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Saxton AT, Scheri RP. Resection of Papillary Thyroid Carcinoma Involving a Functioning Recurrent Laryngeal Nerve: Pushing Boundaries to Preserve Nerve Function. Ann Surg Oncol 2023; 30:6960-6962. [PMID: 37713120 DOI: 10.1245/s10434-023-14287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Affiliation(s)
- Anthony T Saxton
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Thompson JF, Hyngstrom J, Caracò C, Zager JS, Jahkola T, Bowles TL, Pennacchioli E, Hoekstra HJ, Moncrieff M, Ingvar C, van Akkooi A, Sabel MS, Levine EA, Henderson M, Dummer R, Rossi CR, Kane JM, Trocha S, Wright F, Byrd DR, Matter M, MacKenzie-Ross A, Kelley MC, Terheyden P, Huston TL, Wayne JD, Neuman H, Smithers BM, Desai D, Gershenwald JE, Schneebaum S, Gesierich A, Jacobs LK, Lewis JM, O'Donoghue C, Sardi A, McKinnon JG, Slingluff CL, Farma JM, Schultz E, Scheri RP, Vidal-Sicart S, Testori AAE, Scolyer RA, Elashoff DE, Cochran AJ, Faries MB. Regarding: Predicting Regional Lymph Node Recurrence in The Modern Age of Tumor-Positive Sentinel Node Melanoma. Ann Surg Oncol 2023; 30:4359-4360. [PMID: 37149545 DOI: 10.1245/s10434-023-13570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 05/08/2023]
Affiliation(s)
- John F Thompson
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | | | | | | | | | | | | | | | | | - Christian Ingvar
- Swedish Melanoma Study Group-University Hospital Lund, Lund, Sweden
| | | | | | | | | | | | | | - John M Kane
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Steven Trocha
- Greenville Hospital System Cancer Center, Greenville, SC, USA
| | | | | | - Maurice Matter
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | - Patrick Terheyden
- University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany
| | - Tara L Huston
- SUNY at Stony Brook Hospital Medical Center, Stony Brook, NY, USA
| | - Jeffrey D Wayne
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Darius Desai
- St. Luke's University Health, Bethlehem, PA, USA
| | | | | | | | - Lisa K Jacobs
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James M Lewis
- University of Tennessee Medical Center, Knoxville, TN, USA
| | | | | | | | | | | | | | | | | | | | - Richard A Scolyer
- Melanoma Institute Australia, University of Sydney, Sydney, Australia
| | | | | | - Mark B Faries
- Cedars-Sinai Medical Center, The Angeles Clinic and Research Institute, Los Angeles, CA, USA.
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Frisco NA, Gunn AH, Thomas SM, Stang MT, Scheri RP, Kazaure HS. Medullary thyroid cancer with RET V804M mutation: more indolent than expected? Surgery 2023; 173:260-267. [PMID: 36150924 DOI: 10.1016/j.surg.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/19/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Significant genotype-phenotype variability among multiple endocrine neoplasia type 2A patients with a RET V804M mutation has been reported. METHODS Patients with a RET V804M mutation treated at a single center were identified (January 1996-December 2020). The baseline characteristics, operative details, pathology, biochemical, and long-term data were analyzed. RESULTS There were 79 patients; none developed pheochromocytoma or hyperparathyroidism or died in the study period. The mean age was 41.5 years (range = 1.0-81.0 years); 46.8% were men. Of 68 surgical patients, 53 (77.9%) underwent total thyroidectomy and 15 (22.1%) underwent total thyroidectomy with central neck dissection with or without lateral neck dissection. Twenty-four patients had elevated preoperative calcitonin, of whom 12 underwent total thyroidectomy (median = 7.5; range = 5.0-237.0 pg/mL), 10 underwent total thyroidectomy + central neck dissection (median = 27.6; range = 5.1-147.0 pg/mL), and 2 underwent total thyroidectomy + central neck dissection + lateral neck dissection (median = 3182.0; range = 361.0-6003.0 pg/mL). Pathology was benign (27.9%), papillary thyroid cancer alone (1.5%), C-cell hyperplasia (23.5%), and medullary thyroid cancer (47.1%; median tumor size = 3.0 mm). Three patients had elevated calcitonin postoperatively (median follow-up time = 60.0 months). In adjusted modeling, a preoperative calcitonin >5 pg/mL was associated with having medullary thyroid cancer on final pathology (odds ratio = 13.3; 95% confidence interval, 3.2-56.3; P < .001). CONCLUSION In this large United States cohort of surgical patients with a RET V804M mutation, most had indolent disease and were without classic multiple endocrine neoplasia type 2A features. Calcitonin >5 pg/mL may serve as a meaningful value to guide surveillance and timing of surgery.
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Affiliation(s)
- Nicholas A Frisco
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke University School of Medicine, Durham, NC
| | - Alexander H Gunn
- Department of Surgery, Duke University Medical Center, Durham, NC; Duke University School of Medicine, Durham, NC
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University Medical Center, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Michael T Stang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hadiza S Kazaure
- Department of Surgery, Duke University Medical Center, Durham, NC.
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Sag AA, Perkins JM, Kazaure HS, Stang MT, Rocke DJ, Collins A, Choe JH, Scheri RP. Salvage Cryoablation for Local Recurrences of Thyroid Cancer Inseparable from the Trachea and Neurovascular Structures. J Vasc Interv Radiol 2023; 34:54-62. [PMID: 36220608 DOI: 10.1016/j.jvir.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/17/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To demonstrate safety, feasibility, and effectiveness of cryoablation of recurrent papillary thyroid cancer ineligible for reoperation because of scarring, eligible for focal ablation as defined within 2015 American Thyroid Association guideline sections C16 and C17. MATERIALS AND METHODS With multidisciplinary consensus, cryoablation was performed with curative intent for 15 tumors in 10 patients between January 2019 and July 2021. Demographics, procedural details, and serial postprocedural imaging findings were analyzed. RESULTS The mean age was 72.5 years (range, 57-88 years), and 80% of the patients were women. The tumors (mean size, 16 mm ± 6; range, 9-29 mm) received 1 session of cryoablation with 100% technical success. The mean and median postcryoablation tumor volumetric involution rates were 88% and 99%, respectively, with 9 (60%) of 15 tumors involuting completely or down to the scar and 6 (40%) involuting partially at the end of the study period. Tumor size did not increase after cryoablation (0% local progression rate). All tumors abutted the trachea, skin, and/or vascular structures, and hydrodissection failed in all cases because of scarring. The major adverse event rate was 20% (3/15), with 2 cases of voice change and 1 case of Horner syndrome; all resolved at 6 months with no permanent sequelae. No vascular, tracheal, dermal, or infectious adverse events occurred during a mean follow-up of 242 days (range, 114-627 days). One patient died at 386 days after cryoablation because of unrelated cholangiocarcinoma. CONCLUSIONS Cryoablation of local recurrences of papillary thyroid cancer abutting the trachea and/or neurovascular structures in the setting of hydrodissection failure because of scarring yielded a mean volumetric involution of 88%, primary efficacy of 60%, and objective response rate of 100% with no local recurrences or permanent complications during a mean follow-up of 242 days. The secondary efficacy and longer-term outcomes remain forthcoming.
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Affiliation(s)
- Alan Alper Sag
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolinia.
| | - Jennifer M Perkins
- Division of Endocrinology, University of California San Francisco Medical Center, San Francisco, California
| | - Hadiza S Kazaure
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael T Stang
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel J Rocke
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Alissa Collins
- Division of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Choe
- Division of Hematology and Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Randall P Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Crystal JS, Thompson JF, Hyngstrom J, Caracò C, Zager JS, Jahkola T, Bowles TL, Pennacchioli E, Beitsch PD, Hoekstra HJ, Moncrieff M, Ingvar C, van Akkooi A, Sabel MS, Levine EA, Agnese D, Henderson M, Dummer R, Neves RI, Rossi CR, Kane JM, Trocha S, Wright F, Byrd DR, Matter M, Hsueh EC, MacKenzie-Ross A, Kelley M, Terheyden P, Huston TL, Wayne JD, Neuman H, Smithers BM, Ariyan CE, Desai D, Gershenwald JE, Schneebaum S, Gesierich A, Jacobs LK, Lewis JM, McMasters KM, O'Donoghue C, van der Westhuizen A, Sardi A, Barth R, Barone R, McKinnon JG, Slingluff CL, Farma JM, Schultz E, Scheri RP, Vidal-Sicart S, Molina M, Testori AAE, Foshag LJ, Van Kreuningen L, Wang HJ, Sim MS, Scolyer RA, Elashoff DE, Cochran AJ, Faries MB. Therapeutic Value of Sentinel Lymph Node Biopsy in Patients With Melanoma: A Randomized Clinical Trial. JAMA Surg 2022; 157:835-842. [PMID: 35921122 PMCID: PMC9475390 DOI: 10.1001/jamasurg.2022.2055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/19/2022] [Indexed: 12/12/2022]
Abstract
Importance Sentinel lymph node (SLN) biopsy is a standard staging procedure for cutaneous melanoma. Regional disease control is a clinically important therapeutic goal of surgical intervention, including nodal surgery. Objective To determine how frequently SLN biopsy without completion lymph node dissection (CLND) results in long-term regional nodal disease control in patients with SLN metastases. Design, Setting, and Participants The second Multicenter Selective Lymphadenectomy Trial (MSLT-II), a prospective multicenter randomized clinical trial, randomized participants with SLN metastases to either CLND or nodal observation. The current analysis examines observation patients with regard to regional nodal recurrence. Trial patients were aged 18 to 75 years with melanoma metastatic to SLN(s). Data were collected from December 2004 to April 2019, and data were analyzed from July 2020 to January 2022. Interventions Nodal observation with ultrasonography rather than CLND. Main Outcomes and Measures In-basin nodal recurrence. Results Of 823 included patients, 479 (58.2%) were male, and the mean (SD) age was 52.8 (13.8) years. Among 855 observed basins, at 10 years, 80.2% (actuarial; 95% CI, 77-83) of basins were free of nodal recurrence. By univariable analysis, freedom from regional nodal recurrence was associated with age younger than 50 years (hazard ratio [HR], 0.49; 95% CI, 0.34-0.70; P < .001), nonulcerated melanoma (HR, 0.36; 95% CI, 0.36-0.49; P < .001), thinner primary melanoma (less than 1.5 mm; HR, 0.46; 95% CI, 0.27-0.78; P = .004), axillary basin (HR, 0.61; 95% CI, 0.44-0.86; P = .005), fewer positive SLNs (1 vs 3 or more; HR, 0.32; 95% CI, 0.14-0.75; P = .008), and SLN tumor burden (measured by diameter less than 1 mm [HR, 0.39; 95% CI, 0.26-0.60; P = .001] or less than 5% area [HR, 0.36; 95% CI, 0.24-0.54; P < .001]). By multivariable analysis, younger age (HR, 0.57; 95% CI, 0.39-0.84; P = .004), thinner primary melanoma (HR, 0.40; 95% CI, 0.22-0.70; P = .002), axillary basin (HR, 0.55; 95% CI, 0.31-0.96; P = .03), SLN metastasis diameter less than 1 mm (HR, 0.52; 95% CI, 0.33-0.81; P = .007), and area less than 5% (HR, 0.58; 95% CI, 0.38-0.88; P = .01) were associated with basin control. When looking at the identified risk factors of age (50 years or older), ulceration, Breslow thickness greater than 3.5 mm, nonaxillary basin, and tumor burden of maximum diameter of 1 mm or greater and/or metastasis area of 5% or greater and excluding missing value cases, basin disease-free rates at 5 years were 96% (95% CI, 88-100) for patients with 0 risk factors, 89% (95% CI, 82-96) for 1 risk factor, 86% (95% CI, 80-93) for 2 risk factors, 80% (95% CI, 71-89) for 3 risk factors, 61% (95% CI, 48-74) for 4 risk factors, and 54% (95% CI, 36-72) for 5 or 6 risk factors. Conclusions and Relevance This randomized clinical trial was the largest prospective evaluation of long-term regional basin control in patients with melanoma who had nodal observation after removal of a positive SLN. SLN biopsy without CLND cleared disease in the affected nodal basin in most patients, even those with multiple risk factors for in-basin recurrence. In addition to its well-validated value in staging, SLN biopsy may also be regarded as therapeutic in some patients. Trial Registration ClinicalTrials.gov Identifier: NCT00297895.
