Therapeutic Strategy in Low-Risk Papillary Thyroid Carcinoma – Long-Term Results of the First Single-Center Prospective Non-Randomized Trial Between 2011 and 2015

Optimal therapeutic strategy in low advanced papillary thyroid carcinoma (PTC) is still a matter of debate. The management differs depending on the country.A prospective non-randomized study was performed to evaluate whether less extensive surgery could be a safe, acceptable, and sufficient therapeutic option in PTC cT1N0M0 patients. The present paper summarizes the results of over a 5-year follow-upMaterialOur prospective group (PG) treated between 2011 and 2015 consisted of 139 patients with cT1aN0M0 PTC who underwent lobectomy (LT) as initial surgical treatment (PGcT1aN0M0 group) and 102 cT1bN0M0 patients in whom total thyroidectomy (TT) with unilateral central neck dissection (CND) was performed (PGcT1bN0M0). PG was compared with the retrospective group (RG) of patients who underwent TT with bilateral CND between 2004 and 2006: 103 cT1aN0M0 patients (RGcT1aN0M0) and 91cT1bN0M0 (RGcT1bN0M0). The risks of reoperation, cancer relapse and postoperative complications were analyzed.ResultsOnly 12 cT1aN0M0 patients (7.6%) withdrew from the trial and underwent TT with bilateral CND. Over 90% of patients accepted less extensive surgery. In 4 cT1aN0M0 cases, TT with CND was performed due to lymph node metastases found intraoperatively. The initial clinical stage according to the TNM/AJCC 7th edition was confirmed histologically in 77% of cases in PGT1aN0M0 and in 72% in PGT1bN0M0, respectively. 24 PGcT1aN0M0 patients were reoperated on. In this group, cancer lesions in the postoperative histological specimens were found in 8 cases (32%). Five-year disease-free survival (DFS) was excellent. However, no statistically significant differences were found between PG and RG groups (99.3% in PGcT1aN0M0 and 99.0%, in RGcT1aN0M0; p = 0.41 and 98%, in PGcT1bN0M0 and 94.4% in RGcT1bN0M0; p=0.19). No significant differences were observed in the incidence of early paresis of the recurrent laryngeal nerves between PG and RG. However, as predicted, LT completely eliminated the risk of postoperative hypoparathyroidism.SummaryThe results of the prospective clinical trial confirm that less extensive surgery in adequately selected low-advanced PTC patients is both safe and sufficient.

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Pin1 is related with clinical stage of papillary thyroid carcinoma

World Journal of Surgical Oncology ◽

10.1186/s12957-016-0847-z ◽

2016 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Lixin Jiang ◽

Haidi Chu ◽

Haitao Zheng

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Clinical Stage ◽

Papillary Thyroid

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Long-term Results of Observation vs Prophylactic Selective Level VI Neck Dissection for Papillary Thyroid Carcinoma at a Cancer Center

JAMA Otolaryngology–Head & Neck Surgery ◽

10.1001/jamaoto.2015.0786 ◽

2015 ◽

Vol 141 (7) ◽

pp. 599 ◽

Cited By ~ 43

Author(s):

André Ywata de Carvalho ◽

Thiago C. Chulam ◽

Luiz P. Kowalski

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Neck Dissection ◽

Long Term Results ◽

Cancer Center ◽

Papillary Thyroid

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A meta-analysis of prognostic roles of molecular markers in papillary thyroid carcinoma

Endocrine Connections ◽

10.1530/ec-17-0010 ◽

2017 ◽

Vol 6 (3) ◽

pp. R8-R17 ◽

Cited By ~ 35

Author(s):

Huy Gia Vuong ◽

Uyen N P Duong ◽

Ahmed M A Altibi ◽

Hanh T T Ngo ◽

Thong Quang Pham ◽

...

