Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Ir J Med Sci. 2016 Apr 15;

Authors: Lennon P, Deady S, White N, Lambert D, Healy ML, Green A, Kinsella J, Timon C, O' Neill JP

Abstract
BACKGROUND AND OBJECTIVES: Medullary thyroid cancer consists of a spectrum of disease that ranges from extremely indolent tumors to aggressive types associated with a high mortality rate. The objective of our study is to evaluate the prognostic factors and outcomes of patients diagnosed with MTC in a homogenous population, and to examine patients diagnosed with MTC for mutations in the RET proto-oncogene from the same period.
METHODS: A retrospective analysis of the National Cancer Registry in Ireland was undertaken, between 1998 and 2007. The Kaplan-Meier method was used to determine overall survival and factors predictive of outcome were determined by univariate and multivariate analysis by cox regression using Stata 13 software.
MAIN FINDINGS: Forty-three patients were diagnosed with medullary thyroid cancer, 55.8 % were female and 44.2 % were male. A median age of 52 was found. The overall median survival was 6.32 years and the 1- and 5-year overall survival was 88.37 and 62.79 %, respectively, with 10-year survival calculated at 48.63 %. On univariate analysis age, stage and surgical intervention were statistically significant indicators of prognosis. T stage and age remained statistically significant indicators of prognosis on multivariate analysis. Two patients with no history of MEN syndromes or family history of medullary thyroid cancer had RET proto-onocogene mutations.
CONCLUSIONS: Our patient cohort was substantially older and presented at an advanced T status than what is commonly seen in the literature. This may account for poor survival outcomes and the very low pick-up of RET mutations in sporadic medullary thyroid cancer.

PMID: 27083464 [PubMed - as supplied by publisher]

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Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Thyroid. 2016 Apr 15;

Authors: Kluijfhout WP, Pasternak JD, Lim J, Kwon JS, Vriens MR, Clark OH, Shen WT, Gosnell J, Suh I, Duh QY

Abstract
Background Extent of thyroidectomy for low risk well differentiated thyroid cancer (WDTC) remains controversial. Historically, total thyroidectomy (TT) has been recommended for WDTC ≥1 cm in size. However, recent NCCN and draft ATA guidelines recognize unilateral thyroid lobectomy as a viable alternative for 1-4 cm cancers due to their otherwise favorable prognosis, with TT remaining the preferred option for tumors with unfavorable pathological characteristics. We sought to determine how often a completion TT would be recommended based on these guidelines if lobectomy was initially performed in our patients with 1-4 cm WDTC without preoperatively known risk factors. Methods We retrospectively reviewed our patients who underwent thyroidectomy for 1-4 cm WDTC (January 2000 to January 2010). We excluded patients with preoperatively known high risk characteristics, including gross extra-thyroidal extension on preoperative imaging, clinically apparent lymph node metastases, distant metastases, history of radiation and positive family history. We evaluated the pathology specimens from the cancer-containing lobe for features that would lead to a recommendation for TT based on current guidelines, including aggressive histology, vascular invasion, microscopic extra-thyroidal extension (ETE), positive margins and any positive lymph nodes within the specimen. Results Of 1000 consecutive patients operated for WDTC, 287 would have been eligible for lobectomy as the initial operation. The mean age in this cohort was 45 years, and 80% were women. Aggressive tall cell variant histology was found in 1 patients (0.5%), angio-invasion in 34 (12%), ETE in 48 (17%), positive margins in 51 (18%), and positive lymph nodes in 49 (18%). Completion TT would have been recommended in 122/287 (43%) patients. Even in those with 1-2 cm cancers, completion TT would have been recommended in 52/143 (36%). Conclusions Nearly half of patients with 1-4 cm WDTC who are eligible for lobectomy under current guidelines would require completion TT based on pathological characteristics of the initial lobe. Surgeons, endocrinologists, and patients need to balance the relative benefits, risks, and costs of initial TT versus the possible need for reoperative completion TT.

PMID: 27083216 [PubMed - as supplied by publisher]

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Analysis of Risk Factors Contributing to Recurrence of Papillary Thyroid Carcinoma in Chinese Patients Who Underwent Total Thyroidectomy.

Analysis of Risk Factors Contributing to Recurrence of Papillary Thyroid Carcinoma in Chinese Patients Who Underwent Total Thyroidectomy.

