scholarly journals Patient and tumor factors contributing to distant metastasis in well-differentiated thyroid cancer: a retrospective cohort study

2020 ◽  
Vol 49 (1) ◽  
Author(s):  
Usman Khan ◽  
Ayham Al Afif ◽  
Abdullah Aldaihani ◽  
Colin MacKay ◽  
Matthew H. Rigby ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Distant Metastasis ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Univariate Analysis ◽  
Cox Proportional Hazards Model ◽  
Resection Margins ◽  
Substantial Impact ◽  
Well Differentiated ◽  
Over Time

Abstract Background Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC. Methods A retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups. Results Distant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC. Conclusions TS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients. Graphical abstract

Are perceptual disorder signs in diplegic cerebral palsied children stable over time? A retrospective cohort analysis

2020 ◽  
Vol 72 (2) ◽  
Author(s):  
Silvia Alboresi ◽  
Alice Sghedoni ◽  
Giulia Borelli ◽  
Stefania Costi ◽  
Laura Beccani ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Retrospective Cohort Analysis ◽  
Over Time

scholarly journals Regional Variation across Canadian Centers in Radioiodine Administration for Thyroid Remnant Ablation in Well-Differentiated Thyroid Cancer Diagnosed in 2000–2010

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
I. Rachinsky ◽  
M. Rajaraman ◽  
W. D. Leslie ◽  
A. Zahedi ◽  
C. Jefford ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Distant Metastases ◽  
Tnm Staging ◽  
Remnant Ablation ◽  
Thyroid Hormone Withdrawal ◽  
Care Patterns ◽  
Major Variation ◽  
Well Differentiated ◽  
Over Time

Background. Use of radioactive iodine (RAI) ablation has been reported to vary significantly between studies. We explored variation in RAI ablation care patterns between seven thyroid cancer treatment centers in Canada.Methods. The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe and analyze patterns of care for thyroid cancer. We analyzed data from seven participating centers on RAI ablation in patients diagnosed with well-differentiated (papillary and follicular) thyroid cancer between 2000 and 2010. We compared RAI ablation protocols including indications (based on TNM staging), preparation protocols, and administered dose. We excluded patients with known distant metastases at time of RAI ablation.Results. We included 3072 patients. There were no significant differences in TNM stage over time. RAI use increased in earlier years and then declined. The fraction of patients receiving RAI varied significantly between centers, ranging between 20–85% for T1, 44–100% for T2, 58–100% for T3, and 59–100% for T4. There were significant differences in the RAI doses between centers. Finally, there was major variation in the use of thyroid hormone withdrawal or rhTSH for preparation of RAI ablation.Conclusion. Our study identified significant variation in use of RAI for ablation in patients with well-differentiated thyroid cancer both between Canadian centers and over time.

scholarly journals Unusual Presentation of Differentiated Thyroid Cancer Metastasis

2017 ◽  
Vol 22 (02) ◽  
pp. 167-170 ◽  
Author(s):  
Haissan Iftikhar ◽  
Mubasher Ikram ◽  
Adnan Muhammad ◽  
Karim Nathani
Keyword(s):  
Thyroid Cancer ◽  
Distant Metastasis ◽  
Differentiated Thyroid Cancer ◽  
Cancer Metastasis ◽  
Treatment Protocol ◽  
Neck Of Femur ◽  
Thyroid Cancers ◽  
Well Differentiated ◽  
Differentiated Thyroid Cancers ◽  
Histopathology Exam

Introduction The rates of thyroid cancers are on a rise, especially well-differentiated thyroid cancers. This could be partly due to newer diagnostic modalities, like high-resolution ultrasound, that can pick up smaller lesions. Differentiated thyroid cancers with distant metastases are not common, and even rarer is the initial presentation with complaints not related to the neck. Objectives The objective of this series was to study and report the unusual cases of patients with differentiated thyroid cancer with distant metastasis. There is a lack of data in the literature on these cases, and due to the rarity of such metastases, no definite treatment protocol has been defined. Methods A retrospective chart review of 1,200 cases of thyroid surgeries was performed. A total of 10 cases of well-differentiated thyroid cancer on the final histopathology exam that had initially presented with usual complaints to departments other than the Otolaryngology Department were identified. Results A total of 6 patients had papillary carcinoma, whereas 4 patients had follicular carcinoma on final the histopathology exam. Two patients presented with iliac crest lesions, 2 with vertebral lesions one each with parapharyngeal mass, supraclavicular mass, labia majora swelling and bleeding, lung, rib and neck of femur lesion. Conclusion There are still no specific guidelines on how to address these patients with differentiated thyroid cancer with distant metastasis (except for the cases of bone and lung lesions) and on which treatment should be offered in case of recurrence. More studies on the subject are required.