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Affiliation(s)
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - John Hyngstrom
- Department of Surgery, University of Utah, Salt Lake City
| | - Corrado Caracò
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale," Napoli, Italy
| | - Jonathan S Zager
- Departments of Cutaneous Oncology and Sarcoma, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Tiina Jahkola
- Department of Plastic and Reconstructive Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Tawnya L Bowles
- Department of Surgical Oncology, Intermountain Medical Center, Salt Lake City, Utah
| | - Elisabetta Pennacchioli
- Division of Melanoma, Soft Tissue Sarcomas and Rare Tumors, European Institute of Oncology, Milano, Italy
| | | | - Harald J Hoekstra
- Department of Surgery, University Hospital Groningen, Groningen, the Netherlands
| | - Marc Moncrieff
- Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | | | - Alexander van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Edward A Levine
- Department of Surgical Oncology, Wake Forest University, Winston-Salem, North Carolina
| | - Doreen Agnese
- Department of Surgery, Ohio State University, Columbus
| | - Michael Henderson
- Department of Surgery, University of Melbourne, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Rogerio I Neves
- Department of Surgery, Pennsylvania State University Milton S. Hershey Medical Center, Hershey
- Now at Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - John M Kane
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Steven Trocha
- Department of Surgical Oncology, Prisma Health, Columbia, South Carolina
| | - Frances Wright
- Department of Surgical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David R Byrd
- Department of Surgery, University of Washington, Seattle
| | - Maurice Matter
- Department of Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Eddy C Hsueh
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Alastair MacKenzie-Ross
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mark Kelley
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Tara L Huston
- Department of Surgery, Stony Brook University, Stony Brook, New York
| | - Jeffrey D Wayne
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Heather Neuman
- Department of Surgery, University of Wisconsin at Madison
| | - B Mark Smithers
- Department of Surgery, University of Queensland, Brisbane, Australia
| | - Charlotte E Ariyan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Darius Desai
- Department of Surgery, Saint Luke's University Hospital, Bethlehem, Pennsylvania
| | | | - Shlomo Schneebaum
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anja Gesierich
- Department of Dermatology, University Hospital Wurzburg, Wurzburg, Germany
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - James M Lewis
- Department of Surgery, University of Tennessee Medical Center, Knoxville
| | - Kelly M McMasters
- Department of Surgery, University of Louisville, Louisville, Tennessee
| | | | | | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, Maryland
| | - Richard Barth
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
| | - Robert Barone
- Surgical Oncology, Sharp Hospital, San Diego, California
| | - J Greg McKinnon
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Erwin Schultz
- Department of Dermatology, Nuremberg General Hospital, Paracelsus Medical Center, Nuremberg, Germany
| | | | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Barcelona, Spain
| | - Manuel Molina
- Department of Surgery, Lakeland Regional Health, Lakeland, Florida
| | | | - Leland J Foshag
- Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California
| | - Lisa Van Kreuningen
- Manager of Research Operations, Saint John's Cancer Institute, Santa Monica, California
| | - He-Jing Wang
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Myung-Shin Sim
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Richard A Scolyer
- Melanoma Institute Australia, Department of Medicine, University of Sydney, Sydney, Australia
| | - David E Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Alistair J Cochran
- Department of Anatomic Pathology, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Haddad RI, Bischoff L, Ball D, Bernet V, Blomain E, Busaidy NL, Campbell M, Dickson P, Duh QY, Ehya H, Goldner WS, Guo T, Haymart M, Holt S, Hunt JP, Iagaru A, Kandeel F, Lamonica DM, Mandel S, Markovina S, McIver B, Raeburn CD, Rezaee R, Ridge JA, Roth MY, Scheri RP, Shah JP, Sipos JA, Sippel R, Sturgeon C, Wang TN, Wirth LJ, Wong RJ, Yeh M, Cassara CJ, Darlow S. Thyroid Carcinoma, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:925-951. [PMID: 35948029 DOI: 10.6004/jnccn.2022.0040] [Citation(s) in RCA: 91] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Differentiated thyroid carcinomas is associated with an excellent prognosis. The treatment of choice for differentiated thyroid carcinoma is surgery, followed by radioactive iodine ablation (iodine-131) in select patients and thyroxine therapy in most patients. Surgery is also the main treatment for medullary thyroid carcinoma, and kinase inhibitors may be appropriate for select patients with recurrent or persistent disease that is not resectable. Anaplastic thyroid carcinoma is almost uniformly lethal, and iodine-131 imaging and radioactive iodine cannot be used. When systemic therapy is indicated, targeted therapy options are preferred. This article describes NCCN recommendations regarding management of medullary thyroid carcinoma and anaplastic thyroid carcinoma, and surgical management of differentiated thyroid carcinoma (papillary, follicular, Hürthle cell carcinoma).
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Affiliation(s)
| | | | - Douglas Ball
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Paxton Dickson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | - Quan-Yang Duh
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Shelby Holt
- UT Southwestern Simmons Comprehensive Cancer Center
| | - Jason P Hunt
- Huntsman Cancer Institute at the University of Utah
| | | | | | | | - Susan Mandel
- Abramson Cancer Center at the University of Pennsylvania
| | - Stephanie Markovina
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | - Rod Rezaee
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Mara Y Roth
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Jennifer A Sipos
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | - Cord Sturgeon
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | | | - Michael Yeh
- UCLA Jonsson Comprehensive Cancer Center; and
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Abstract
Background: Graves' disease accounts for ∼80% of all cases of hyperthyroidism and is associated with significant morbidity and decreased quality of life. Understanding the association of total thyroidectomy with patient-reported quality-of-life and thyroid-specific symptoms is critical to shared decision-making and high-quality care. We estimate the change in patient-reported outcomes (PROs) before and after surgery for patients with Graves' disease to inform the expectations of patients and their physicians. Methods: PROs using the MD Anderson Symptom Inventory (MDASI) validated questionnaire were collected prospectively from adult patients with Graves' disease from January 1, 2015, to November 20, 2020, on a longitudinal basis. Survey responses were categorized as before surgery (≤120 days), short term after surgery (<30 days; ST), and long term after surgery (≥30 days; LT). Negative binomial regression was used to estimate the association of select covariates with PROs. Results: Eighty-five patients with Graves' disease were included. The majority were female (83.5%); 47.1% were non-Hispanic white and 35.3% were non-Hispanic black. The median thyrotropin (TSH) value before surgery was 0.05, which increased to 0.82 in ST and 1.57 in LT. In bivariate analysis, the Total Symptom Burden Score, a composite of all patient-reported burden, significantly reduced shortly after surgery (before surgery mean of 56.88 vs. ST 39.60, p < 0.001), demonstrating improvement in PROs. Furthermore, both the Thyroid Symptoms Score, including patient-reported thermoregulation, palpitations, and dysphagia, and the Quality-of-Life Symptom Score improved in ST and LT (thyroid symptoms, before surgery 13.88 vs. ST 8.62 and LT 7.29; quality of life, before surgery 16.16 vs. ST 9.14 and LT 10.04, all p < 0.05). After multivariate adjustment, the patient-reported burden in the Thyroid Symptom Score and the Quality-of-Life Symptom Score exhibited reduction in ST (thyroid symptoms, rate ratio [RR] 0.55, confidence interval [CI]: 0.42-0.72; quality of life, RR 0.57, CI: 0.40-0.81) and LT (thyroid symptoms, RR 0.59, CI: 0.44-0.79; quality of Life, RR 0.43, CI: 0.28-0.65). Conclusions: Quality of life and thyroid-specific symptoms of Graves' patients improved significantly from their baseline before surgery to both shortly after and longer after surgery. This work can be used to guide clinicians and patients with Graves' disease on the expected outcomes following total thyroidectomy.
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Affiliation(s)
- Alexander H. Gunn
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Duke-Margolis Center for Health Policy, Durham, North Carolina, USA
| | - Nicholas Frisco
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Samantha M. Thomas
- Duke University Cancer Institute, Durham, North Carolina, USA
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Michael T. Stang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Randall P. Scheri
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Hadiza S. Kazaure
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Address correspondence to: Hadiza S. Kazaure, MD, Department of Surgery, Duke University Medical Center, 466G Seeley Mudd Building, Durham, NC 27710, USA
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8
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Figge JJ, Gooding WE, Steward DL, Yip L, Sippel RS, Yang SP, Scheri RP, Sipos JA, Mandel SJ, Mayson SE, Burman KD, Folek JM, Haugen BR, Sosa JA, Parameswaran R, Tan WB, Nikiforov YE, Carty SE. Do Ultrasound Patterns and Clinical Parameters Inform the Probability of Thyroid Cancer Predicted by Molecular Testing in Nodules with Indeterminate Cytology? Thyroid 2021; 31:1673-1682. [PMID: 34340592 PMCID: PMC8917891 DOI: 10.1089/thy.2021.0119] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further inform the risk of thyroid cancer in nodules predicted to be positive or negative by MT remains unknown. The aim of this study was to test if clinical parameters, including patient age, sex, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] vs. American College of Radiology Thyroid Image Reporting and Data System [TI-RADS] systems), radiation exposure, or family history of thyroid cancer can modify the probability of thyroid cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) predicted by MT. Methods: We studied 257 thyroid nodules in 232 patients from 10 study centers with indeterminate fine needle aspiration cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression was used for data analysis. Results: The presence of cancer/NIFTP was associated with positive TSv3 results (odds ratio 61.39, p < 0.0001). On univariate regression, patient sex, age, and Bethesda category were associated with cancer/NIFTP probability (p < 0.05 for each). Although ATA (p = 0.1211) and TI-RADS (p = 0.1359) US categories demonstrated positive trends, neither was significantly associated with cancer/NIFTP probability. A multivariate regression model incorporating the four most informative non-MT covariates (sex, age, Bethesda category, and ATA US pattern; Model No. 1) yielded a C index of 0.653; R2 = 0.108. When TSv3 was added to Model number 1, the C index increased to 0.888; R2 = 0.572. However, age (p = 0.341), Bethesda category (p = 0.272), and ATA US pattern (p = 0.264) were nonsignificant, and other than TSv3 (p < 0.0001), male sex was the only non-MT parameter that potentially contributed to cancer/NIFTP risk (p = 0.095). The simplest and most efficient clinical model (No. 3) incorporated TSv3 and sex (C index = 0.889; R2 = 0.588). Conclusions: In this multicenter study of thyroid nodules with indeterminate cytology and MT, neither the ATA nor TI-RADS US scoring systems further informed the risk of cancer/NIFTP beyond that predicted by TSv3. Although age and Bethesda category were associated with cancer/NIFTP probability on univariate analysis, in sequential nomograms they provided limited incremental value above the high predictive ability of TSv3. Patient sex may contribute to cancer/NIFTP risk in thyroid nodules with indeterminate cytology.
