scholarly journals Extranodal Extension Is an Independent Prognostic Factor in Papillary Thyroid Cancer: A Propensity Score Matching Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Tian-han Zhou ◽  
Bei Lin ◽  
Fan Wu ◽  
Kai-ning Lu ◽  
Lin-lin Mao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Prognostic Factor ◽  
Propensity Score ◽  
Tumor Size ◽  
Cox Regression ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid ◽  
Extranodal Extension ◽  
Independent Risk Factors

PurposeTo investigate the prognostic significance of extranodal extension (ENE) in papillary thyroid cancer (PTC).MethodsSeven hundred forty-three PTC patients were enrolled in the study from January 2014 to December 2017. The patients were dichotomized according to the presence of ENE. Logistic analysis was used to compare differences between the two groups. Kaplan–Meier (K-M) curve and propensity score matching (PSM) analyses were used for recurrence-free survival (RFS) comparisons. Cox regression was performed to analyze the effects of ENE on RFS in PTC.ResultsThirty-four patients (4.58%) had ENE. Univariate analysis showed that age, tumor size, extrathyroidal extension, and nodal stage were associated with ENE. Further logistic regression analysis showed that age, extrathyroidal extension, and nodal stage remained statistically significant. Evaluation of K-M curves showed a statistically significant difference between the two groups before and after PSM. Cox regression showed that tumor size and ENE were independent risk factors for RFS.ConclusionsAge ≥55 years, extrathyroidal extension, and lateral cervical lymph node metastasis were identified as independent risk factors for ENE. ENE is an independent prognostic factor in PTC.

scholarly journals Risk Factors for Recurrent Papillary Thyroid Carcinoma

2018 ◽  
Vol 32 (2) ◽  
pp. 25-29
Author(s):  
Jonel Donn Leo S. Gloria ◽  
Alfredo Quintin Y. Pontejos ◽  
Precious Eunice R. Grullo
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Papillary Thyroid Cancer ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid ◽  
Clinicopathologic Factor

Objective:  To identify risk factors associated with disease recurrence among Filipinos with papillary thyroid carcinoma (PTC). Methods: Design:           Retrospective cohort study Setting:           Tertiary National University Hospital Participants: 76 patients diagnosed with papillary thyroid carcinoma, classified as low and low-to-intermediate risk (2015 ATA classification) that underwent total thyroidectomy with or without neck dissection from 2010-2014 and were followed up from 10 months to 5 years. Log rank and Cox regression analyses were used to determine significant risk factors for recurrence. Results:  29 (38.15%) had recurrence.  On univariate analysis, age, tumor size, multifocality, extrathyroidal extension, presence of lateral neck nodes and RAI therapy were statistically associated with recurrence.  However, on multivariate analysis, no clinicopathologic factor was statistically associated with recurrence. Conclusion: Age of >45 years, female sex, tumor size of >2 cm, multifocality, presence of microscopic extrathyroidal extension, and lymph node metastasis might contribute to the recurrence of papillary thyroid cancer while post-operative radioactive ablation may have some protective effect.  However, this study suggests that other factors must be included in the model to better understand the relationship between these factors and recurrence.   Keywords: papillary thyroid cancer, thyroid neoplasm, recurrence

scholarly journals Nomogram-Based New Recurrence Predicting System in Early-Stage Papillary Thyroid Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yongfeng Ding ◽  
Zhuochao Mao ◽  
Jiaying Ruan ◽  
Xingyun Su ◽  
Linrong Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Cox Regression ◽  
Early Stage ◽  
Cox Model ◽  
Staging System ◽  
Papillary Thyroid ◽  
Cox Regression Analysis ◽  
Ajcc Staging

Background and Objectives. The clinicopathological risk factors to predict recurrence of papillary thyroid cancer (PTC) patients remain controversial. Methods. PTC patients treated with thyroidectomy between January 1997 and December 2011 at the First Affiliated Hospital of Zhejiang University (Zhejiang cohort) were included. Multivariate Cox regression analysis was conducted to identify independent recurrence predictors. Then, the nomogram model for predicting probability of recurrence was built. Results. According to Zhejiang cohort (N = 1,697), we found that the 10-year event-free survival (EFS) rates of PTC patients with early-stage (TNM stages I, II, and III) were not well discriminated (91.6%, 89.0%, and 90.7%; P=0.768). The multivariate Cox model identified age, bilaterality, tumor size, and nodal status as independent risk factors for tumor recurrence in PTC patients with TNM stages I–III. We then developed a nomogram with the C-index 0.70 (95% CI, 0.64 to 0.76), which was significantly higher (P<0.0001) than the AJCC staging system (0.52). In the validation group, the C-index remained at a similar level. Conclusions. In this study, we build up a new recurrence predicting system and establish a nomogram for early-stage PTC patients. This prognostic model may better predict individualized outcomes and conduct personalized treatments.