Keyword(s):

Molecular Markers ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Random Effect ◽

Random Effect Model ◽

Disease Free Survival ◽

Papillary Thyroid ◽

Promoter Mutation ◽

Meta Analyses ◽

The Impact

The prognostic role of molecular markers in papillary thyroid carcinoma (PTC) is a matter of ongoing debate. The aim of our study is to investigate the impact of RAS, BRAF, TERT promoter mutations and RET/PTC rearrangements on the prognosis of PTC patients. We performed a search in four electronic databases: PubMed, Scopus, Web of Science and Virtual Health Library (VHL). Data of hazard ratio (HR) and its 95% confidence interval (CI) for disease-specific survival (DSS) and disease-free survival (DFS) were directly obtained from original papers or indirectly estimated from Kaplan–Meier curve (KMC). Pooled HRs were calculated using random-effect model weighted by inverse variance method. Publication bias was assessed by using Egger’s regression test and visual inspection of funnel plots. From 2630 studies, we finally included 35 studies with 17,732 patients for meta-analyses. TERT promoter mutation was significantly associated with unfavorable DSS (HR = 7.64; 95% CI = 4.00–14.61) and DFS (HR = 2.98; 95% CI = 2.27–3.92). BRAF mutations significantly increased the risk for recurrence (HR = 1.63; 95% CI = 1.27–2.10) but not for cancer mortality (HR = 1.41; 95% CI = 0.90–2.23). In subgroup analyses, BRAF mutation only showed its prognostic value in short-/medium-term follow-up. Data regarding RAS mutations and RET/PTC fusions were insufficient for meta-analyses. TERT promoter mutation can be used as an independent and reliable marker for risk stratification and predicting patient’s outcomes. The use of BRAF mutation to assess patient prognosis should be carefully considered.

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Isthmusectomy for well-differentiated thyroid carcinoma located to the isthmus: A report of two cases and review of the literature

Medwave ◽

10.5867/medwave.2021.10.8493 ◽

2021 ◽

Vol 21 (10) ◽

pp. e8493-e8493

Author(s):

Roberto Ignacio Olmos Borzone ◽

Jorge Andrés López Ruiz-Esquide ◽

Francisco Domínguez Covarrubias ◽

José Miguel Domínguez Ruiz-Tagle

Keyword(s):

Lymph Node ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Therapeutic Option ◽

Lymph Node Involvement ◽

Differentiated Thyroid Carcinoma ◽

Papillary Thyroid ◽

Node Involvement ◽

Well Differentiated ◽

Prophylactic Lymph Node Dissection

Papillary thyroid cancer is the most common endocrine malignancy, and due to its favorable prognosis, the extent of surgery has been a matter of debate. About 10% of these tumors are located in the thyroid isthmus, with no specific management in current guidelines. In the last decades, isthmusectomy has been proposed as a therapeutic option for isthmic papillary thyroid carcinoma, although there is no consensus on its management. We present two cases of patients from our institution with solitary isthmic papillary thyroid carcinoma without clinical macroscopic extrathyroidal extension or clinical-radiological lymph node involvement who were treated with isthmusectomy without prophylactic lymph node dissection. Neither of them had any postoperative complications. Both had an intermediate risk of recurrence due to aggressive variants. None of them had signs of recurrence during follow-up. We intend to show that isthmusectomy seems to be an effective and safe surgical alternative in selected patients through these cases.

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Is Completion Thyroidectomy Necessary in Patients with Papillary Thyroid Carcinoma who Underwent Lobectomy?

