Histology does not influence prognosis in differentiated thyroid carcinoma when accounting for age, tumour diameter, invasive growth and metastases

ObjectivePapillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) show considerable differences in disease stage at initial presentation. The aim of this study was to investigate whether there are differences in tumour-specific survival if initial staging is accounted for.DesignRetrospective chart review study.PatientsThe study sample comprised 875 PTC and 350 FTC patients (856 females, 369 males, mean age 47.8 years) treated in our hospital from 1978 to 2002. All patients received total thyroidectomy with subsequent I-131 ablation except for those patients with an isolated papillary microcarcinoma.MethodsKaplan–Meier analyses and Cox-regression analyses were performed to assess the influence of histology on thyroid cancer-specific survival.ResultsFTC patients were on average older, more likely to be male, presented with a larger tumour and more frequently had multifocal carcinoma and distant metastases than PTC patients, whereas they presented less frequently with extrathyroidal invasion or lymph node metastases. Twenty-year tumour-specific survival in PTC was 90.6% and in FTC 73.7% (P<0.001). In multivariate analysis the presence of distant metastases (P<0.001), age (P<0.001), tumour size (P=0.001) and the presence of extrathyroidal invasion (P=0.007), but not histology (P=0.26), were independent determinant variables for tumour-specific survival.ConclusionThere is no difference in tumour-specific survival between PTC and FTC when accounting for the presence of metastases, age, tumour size and the presence of extrathyroidal invasion.

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Primary tumour size is a prognostic parameter in patients suffering from differentiated thyroid carcinoma with extrathyroidal growth: results of the MSDS trial

Acta Endocrinologica ◽

10.1530/eje-10-0116 ◽

2010 ◽

Vol 163 (4) ◽

pp. 637-644 ◽

Cited By ~ 20

Author(s):

Jan Alexander Krämer ◽

Kurt Werner Schmid ◽

Henning Dralle ◽

Markus Dietlein ◽

Harald Schicha ◽

...

Keyword(s):

Overall Survival ◽

Thyroid Carcinoma ◽

Tnm Classification ◽

Tumour Size ◽

Primary Tumour ◽

Distant Metastases ◽

Differentiated Thyroid Carcinoma ◽

Thyroid Carcinomas ◽

Tumour Diameter ◽

The Relationship

ObjectiveThe Multicentre Study Differentiated Thyroid Cancer (MSDS) collective represents a well-defined group of patients with thyroid carcinomas with extrathyroidal extension. The aim of the present study was to evaluate the relationship of the primary tumour size with clinicopathological features as well as the outcome of patients with minimum and extensive extrathyroidal growth (pT3b- and pT4a-tumours; UICC 2002/2003, 6th ed).MethodsThe tumour diameter was available in 324 out of 351 MSDS patients (244 females, 80 males). Mean age of patients was 47.7±12.0 years (range, 20.1–69.8 years), and the median follow-up was 6.2 years. The relationship between primary tumour size and the following clinicopathological data was investigated: age, gender, histological tumour type (papillary thyroid carcinomas (PTC) versus follicular thyroid carcinomas (FTC)) and UICC/AJCC TNM classification. In addition, the correlation between primary tumour size and event-free and overall survival was assessed.ResultsThe FTC of our series were significantly larger than PTC (3.46 vs 1.84 cm;P<0.001). Patients suffering from pT3b-tumours presented with significantly smaller tumour size than those with extensive extrathyroidal growth (pT4a-tumours) (1.9 vs 3.0 cm;P<0.01). All patients with distant metastases suffered from tumours >2 cm. Furthermore, event-free and overall survival were significantly correlated with increasing tumour size (P<0.05). Using multivariate analysis, a pT4a-category and a tumour diameter >2 cm remained independent predictors of survival.ConclusionsIn patients suffering from differentiated thyroid carcinoma with extrathyroidal growth (pT3b and pT4a), the tumour size is an independent predictor of event-free and overall survival.

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The RET polymorphic allele S836S is associated with early metastatic disease in patients with hereditary or sporadic medullary thyroid carcinoma

Endocrine Related Cancer ◽

10.1677/erc-09-0312 ◽

2010 ◽

Vol 17 (4) ◽

pp. 953-963 ◽

Cited By ~ 25

Author(s):

Débora R Siqueira ◽

Mírian Romitti ◽

Andreia P da Rocha ◽

Lucieli Ceolin ◽

Camila Meotti ◽

...