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Affiliation(s)
- James J. Figge
- Diabetes & Endocrine Care, St. Peter's Health Partners/Trinity Health, Rensselaer, New York, USA
- Address correspondence to: James J. Figge, MD, MBA, Diabetes & Endocrine Care, St. Peter's Health Partners/Trinity Health, 279 Troy Road, Rensselaer, NY 12144, USA
| | - William E. Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - David L. Steward
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin, USA
| | - Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
- Endocrinology Division, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Randall P. Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Jennifer A. Sipos
- Division of Endocrinology, Diabetes, and Metabolism, Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Susan J. Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah E. Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth D. Burman
- Endocrinology Section, Department of Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | - Bryan R. Haugen
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie A. Sosa
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Rajeev Parameswaran
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Boon Tan
- Division of Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
- Division of Endocrine Surgery, Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yuri E. Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sally E. Carty
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Sally E. Carty, MD, Division of Endocrine Surgery, University of Pittsburgh, 101 Kauffmann, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
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9
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Rhodin KE, Hong CS, Olivere LA, Howell EP, Giri VK, Mehta KA, Oyekunle T, Scheri RP, Tong BC, Sosa JA, Fayanju OM. Implementation of a Surgical Oncology Disparities Curriculum for Preclinical Medical Students. J Surg Res 2020; 253:214-223. [PMID: 32380347 PMCID: PMC7384959 DOI: 10.1016/j.jss.2020.03.058] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/18/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Underinsured and uninsured surgical-oncology patients are at higher risk of perioperative morbidity and mortality. Curricular innovation is needed to train medical students to work with this vulnerable population. We describe the implementation of and early educational outcomes from a student-initiated pilot program aimed at improving medical student insight into health disparities in surgery. MATERIALS/METHODS First-year medical students participated in a dual didactic and perioperative-liaison experience over a 10-month period. Didactic sessions included surgical-skills training and faculty-led lectures on financial toxicity and management of surgical-oncology patients. Students were partnered with uninsured and Medicaid patients receiving surgical-oncology care and worked with these patients by providing appointment reminders, clarifying perioperative instructions, and accompanying patients to surgery and clinic appointments. Students' interest in surgery and self-reported comfort in 15 Association of American Medical Colleges core competencies were assessed with preparticipation and postparticipation surveys using a 5-point Likert scale. RESULTS Twenty-four first-year students were paired with 14 surgical-oncology patients during the 2017-2018 academic year. Sixteen students (66.7%) completed both preprogram and postprogram surveys. Five students (31.3%) became "More Interested" in surgery, whereas 11 (68.8%) reported "Similar Interest or No Change." Half of the students (n = 8) felt more prepared for their surgery clerkship after participating. Median self-reported comfort improved in 7/15 competencies including Oral Communication and Ethical Responsibility. All students reported being "Somewhat" or "Extremely Satisfied" with the program. CONCLUSIONS We demonstrate that an innovative program to expose preclinical medical students to challenges faced by financially and socially vulnerable surgical-oncology patients is feasible and may increase students' clinical preparedness and interest in surgery.
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Affiliation(s)
- Kristen E Rhodin
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Cierra S Hong
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Vinay K Giri
- Duke University School of Medicine, Durham, North Carolina
| | - Kurren A Mehta
- Duke University School of Medicine, Durham, North Carolina
| | - Taofik Oyekunle
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, North Carolina
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Julie A Sosa
- Department of Surgery, University of California, San Francisco (UCSF), San Francisco, California
| | - Oluwadamilola M Fayanju
- Department of Surgery, Duke University Medical Center, Durham, North Carolina; Women's Cancer Program, Duke Cancer Institute, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke Forge, Duke University, Durham, North Carolina; Department of Surgery, Durham VA Medical Center, Durham, North Carolina.
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10
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Ahmadi S, Gonzalez JM, Talbott M, Reed SD, Yang JC, Scheri RP, Stang M, Roman S, Sosa JA. Patient Preferences Around Extent of Surgery in Low-Risk Thyroid Cancer: A Discrete Choice Experiment. Thyroid 2020; 30:1044-1052. [PMID: 32143553 DOI: 10.1089/thy.2019.0590] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background: Patient preferences pertaining to surgical options for thyroid cancer management are not well studied. Our aim was to conduct a discrete choice experiment (DCE) to characterize participants' views on the relative importance of various risks and benefits associated with lobectomy versus total thyroidectomy for low-risk thyroid cancer. Methods: Adult participants with low-risk thyroid cancer or a thyroid nodule requiring surgery were asked to choose between experimentally designed surgical options with varying levels of risk of nerve damage (1%, 9%, 14%), hypocalcemia (0%, 3%, 8%), risk of needing a second surgery (0%, 40%), cancer recurrence (1%, 3%, 5%), and need for daily thyroid hormone supplementation (yes, no). Their choices were analyzed using random-parameters logit regression. Results: One hundred fifty participants completed an online DCE survey. Median age was 58 years; 82% were female. Twenty-four participants (16%) had a diagnosis of thyroid cancer at the time of completing the survey, and 126 (84%) had a thyroid nodule necessitating surgery. On average, 35% of participants' choices were explained by differences in the risk of cancer recurrence; 28% by the chance of needing a second surgery; 19% by the risk of nerve damage; and 9% by differences in risks of hypocalcemia and the need for thyroid hormone supplementation. When accounting for differences in postoperative risks, the average patient favored lobectomy over total thyroidectomy as long as the chance of needing a second (i.e., completion) surgery after initial lobectomy remained below 30%. Participants would accept a 4.1% risk of cancer recurrence if the risk of a second surgery could be reduced from 40% to 10%. Conclusions: While patients with thyroid cancer may have clear preferences for extent of surgery, common themes moderating preferences for surgical interventions were identified in the DCE. Adequate preoperative evaluation to decrease the chance of a second surgery and providing patients with a good understanding of risks and benefits associated with extent of surgery can lead to better treatment decision-making.
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Affiliation(s)
- Sara Ahmadi
- Division of Endocrinology and Metabolism, Thyroid Section, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Maya Talbott
- Department of Medicine, and Durham, North Carolina, USA
| | - Shelby D Reed
- Department of Population Health Sciences, Durham, North Carolina, USA
- Department of Medicine, and Durham, North Carolina, USA
| | - Jui-Chen Yang
- Pacific Economic Research, LLC, Bellevue, Washington, USA
| | - Randall P Scheri
- Department of Surgery; Duke University Medical Center, Durham, North Carolina, USA
| | - Michael Stang
- Department of Surgery; Duke University Medical Center, Durham, North Carolina, USA
| | - Sanziana Roman
- Department of Surgery, University of California San Francisco-UCSF, San Francisco, California, USA
| | - Julie Ann Sosa
- Department of Surgery, University of California San Francisco-UCSF, San Francisco, California, USA
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11
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Figge JJ, Gooding WE, Burman KD, Mayson S, Scheri RP, Sipos JA, Sippel RS, Steward DL, Yang SP, Yip L, Nikiforov YE, Carty SE. MON-LB79 Do Ultrasound Patterns and Clinical Parameters Modify the Probability of Thyroid Cancer Predicted by Molecular Testing in Thyroid Nodules With Indeterminate Cytology? J Endocr Soc 2020. [PMCID: PMC7209362 DOI: 10.1210/jendso/bvaa046.2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further modify the risk of cancer in nodules predicted to be positive or negative by molecular testing remains unknown. Aim: To test if clinical parameters, including age, gender, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] system vs American College of Radiology TIRADS), radiation exposure, and family history of thyroid cancer (TC) can modify the probability of TC or NIFTP predicted by MT in thyroid nodules with indeterminate cytology. Methods: We studied 257 thyroid nodules from 10 study centers with fine-needle aspiration (FNA) yielding indeterminate cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression were used for data analysis. Results: In this group of thyroid nodules, out of all parameters studied using univariate regression, patient gender, age, and Bethesda category were significantly associated with TC/NIFTP probability (P<0.05 for each). The ATA US patterns showed a positive trend (P=0.1211), whereas TIRADS was not predictive (P=0.3135). A multivariate regression model incorporating the four most informative covariates (gender, age, Bethesda category, and ATA US patterns) (model #1) yielded a C index=0.653; R2=0.108. Male gender and Bethesda category V significantly increased risk, and age demonstrated a nonlinear risk profile. When TSv3 was added to model #1, the C index increased to 0.888; R2=0.572. However, age (P=0.341), Bethesda category (P=0.272), and the ATA US patterns (P=0.264) had limited predictive ability in comparison with TSv3, which dominated the predictive performance (P<0.001). Gender was the only parameter showing tendency for significance beyond MT (P=0.095). The most parsimonious model incorporated gender and TSv3 (C index=0.889; R2=0.588). Conclusions: While often useful in selecting thyroid nodules for FNA, neither the ATA US nor the TIRADS scoring systems were informative in further predicting TC/NIFTP in thyroid nodules with indeterminate FNA cytology. Although age and Bethesda category were associated with TC/NIFTP probability on univariate analysis, they had limited incremental value above the high predictive ability of TSv3. Gender was the only parameter with potential contribution to predicting TC/NIFTP in addition to MT.
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Affiliation(s)
- James J Figge
- Department of Medicine, Division of Endocrinology, St Peter’s Hospital, Albany, NY, USA
| | - William E Gooding
- Biostatistics Facility, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Kenneth D Burman
- Department of Medicine, Endocrinology Section, Medstar Washington Hospital Center, Washington, DC, USA
| | - Sarah Mayson
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO, USA
| | | | - Jennifer A Sipos
- Division of Endocrinology, Diabetes and Metabolism, Ohio State University, Columbus, OH, USA
| | - Rebecca S Sippel
- Division of Endocrine Surgery, University of Wisconsin, Madison, WI, USA
| | - David L Steward
- Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Samantha Peiling Yang
- Endocrinology Division, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Linwah Yip
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sally E Carty
- Division of Endocrine Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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12
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Marrero AP, Kazaure HS, Thomas SM, Stang MT, Scheri RP. Patient selection and outcomes of laparoscopic transabdominal versus posterior retroperitoneal adrenalectomy among surgeons in the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP). Surgery 2020; 167:250-256. [DOI: 10.1016/j.surg.2019.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
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13
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Haddad RI, Nasr C, Bischoff L, Busaidy NL, Byrd D, Callender G, Dickson P, Duh QY, Ehya H, Goldner W, Haymart M, Hoh C, Hunt JP, Iagaru A, Kandeel F, Kopp P, Lamonica DM, McIver B, Raeburn CD, Ridge JA, Ringel MD, Scheri RP, Shah JP, Sippel R, Smallridge RC, Sturgeon C, Wang TN, Wirth LJ, Wong RJ, Johnson-Chilla A, Hoffmann KG, Gurski LA. NCCN Guidelines Insights: Thyroid Carcinoma, Version 2.2018. J Natl Compr Canc Netw 2019; 16:1429-1440. [PMID: 30545990 DOI: 10.6004/jnccn.2018.0089] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The NCCN Guidelines for Thyroid Carcinoma provide recommendations for the management of different types of thyroid carcinoma, including papillary, follicular, Hürthle cell, medullary, and anaplastic carcinomas. These NCCN Guidelines Insights summarize the panel discussion behind recent updates to the guidelines, including the expanding role of molecular testing for differentiated thyroid carcinoma, implications of the new pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features, and the addition of a new targeted therapy option for BRAF V600E-mutated anaplastic thyroid carcinoma.
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14
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Zambeli-Ljepovic A, Wang F, Dinan MA, Hyslop T, Stang MT, Roman SA, Sosa JA, Scheri RP. Low Risk Thyroid Cancer in Older Adults: More Extensive Surgery Comes with Increased Cost of Surveillance. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Zambeli-Ljepović A, Wang F, Dinan MA, Hyslop T, Stang MT, Roman SA, Sosa JA, Scheri RP. Extent of surgery for low-risk thyroid cancer in the elderly: Equipoise in survival but not in short-term outcomes. Surgery 2019; 166:895-900. [PMID: 31288935 DOI: 10.1016/j.surg.2019.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Total thyroidectomy is more common than lobectomy for low-risk papillary thyroid cancer, despite equipoise in survival. Because postoperative morbidity increases with age, we aimed to investigate how the extent of thyroidectomy affects short-term outcomes among older patients. METHODS Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified patients aged ≥66 years who were treated between 1996 and 2011 for papillary thyroid cancer with tumors ≤2 cm in diameter. We used multivariable logistic regression to evaluate the effect of extent of surgery on complications, emergency-department visits, and unplanned readmissions. RESULTS Among 3,341 selected patients, 77.3% were female, mean age was 72.9 years, and tumors averaged 0.8 cm in diameter. A total of 67.6% of patients underwent total thyroidectomy, and 32.4% underwent lobectomy. Total thyroidectomy was associated with complications (odds ratio = 1.99) and readmissions (odds ratio = 1.59; both P < 0.01). Complications were higher in female patients (odds ratio = 1.34), black patients (versus white patients, odds ratio = 1.65), and those with ≥2 comorbidities (vs 0, odds ratio = 1.43; all P < 0.01). Black patients and those with ≥2 comorbidities had more emergency-department visits (odds ratio = 1.50 and 1.92, respectively) and readmissions (odds ratio = 2.19 and 2.29, respectively; all P < 0.01). CONCLUSION Total thyroidectomy for older adults with low-risk papillary thyroid cancer may lead to potentially avoidable complications and readmissions, particularly for black and female patients. In many cases, lobectomy may be a safer and less costly alternative.