scholarly journals Preoperative Factors Associated with Extrathyroidal Extension in Papillary Thyroid Cancer

2020 ◽  
Vol 9 (5) ◽  
pp. 256-262 ◽  
Author(s):  
Chi-Yu Kuo ◽  
Po-Sheng Yang ◽  
Ming-Nan Chien ◽  
Shih-Ping Cheng
Keyword(s):  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Tumor Size ◽  
Braf Mutation ◽  
Extrathyroidal Extension ◽  
Additive Models ◽  
Braf V600e ◽  
Papillary Thyroid ◽  
Factors Associated ◽  
Preoperative Factors

Objective: Extrathyroidal extension may not be accurately recognized during thyroidectomy and can increase the risk of positive margins and even recurrence. This study aimed to investigate the preoperative factors associated with extrathyroidal extension. Methods: We analyzed 887 patients with papillary thyroid cancer (PTC) who underwent surgery in the period of 2005–2017. Binary logistic regression analyses and generalized additive models were used to identify associations. Results: Minimal extrathyroidal extension was present in 233 (26%) patients and advanced extrathyroidal extension was found in 60 (7%) patients. Age, BMI, and tumor size were independent predictors of all or advanced extrathyroidal extension. Among the 493 patients whose BRAF mutation status was available, age (OR = 1.025), BMI (OR = 1.091), tumor size (OR = 1.544), and BRAF V600E mutation (OR = 2.311) were independently associated with extrathyroidal extension. Conclusions: Older age, a greater BMI, a larger tumor size, and presence of the BRAF mutation were predictive of extrathyroidal extension. These factors should be taken into consideration in decision-making before surgery is performed.

scholarly journals Risk Factors for Cervical Lymph Node Metastasis of Papillary Thyroid Microcarcinoma: A Single-Center Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Feng Cheng ◽  
Yanyan Chen ◽  
Lei Zhu ◽  
Bin Zhou ◽  
Yonghong Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Multivariate Logistic Regression Analysis ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Node Metastasis ◽  
Thyroid Microcarcinoma ◽  
Independent Risk Factors

Objective. To identify the clinicopathological features correlated to lymph node metastasis (LNM) in patients with papillary thyroid microcarcinoma (PTMC). Methods. Clinical data of 785 PTMC patients who underwent surgical treatment at the Lishui Municipal Central Hospital from September 2008 to December 2017 were retrospectively analyzed. Clinical and pathological risk factors for lymph node metastasis (LNM), central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) were analyzed. Results. LNM was found in 236 (30.2%) patients. Multivariate logistic regression analysis revealed that in PTMC, male gender, age<55 years, tumor size>5 mm, bilateral lesions, and extrathyroidal extension were independent risk factors for LNM in general and for CLNM. For LLNM, tumor size>5 mm, multifocal lesions, and extrathyroidal extension were independent risk factors. Conclusions. Identification of risk factors for cervical LNM could assist individualization of clinical management for PTMC.

scholarly journals Prognostic Significance of Preoperative Serum Uric Acid-to-Lymphocyte Ratio in Hepatocellular Carcinoma Patients Undergoing Postoperative Transarterial Chemoembolization: A Propensity Score-Matching Study

2020 ◽  
Author(s):  
Shan-shan Hu ◽  
Li-heng Liu ◽  
Li-ping Tang
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Uric Acid ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Tumor Size ◽  
Lymphocyte Ratio ◽  
Low Level ◽  
Liver Cancers ◽  
Independent Risk Factors

Abstract BackgroundHepatocellular carcinoma (HCC) accounts for 85%–90% of primary liver cancers and is the seventh most common cancer worldwide. The purpose of this study is to determine an innovative and effective clinical index for prognosis prediction in HCC patients. MethodsA total of 132 patients with HCC were included in this research. A cohort of 72 cases was obtained through propensity score-matching. Patients were divided into high- and low-level groups based on the ratio of preoperative uric acid levels to lymphocytes. The differences in clinical characteristics and survival indicators were compared between the two groups.ResultsThere was a statistical difference between uric acid-to-lymphocyte ratio (ULR) level and tumor size (P < 0.01). Multivariate analysis showed that ULR (P = 0.03) and tumor size (P = 0.03) were independent risk factors for overall survival (OS). ULR (P < 0.04) and diabetes (P = 0.04) were independent risk factors for progression-free survival (PFS) in HCC patients. Further survival analysis of the entire cohort and propensity score-matching cohort showed that the OS and PFS in the high-level ULR group were significantly shorter than those in the low-level ULR group (log-rank P < 0.001). Conclusion This study demonstrated that ULR is a marker of poor prognosis in postoperative HCC patients, while high ULR levels predicted shorter OS and PFS.