Keyword(s):

Lymph Node ◽

Thyroid Carcinoma ◽

Medullary Thyroid Carcinoma ◽

Metastatic Disease ◽

Cox Regression ◽

Distant Metastases ◽

Medullary Thyroid ◽

Kaplan Meier ◽

Increased Risk

The possible role of RET variants in modifying the natural course of medullary thyroid carcinoma (MTC) is still a matter of debate. Here, we investigate whether the RET variants L769L, S836S, and G691S/S904S influence disease presentation in hereditary or sporadic MTC patients. One hundred and two patients with hereditary MTC and 81 patients with sporadic MTC attending our institution were evaluated. The frequencies of RET polymorphisms in hereditary MTC were as follows: L769L, 17.3%; S836S, 7.95%; and S904S/G691S, 18.2%. No associations were observed between these polymorphisms and pheochromocytoma, hyperparathyroidism, lymph node, or distant metastasis. However, patients harboring the S836S variant were younger than those without this allele (17±8.2 vs 28.6±14.4 years, P=0.01), suggesting that these patients had metastases at a young age. Accordingly, the cumulative frequency of local and/or distant metastases as estimated by Kaplan–Meier curves showed that lymph node and distant metastases occurred earlier in patients harboring the S836S variant (P=0.003 and P=0.026 respectively). The S836S allele frequency was higher in sporadic MTC patients than in controls (10.5 vs 3.1%, P=0.01). Individuals harboring the S836S variant were younger (38.6±13.3 vs 48.5±16.7 years, P=0.02) and showed a higher percentage of lymph node and distant metastases (P=0.02 and P=0.04 respectively). Kaplan–Meier estimates of lymph node and distant metastases yielded distinct curves for patients with or without the S836S allele (P=0.002 and P=0.001 respectively). Additional analyses using a COX regression model showed that the S836S variant was independently associated with metastatic disease (hazard ratio 2.82 (95% confidence interval 1.51–5.26), P=0.001). In conclusion, the RET S836S variant is associated with early onset and increased risk for metastatic disease in patients with hereditary or sporadic MTC.

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Pleural effusion as a novel prognostic factor in metastatic thyroid carcinoma

Endocrine Connections ◽

10.1530/ec-20-0193 ◽

2020 ◽

Vol 9 (8) ◽

pp. 812-823

Author(s):

David T Broome ◽

Gauri B Gadre ◽

Ehsan Fayazzadeh ◽

James F Bena ◽

Christian Nasr

Keyword(s):

Risk Factors ◽

Pleural Effusion ◽

Thyroid Carcinoma ◽

Care Center ◽

Tertiary Care ◽

Tumor Resection ◽

Distant Metastases ◽

Cancer Specific Survival ◽

Kaplan Meier ◽

Prognostic Risk Factors

Objective: To identify novel prognostic risk factors and compare them with other known prognostic risk factors in follicular-cell-derived thyroid carcinoma (FDTC) with distant metastases. Methods: A retrospective review was conducted of adult patients with metastatic FDTC seen at a tertiary care center between January 1990 and December 2010. A 15-year Kaplan–Meier survival estimate was created for overall survival (OS) and cancer-specific survival (CSS). Hazard ratios (HR) and P values from Cox proportional hazard models were used with a 95% CI. Results: There were 143 patients (60.1% male, 39.9% female), of whom 104 (72.7%) patients had papillary, 30 (21.0%) had follicular, 5 (3.5%) had poorly differentiated, and 4 (2.8%) had Hürthle cell cancers. Median length of follow-up was 80.0 months (range 1.0–564.0). The 15-year mortality rate was 32.2% and cancer-specific mortality was 25.2%, with OS and CSS having the same risk factors. Lung was the most common site of metastases in 53 patients (37.1%), and patients with pleural effusions had significantly lower CSS (HR = 5.21, CI = 1.79–15.12). Additional risk factors for a decreased CSS included: older age upon diagnosis (>45 years, HR = 4.15, CI = 1.43–12.02), multiple metastatic locations (HR = 3.75, CI = 1.32–10.67), and incomplete/unknown tumor resection (HR = 2.35, CI = 1.18–4.67). Conclusion: This study is the first to demonstrate that pleural effusion is a poor prognostic sign in patients with FDTC with distant metastases and compare this risk with other accepted prognostic variables.