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Affiliation(s)
| | - Frances Wang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Michaela A Dinan
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Terry Hyslop
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Michael T Stang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Sanziana A Roman
- Department of Surgery, University of California at San Fransisco, San Francisco, CA
| | - Julie A Sosa
- Department of Surgery, University of California at San Fransisco, San Francisco, CA
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, NC.
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16
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Berger M, Oyeyemi D, Olurinde MO, Whitson HE, Weinhold KJ, Woldorff MG, Lipsitz LA, Moretti E, Giattino CM, Roberts KC, Zhou J, Bunning T, Ferrandino M, Scheri RP, Cooter M, Chan C, Cabeza R, Browndyke JN, Murdoch DM, Devinney MJ, Shaw LM, Cohen HJ, Mathew JP. The INTUIT Study: Investigating Neuroinflammation Underlying Postoperative Cognitive Dysfunction. J Am Geriatr Soc 2019; 67:794-798. [PMID: 30674067 DOI: 10.1111/jgs.15770] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 11/16/2018] [Revised: 12/20/2018] [Accepted: 12/20/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND/OBJECTIVES Every year, up to 40% of the more than 16 million older Americans who undergo anesthesia/surgery develop postoperative cognitive dysfunction (POCD) or delirium. Each of these distinct syndromes is associated with decreased quality of life, increased mortality, and a possible increased risk of Alzheimer's disease. One pathologic process hypothesized to underlie both delirium and POCD is neuroinflammation. The INTUIT study described here will determine the extent to which postoperative increases in cerebrospinal fluid (CSF) monocyte chemoattractant protein 1 (MCP-1) levels and monocyte numbers are associated with delirium and/or POCD and their underlying brain connectivity changes. DESIGN Observational prospective cohort. SETTING Duke University Medical Center, Duke Regional Hospital, and Duke Raleigh Hospital. PARTICIPANTS Patients 60 years of age or older (N = 200) undergoing noncardiac/nonneurologic surgery. MEASUREMENTS Participants will undergo cognitive testing before, 6 weeks, and 1 year after surgery. Delirium screening will be performed on postoperative days 1 to 5. Blood and CSF samples are obtained before surgery, and 24 hours, 6 weeks, and 1 year after surgery. CSF MCP-1 levels are measured by enzyme-linked immunosorbent assay, and CSF monocytes are assessed by flow cytometry. Half the patients will also undergo pre- and postoperative functional magnetic resonance imaging scans. 32-channel intraoperative electroencephalogram (EEG) recordings will be performed to identify intraoperative EEG correlates of neuroinflammation and/or postoperative cognitive resilience. Eighty patients will also undergo home sleep apnea testing to determine the relationships between sleep apnea severity, neuroinflammation, and impaired postoperative cognition. Additional assessments will help evaluate relationships between delirium, POCD, and other geriatric syndromes. CONCLUSION INTUIT will use a transdisciplinary approach to study the role of neuroinflammation in postoperative delirium and cognitive dysfunction and their associated functional brain connectivity changes, and it may identify novel targets for treating and/or preventing delirium and POCD and their sequelae. J Am Geriatr Soc 67:794-798, 2019.
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Affiliation(s)
- Miles Berger
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.,Center for Cognitive Neuroscience, Duke University Medical Center, Durham, North Carolina
| | - Deborah Oyeyemi
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Mobolaji O Olurinde
- Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Heather E Whitson
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Kent J Weinhold
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Marty G Woldorff
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Eugene Moretti
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Charles M Giattino
- Center for Cognitive Neuroscience, Duke University Medical Center, Durham, North Carolina.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Kenneth C Roberts
- Center for Cognitive Neuroscience, Duke University Medical Center, Durham, North Carolina
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Thomas Bunning
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Michael Ferrandino
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Mary Cooter
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Cliburn Chan
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Roberto Cabeza
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Jeffrey N Browndyke
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - David M Murdoch
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Michael J Devinney
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Leslie M Shaw
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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17
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Ji KSY, Oyekunle TO, Scheri RP, Stang MT, Roman SA, Sosa JA. (In)Adequacy of Lymph Node Yield for Papillary Thyroid Cancer in the US: An Analysis of 52,820 Patients. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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18
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Koh J, Hogue JA, Roman SA, Scheri RP, Fradin H, Corcoran DL, Sosa JA. Transcriptional profiling reveals distinct classes of parathyroid tumors in PHPT. Endocr Relat Cancer 2018; 25:407-420. [PMID: 29475894 PMCID: PMC5826637 DOI: 10.1530/erc-17-0470] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 12/20/2022]
Abstract
The clinical presentation of primary hyperparathyroidism (PHPT) varies widely, although the underlying mechanistic reasons for this disparity remain unknown. We recently reported that parathyroid tumors can be functionally segregated into two distinct groups on the basis of their relative responsiveness to ambient calcium, and that patients in these groups differ significantly in their likelihood of manifesting bone disability. To examine the molecular basis for this phenotypic variation in PHPT, we compared the global gene expression profiles of calcium-sensitive and calcium-resistant parathyroid tumors. RNAseq and proteomic analysis identified a candidate set of differentially expressed genes highly correlated with calcium-sensing capacity. Subsequent quantitative assessment of the expression levels of these genes in an independent cohort of parathyroid tumors confirmed that calcium-sensitive tumors cluster in a discrete transcriptional profile group. These data indicate that PHPT is not an etiologically monolithic disorder and suggest that divergent molecular mechanisms could drive the observed phenotypic differences in PHPT disease course, provenance, and outcome.
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Affiliation(s)
- James Koh
- Dept. of Surgery, Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Duke University Medical Center
- To whom reprint requests should be addressed: James Koh, Ph.D., Department of Surgery, Duke University Medical Center, Durham, NC 27710, Phone: 919-684-0892, FAX: 919-681-6622,
| | - Joyce A. Hogue
- Dept. of Surgery, Duke University Medical Center, Durham, NC
| | | | | | | | | | - Julie A. Sosa
- Dept. of Surgery, Duke University Medical Center, Durham, NC
- Dept. of Medicine, Duke University
- Duke Cancer Institute, Duke University Medical Center
- Duke Clinical Research Institute, Duke University Medical Center
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Anderson KL, Adam MA, Thomas SM, Youngwirth L, Stang MT, Scheri RP, Roman SA, Sosa JA. Impact of Micro- and Macroscopically Positive Surgical Margins on Survival after Resection of Adrenocortical Carcinoma. Ann Surg Oncol 2018; 25:1425-1431. [DOI: 10.1245/s10434-018-6398-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 11/18/2022]
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Youngwirth LM, Adam MA, Thomas SM, Roman SA, Sosa JA, Scheri RP. Pediatric thyroid cancer patients referred to high-volume facilities have improved short-term outcomes. Surgery 2018; 163:361-366. [DOI: 10.1016/j.surg.2017.09.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/12/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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Anderson KL, Thomas SM, Adam MA, Pontius LN, Stang MT, Scheri RP, Roman SA, Sosa JA. Each procedure matters: threshold for surgeon volume to minimize complications and decrease cost associated with adrenalectomy. Surgery 2018; 163:157-164. [DOI: 10.1016/j.surg.2017.04.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/22/2017] [Accepted: 04/05/2017] [Indexed: 02/02/2023]
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Pontius LN, Oyekunle TO, Thomas SM, Stang MT, Scheri RP, Roman SA, Sosa JA. Projecting Survival in Papillary Thyroid Cancer: A Comparison of the Seventh and Eighth Editions of the American Joint Commission on Cancer/Union for International Cancer Control Staging Systems in Two Contemporary National Patient Cohorts. Thyroid 2017; 27:1408-1416. [PMID: 28891405 PMCID: PMC6436028 DOI: 10.1089/thy.2017.0306] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aims to compare the seventh and eighth editions of the American Joint Commission on Cancer/Union for International Cancer Control (AJCC/UICC) tumor, node, metastasis staging system for patients with papillary thyroid cancer (PTC) in two national patient cohorts. METHODS Adult PTC patients undergoing surgery were selected from the Surveillance, Epidemiology and End Results (SEER) program (2004-2012) and the National Cancer Database (2004-2012). Staging criteria for the seventh and eighth AJCC/UICC editions were applied separately to each cohort. Survival probabilities were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards models were used to estimate the association of stage with survival in both settings. The Akaike information criterion was used to assess model performance. RESULTS About 23% of patients were downstaged from the seventh to the eighth edition in SEER, while 24% were downstaged in the National Cancer Database. Disease-specific survival (DSS) and overall survival (OS) were significantly related to stage at diagnosis when using both the seventh and eighth editions of the AJCC/UICC staging system (p < 0.001). Patients classified into higher stages (III and IV) in the eighth edition showed a worse prognosis than those classified into similar stages in the seventh edition. After adjustment, PTC stages as defined by both editions were significantly associated with DSS and OS. With respect to both DSS and OS, the eighth edition PTC model appeared to be a better fit to the data (smaller Akaike information criterion values) compared to the seventh edition. CONCLUSION Based on these large contemporary national cohorts, the eighth edition AJCC/UICC tumor, node, metastasis classification for PTC is superior to the seventh edition for predicting survival.
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Affiliation(s)
| | | | - Samantha M. Thomas
- Duke Cancer Institute, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Michael T. Stang
- Duke Cancer Institute, Durham, North Carolina
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Randall P. Scheri
- Duke Cancer Institute, Durham, North Carolina
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Sanziana A. Roman
- Duke Cancer Institute, Durham, North Carolina
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Julie A. Sosa
- Duke Cancer Institute, Durham, North Carolina
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
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Anderson K, Ruel E, Adam MA, Thomas S, Youngwirth L, Stang MT, Scheri RP, Roman SA, Sosa JA. Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes. Am J Surg 2017; 214:914-919. [DOI: 10.1016/j.amjsurg.2017.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/14/2017] [Accepted: 07/02/2017] [Indexed: 02/08/2023]
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Hoffman K, Lorenzo A, Butt CM, Hammel SC, Henderson BB, Roman SA, Scheri RP, Stapleton HM, Sosa JA. Exposure to flame retardant chemicals and occurrence and severity of papillary thyroid cancer: A case-control study. Environ Int 2017; 107:235-242. [PMID: 28772138 DOI: 10.1016/j.envint.2017.06.021] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/01/2017] [Accepted: 06/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Thyroid cancer is the fastest increasing cancer in the U.S., and papillary thyroid cancer (PTC) accounts for >80% of incident cases. Increasing exposure to flame retardant chemicals (FRs) has raised concerns about their possible role in this 'epidemic'. The current study was designed to test the hypothesis that higher exposure to FRs is associated with increased odds of PTC. METHODS PTC patients at the Duke Cancer Institute were approached and invited to participate. Age- and gender-matched controls were recruited from the Duke Health System and surrounding communities. Because suitable biomarkers of long-term exposure do not exist for many common FRs, and levels of FRs in dust are significantly correlated with exposure, relationships between FRs in household dust and PTC were evaluated in addition to available biomarkers. PTC status, measures of aggressiveness (e.g. tumor size) and BRAF V600E mutation were included as outcomes. RESULTS Higher levels of some FRs, particularly decabromodiphenyl ether (BDE-209) and tris(2-chloroethyl) phosphate in dust, were associated with increased odds of PTC. Participants with dust BDE-209 concentrations above the median level were 2.29 times as likely to have PTC [95% confidence interval: 1.03, 5.08] compared to those with low BDE-209 concentrations. Associations varied based on tumor aggressiveness and mutation status; TCEP was more strongly associated with larger, more aggressive tumors and BDE-209 was associated with smaller, less aggressive tumors. CONCLUSIONS Taken together, these results suggest exposure to FRs in the home, particularly BDE-209 and TCEP, may be associated with PTC occurrence and severity, and warrant further study.