scholarly journals Risk Factors for Tumor Size Increase During Active Surveillance of Papillary Thyroid Cancer: Meta-Analysis and Systematic Review

2021 ◽  
Vol 64 (12) ◽  
pp. 914-921
Author(s):  
Doh Young Lee ◽  
Pilkeun Jang
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Thyroid Cancer ◽  
Papillary Thyroid Cancer ◽  
Active Surveillance ◽  
Tumor Size ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Size Increase ◽  
Papillary Thyroid

Background and Objectives The purpose of this study was to systematically review literatures on active surveillance for low-risk differentiated thyroid cancer, and to evaluate risk factors for tumor size increase during active surveillance.Subjects and Method We conducted a systematic review and a meta-analysis of studies reporting on tumor growth during active surveillance of papillary thyroid cancer. Using the MEDLINE and EMBASE databases, we searched studies published from the inception of database to December 2020. Studies were included if reported on at least one clinical risk parameter in addition to reporting on the change in tumor size during active surveillance.Results Out of 33 studies screened, seven were included in the meta-analysis. The odds ratio of a temporal size increase of more than 3 mm in papillary thyroid cancer was 0.011 person-years (95% confidence interval [CI]: 0.009 to 0.013). The odds ratio of lymph node metastasis was 0.002 person-years (95% CI: 0.001 to 0.003). Younger age was a significant risk factor for tumor growth during active surveillance, with a standardized median difference of -0.63 (95% CI: -1.00 to -0.27). In the three studies that evaluated the association of thyroid-stimulating hormone levels and tumor size, the results were contradictory.Conclusion Active surveillance may be used more cautiously for younger patients.

scholarly journals Sex Disparities in Thyroid Cancer: A SEER Population Study

2021 ◽  
Author(s):  
Peng Li ◽  
Ying Ding ◽  
Mengyuan Liu ◽  
Wenlong Wang ◽  
Xinying Li
Keyword(s):  
Thyroid Cancer ◽  
Prognostic Factor ◽  
Propensity Score ◽  
Cancer Patients ◽  
Tumor Size ◽  
Median Income ◽  
Male And Female ◽  
Kaplan Meier ◽  
Sex Disparities ◽  
Male Patients

Abstract Background: The incidence and mortality of thyroid cancer vary according to race and sex. Male and female thyroid cancer patients are also given differences in some clinical characteristics, such as tumor size and distant metastasis. However, whether there are sex differences in the prognosis of thyroid cancer remains controversial. Therefore, the present study is intended to explore the relationship between sex and prognosis of patients with thyroid cancer and to provide guidelines for the treatment and management of thyroid cancer patients.Methods: A retrospective analysis of patients with pathologically proven thyroid cancer from the Surveillance, Epidemiology and End Results database. The sex disparities in the prognosis of different cohorts derived by propensity score matching was investigated using Cox proportional hazards models and Kaplan–Meier functions. Results: Among 41,270 female and 13,188 male with thyroid cancer, sex was an independent prognostic factor for overall (OS) and cancer-specific (CSS) survival (HR=1.632, 95%CI=1.499-1.777, P<0.001; HR= 1.473, 95% CI= 1.245-1.741, P<0.001). Male developed a larger tumor size (17.44 vs. 23.51cm) and had a larger proportion of metastasis (lymph nodes: 33.2 vs. 21.0%; distant: 2.3 vs. 0.9%), through female had a higher incidence and were diagnosed with thyroid cancer at an earlier age (47.98 vs. 52.45 years old). Survival month of male patients was significantly lower than that of female patients (72.39 vs. 76.8 months). In Kaplan-Meier analyses of cohorts derived by propensity score matching, OS and CSS declined more sharply for male (P<0.01). The mean number (2.0 vs 4.0) and mean ratio (0.192 vs 0.297) of positive nodes supported that male patients have a worse prognosis. Factors including race, age, surgery, histology recode, T, N, M stage and combined summary stage affected the CSS of male and female, plus median income had an extra impact in male (≥$55000 versus <$55,000: HR= 0.739, 95% CI= 0.574-0.953, P= 0.020).Conclusion: Thyroid cancer is a tumor with a female prevalence but a male bias in poor prognosis. Sex was an independent prognostic factor for OS and CSS. Other factors including race, age, income, histological type, surgery, T, N, M stage influenced OS of male and female with thyroid cancer. But race had no impact on CSS of thyroid cancer patients and median income only affected male CSS.