Med Sci Monit. 2016;22:1274-1279

Authors: Zhang W, Jiao, Liu B, Sun S

Abstract
BACKGROUND Thyroid cancer is a very common endocrine malignancy, with a rate of total thyroidectomy reported to be up to 27.8%. However, studies analyzing the risk factors that contribute to recurrence of papillary thyroid carcinoma (PTC) after total thyroidectomy in China are still scarce. MATERIAL AND METHODS A total of 536 patients with PTC who underwent total thyroidectomy were retrospectively analyzed. Patients were divided into 2 groups: patients with no recurrent tumor were included in group 1 and patients with tumor recurrence were included in group 2. RESULTS Of 536 patients, 65 patients (12.1%) developed a recurrence of PTC, and 471 patients (87.9%) did not have a recurrence. Univariate analysis indicated that male sex, age ≥50 years, tumor ≥1 cm, poor differentiation, lymph node metastasis, bilaterality, and multifocality may be related to PTC recurrence. Additionally, the results of the logistic regression analysis indicated that male sex, age ≥50 years, primary tumor ≥1 cm, poor dedifferentiation of the tumor, lymph node metastasis, and multifocality may be independent factors contributing to PTC recurrence. CONCLUSIONS Male sex, age more than 50 years, primary tumor larger than 1 cm, poor dedifferentiation of the primary tumor, lymph node metastasis, and multifocality were found to increase the risk of PTC recurrence in patients who underwent total thyroidectomy. Additionally, it is necessary to use strictly aggressive and extensive surgery, as well as close monitoring, after the operation.

PMID: 27084873 [PubMed - as supplied by publisher]

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Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Aggressive medullary thyroid cancer, an analysis of the Irish National Cancer Registry.

Ir J Med Sci. 2016 Apr 15;

Authors: Lennon P, Deady S, White N, Lambert D, Healy ML, Green A, Kinsella J, Timon C, O' Neill JP

Abstract
BACKGROUND AND OBJECTIVES: Medullary thyroid cancer consists of a spectrum of disease that ranges from extremely indolent tumors to aggressive types associated with a high mortality rate. The objective of our study is to evaluate the prognostic factors and outcomes of patients diagnosed with MTC in a homogenous population, and to examine patients diagnosed with MTC for mutations in the RET proto-oncogene from the same period.
METHODS: A retrospective analysis of the National Cancer Registry in Ireland was undertaken, between 1998 and 2007. The Kaplan-Meier method was used to determine overall survival and factors predictive of outcome were determined by univariate and multivariate analysis by cox regression using Stata 13 software.
MAIN FINDINGS: Forty-three patients were diagnosed with medullary thyroid cancer, 55.8 % were female and 44.2 % were male. A median age of 52 was found. The overall median survival was 6.32 years and the 1- and 5-year overall survival was 88.37 and 62.79 %, respectively, with 10-year survival calculated at 48.63 %. On univariate analysis age, stage and surgical intervention were statistically significant indicators of prognosis. T stage and age remained statistically significant indicators of prognosis on multivariate analysis. Two patients with no history of MEN syndromes or family history of medullary thyroid cancer had RET proto-onocogene mutations.
CONCLUSIONS: Our patient cohort was substantially older and presented at an advanced T status than what is commonly seen in the literature. This may account for poor survival outcomes and the very low pick-up of RET mutations in sporadic medullary thyroid cancer.

PMID: 27083464 [PubMed - as supplied by publisher]

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Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Frequency of High Risk Characteristics Requiring Total Thyroidectomy for 1-4 cm Well Differentiated Thyroid Cancer.

Thyroid. 2016 Apr 15;

Authors: Kluijfhout WP, Pasternak JD, Lim J, Kwon JS, Vriens MR, Clark OH, Shen WT, Gosnell J, Suh I, Duh QY

Abstract
Background Extent of thyroidectomy for low risk well differentiated thyroid cancer (WDTC) remains controversial. Historically, total thyroidectomy (TT) has been recommended for WDTC ≥1 cm in size. However, recent NCCN and draft ATA guidelines recognize unilateral thyroid lobectomy as a viable alternative for 1-4 cm cancers due to their otherwise favorable prognosis, with TT remaining the preferred option for tumors with unfavorable pathological characteristics. We sought to determine how often a completion TT would be recommended based on these guidelines if lobectomy was initially performed in our patients with 1-4 cm WDTC without preoperatively known risk factors. Methods We retrospectively reviewed our patients who underwent thyroidectomy for 1-4 cm WDTC (January 2000 to January 2010). We excluded patients with preoperatively known high risk characteristics, including gross extra-thyroidal extension on preoperative imaging, clinically apparent lymph node metastases, distant metastases, history of radiation and positive family history. We evaluated the pathology specimens from the cancer-containing lobe for features that would lead to a recommendation for TT based on current guidelines, including aggressive histology, vascular invasion, microscopic extra-thyroidal extension (ETE), positive margins and any positive lymph nodes within the specimen. Results Of 1000 consecutive patients operated for WDTC, 287 would have been eligible for lobectomy as the initial operation. The mean age in this cohort was 45 years, and 80% were women. Aggressive tall cell variant histology was found in 1 patients (0.5%), angio-invasion in 34 (12%), ETE in 48 (17%), positive margins in 51 (18%), and positive lymph nodes in 49 (18%). Completion TT would have been recommended in 122/287 (43%) patients. Even in those with 1-2 cm cancers, completion TT would have been recommended in 52/143 (36%). Conclusions Nearly half of patients with 1-4 cm WDTC who are eligible for lobectomy under current guidelines would require completion TT based on pathological characteristics of the initial lobe. Surgeons, endocrinologists, and patients need to balance the relative benefits, risks, and costs of initial TT versus the possible need for reoperative completion TT.

PMID: 27083216 [PubMed - as supplied by publisher]

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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174

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