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Affiliation(s)
- Kate Hoffman
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Amelia Lorenzo
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Craig M Butt
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Stephanie C Hammel
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Brittany Bohinc Henderson
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, Wake Forest University Baptist Medical Center and Wake Forest Comprehensive Cancer Center, Winston-Salem, NC 27157, United States
| | - Sanziana A Roman
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States
| | - Heather M Stapleton
- Nicholas School of the Environment, Duke University, Durham, NC 27708, United States
| | - Julie Ann Sosa
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, United States; Department of Surgery, Duke University Medical Center, Durham, NC 27710, United States; Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, United States; Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710, United States.
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Pontius LN, Oyekunle T, Thomas SM, Stang MT, Scheri RP, Roman SA, Sosa JA. Projecting Survival in Papillary Thyroid Cancer: A Comparison of the 7th and 8th Editions of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) Staging Systems in A Contemporary National Patient Cohort. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Weber TJ, Koh J, Thomas SM, Hogue JA, Scheri RP, Roman SA, Sosa JA. Impaired calcium sensing distinguishes primary hyperparathyroidism (PHPT) patients with low bone mineral density. Metabolism 2017; 74:22-31. [PMID: 28764845 PMCID: PMC5561769 DOI: 10.1016/j.metabol.2017.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 12/11/2022]
Abstract
CONTEXT A subset of PHPT patients exhibit a more severe disease phenotype characterized by bone loss, fractures, recurrent nephrolithiasis, and other dysfunctions, but the underlying reasons for this disparity in clinical presentation remain unknown. OBJECTIVE We sought to identify new mechanistic indices that could inform more personalized management of PHPT. DESIGN Pre-, peri-, and postoperative data and demographic, clinical, and pathological information from patients undergoing parathyroidectomy for PHPT were collected. Univariate and partial Spearman correlation was used to estimate the association of parathyroid tumor calcium sensing capacity with select variables. PATIENTS OR OTHER PARTICIPANTS An unselected series of 237 patients aged >18years and undergoing parathyroidectomy for PHPT were enrolled. MAIN OUTCOME MEASURES Calcium sensing capacity, expressed as the concentration required for half-maximal biochemical response (EC50), was evaluated in parathyroid tumors from an unselected series of 74 patients and assessed for association with clinical parameters. The hypothesis was that greater disease severity would be associated with attenuated calcium sensitivity and biochemically autonomous parathyroid tumor behavior. RESULTS Parathyroid tumors segregated into two distinct groups of calcium responsiveness (EC50<3.0 and ≥3.0mM). The low EC50 group (n=27) demonstrated a mean calcium EC50 value of 2.49mM [95% confidence interval (CI): 2.43-2.54mM], consistent with reference normal activity. In contrast, the high EC50 group (n=47) displayed attenuated calcium sensitivity with a mean EC50 value of 3.48mM [95% CI: 3.41-3.55mM]. Retrospective analysis of the clinical registry data suggested that high calcium EC50 patients presented with a more significant preoperative bone mineral density (BMD) deficit with a t-score of -2.7, (95% CI: -3.4 to -1.9) versus 0.9, (95% CI: -2.1 to -0.4) in low EC50 patients (p<0.001). After adjusting for gender, age, BMI, 25 OH vitamin D level and preoperative iPTH, lowest t-score and calcium EC50 were inversely correlated, with a partial Spearman correlation coefficient of -0.35 (p=0.02). CONCLUSIONS Impaired calcium sensing in parathyroid tumors is selectively observed in a subset of patients with more severe bone mineral density deficit. Assessment of parathyroid tumor biochemical behavior may be a useful predictor of disease severity as measured by bone mineral density in patients with PHPT.
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Affiliation(s)
- Thomas J Weber
- Dept. of Medicine, Duke University Medical Center, Durham, NC, United States.
| | - James Koh
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute, Duke University Medical Center, United States
| | - Samantha M Thomas
- Dept. of Biostatistics and Bioinformatics, Duke University, United States; Duke Cancer Institute, Duke University Medical Center, United States
| | - Joyce A Hogue
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Randall P Scheri
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Sanziana A Roman
- Dept. of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Julie A Sosa
- Dept. of Medicine, Duke University Medical Center, Durham, NC, United States; Dept. of Surgery, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute, Duke University Medical Center, United States; Duke Clinical Research Institute, Duke University Medical Center, United States
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Beasley GM, Hu Y, Youngwirth L, Scheri RP, Salama AK, Rossfeld K, Gardezi S, Agnese DM, Howard JH, Tyler DS, Slingluff CL, Terando AM. Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study. Ann Surg Oncol 2017; 24:2728-2733. [PMID: 28508145 PMCID: PMC9742856 DOI: 10.1245/s10434-017-5883-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is routinely performed for primary cutaneous melanomas; however, limited data exist for SLNB after locally recurrent (LR) or in-transit (IT) melanoma. METHODS Data from three centers performing SLNB for LR/IT melanoma (1997 to the present) were reviewed, with the aim of assessing (1) success rate; (2) SLNB positivity; and (3) prognostic value of SLNB in this population. RESULTS The study cohort included 107 patients. Management of the primary melanoma included prior SLNB for 56 patients (52%), of whom 10 (18%) were positive and 12 had complete lymph node dissections (CLNDs). In the present study, SLNB was performed for IT disease (48/107, 45%) or LR melanoma (59/107, 55%). A sentinel lymph node (SLN) was removed in 96% (103/107) of cases. Nodes were not removed for four patients due to lymphoscintigraphy failures (2) or nodes not found during surgery (2). SLNB was positive in 41 patients (40%, 95% confidence interval (CI) 31.5-50.5), of whom 35 (88%) had CLND, with 13 (37%) having positive nonsentinel nodes. Median time to disease progression after LR/IT metastasis was 1.4 years (95% CI 0.75-2.0) for patients with a positive SLNB, and 5.9 years (95% CI 1.7-10.2) in SLNB-negative patients (p = 0.18). There was a trend towards improved overall survival for patients with a negative SLNB (p = 0.06). CONCLUSION SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.
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Affiliation(s)
- Georgia M. Beasley
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Yinin Hu
- Division of Surgical Oncology, University of Virginia, Charlottesville, VA
| | | | | | | | - Kara Rossfeld
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Syed Gardezi
- Division of Surgical Oncology, University of Virginia, Charlottesville, VA
| | - Doreen M. Agnese
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - J. Harrison Howard
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
| | - Douglas S. Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Craig L. Slingluff
- Division of Surgical Oncology, University of Virginia, Charlottesville, VA
| | - Alicia M. Terando
- Division of Surgical Oncology, Ohio State University Wexner Medical Center, Columbus, OH
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Abstract
BACKGROUND Racial disparities in the management of differentiated thyroid cancer (DTC) exist in the United States. There is a paucity of data examining their temporal trends. It was hypothesized that racial disparities in care provided to patients with DTC have improved over the past 15 years. METHODS Adult patients undergoing surgery for DTC were included from the National Cancer Data Base (1998-2012). Temporal trends in appropriate extent of thyroidectomy and radioactive iodine therapy (RAI) were described for different racial groups. Multivariable logistic regression models were employed to estimate the adjusted association of receipt of appropriate extent of surgery and RAI, specifically under- and over-treatment, among different racial groups. RESULTS Among 282,043 DTC patients, 80.3% were non-Hispanic white (white), 8.1% Hispanic, 7.2% non-Hispanic black (black), and 4.4% Asian. Black versus white race/ethnicity was associated with lower odds of receiving appropriate surgery (odds ratio [OR] = 0.78 [confidence interval (CI) 0.71-0.87]; p < 0.001). Appropriate RAI treatment was higher in blacks (OR = 1.07 [CI 1.02-1.12]; p = 0.01) and lower for Hispanics (OR = 0.90 [CI 0.86-0.95]; p < 0.001) compared with whites. There was a higher likelihood of RAI under-treatment in minority groups (Hispanic OR = 1.27, black OR = 1.26, Asian OR = 1.25; p < 0.001), and a lower likelihood of RAI over-treatment (Hispanic OR = 0.89, black OR = 0.83, Asian OR = 0.79; p < 0.001) compared with whites. Over time, an increasing proportion of black and white patients underwent appropriate extent of thyroidectomy (1998 vs. 2012: 78% vs. 88% and 81% vs. 91%, respectively). Compared with 1998, fewer patients in 2012 were under-treated with RAI: whites (48% vs. 29%, respectively), blacks (51% vs. 33%), Hispanics (51% vs. 37%), and Asians (55% vs. 39%). The extent of RAI over-treatment increased (1998 vs. 2012): whites (1% vs. 4%), blacks (2% vs. 4%), Hispanics (2% vs. 4%), and Asians (2% vs. 3%), respectively. CONCLUSIONS Appropriate utilization of surgery and RAI for DTC has improved over time. However, the proportion of patients receiving appropriate thyroid surgery is consistently lower for blacks compared with whites. RAI over-treatment increased for all races over the study period. Efforts are needed to standardize DTC care among minority patients.
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Affiliation(s)
- Syed A Shah
- 1 Department of Surgery Virginia Commonwealth University , VCU Medical Center, Richmond, Virginia
| | - Mohamed A Adam
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Samantha M Thomas
- 3 Department of Biostatistics, Duke University , Duke University Medical Center, Durham, North Carolina
- 4 Department of Bioinformatics, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Randall P Scheri
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Michael T Stang
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
| | - Julie A Sosa
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
- 5 Department of Medicine (Oncology), Duke University , Duke University Medical Center, Durham, North Carolina
| | - Sanziana A Roman
- 2 Department of Surgery, Duke University , Duke University Medical Center, Durham, North Carolina
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Abstract
BACKGROUND Patients with thyroid cancer who have extrathyroidal extension (ETE) are considered to have more advanced tumors. However, data on the impact of ETE on patient outcomes remain limited. The purpose of this study was to evaluate the association between ETE and survival in patients with thyroid cancer. METHODS The National Cancer Database (1998-2012) was queried for all adult patients with differentiated thyroid cancer and medullary thyroid cancer. Patients were divided into three groups: no ETE (T1 and T2 tumors), minimal ETE (T3 tumors <4 cm), and extensive ETE (T4 tumors <4 cm). Patient demographic, clinical, and pathologic factors were evaluated for all patients. A Cox proportional hazards model was developed for each histology to identify factors associated with survival. RESULTS In total, 241,118 patients with differentiated thyroid cancer met the inclusion criteria; 86.9% had no ETE, 9.1% minimal ETE, and 4.0% extensive ETE. Compared with patients with no ETE, patients with minimal and extensive ETE were more likely to have larger tumors (1.4 cm vs. 1.8 cm and 2.0 cm, respectively), lymphovascular invasion (8.6% vs. 28.0% and 35.1%, respectively), positive margins after thyroidectomy (6.1% vs. 35.2% and 45.9%, respectively), and regional lymph node metastases (32.5% vs. 67.0% and 74.6%, respectively; all p < 0.01). After adjustment, minimal ETE (hazard ratio [HR] = 1.13; p < 0.01) and extensive ETE (HR = 1.74; p < 0.01) were associated with compromised survival for patients with differentiated thyroid cancer. In total, 3415 patients with medullary thyroid cancer met the inclusion criteria; 87.9% had no ETE, 7.1% minimal ETE, and 5.0% extensive ETE. Compared with patients with no ETE, patients with minimal and extensive ETE were more likely to have larger tumors (1.7 cm vs. 2.2 cm and 2.2 cm, respectively), lymphovascular invasion (19.2% vs. 68.9% and 79.3%, respectively), positive margins after thyroidectomy (5.8% vs. 44.1% and 51.9%, respectively), and regional lymph node metastases (39.0% vs. 90.5% and 94.4%, respectively; all p < 0.01). After adjustment, extensive ETE (HR = 1.63; p = 0.01) was associated with compromised survival for patients with medullary thyroid cancer. CONCLUSION In patients with differentiated and medullary thyroid cancers, ETE is associated with compromised survival. Given these findings, ETE should be included in the thyroid cancer treatment guidelines.