scholarly journals Clinicopathological and Ultrasound Features as Risk Stratification Predictors of Clinical and Pathological Nodal Status in Papillary Thyroid Carcinoma: A Study of 748 Patients

2021 ◽  
Author(s):  
Cui ZHANG ◽  
Baojun LI ◽  
LEI ZHANG ◽  
Fengjiao CHEN ◽  
Yanhua ZHANG ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Papillary Thyroid Carcinoma ◽  
Tumor Size ◽  
Primary Tumor ◽  
Intermediate Risk ◽  
Papillary Thyroid ◽  
Primary Tumor Size ◽  
Independent Risk Factors ◽  
Ultrasound Features

Abstract Background: Papillary thyroid carcinoma (PTC) is the most common histological type of thyroid malignancy that tends to metastasize to cervical lymph nodes. In the present study, we aimed to investigate which clinicopathologic and ultrasound features of PTC are associated with clinical lymph node metastasis (LNM) and numbers of pathological LNM.Methods: From January 2016 to December 2018, we identified a cohort of patients with PTC who underwent cervical ultrasonography and were diagnosed through operation and pathology. Clinical N1(cN1) and >5 pathologic N1(pN1) was performed in accordance with a standardized protocol. A model to determine the intermediate risk stratification of the 2015 ATA was established using the outcomes of univariate and multivariate analyses. Results: we collected 748 PTC patients in the final inclusion criteria. From the analyses, primary tumor size >21mm, capsule contact, extrathyroidal extensions (ETE), postsurgical radioiodine (RAI) treatment and central LNM remained independent risk factors for cN1 in PTC patients. Multifocality, primary tumor size >21mm, capsule contact, ETE and RAI treatment are significant independent risk factors for >5 pN1. Primary tumor size >21mm, capsule contact, ETE and RAI treatment were independent risk factors for both cN1 and >5 pN1.Conclusions: We conclude that primary tumor size >21mm, capsule contact, ETE and RAI treatment were independent predictors of for intermediate risk of recurrence in patients with PTC. Ultrasonography is a good technique for the preoperative lymph node staging of PTC and is helpful for detecting LNM.

scholarly journals Extent of Surgery and the Prognosis of Unilateral Papillary Thyroid Microcarcinoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Hengqiang Zhao ◽  
Le Cui
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Extrathyroidal Extension ◽  
Papillary Thyroid Microcarcinoma ◽  
Papillary Thyroid ◽  
Thyroid Microcarcinoma ◽  
Kaplan Meier ◽  
Extent Of Surgery

It remains controversial whether patients with papillary thyroid microcarcinoma (PTMC) benefit from total thyroidectomy (TT) or thyroid lobectomy (TL). We aimed to investigate the impact of extent of surgery on the prognosis of patients with unilateral PTMC. Patients were obtained from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. Cancer-specific survival (CSS) and overall survival (OS) were evaluated by Cox regression and Kaplan–Meier curves with propensity score matching. Of 31167 PTMC patients enrolled, 22.2% and 77.8% of which underwent TL and TT, respectively. Patients with TT were more likely to be younger, females, present tumors of multifocality, extrathyroidal extension, cervical lymph node metastasis (CLNM), distant metastasis, and receive radioactive iodine (RAI) compared with those receiving TL. The multivariate Cox regression model showed that TT was not associated with an improved CSS and OS compared with TL with hazard ratio (HR) and 95% confidence interval (CI) of 0.53 (0.25-1.12) and 0.86 (0.72-1.04), respectively. In addition, the Kaplan–Meier curves further confirmed the similar survival between TL and TT after propensity score matching. The subgroup analysis showed that TT was associated with better CSS for patients &lt; 55 years, those with tumors of gross extrathyroidal extension, CLNM (N1b), and cases not receiving RAI with HR 95% CI of 0.13 (0.02-0.81), 0.12 (0.02-0.66), 0.11 (0.02-0.64) and 0.36 (0.13-0.90), respectively. TT predicted a trend of better OS for patients with N1b and distant metastasis after adjustment. In addition, TT was associated with better CSS than TL for patients with risk factors like N1b combined with gross extrathyroidal extension, and/or multifocality after matching. In conclusion, TL may be enough for low-risk PTMC patients. TT may improve the prognosis of unilateral PTMC patients with 2 or more risk clinicopathologic factors like CLNM, multifocality, extrathyroidal extension and a younger age compared with TL.

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