Korean Society for Head and Neck Oncology ◽

10.21593/kjhno/2021.37.2.25 ◽

2021 ◽

Vol 37 (2) ◽

pp. 25-31

Author(s):

Il Ku Kang ◽

Kwangsoon Kim ◽

Ja Seong Bae ◽

Jeong Soo Kim

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Lymph Nodes ◽

Disease Free Survival ◽

Completion Thyroidectomy ◽

Papillary Thyroid ◽

Free Survival ◽

Disease Free ◽

Positive Lymph Nodes

Background/Objectives: Although thyroid lobectomy recently is considered as sufficient for low-risk papillary thyroid carcinoma (PTC), completion thyroidectomy is required due to the insufficiency of the preoperative evaluation. The aim of this study was to investigate recurrence rate and disease free survival depending on the gross extrathyroidal extension (gETE) or the number of metastatic lymph node identified in patients with PTC.Materials & Methods: We assessed 3373 patients with PTC who underwent lobectomy at Seoul St. Mary’s Hospital (Seoul, Korea) between January 2009 and December 2014. Clinicopathological characteristics and long-term surgical outcomes were retrospectively analyzed through complete chart reviews. The mean follow-up duration was 97.1 ± 21.4 months.Results: The rate of recurrence was higher in gETE group (1.8% vs. 6.0%, p=0.004), leading to decreased disease free survival in Kaplan-Meier analysis (log-rank p<0.001). N1 group (n=1389) was analyzed into two groups whether the number of positive nodes is more than 5 or less. For the group of the more metastatic nodes, the recurrence rate higher compared to the other group (3.0% vs. 9.3%, p<0.001). DFS was longer in the group that had lesser metastatic nodes (log-rank p<0.001). However, in terms of N1 group over 1cm (n=492), No statistical difference was observed according to the number of positive lymph nodes (4.5% vs. 9.1%, p=0.092)Conclusion: When it comes to node positive PTC, Despite the number of positive lymph nodes was over 5, follow-up with no further surgery can be an option.

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BRAF V600E mutation in papillary thyroid carcinoma: it’s relation to clinical features and oncologic outcomes in a single cancer centre experience

Endocrine Connections ◽

10.1530/ec-21-0410 ◽

2021 ◽

Author(s):

Mahmoud Al-Masri ◽

Tawfiq Al-Shobaki ◽

Hani Al-Najjar ◽

Rafal Iskanderian ◽

Enas Younis ◽

...

Keyword(s):

Overall Survival ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Disease Free Survival ◽

Braf V600e Mutation ◽

Braf V600e ◽

Cancer Center ◽

Papillary Thyroid ◽

Free Survival ◽

Disease Free

Purpose: This study focuses on the oncologic influence of BRAF V600E mutations in a cohort of Middle Eastern PTC patients treated at a single centre. We test the association of BRAFV600E mutation with papillary thyroid carcinoma at King Hussein Cancer Center. Methods: Patients with histologically confirmed PTC who underwent surgical treatment between 2006 and 2015 were included in this study. Oncological outcomes, both short and long termed were collected. Results: A total of 128 patients (68% females) were included in this study with a mean age of 38 years (±13.8). The median follow-up period was 50 months. The BRAF V600E mutation was found in 71% of patients. The tumor size for patients with a negative BRAF V600E mutation were significantly larger in comparison to patients who tested positive for the mutation (3.47 cm versus 2.31 cm, respectively, P = 0.009). The two groups showed similar disease-free survival (DFS) rates; positive = 75% (median 43 months (0-168)) compared to 78% for the negative BRAF V600E mutation (median 38 months (3-142)) (P= 0.162, HR=0.731) Furthermore, both groups showed similar overall survival rates: positive = 94.5% (median 56 months (0-228)) compared to 94.6% for the negative BRAF V600E mutation (median 43 months (3-157)) (P = 0.941, HR= 0.940). Conclusion: BRAF V600E mutation had no effect on loco-regional recurrence, distant metastasis, overall survival or disease-free survival. These findings may be attributed to geographic variations or reflect that BRAF V600E may only serve as an indicator of poor prognosis in high risk groups.

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Clinical outcomes of low-dose and high-dose postoperative radioiodine therapy in intermediate-risk papillary thyroid carcinoma patients with low postoperative stimulated thyroglobulin (1-20 ng/ml) and non-structural or functional metastasis: study protocol for a randomized-controlled trial

10.21203/rs.3.rs-59344/v1 ◽

2021 ◽

Author(s):

Pan Chen ◽

Jia-Xin Luo ◽

Wei Ouyang ◽

Hui-Juan Feng ◽

Ju-Qing Wu ◽

...