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The Effect of Marital Status on Survival of Patients with Gastrointestinal Stromal Tumors: A SEER Database Analysis

Gastroenterology Research and Practice ◽

10.1155/2018/5740823 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Wei Song ◽

Chuan Tian

Keyword(s):

Prognostic Factor ◽

Marital Status ◽

Gastrointestinal Stromal Tumors ◽

Cox Regression ◽

Seer Database ◽

Cancer Specific Survival ◽

Stromal Tumors ◽

Kaplan Meier ◽

Risk Of Cancer ◽

The Impact

Background. Marital status has been reported to be a prognostic factor in multiple malignancies. However, its prognostic value on gastrointestinal stromal tumors (GISTs) have not yet been determined. The objective of the present analysis was to assess the effects of marital status on survival in patients with GISTs. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was used to analyze 6195 patients who were diagnosed with GISTs from 2001 to 2014. We also use Kaplan-Meier analysis and Cox regression to analyze the impact of marital status on cancer-specific survival (CSS). Results. Patients in the married group had more frequency in white people, more high/moderate grade tumors, and were more likely to receive surgery. Widowed patients had a higher proportion of women, a greater proportion of older patients (>60 years), and more common site of the stomach. Multivariate analysis demonstrated that marital status was an independent prognostic factor for GISTs (P<0.001). Married patients had better CSS than unmarried patients (P<0.001). Subgroup analysis suggested that widowed patients had the lowest CSS compared with all other patients. Conclusions. Marital status is a prognostic factor for survival in patients with GISTs, and widowed patients are at greater risk of cancer-specific mortality.

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Down-Regulation of LncRNA DGCR5 Correlates with Poor Prognosis in Hepatocellular Carcinoma

Cellular Physiology and Biochemistry ◽

10.1159/000452582 ◽

2016 ◽

Vol 40 (3-4) ◽

pp. 707-715 ◽

Cited By ~ 45

Author(s):

Ruyi Huang ◽

Xiaochen Wang ◽

Wenjie Zhang ◽

Guangyan Zhangyuan ◽

Kangpeng Jin ◽

...

Keyword(s):

Roc Curve ◽

Cox Regression ◽

Cancer Specific Survival ◽

Term Survival ◽

Diagnosis And Prognosis ◽

Kaplan Meier ◽

High Expression Group ◽

Negative Prognostic Factor ◽

Potential Biomarker ◽

Low Expression

Background/Aims: Long non-coding RNAs (lncRNAs) have been reported to play pivotal roles in multiple tumors and can act as tumor biomarkers. In this study, we explored the association of the expression of an lncRNA, DGCR5 with clinicopathological features and prognosis in HCC. Methods: Expression levels of DGCR5 were detected by quantitative real-time PCR (qRT-PCR) and the clinical data was obtained, including basic information, data of clinicopathology and cancer specific survival rate. Receiver operating characteristic (ROC) curve, Kaplan-Meier methods and multivariable Cox regression models were used to analyze predictive efficiency, long-term survival outcomes and risk factors. Results: DGCR5 was found down-regulated in HCC tissues (P<0.001) and serum (P = 0.0035) and low expression of DGCR5 was correlated with a poor cancer specific survival (CSS) (P = 0.0019), as the overall 5-year CSS rates were 10.3% (low expression group) and 36.6% (high expression group), respectively. A stratified analysis demonstrated that low DGCR5 expression was an independent negative prognostic factor for HCC. In addition, the area under the ROC curve was 0.782 with a sensitivity of 0.633 and a specificity of 0.833. Conclusions: Our results suggest that DGCR5 may be a participator in HCC and can serve as potential biomarker for the diagnosis and prognosis in HCC.