scholarly journals Not the same thing: metastatic PTCs have a different background than ATCs

2018 ◽  
Vol 7 (12) ◽  
pp. 1370-1379 ◽  
Author(s):  
Dario de Biase ◽  
Federica Torricelli ◽  
Moira Ragazzi ◽  
Benedetta Donati ◽  
Elisabetta Kuhn ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Distant Metastasis ◽  
Genetic Background ◽  
Anaplastic Thyroid Cancer ◽  
Well Differentiated ◽  
Different Genetic Background ◽  
Definition Of ◽  
Next Generation Sequencing Ngs ◽  
Promoter Mutations ◽  
Generation Sequencing

Anaplastic thyroid cancer (ATC) is a rare but highly aggressive form of thyroid cancer. By contrast, differentiated papillary thyroid cancer (PTC) only rarely behave aggressively and develop distant metastasis. Whether distantly metastatic PTC (DM-PTC) and ATC share a common genetic background is still to be defined. We used next-generation sequencing (NGS) to explore the genetic background of a cohort of ATC and DM-PTC and a group of well-differentiated PTCs that did not developed distant metastasis as control (ctrl-PTC). A panel of 128 amplicons within 21 thyroid cancer-related genes was analyzed in a set of 151 thyroid cancer samples including 66 ATCs and DM-PTCs. We showed that the ATC/DM-PTC group had an overall mutational load higher than ctrl-PTCs and that ATCs and DM-PTCs are characterized by a different genetic background, with the exception of mutations in the TERT promoter that were overrepresented in both ATCs (61.1%) and DM-PTCs (48.2%) vs non-aggressive ctrl-PTCs (7.6%). In ATCs, TERT promoter mutations were frequently associated with TP53 mutations, while in the DM-PTCs no significant co-occurrence was observed. No significant association of MED12 mutations with aggressiveness of thyroid cancer was observed in our analysis. Finally, correlation analysis showed that increasing number of mutations negatively impact on patient overall survival also within the ATC and DM-PTC group. In conclusions, overall our analysis further highlights the relevance of TERT promoter mutations in driving aggressiveness and provides new pieces of information in the definition of aggressiveness evolution of thyroid cancer lesions.

scholarly journals Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054666
Author(s):  
Evangelos Kontopantelis ◽  
Maria Panagioti ◽  
Tracey Farragher ◽  
Luke A Munford ◽  
Rosa Parisi ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Negative Binomial ◽  
Cohort Analysis ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Face To Face ◽  
Frequent Attenders ◽  
General Practices ◽  
Rate Ratios ◽  
Over Time

ObjectiveTo describe the distribution of consultations at the practice level and examine whether increases are uniform or driven by people who consult more frequently.DesignRetrospective cohort study.SettingUK general practice data from the Clinical Practice Research Datalink (CPRD) GOLD database.Participants1 699 709 314 consultation events from 12 330 545 patients, in 845 general practices (1 April 2000 to 31 March 2019).MethodsConsultation information was aggregated by financial year into: all consultations/all staff; all consultations/general practitioners (GPs); face-to-face consultations/all staff; face-to-face consultations/GPs. Patients with a number of consultations above the 90th centile, within each year, were classified as frequent attenders. Negative binomial regressions examined the association between available practice characteristics and consultation distribution.ResultsAmong frequent attenders, all consultations by GPs increased from a median (25th and 75th centile) of 13 (10 and 16) to 21 (18 and 25) and all consultations by all staff increased from 27 (23–30) to 60 (51–69) over the study period. Approximately four out of ten consultations of any type concerned frequent attenders and the proportion of consultations attributed to them increased over time, particularly for face-to-face consultations with GPs, from a median of 38.0% (35.9%–40.3%) in 2000–2001 to 43.0% (40.6%–46.4%) in 2018–2019. Regression analyses indicated decreasing trends over time for face-to-face consultations and increasing trends for all consultation types, for both GPs and all staff. Frequent attenders consulted approximately five times more than the rest of the practice population, on average, with adjusted incidence rate ratios ranging between 4.992 (95% CI 4.917 to 5.068) for face-to-face consultations with all staff and 5.603 (95% CI 5.560 to 5.647) for all consultations with GPs.ConclusionsFrequent attenders progressively contributed to increased workload in general practices across the UK from 2000 to 2019. Important knowledge gaps remain in terms of the demographic, social and health characteristics of frequent attenders and how UK general practices can be prepared to meet the needs of these patients.