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Affiliation(s)
- Linda M Youngwirth
- Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Mohamed A Adam
- Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Sanziana A Roman
- Department of Surgery, Duke University Medical Center , Durham, North Carolina
| | - Julie A Sosa
- Department of Surgery, Duke University Medical Center , Durham, North Carolina
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Adam MA, Thomas S, Hyslop T, Scheri RP, Roman SA, Sosa JA. Exploring the Relationship Between Patient Age and Cancer-Specific Survival in Papillary Thyroid Cancer: Rethinking Current Staging Systems. J Clin Oncol 2016; 34:4415-4420. [PMID: 27998233 DOI: 10.1200/jco.2016.68.9372] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patient age is considered to play a unique prognostic role in papillary thyroid cancer (PTC), with a distinct staging dichotomization at 45 years of age. This is based on older, limited data demonstrating a marked rise in mortality around the ages of 40 to 50 years. We hypothesized that age is associated with compromised survival from cancer, with no cutoff denoting survival difference. Patients and Methods Patients with PTC who had surgery were identified from the SEER database (1998 to 2012). Multivariable proportional hazards modeling utilizing several flexible smoothing approaches were used to examine the association between age and cancer-specific survival (CSS) and to determine whether there is an age cut point that is associated with CSS decrement. Results A total of 31,802 patients with PTC were included. Median age was 45 years (range, 2 to 105 years). Ten-year CSS according to age was as follows: 2 to 19 years, 99.8%; 20 to 29 years, 99.9%; 30 to 39 years, 99.8%; 40 to 49 years, 99.5%; 50 to 59 years, 98.1%; 60 to 69 years, 94.8%; 70 to 79 years, 91.5%; 80 to 89 years, 79.2%; and ≥ 90 years, 73.9%. After adjustment for patient demographic and clinicopathologic characteristics, increasing age was associated with increasing mortality from the disease in a dose-dependent fashion, without an apparent cut point. Each of the smoothing approaches demonstrated a similar linearity of risk over all ages and provided close measures of goodness of fit to the data. Conclusion Patient age is significantly associated with death from PTC in a linear fashion, without an apparent age cut point demarcating survival difference. These results challenge the appropriateness of a patient age cut point in current staging systems for PTC and argue for considering a revision in how we anticipate prognosis for patients with PTC.
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Affiliation(s)
- Mohamed Abdelgadir Adam
- Mohamed Abdelgadir Adam, Randall P. Scheri, Sanziana A. Roman, and Julie A. Sosa, Duke University Medical Center; Samantha Thomas and Terry Hyslop, Duke University; Julie A. Sosa, Duke Clinical Research Institute; and Samantha Thomas, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa, Duke Cancer Institute, Durham, NC
| | - Samantha Thomas
- Mohamed Abdelgadir Adam, Randall P. Scheri, Sanziana A. Roman, and Julie A. Sosa, Duke University Medical Center; Samantha Thomas and Terry Hyslop, Duke University; Julie A. Sosa, Duke Clinical Research Institute; and Samantha Thomas, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa, Duke Cancer Institute, Durham, NC
| | - Terry Hyslop
- Mohamed Abdelgadir Adam, Randall P. Scheri, Sanziana A. Roman, and Julie A. Sosa, Duke University Medical Center; Samantha Thomas and Terry Hyslop, Duke University; Julie A. Sosa, Duke Clinical Research Institute; and Samantha Thomas, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa, Duke Cancer Institute, Durham, NC
| | - Randall P Scheri
- Mohamed Abdelgadir Adam, Randall P. Scheri, Sanziana A. Roman, and Julie A. Sosa, Duke University Medical Center; Samantha Thomas and Terry Hyslop, Duke University; Julie A. Sosa, Duke Clinical Research Institute; and Samantha Thomas, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa, Duke Cancer Institute, Durham, NC
| | - Sanziana A Roman
- Mohamed Abdelgadir Adam, Randall P. Scheri, Sanziana A. Roman, and Julie A. Sosa, Duke University Medical Center; Samantha Thomas and Terry Hyslop, Duke University; Julie A. Sosa, Duke Clinical Research Institute; and Samantha Thomas, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa, Duke Cancer Institute, Durham, NC
| | - Julie A Sosa
- Mohamed Abdelgadir Adam, Randall P. Scheri, Sanziana A. Roman, and Julie A. Sosa, Duke University Medical Center; Samantha Thomas and Terry Hyslop, Duke University; Julie A. Sosa, Duke Clinical Research Institute; and Samantha Thomas, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa, Duke Cancer Institute, Durham, NC
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31
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Abstract
BACKGROUND The 7th edition of the American Joint Committee on Cancer (AJCC) staging system trialed a subdivision of T1 tumors into T1a (<1 cm) and T1b (1.0-2 cm). The 2009 American Thyroid Association (ATA) guidelines recommended total thyroidectomy for tumors >1 cm, and lobectomy for those ≤1 cm. These AJCC staging parameters remain a focus of debate, and ATA guidelines are in transition. The aim of this study was to determine if the T1 staging subdivision is associated with different treatment strategies and patterns of patient survival. METHODS All adult patients with AJCC pT1 differentiated thyroid cancer (DTC) from the National Cancer Data Base (NCDB; 1998-2012) and Surveillance, Epidemiology, and End Results (SEER) program (2004-2012) were divided into two groups based on tumor size: T1a versus T1b. Demographic, clinical, and pathologic features were evaluated. Multivariate regression analysis was used to determine factors associated with undergoing total thyroidectomy and radioactive iodine. Cox proportional hazards models were performed to determine factors associated with overall and disease-specific survival. RESULTS Among 149,912 DTC patients, 98,111 (65.4%) were T1a and 51,801 (34.6%) T1b in the NCDB; in SEER, among 18,381 patients, 11,208 (61.0%) had T1a and 7173 (39.0%) T1b tumors. Patients with T1b cancers were younger (48 vs. 51 years T1a) and more likely to have private insurance (76.2% vs. 74.1%), no comorbidities (86.0% vs. 83.8%), and undergo treatment at academic medical centers (41.4% vs. 40.3%; all p < 0.01). They also were more likely to undergo total thyroidectomy (87.7% vs. 74.3%), and had more lymphovascular invasion (10.2% vs. 3.3%), positive surgical margins (7.9% vs. 3.8%), metastatic lymph nodes (35.8% vs. 23.8%), and distant metastases (0.4% vs. 0.3%; all p < 0.01). Factors associated with radioactive-iodine use included younger patient age, lower income, having insurance, positive surgical margins, and T1b stage (p < 0.01). After adjustment, overall (p = 0.23) and disease-specific survival (p = 0.93) were similar among patients with T1a versus T1b tumors. CONCLUSION These results illustrate that patients with pT1a versus pT1b tumors undergo different treatment strategies. Based on the newly published 2015 ATA guidelines, whereby either lobectomy or total thyroidectomy can be performed for low-risk tumors, it might be anticipated that treatment differences will diminish over time. Therefore, division of AJCC T1 staging into T1a versus T1b subgroups might become obsolete over time.
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Affiliation(s)
- Kevin L. Anderson
- School of Medicine, Duke University, Duke University Medical Center, Durham, North Carolina
| | - Linda M. Youngwirth
- Department of Surgery, Duke University, Duke University Medical Center, Durham, North Carolina
| | - Randall P. Scheri
- School of Medicine, Duke University, Duke University Medical Center, Durham, North Carolina
- Department of Surgery, Duke University, Duke University Medical Center, Durham, North Carolina
| | - Michael T. Stang
- School of Medicine, Duke University, Duke University Medical Center, Durham, North Carolina
- Department of Surgery, Duke University, Duke University Medical Center, Durham, North Carolina
| | - Sanziana A. Roman
- School of Medicine, Duke University, Duke University Medical Center, Durham, North Carolina
- Department of Surgery, Duke University, Duke University Medical Center, Durham, North Carolina
| | - Julie A. Sosa
- School of Medicine, Duke University, Duke University Medical Center, Durham, North Carolina
- Department of Surgery, Duke University, Duke University Medical Center, Durham, North Carolina
- Department of Medicine (Oncology), Duke University, Duke University Medical Center, Durham, North Carolina
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Abstract
BACKGROUND Hürthle cell carcinoma (HCC) is not typically iodine avid, raising questions regarding postoperative use of radioactive iodine (RAI). The aims of this study were to describe current practice patterns regarding the use of RAI for HCC and to assess its association with survival. METHODS The National Cancer Data Base 1998-2006 was queried for all patients with HCC who underwent total thyroidectomy. Inclusion was limited to T1 tumors with N1/M1 disease, and T2-4 tumors with any N/M disease. Patients were divided into two treatment groups based on receipt of RAI. Baseline patient characteristics were compared between the two groups. Survival was examined using Kaplan-Meier and Cox regression analyses. RESULTS A total of 1909 patients were included. Of these, 1162 (60.9%) received RAI, and 747 (39.1%) did not. Patients treated with RAI were younger (57 vs. 61 years for no RAI, p < 0.001), more often had private insurance (61.7% vs. 53.5% for no RAI, p < 0.003), and were more likely to be treated at an academic center (40.0% vs. 33.1% for no RAI, p < 0.001). Five- and 10-year survival rates were improved for patients who received RAI compared with those who did not (88.9 vs. 83.1% and 74.4 vs. 65.0%, respectively, p < 0.001). RAI administration was associated with a 30% reduction in mortality (hazard ratio = 0.703, p = 0.001). CONCLUSION Present guidelines are inconsistent with regard to indications for using RAI for HCC. This could explain why nearly 40% of HCC patients did not receive RAI. RAI is associated with improved survival, suggesting that it should be advocated for HCC patients with tumors >2 cm and those with nodal and distant metastatic disease.
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Affiliation(s)
- Christa L Jillard
- Duke Cancer Institute and Duke Clinical Research Institute, Duke University Medical Center , Durham, North Carolina
| | - Linda Youngwirth
- Duke Cancer Institute and Duke Clinical Research Institute, Duke University Medical Center , Durham, North Carolina
| | - Randall P Scheri
- Duke Cancer Institute and Duke Clinical Research Institute, Duke University Medical Center , Durham, North Carolina
| | - Sanziana Roman
- Duke Cancer Institute and Duke Clinical Research Institute, Duke University Medical Center , Durham, North Carolina
| | - Julie A Sosa
- Duke Cancer Institute and Duke Clinical Research Institute, Duke University Medical Center , Durham, North Carolina
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Pontius LN, Youngwirth LM, Thomas SM, Scheri RP, Roman SA, Sosa JA. Lymphovascular invasion is associated with survival for papillary thyroid cancer. Endocr Relat Cancer 2016; 23:555-62. [PMID: 27317633 DOI: 10.1530/erc-16-0123] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 01/19/2023]
Abstract
Data are limited regarding the association between tumor lymphovascular invasion and survival for patients with papillary thyroid cancer (PTC). This study sought to examine lymphovascular invasion as an independent prognostic factor for patients with PTC undergoing thyroid resection. The National Cancer Data Base (2010-2011) was queried for patients with PTC who underwent total thyroidectomy or lobectomy. Patients were classified into two groups based on the presence/absence of lymphovascular invasion. Demographic, clinical and pathological features were evaluated for all patients. A Cox proportional hazards model was utilized to identify factors associated with survival. Results show that 45,415 patients met inclusion criteria; 11.6% had lymphovascular invasion. Patients with lymphovascular invasion were more likely to have larger tumors (2.8cm vs 1.5cm, P<0.01), metastatic lymph nodes (74.1% vs 32.5%, P<0.01), and distant metastases (3.0% vs 0.5%, P<0.01). They were also more likely to receive radioactive iodine (69.3% vs 44.9%, P<0.01). Unadjusted overall 5-year survival was lower for patients who had tumors with lymphovascular invasion (86.6% vs 94.5%) (log-rank P<0.01). After adjustment, increasing patient age (HR=1.06, P<0.01), male gender (HR=1.68, P<0.01), presence of metastatic lymph nodes (HR=1.77, P<0.01), distant metastases (HR=3.49, P<0.01), and lymphovascular invasion (HR=1.88, P<0.01) were associated with compromised survival. For patients with lymphovascular invasion, treatment with RAI was associated with reduced mortality (HR=0.43, P<0.01). The presence of lymphovascular invasion among patients with PTC is independently associated with compromised survival. Patients who have PTC with lymphovascular invasion should be considered higher risk, and adjuvant RAI should be more strongly considered.