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Radioactive Iodine Therapy in Patients With Thyroid Carcinoma With Distant Metastases: A SEER-Based Study

Cancer Control ◽

10.1177/1073274820914661 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482091466

Author(s):

Chenyuan Li ◽

Qi Wu ◽

Shengrong Sun

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Pulmonary Metastasis ◽

Radioactive Iodine ◽

Follicular Carcinoma ◽

Distant Metastases ◽

Dominant Negative ◽

Grade Group ◽

Cancer Specific Survival ◽

Poor Grade

Distant metastasis (DM) is the dominant negative prognosis for thyroid carcinoma. Radioactive iodine (RAI) therapy serves as an effective treatment for thyroid carcinoma. However, resistance to RAI occurs in patients with DMs. The present study aims to discriminate patients who may benefit from RAI. We extracted patients with thyroid cancer in the Surveillance, Epidemiology, and End Results program and analyzed thyroid cancer–specific survival after radiotherapy based on age and grade subgroups. A total of 1608 patients having DMs were eligible, including 521 (32.4%) cases with bone metastasis, 90 (5.6%) cases with brain metastasis, 158 (9.8%) cases with liver metastasis, 995 (61.9%) cases with lung metastasis, and 50 (3.1%) cases with other metastases. Advanced age, poor differentiation, follicular carcinoma, lymphatic metastasis, tumor size >10 mm, and extracapsular invasion are associated with pulmonary metastases. With respect to patients with DM, RAI therapy improved the survival in the age <45 years group and the well-/moderately differentiated group. For patients with pulmonary metastasis, RAI improved the survival in the higher grade group but did not have a strong effect in the better grade group. Our data indicate that the disparity of metastatic sites has different risk factors. Similarly, this finding indicates that RAI should be precisely applied to patients who undergo DM but are young and have well-/moderately differentiated tumors and may improve survival in pulmonary metastasis patients with poor grade tumors.

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Two-Year Outcomes of Orbital Atherectomy Combined With Drug-Coated Balloon Angioplasty for Treatment of Heavily Calcified Femoropopliteal Lesions

Journal of Endovascular Therapy ◽

10.1177/1526602820915244 ◽

2020 ◽

Vol 27 (3) ◽

pp. 492-501 ◽

Cited By ~ 2

Author(s):

Damianos G. Kokkinidis ◽

Omar Jawaid ◽

David Cantu ◽

Brad J. Martinsen ◽

Zsuzsanna Igyarto ◽

...

Keyword(s):

Cox Regression ◽

De Novo ◽

Combined Therapy ◽

Statistical Significance ◽

Retrospective Chart Review ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Effective Combination ◽

Orbital Atherectomy ◽

Procedural Complications

Purpose: To examine whether the combination of orbital atherectomy (OA) and drug-coated balloons (DCB) can lead to superior procedural and 2-year outcomes compared with DCB only in heavily calcified femoropopliteal (FP) lesions. Materials and Methods: A retrospective chart review was conducted to identify patients treated with DCB only or OA+DCB for de novo FP lesions at a single center over a 4-year period (2014–2017). In the observation period, 113 patients met the inclusion criteria: 63 treated with DCB only (mean age 69.0±8.6 years; 62 men) vs 50 treated with OA+DCB (mean age 70.3±7.1 years; 48 men). The OA+DCB group had higher calcification rates (78% with severe calcification vs 37% in the DCB only group). Propensity score matching (PSM) was used to adjust for baseline differences between the 2 groups. Cox regression analysis was used to compare the follow-up outcomes between lesions treated with OA+DCB vs DCB only. Results: No difference in procedural complications or success was found. After PSM adjustment, the OA+DCB group was associated with lower bailout stenting rates (39.4% vs 66.7% in the DCB only group; p=0.026). The 2 groups had similar long-term outcomes, although the OA+DCB arm had a trend toward reduced TLR rates that did not reach statistical significance. The Kaplan-Meier estimates for 2-year freedom from TLR were 76.1% for the OA+DCB group vs 55.5% for the DCB only group (p=0.109). Conclusion: OA+DCB is a safe and effective combination for the treatment of calcified FP lesions. The combined therapy decreased the bailout stenting rates in the adjusted analysis. Larger cohorts and randomized trials are needed to examine OA efficacy in FP lesions.