scholarly journals Prevalence, characteristics, and patterns of patients with multimorbidity in primary care: a retrospective cohort analysis in Canada

2019 ◽  
Vol 69 (686) ◽  
pp. e647-e656 ◽  
Author(s):  
Kathryn Nicholson ◽  
Amanda L Terry ◽  
Martin Fortin ◽  
Tyler Williamson ◽  
Michael Bauer ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Retrospective Cohort ◽  
Cohort Analysis ◽  
Analysis Tool ◽  
Patient Age ◽  
Patient Âgé ◽  
Retrospective Cohort Analysis ◽  
Primary Care Patients ◽  
Over Time

BackgroundMultimorbidity is a complex issue in modern medicine and a more nuanced understanding of how this phenomenon occurs over time is needed.AimTo determine the prevalence, characteristics, and patterns of patients living with multimorbidity, specifically the unique combinations (unordered patterns) and unique permutations (ordered patterns) of multimorbidity in primary care.Design and settingA retrospective cohort analysis of the prospectively collected data from 1990 to 2013 from the Canadian Primary Care Sentinel Surveillance Network electronic medical record database.MethodAdult primary care patients who were aged ≥18 years at their first recorded encounter were followed over time. A list of 20 chronic condition categories was used to detect multimorbidity. Computational analyses were conducted using the Multimorbidity Cluster Analysis Tool to identify all combinations and permutations.ResultsMultimorbidity, defined as two or more and three or more chronic conditions, was prevalent among adult primary care patients and most of these patients were aged <65 years. Among female patients with two or more chronic conditions, 6075 combinations and 14 891 permutations were detected. Among male patients with three or more chronic conditions, 4296 combinations and 9716 permutations were detected. While specific patterns were identified, combinations and permutations became increasingly rare as the total number of chronic conditions and patient age increased.ConclusionThis research confirms that multimorbidity is common in primary care and provides empirical evidence that clinical management requires a tailored, patient-centred approach. While the prevalence of multimorbidity was found to increase with increasing patient age, the largest proportion of patients with multimorbidity in this study were aged <65 years.

scholarly journals Changes in the clinicopathological characteristics and genetic alterations of follicular thyroid cancer

2017 ◽  
Vol 177 (6) ◽  
pp. 465-473 ◽  
Author(s):  
Young Shin Song ◽  
Jung Ah Lim ◽  
Hye Sook Min ◽  
Min Joo Kim ◽  
Hoon Sung Choi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Distant Metastasis ◽  
Genetic Alterations ◽  
Clinicopathological Characteristics ◽  
Extrathyroidal Extension ◽  
Age At Diagnosis ◽  
University Hospital ◽  
Follicular Thyroid Cancer ◽  
Promoter Mutations ◽  
Over Time

ObjectiveChanges in the clinicopathological characteristics and genetic alterations of follicular thyroid cancer (FTC) over time have not been reported. Moreover, the prognostic effects ofRASandTERTpromoter mutations in FTC have not been clearly elucidated. We investigated changes in the clinicopathological characteristics of patients with FTC over four decades, as well as the clinical significance of genetic mutations of FTC.Design and methodsThis retrospective study included 690 patients with FTC who underwent thyroidectomy between 1973 and 2015 at the Seoul National University Hospital. In 134 samples, genetic tests forN/H/KRASandTERTpromoter mutations andPAX8/PPARγrearrangement were performed.ResultsThe age at diagnosis has increased (P < 0.001) in recent decades and extrathyroidal extension of the tumor has become less common (P = 0.033). Other clinicopathological characteristics and prognosis of FTC have not significantly changed. The prevalence ofRASmutations decreased (P = 0.042) over time, whereas that ofTERTpromoter mutations remained stable.RASmutations were associated with distant metastasis and persistent disease, andTERTpromoter mutations were associated with distant metastasis, advanced TNM stage, recurrence and disease-specific mortality. FTC patients with coexistentRASandTERTpromoter mutations showed a higher recurrence risk than those with only one mutation.ConclusionsThe age at diagnosis of FTC and the frequency of extrathyroidal extension have changed over four decades. Moreover, the prevalence ofRASmutations decreased.RASandTERTpromoter mutations may be associated with poor clinical outcomes in FTC, especially when the two mutations coexist.

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