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Affiliation(s)
| | | | | | | | | | - Julie A Sosa
- Duke University Medical CenterDurham, North Carolina, USA
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Haddad RI, Lydiatt WM, Ball DW, Busaidy NL, Byrd D, Callender G, Dickson P, Duh QY, Ehya H, Haymart M, Hoh C, Hunt JP, Iagaru A, Kandeel F, Kopp P, Lamonica DM, McCaffrey JC, Moley JF, Parks L, Raeburn CD, Ridge JA, Ringel MD, Scheri RP, Shah JP, Smallridge RC, Sturgeon C, Wang TN, Wirth LJ, Hoffmann KG, Hughes M. Anaplastic Thyroid Carcinoma, Version 2.2015. J Natl Compr Canc Netw 2016; 13:1140-50. [PMID: 26358798 DOI: 10.6004/jnccn.2015.0139] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Thyroid Carcinoma focuses on anaplastic carcinoma because substantial changes were made to the systemic therapy recommendations for the 2015 update. Dosages and frequency of administration are now provided, docetaxel/doxorubicin regimens were added, and single-agent cisplatin was deleted because it is not recommended for patients with advanced or metastatic anaplastic thyroid cancer.
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Goffredo P, Jillard C, Thomas S, Scheri RP, Sosa JA, Roman S. Minimally invasive follicular carcinoma: predictors of vascular invasion and impact on patterns of care. Endocrine 2016; 51:123-30. [PMID: 26077949 DOI: 10.1007/s12020-015-0649-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022]
Abstract
Some studies have reported that minimally invasive follicular carcinoma (MIFC) with vascular invasion is associated with compromised prognosis, leading to an ongoing debate regarding extent of surgery for MIFC. Our goal was to identify predictors of vascular invasion and determine its impact on patterns of care. Adult patients with MIFC were culled from the National Cancer Database, 2010-2011, and segregated according to the presence/absence of capsular or vascular invasion. Variables of interest were examined using Chi-square and student's t tests. Multivariate analysis was performed with logistic regression. A total of 617 patients with MIFC were identified: 54% with capsular invasion only and 46% with vascular invasion. Demographic characteristics were similarly distributed between the two groups. Tumor size was larger in patients with vascular invasion (mean = 35.7 vs. 29.2 mm capsular invasion only, p < 0.001); a 2% increase in risk of vascular invasion was observed with each 1 mm increase in size. The rate of total thyroidectomy was similar for MIFCs with vascular invasion compared to capsular invasion only (72.9 vs. 75.1%, p = 0.537). The RAI administration rate was higher in patients with vascular invasion (62.1 vs. 52.6% capsular invasion only, p = 0.017). In multivariate analysis, the presence of vascular invasion was independently associated with increased likelihood of receiving RAI (OR 1.641, p = 0.007). MIFC remains aggressively treated despite current guidelines favoring a more conservative approach. Building consensus around MIFC management is important for standardization of practice patterns and improvement in quality of care.
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Affiliation(s)
| | - Christa Jillard
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA
| | - Samantha Thomas
- Department of Biostatistics, Duke University, Durham, NC, USA
| | - Randall P Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA
| | - Julie Ann Sosa
- Duke Clinical Research Institute, Durham, NC, USA
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA
| | - Sanziana Roman
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Duke University School of Medicine, Erwin Road, Durham, NC, 27710, USA.
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Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA. Patients Treated at Low-Volume Centers have Higher Rates of Incomplete Resection and Compromised Outcomes: Analysis of 31,129 Patients with Papillary Thyroid Cancer. Ann Surg Oncol 2015; 23:403-9. [PMID: 26416710 DOI: 10.1245/s10434-015-4867-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Data on the importance of margin status after total thyroidectomy for papillary thyroid cancer (PTC) remain limited. This study sought to identify factors associated with positive margins and to determine the impact of positive margins on survival for patients with PTC. METHODS The National Cancer Data Base (1998-2006) was queried for patients with PTC who had undergone total thyroidectomy. The patients were divided into three groups based on margin status (negative, microscopically positive, and macroscopically positive). Patient demographic, clinical, and pathologic features were evaluated. A binary logistic regression model was developed to identify factors associated with positive margins. A Cox proportional hazards model was developed to identify factors associated with survival. RESULTS Of the 31,129 patients enrolled in the study, 91.3 % had negative margins, 8.1 % had microscopically positive margins, and 0.6 % had macroscopically positive margins. The patients with negative margins were younger and more likely to be female, white, covered by private insurance, and treated at an academic or high-volume center (p < 0.05). They had smaller tumors and were less likely to have advanced-stage disease. After multivariable adjustment, increasing patient age [odds ratio (OR) = 1.02; p < 0.01], government insurance (OR = 1.20; p < 0.01), and no insurance (OR = 1.34; p = 0.01) were associated with positive margins. Reception of surgery at a high-volume facility (OR = 0.72; p < 0.01) was protective. After multivariable adjustment, both microscopically [hazard ratio (HR), 1.49; p < 0.01] and macroscopically positive margins (HR = 2.38; p < 0.01) were associated with compromised survival. CONCLUSIONS Several vulnerable patient populations have a higher risk of incomplete resection after thyroidectomy for PTC. High-risk thyroid cancer patients should be referred to high-volume centers to optimize outcomes.
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Affiliation(s)
| | | | | | | | - Julie A Sosa
- Duke University Medical Center, Durham, NC, USA. .,Duke Cancer Institute and Duke Clinical Research Institute, Duke University School of Medicine, DUMC 2945, Durham, NC, USA.
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Adam MA, Pura J, Goffredo P, Dinan MA, Reed SD, Scheri RP, Hyslop T, Roman SA, Sosa JA. Presence and Number of Lymph Node Metastases Are Associated With Compromised Survival for Patients Younger Than Age 45 Years With Papillary Thyroid Cancer. J Clin Oncol 2015; 33:2370-5. [DOI: 10.1200/jco.2014.59.8391] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Cervical lymph node metastases are recognized as a prognostic indicator only in patients age 45 years or older with papillary thyroid cancer (PTC); patients younger than age 45 years are perceived to have low-risk disease. The current American Joint Committee on Cancer staging for PTC in patients younger than age 45 years does not include cervical lymph node metastases. Our objective was to test the hypothesis that the presence and number of cervical lymph node metastases have an adverse impact on overall survival (OS) in patients younger than age 45 years with PTC. Patients and Methods Adult patients younger than age 45 years undergoing surgery for stage I PTC (no distant metastases) were identified from the National Cancer Data Base (NCDB; 1998-2006) and from SEER 1988-2006 data. Multivariable models were used to examine the association of OS with the presence of lymph node metastases and number of metastatic nodes. Results In all, 47,902 patients in NCDB (11,740 with and 36,162 without nodal metastases) and 21,855 in the SEER database (5,188 with and 16,667 without nodal metastases) were included. After adjustment, OS was compromised for patients with nodal metastases compared with patients who did not have them (NCDB: hazard ratio (HR), 1.32; 95% CI, 1.04 to 1.67; P = .021; SEER: HR, 1.29; 95% CI, 1.08 to 1.56; P = .006). After adjustment, increasing number of metastatic lymph nodes was associated with decreasing OS up to six metastatic nodes (HR, 1.12; 95% CI, 1.01 to 1.25; P = .03), after which more positive nodes conferred no additional mortality risk (HR, 0.99; 95% CI, 0.99 to 1.05; P = .75). Conclusion Our results suggest that cervical lymph node metastases are associated with compromised survival in young patients, warranting consideration of revised American Joint Committee on Cancer staging. A change point of six or fewer metastatic lymph nodes seems to carry prognostic significance, thus advocating for rigorous preoperative screening for nodal metastases.
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Affiliation(s)
- Mohamed Abdelgadir Adam
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - John Pura
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - Paolo Goffredo
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - Michaela A. Dinan
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - Shelby D. Reed
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - Randall P. Scheri
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - Terry Hyslop
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - Sanziana A. Roman
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
| | - Julie A. Sosa
- Mohamed Abdelgadir Adam, John Pura, Randall P. Scheri, Terry Hyslop, Sanziana A. Roman, and Julie A. Sosa; and Paolo Goffredo, Michaela A. Dinan, Shelby D. Reed, and Julie A. Sosa, Duke Clinical Research Institute, Durham, NC
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Wang H, Heck K, Pruitt SK, Wong TZ, Scheri RP, Georgiade GS, Ichite I, Hwang ES. Impact of delayed lymphoscintigraphy for sentinel lymphnode biopsy for breast cancer. J Surg Oncol 2015; 111:931-4. [DOI: 10.1002/jso.23915] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/12/2015] [Accepted: 03/09/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Hanghang Wang
- Department of Surgery; Duke University Medical Center; Durham North Carolina
- Computational Biology and Bioinformatics; Duke University; Durham North Carolina
| | - Karissa Heck
- School of Medicine; Duke University; Durham North Carolina
| | - Scott K. Pruitt
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | - Terence Z. Wong
- Department of Radiology; North Carolina School of Medicine; Chapel Hill North Carolina
| | - Randall P. Scheri
- Department of Surgery; Duke University Medical Center; Durham North Carolina
| | | | - Ikwunze Ichite
- Department of Radiology; Duke University Medical Center; Durham North Carolina
| | - E. Shelley Hwang
- Department of Surgery; Duke University Medical Center; Durham North Carolina
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39
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Affiliation(s)
- Christa L Jillard
- Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, DUMC 2945, Durham, NC 27710, USA
| | - Randall P Scheri
- Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, DUMC 2945, Durham, NC 27710, USA
| | - Julie Ann Sosa
- Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, DUMC 2945, Durham, NC 27710, USA.
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Adam MA, Pura J, Goffredo P, Dinan MA, Hyslop T, Reed SD, Scheri RP, Roman SA, Sosa JA. Impact of extent of surgery on survival for papillary thyroid cancer patients younger than 45 years. J Clin Endocrinol Metab 2015; 100:115-21. [PMID: 25337927 PMCID: PMC5399499 DOI: 10.1210/jc.2014-3039] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/14/2014] [Indexed: 11/19/2022]
Abstract
CONTEXT Papillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors >1.0 cm, regardless of age. OBJECTIVE Our objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm. DESIGN, SETTING, AND PATIENTS Adult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998-2006) and the Surveillance, Epidemiology, and End RESULTS dataset (SEER, 1988-2006). MAIN OUTCOME MEASURE Multivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy. RESULTS In total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88-2.51], P = 0.19; SEER: 0.95 (0.70-1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50-2.51], P = 0.78; SEER: 0.95 [0.56-1.62], P = 0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88-4.23], P = 0.10; SEER: 0.94 [0.60-1.49], P = 0.80). CONCLUSIONS After adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection.