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Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma

Journal of the American College of Surgeons ◽

10.1016/s1072-7515(03)00332-6 ◽

2003 ◽

Vol 197 (2) ◽

pp. 191-197 ◽

Cited By ~ 172

Author(s):

Margo Shoup ◽

Alexander Stojadinovic ◽

Aviram Nissan ◽

Ronald A Ghossein ◽

Sam Freedman ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Distant Metastases ◽

Differentiated Thyroid Carcinoma ◽

Prognostic Indicators

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Oncologic outcomes comparison of partial ureterectomy and radical nephroureterectomy for urothelial carcinoma

BMC Urology ◽

10.1186/s12894-019-0557-2 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Shengxian Li ◽

Yuchen Pan ◽

Jinghai Hu

Keyword(s):

Cox Regression ◽

Oncologic Outcomes ◽

Radical Nephroureterectomy ◽

Cancer Specific Survival ◽

Urothelial Carcinomas ◽

Kaplan Meier ◽

Significant Difference ◽

Function Preservation ◽

The Mean

Abstract Background The appropriate application of various treatment for upper tract urothelial carcinomas (UTUCs) is the key to prolong the survival of UTUC patients. Herein, we used data in our database to assess the oncological outcomes between partial ureterectomy (PU) and radical nephroureterectomy (RNU). Methods From 2007 to 2014, 255 patients with UTUC undergoing PU or RNU in our hospital database were investigated. Perioperative, postoperative data, and pathologic outcomes were obtained from our database. Cancer-specific survival (CSS) was assessed through the Kaplan-Meier method with Cox regression models to test the effect of these two surgery types. Results The mean length of follow-up was 35.8 months (interquartile range 10–47 months). Patients with high pT stage (pT2–4) suffered shorter survival span (HR: 9.370, 95% CI: 2.956–29.697, P < 0.001). There were no significant differences in CSS between PU and RNU (P = 0.964). In the sub-analysis, CSS for RNU and PU showed no significant difference for pTa–1 or pT2–4 tumor patients (P = 0.516, P = 0.475, respectively). Conclusions PU is not inferior to RNU in oncologic outcomes. Furthermore, PU is generally recognized with less invasive and better renal function preservation compared with RNU. Thus, PU would be rational for specific patients with UTUCs.

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De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase) as a Significant Prognostic Factor in Patients Undergoing Radical Cystectomy with Bladder Urothelial Carcinoma: A Propensity Score-Matched Study

Disease Markers ◽

10.1155/2019/6702964 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Hyeong Dong Yuk ◽

Chang Wook Jeong ◽

Cheol Kwak ◽

Hyeon Hoe Kim ◽

Ja Hyeon Ku

Keyword(s):

Prognostic Factor ◽

Propensity Score ◽

Radical Cystectomy ◽

Cox Regression ◽

Alanine Transaminase ◽

Significant Prognostic Factor ◽

Aspartate Transaminase ◽

Cancer Specific Survival ◽

T Stage ◽

Kaplan Meier

Introduction. To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase (AST)/alanine transaminase (ALT)) and postoperative outcome in patients with urothelial cell carcinoma (UC) treated with radical cystectomy. Materials and Methods. We analyzed the clinical and pathological data of 771 patients who underwent radical cystectomy for bladder UC. Patients were divided into two groups according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed using the Kaplan–Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In addition, propensity score matching of 1 : 1 was performed between the two groups. Results. Median follow-up was 84.0 (36–275) months. Mean age was 64.8±10.0 years. According to the receiver operating characteristic (ROC) analysis, the optimal threshold of the AST/ALT ratio was 1.1. In Kaplan–Meier analyses, the high AST/ALT group showed worse outcomes in CSS and OS (all P<0.001). Also, RFS (P=0.001) in the Cox regression models of clinical and pathological parameters was used to predict CSS, OS, and AST/ALT ratio (HR 2.15, 95% CI 1.23-3.73, P=0.007) and pathological T stage (HR 4.80, 95% CI 1.19-19.28, P=0.003). To predict OS and AST/ALT ratio (HR 2.05, 95% CI 1.65–2.56, P<0.001), pathological T stage (HR 2.96, 95% CI 0.57–17.09, P=0.037) and positive lymph node (HR 1.71, 95% CI 1.50–1.91, P=0.021) were determined as independent prognostic factors. Conclusion. Preoperative AST/ALT ratio could be an independent prognostic factor in patients with UC treated with radical cystectomy.

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