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Piscopo L, Zampella E, Volpe F, Gaudieri V, Nappi C, Cutillo P, Volpicelli F, Falzarano M, Pace L, Cuocolo A, Klain M. Efficacy of Empirical Radioiodine Therapy in Patients with Differentiated Thyroid Cancer and Elevated Serum Thyroglobulin without Evidence of Structural Disease: A Propensity Score Analysis. Cancers (Basel) 2023; 15:4196. [PMID: 37627224 PMCID: PMC10453751 DOI: 10.3390/cancers15164196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
We assessed the outcome of administration of empiric radioactive iodine (RAI) therapy to patients with differentiated thyroid cancer (DTC), in a propensity-score-matched cohort of patients with biochemical incomplete response (BIR) and without evidence of structural disease. We retrospectively evaluated 820 DTC patients without distant metastases, who underwent total thyroidectomy followed by RAI therapy, with available BIR at 12 months and follow-up evaluations. The patients were categorized according to the administration of empiric therapy (ET). To account for differences between patients with (n = 119) and without (n = 701) ET, a propensity-score-matched cohort of 119 ET and 119 no-ET patients was created. The need for additional therapy and the occurrence of structural disease were considered as end-points. During a median follow-up of 53 months (range 3-285), 57 events occurred (24% cumulative event rate). The rate of events was significantly higher in the no-ET compared to the ET patients (30% vs. 18% p < 0.001). The multivariate Cox analysis identified age (p < 0.01), pre-therapy Tg (p < 0.05) and empiric RAI therapy (p < 0.01) as predictors of outcome. The Kaplan-Meier analysis found that progression-free survival was lower in no-ET patients compared to the ET group (p < 0.01). In patients with DTC treated with surgery and RAI, and with biochemical incomplete response at the 12-month evaluation, their prognosis seemed to be affected by Tg values and the empiric treatment. The identification of candidates for this approach may improve prognosis.
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Affiliation(s)
- Leandra Piscopo
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Fabio Volpe
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Paolo Cutillo
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Federica Volpicelli
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Maria Falzarano
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Leonardo Pace
- Department of Medicine Surgery and Dentistry, University of Salerno, 84081 Salerno, Italy;
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80131 Naples, Italy; (L.P.); (E.Z.); (F.V.); (V.G.); (C.N.); (P.C.); (F.V.); (M.F.); (A.C.)
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Volpe F, Piscopo L, Manganelli M, Falzarano M, Volpicelli F, Nappi C, Imbriaco M, Cuocolo A, Klain M. Intramedullary Spinal Cord Metastases from Differentiated Thyroid Cancer, a Case Report. Life (Basel) 2022; 12:863. [PMID: 35743894 PMCID: PMC9225536 DOI: 10.3390/life12060863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023] Open
Abstract
Intramedullary spinal cord metastases (ISCM) are uncommon metastases of the spinal cord. Magnetic resonance (MR) plays an important role in surgical planning when ISCM is suspected in the differential diagnosis. The incidence of ISCM is expected to increase due to the longer survival of cancer patients as well as the widespread use of MR in the diagnosis of neurological syndromes. The management of these patients is controversial because of the multiple clinical presentations and lack of controlled studies on the efficacy of different therapeutic approaches. Increased awareness of this rare entity may lead to an earlier diagnosis with novel imaging approaches at a stage when neurological deficits are reversible. A case of ISCM in a 49-year-old patient with differentiated thyroid cancer is reported.
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Pernas-Alonso R, Perrone-Capano C, Volpicelli F, di Porzio U. Regionalized neurofilament accumulation and motoneuron degeneration are linked phenotypes in wobbler neuromuscular disease. Neurobiol Dis 2001; 8:581-9. [PMID: 11493023 DOI: 10.1006/nbdi.2001.0403] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abnormal neurofilament aggregates are pathological hall-mark of most neurodegenerative diseases, although their pathogenic role remains unclear. Increased expression of medium neurofilament (NFM) is an early molecular marker of wobbler mouse, an animal model of motoneuron disease. In the wr/wr, a vacuolar neuronal degeneration (VND) starts at 15 days postnatally, selectively in cervical spinal cord and brain stem motoneurons. Here we show that nfm gene hyperexpression is restricted to the aforementioned motoneurons and is specific for wr mutation. NF proteins accumulate in wr/wr before VND. wr/+ mice, which are asymptomatic, show intermediate NF accumulation between wr/wr and +/+ littermates, suggesting a gene dosage dependence of the wobbler pathology. Altogether our data indicate that NF hyperexpression and regionalized motoneuron degeneration are linked to the wr mutation, although with a still unknown relationship to the mutant gene activity.
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Affiliation(s)
- R Pernas-Alonso
- International Institute of Genetics and Biophysics, CNR, Naples, Italy
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