia, 11 000 Belgrade, Serbia
| | - Dragana Šobić Šaranović
- Faculty of Medicine, University of Belgrade, 11 000 Belgrade, Serbia
- Center for Nuclear Medicine with PET, University Clinical Center of Serbia, 11 000 Belgrade, Serbia
| | - Ljiljana Mijatović Teodorović
- Department of Nuclear Medicine, Institute for Oncology and Radiology of Serbia, 11 000 Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, 34 000 Kragujevac, Serbia
| | - Nemanja Krajčinović
- Department of Power, Electronics and Telecommunications, Faculty of Technical Sciences, University of Novi Sad, 21 000 Novi Sad, Serbia
| | - Nataša Avramović
- Department of Power, Electronics and Telecommunications, Faculty of Technical Sciences, University of Novi Sad, 21 000 Novi Sad, Serbia
| | - Živko Bojović
- Department of Power, Electronics and Telecommunications, Faculty of Technical Sciences, University of Novi Sad, 21 000 Novi Sad, Serbia
| | - Zoran Bukumirić
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11 000 Belgrade, Serbia
| | - Ivan Marković
- Faculty of Medicine, University of Belgrade, 11 000 Belgrade, Serbia
- Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, 11 000 Belgrade, Serbia
| | - Saša Rajšić
- Department of Anesthesiology and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria
| | - Biljana Bazić Djorović
- Department of Nuclear Medicine, Institute for Oncology and Radiology of Serbia, 11 000 Belgrade, Serbia
| | - Vera Artiko
- Faculty of Medicine, University of Belgrade, 11 000 Belgrade, Serbia
- Center for Nuclear Medicine with PET, University Clinical Center of Serbia, 11 000 Belgrade, Serbia
| | - Mihajlo Karličić
- School of Electrical Engineering, University of Belgrade, 11 000 Belgrade, Serbia
| | - Miljana Tanić
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, 11 000 Belgrade, Serbia
- UCL Cancer Institute, London WC1E 6DD, UK
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Wang W, Bai N, Li X. A critical analysis of the current TNM classification for differentiated thyroid carcinoma in young patients: Time for a change? Front Endocrinol (Lausanne) 2022; 13:939131. [PMID: 36339438 PMCID: PMC9627501 DOI: 10.3389/fendo.2022.939131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background The current TNM classification that simply classifies differentiated thyroid carcinoma (DTC) patients younger than 55 years into stage I and stage II based on the presence or absence of distant metastases has been questioned. In this study, we reexamined the impact of T status and N status on prognosis and then developed a new prediction model to improve the predictability of cancer-specific survival (CSS) in young patients. Materials and methods Kaplan-Meier method was applied to calculate the CSS. Multivariable Cox proportional hazards models were used to assess the impact of T status and N status on CSS after adjustment for known covariates. The area under the receiver operating characteristic curve (AUC), C-index, Bayesian information criterion (BIC), and Akaike information criterion (AIC) were calculated to compare model performance. Results A total of 9,242 DTC patients younger than 55 years were enrolled in the study. After adjusting for gender, age at diagnosis, race, pathology subtype, N stage, and M stage, T3 disease [hazard ratio (HR): 3.78, P = 0.006] and T4 disease (HR: 7.96, P < 0.001) remain independent predictors of CSS. Similarly, the 10-year CSS rate of N1b disease (HR: 3.78, P < 0.001) was significantly higher than that of N0 disease after adjustment. Moreover, Kaplan-Meier survival analysis showed that the 10-year CSS of stage II disease in younger patients with DTC showed a sharp decrease compared with that in older patients with DTC (74.47% vs. 98.43%, P < 0.001). Furthermore, a modified TNM staging system based on significantly prognostic T stage and N stage was established, which showed better performance than the current TNM staging system (P < 0.05). The new prediction model is also applicable to papillary thyroid carcinoma patients and follicular thyroid carcinoma patients. Conclusions This is the first study to question the rationality of the current TNM staging system for patients younger than 55 years and successfully develop a new prognostic model, which improves prognostic stratification and guides individualized management.