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Dose Group ◽

Low Dose ◽

Disease Free Survival ◽

High Dose Group ◽

High Dose ◽

Intermediate Risk ◽

Papillary Thyroid ◽

Free Survival

Abstract Background: For some intermediate risk papillary thyroid carcinoma patients, if there are structural metastases, reoperation is preferred. If there are functional metastases (131I avidity), they can be treated with high-dose radioactive iodine (131I). However, it is still controversial whether 131I ablation should be used and the determination of 131I dosage for another part of intermediate risk patients with non-structural or functional metastases, especially those with postoperative stimulated thyroglobulin (ps-Tg) 1-20 ng/ml. The aim of the present study is mainly to compare the 3-years disease-free survival between low-dose group (1.1 GBq) and high-dose group (3.7 GBq) in intermediate risk papillary thyroid carcinoma patients with non-structural or functional metastases and ps-Tg 1-20 ng/ml.Methods: A single-center, randomized, double-blind parallel controlled study is designed at the Zhujiang Hospital of Southern Medical University. Participants will be randomized to low-dose group (1.1 GBq) or high-dose group (3.7 GBq) in a 1:1 ratio. After orally receiving different dosage of 131I once on an empty stomach, all patients will return to our hospital every 3-12 months to be performed related inspection items. Discussion: We believe that the 3-year disease-free survival of low-dose group (1.1 GBq) may not be lower than that of high-dose group (3.7 GBq) in intermediate-risk thyroid papillary carcinoma patients with no structural or functional metastases and ps-Tg 1-20 ng/ml. Besides we expect to clarify whether there are apparent differences in successful remnant ablation, efficacy, progression-free survival, safety, and health economics evaluation between the two groups.Trial registration: ClinicalTrials.gov (https://clinicaltrials.gov/), ID: NCT04354324. Registered on 16 April, 2020.

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TERT Genetic Polymorphism rs2736100 Was Associated With Papillary Thyroid Carcinoma Aggressive Manifestation

10.21203/rs.3.rs-904123/v1 ◽

2021 ◽

Author(s):

Xilin Nie ◽

Jinbiao Shang ◽

Wendong Wang

Keyword(s):

Genetic Polymorphism ◽

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Cox Regression ◽

Cell Transformation ◽

Disease Free Survival ◽

Clinicopathological Characteristics ◽

Papillary Thyroid ◽

Lateral Lymph Node ◽

Tumor Spread

Abstract Background: The TERT rs2736100 genetic polymorphism was commonly found in human malignancies, indicated its key role in cancer cell transformation. The aim of this study was to investigate the effects of the functional TERT rs2736100 genetic polymorphism in papillary thyroid carcinoma (PTC) patients` outcomes.Methods: We had performed a retrospective study of the relationship betweenrs2736100and clinicopathological outcomes of PTC in 500 patients (378 female and 122 male) aged 43.8±11.4 years (rang 15-74 years) with median follow-up of 60 months (range, 1 to 455 months). Results: The TERT rs2736100 genetic polymorphism (TG/GG versus TT) were significantly associated with several high risk clinicopathological features such as tumor spread, extra-thyroidal extension, central/lateral lymph node metastases, stage T III or IV disease. However, in the Kaplan-Meier survival analyses, the rs2736100 mutation was unrelated to the overall disease-free survival with a log-rank p>0.05. In the Cox-regression analyses, the overall survival rate of recurrence/neo-metastasis was related with lager size of tumor, younger age and tumor spread, but unrelated with rs2736100 mutation. Conclusion: The TERT rs2736100 genetic polymorphism positive was more likely to manifest with aggressive clinicopathological characteristics but cannot worse prognosis much in PTC.

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