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Affiliation(s)
- Mohamed Abdelgadir Adam
- Department of Surgery (M.A.A., R.P.S., S.A.R., J.A.S.), Duke University Medical Center; Department of Biostatistics (J.P., T.H.), Duke University; and Duke Clinical Research Institute (P.G., M.A.D., S.D.R., J.A.S.), Durham, North Carolina 27710
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41
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Tuttle RM, Haddad RI, Ball DW, Byrd D, Dickson P, Duh QY, Ehya H, Haymart M, Hoh C, Hunt JP, Iagaru A, Kandeel F, Kopp P, Lamonica DM, Lydiatt WM, McCaffrey J, Moley JF, Parks L, Raeburn CD, Ridge JA, Ringel MD, Scheri RP, Shah JP, Sherman SI, Sturgeon C, Waguespack SG, Wang TN, Wirth LJ, Hoffmann KG, Hughes M. Thyroid carcinoma, version 2.2014. J Natl Compr Canc Netw 2014; 12:1671-80; quiz 1680. [PMID: 25505208 DOI: 10.6004/jnccn.2014.0169] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
These NCCN Guidelines Insights focus on some of the major updates to the 2014 NCCN Guidelines for Thyroid Carcinoma. Kinase inhibitor therapy may be used to treat thyroid carcinoma that is symptomatic and/or progressive and not amenable to treatment with radioactive iodine. Sorafenib may be considered for select patients with metastatic differentiated thyroid carcinoma, whereas vandetanib or cabozantinib may be recommended for select patients with metastatic medullary thyroid carcinoma. Other kinase inhibitors may be considered for select patients with either type of thyroid carcinoma. A new section on "Principles of Kinase Inhibitor Therapy in Advanced Thyroid Cancer" was added to the NCCN Guidelines to assist with using these novel targeted agents.
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Affiliation(s)
- R Michael Tuttle
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Robert I Haddad
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Douglas W Ball
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - David Byrd
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Paxton Dickson
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Quan-Yang Duh
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Hormoz Ehya
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Megan Haymart
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Carl Hoh
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Jason P Hunt
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Andrei Iagaru
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Fouad Kandeel
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Peter Kopp
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Dominick M Lamonica
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - William M Lydiatt
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Judith McCaffrey
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Jeffrey F Moley
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Lee Parks
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Christopher D Raeburn
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - John A Ridge
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Matthew D Ringel
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Randall P Scheri
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Jatin P Shah
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Steven I Sherman
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Cord Sturgeon
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Steven G Waguespack
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Thomas N Wang
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Lori J Wirth
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Karin G Hoffmann
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
| | - Miranda Hughes
- From Memorial Sloan Kettering Cancer Center; Dana-Farber/Brigham and Women's Cancer Center; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; University of Washington/Seattle Cancer Care Alliance; St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; UCSF Helen Diller Family Comprehensive Cancer Center; Fox Chase Cancer Center; University of Michigan Comprehensive Cancer Center; UC San Diego Moores Cancer Center; Huntsman Cancer Institute at the University of Utah; Stanford Cancer Institute; City of Hope Comprehensive Cancer Center; Robert H. Lurie Comprehensive Cancer Center of Northwestern University; Roswell Park Cancer Institute; Fred & Pamela Buffett Cancer Center at The Nebraska Medical Center; Moffitt Cancer Center; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; Vanderbilt-Ingram Cancer Center; University of Colorado Cancer Center; The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute; Duke Cancer Institute; The University of Texas MD Anderson Cancer Center; University of Alabama at Birmingham Comprehensive Cancer Center; Massachusetts General Hospital Cancer Center; and National Comprehensive Cancer Network
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Abstract
OBJECTIVE To report a rare case of primary hyperparathyroidism presenting with hyperparathyroid crisis due to parathyroid hyperplasia with ectopic glands. METHODS We present the initial clinical manifestations, laboratory results, radiologic and surgical findings, and management in a patient who had hyperparathyroid crisis. The pertinent literature and management options are also reviewed. RESULTS A 60-year-old female presented with hyperparathyroid crisis requiring preoperative stabilization with rehydration, diuresis, bisphosphonate therapy, and ultimately hemodialysis. Parathyroidectomy revealed asymmetric 4-gland hyperplasia, with a massive ectopic parathyroid gland in the tracheoesophageal groove extending into the mediastinum. Her postoperative course was complicated by hungry bone syndrome and hypocalcemia. CONCLUSION This case illustrates the rare occurrence of hyperparathyroid crises due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland.
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Affiliation(s)
- Lauren F Gratian
- Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, North Carolina
| | - Kristen A Hyland
- Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, North Carolina
| | - Randall P Scheri
- Department of Surgery, Duke University Medical Center, Duke University, Durham, North Carolina
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Abstract
The management of clinically normal regional lymph nodes in early-stage melanoma has been controversial for over 100 years. Lymphatic mapping and sentinel lymphadenectomy has been developed as a minimally invasive surgical technique to stage regional lymph nodes without the associated morbidity of complete lymph node dissection. Multiple retrospective studies have validated the accuracy of lymphatic mapping and sentinel lymphadenectomy and the importance of the sentinel lymph node as a prognostic tool for melanoma. Several multicenter, prospective, randomized trials are underway to validate the data of the Phase II studies and determine the therapeutic benefit of lymphatic mapping and sentinel lymphadenectomy.
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Affiliation(s)
- Randall P Scheri
- Division of Surgical Oncology, John Wayne Cancer Institute, 2200 Santa Monica Boulevard, Santa Monica, CA 90404, USA.
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44
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Abstract
Lymph node metastases in papillary thyroid cancer are a common occurrence; however, the management of clinically negative cervical lymph nodes remains controversial. Preoperative neck ultrasound mapping is crucial, and complete dissection of a nodal compartment is recommended for any metastatic lymph nodes. The role of prophylactic central neck dissection remains controversial. The BRAF V600E mutation is a common mutation in papillary thyroid cancer, and has been associated with more aggressive tumor behavior. Evaluating the BRAF status of tumors may have implications for treatment and surveillance. New areas of research continue to focus on risk stratification and identifying which patients benefit from a more aggressive treatment, such as prophylactic central lymphadenectomy and radioiodine ablation and more intense surveillance strategies.
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Affiliation(s)
- Dawn M Elfenbein
- a Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Randall P Scheri
- a Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Sanziana Roman
- a Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Julie A Sosa
- b Section of Endocrine Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
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Salama AKS, de Rosa N, Scheri RP, Pruitt SK, Herndon JE, Marcello J, Tyler DS, Abernethy AP. Hazard-rate analysis and patterns of recurrence in early stage melanoma: moving towards a rationally designed surveillance strategy. PLoS One 2013; 8:e57665. [PMID: 23516415 PMCID: PMC3596369 DOI: 10.1371/journal.pone.0057665] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While curable at early stages, few treatment options exist for advanced melanoma. Currently, no consensus exists regarding the optimal surveillance strategy for patients after resection. The objectives of this study were to identify patterns of metastatic recurrence, to determine the influence of metastatic site on survival, and to identify high-risk periods for recurrence. METHODS A retrospective review of the Duke Melanoma Database from 1970 to 2004 was conducted that focused on patients who were initially diagnosed without metastatic disease. The time to first recurrence was computed from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. Metastatic sites were coded by the American Joint Committee on Cancer (AJCC) system including local skin, distant skin and nodes (M1a), lung (M1b), and other distant (M1c). RESULTS Of 11,615 patients initially diagnosed without metastatic disease, 4616 (40%) had at least one recurrence. Overall the risk of initial recurrence peaked at 12 months. The risk of initial recurrence at the local skin, distant skin, and nodes peaked at 8 months, and the risk at lung and other distant sites peaked at 24 months. Patients with a cutaneous or nodal recurrence had improved survival compared to other recurrence types. CONCLUSIONS The risk of developing recurrent melanoma peaked at one year, and the site of first recurrence had a significant impact on survival. Defining the timing and expected patterns of recurrence will be important in creating an optimized surveillance strategy for this patient population.
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Affiliation(s)
- April K. S. Salama
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nicole de Rosa
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Randall P. Scheri
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Scott K. Pruitt
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - James E. Herndon
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Jennifer Marcello
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Douglas S. Tyler
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Amy P. Abernethy
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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Elfenbein DM, Weber TJ, Scheri RP. Tumor-induced osteomalacia masking primary hyperparathyroidism. Surgery 2013; 152:1256-8. [PMID: 23158192 DOI: 10.1016/j.surg.2012.08.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 08/29/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Dawn M Elfenbein
- Department of Surgery, Duke University Hospital, Durham, NC 27710, USA.
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Lyman GH, Baker J, Geradts J, Horton J, Kimmick G, Peppercorn J, Pruitt S, Scheri RP, Hwang ES. Multidisciplinary care of patients with early-stage breast cancer. Surg Oncol Clin N Am 2013; 22:299-317. [PMID: 23453336 DOI: 10.1016/j.soc.2012.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There is a compelling need for close coordination and integration of multiple specialties in the management of patients with early-stage breast cancer. Optimal patient care and outcomes depend on the sequential and often simultaneous participation and dialogue between specialists in imaging, pathologic and molecular diagnostic and prognostic stratification, and the therapeutic specialties of surgery, radiation oncology, and medical oncology. These are but a few of the various disciplines needed to provide modern, sophisticated management. The essential role for coordinated involvement of the entire health care team in optimal management of patients with early-stage breast cancer is likely to increase further.
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Affiliation(s)
- Gary H Lyman
- Comparative Effectiveness and Outcomes Research Program, Department of Medicine, Duke Cancer Institute, Duke University School of Medicine, Durham, NC 27705, USA.
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Salama AKS, Rosa ND, Scheri RP, Herndon JE, Tyler DS, Marcello J, Pruitt SK, Abernethy AP. The Effect of Metastatic Site and Decade of Diagnosis on the Individual Burden of Metastatic Melanoma: Contemporary Estimates of Average Years of Life Lost. Cancer Invest 2012; 30:637-41. [DOI: 10.3109/07357907.2012.726387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Untch BR, Adam MA, Danko ME, Barfield ME, Dixit D, Scheri RP, Olson JA. Tumor proximity to the recurrent laryngeal nerve in patients with primary hyperparathyroidism undergoing parathyroidectomy. Ann Surg Oncol 2012; 19:3823-6. [PMID: 22847120 DOI: 10.1245/s10434-012-2495-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) injury is a rare complication for patients undergoing neck exploration for primary hyperparathyroidism (pHPT). Distances between RLNs and parathyroid adenomas have not been previously published. In this study we used a RLN monitor to identify the RLN and to measure the proximity to parathyroid tumors. METHODS Patients with pHPT (n = 136) underwent neck exploration and had the clinical data recorded prospectively. Adenomas were recorded in 1 of 4 locations (right upper, right lower, left upper, left lower). Measurement of RLN to adenoma distances were recorded intraoperatively with the gland in situ. The RLN location was confirmed with a RLN monitor. RESULTS The average RLN to adenoma distance was 0.52 ± 0.52 cm. Adenomas in the right upper position were significantly closer to the nerve (0.25 ± 0.39 cm) compared with adenomas in the left upper (0.48 ± 0.61 cm, p = .03), left lower (0.70 ± 0.53 cm, p < .001), and right lower position (1.02 ± 0.56 cm, p < .001). Left upper adenomas were also significantly closer to the nerve compared with right lower adenomas (p < .001). Adenomas in the right upper position abutted the nerve more often (47 %) compared with adenomas in other positions (p = .001). There were no perioperative characteristics that predicted tumor abutment. There were no permanent RLN injuries. CONCLUSION In patients with sporadic pHPT, parathyroid adenomas in the right upper location have, on average, greater proximity to the RLN and are more often directly abutting compared with adenomas in other locations.
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Affiliation(s)
- Brian R Untch
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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