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Affiliation(s)
- Wenlong Wang
- Thyroid Surgery Department, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Ning Bai
- Thyroid Surgery Department, Xiangya Hospital, Central South University, Changsha, China
| | - Xinying Li
- Thyroid Surgery Department, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Development of a Risk Predictive Model for Evaluating Immune Infiltration Status in Invasive Thyroid Carcinoma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5803077. [PMID: 35692574 PMCID: PMC9187459 DOI: 10.1155/2022/5803077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022]
Abstract
Aims This study aimed to reveal the molecular characteristics and potential biomarker of immune-activated and immunosuppressive invasive thyroid carcinoma. Methods Expression and clinical data for invasive thyroid carcinoma were obtained from the TCGA database. Tumor samples were divided into immune-activated or immunosuppressive groups based on the immune enrichment score calculated by ssGSEA. Differentially expressed genes (DEGs) between tumor vs. normal groups or between immune-activated vs. immunosuppressive groups were screened, followed by functional enrichment. Immune infiltration was evaluated using the ESTIMATE, CIBERSORTx, and EPIC algorithms, respectively. A random forest algorithm and Lasso cox analysis were used to identify gene signatures for risk model construction. Results Totally 1171 DEGs were screened between tumor vs. normal groups, and multiple tumorigenesis-associated pathways were significantly activated in invasive thyroid carcinoma. Compared to immune-activated samples, immunosuppressive samples showed higher tumor purity, lower immune/stromal scores, and lower expression of immune markers, as well as lower infiltration abundance of CD4+ T cells and CD8+ T cells. A risk model based on a 12-immune signature (CCR7, CD1B, CD86, CSF2RB, HCK, HLA-DQA1, LTA, LTB, LYZ, NOD2, TNFRSF9, and TNFSF11) was developed to evaluate the immune infiltration status (AUC = 0.998; AUC of 0.958 and 0.979 in the two external validation datasets), which showed a higher clinical benefit and high accuracy. Immune-activated samples presented lower IC50 value for bortezomib, MG.132, staurosporine, and AZD8055, indicating sensitivity to these drugs. Conclusion A 12-gene-based immune signature was developed to predict the immune infiltration status for invasive thyroid carcinoma patients and then to identify the subsets of invasive thyroid carcinoma patients who might benefit from immunotherapy.
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Prognostic Impact of Microscopic Extra-Thyroidal Extension (mETE) on Disease Free Survival in Patients with Papillary Thyroid Carcinoma (PTC). Cancers (Basel) 2022; 14:cancers14112591. [PMID: 35681573 PMCID: PMC9179642 DOI: 10.3390/cancers14112591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background: This study assessed the risk of reduced disease-free survival (DFS) and poor clinical outcome in patients with papillary thyroid carcinomas (PTC) with microscopic extra-thyroidal extension (mETE), as compared to PTC patients without mETE. Methods: Retrospective analysis of a prospective database of patients treated by total thyroidectomy and radioactive iodine (RAI) with a five-year follow-up and tumors < 40 mm. In total, 303 patients were analyzed: 30.7% presented tumors with mETE, and 69.3% without. mETE was defined as extra-thyroidal invasion without skeletal muscle involvement. The primary outcome, DFS, was defined as the interval between initial treatment and any subsequent PTC-related treatment. The second outcome was the clinical status at five years. Results: In univariate analyses, the five-year DFS was significantly lower for tumors with mETE (62.4% versus 88.1%, p < 0.001). In multivariate analysis, mETE and massive lymph node involvement (LNI) were independent prognostic factors, associated respectively with a hazard ratio of 2.55 (95% CI 1.48−4.40) and 8.94 (95% CI 4.92−16.26). mETE was significantly associated with a pejorative clinical outcome at five years, i.e., biochemical/indeterminate response and structural persistence (Respectively OR 1.83 (95% CI 0.83; 4.06) and OR 4.92 (95% CI 1.87; 12.97)). Conclusion: Our results suggest that mETE is an independent poor prognosis factor of reduced DFS and predictive of poor clinical outcome.
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