Changing concepts in the pathogenesis and management of thyroid carcinoma

Gagel, Robert F.; Goepfert, Helmuth; Callender, David L.

doi:10.3322/canjclin.46.5.261

Cited by 47 publications

(40 citation statements)

References 92 publications

(118 reference statements)

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“…Our series revealed that the majority of thyroid cancer patients, excluding those with distant metastases at diagnosis, developed recurrence within the first 5 yr of diagnosis. This finding is consistent with other series and emphasizes the need for frequent follow-up examinations regardless of low risk categories, especially during the first 5 yr after primary surgery (11,18). Despite being a relatively benign disease, a continual decline in both disease-free survival and cancer-specific survival is noted in all tumor stages at successive follow-up intervals.…”

Section: Discussionsupporting

confidence: 91%

Pathological Tumor-Node-Metastasis (pTNM) Staging for Papillary and Follicular Thyroid Carcinomas: A Retrospective Analysis of 700 Patients

Loh¹,

Greenspan²,

Gee³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

274

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The TNM classification (tumor-node-metastasis) was adopted by the American Joint Committee on Cancer and the International Union against Cancer a decade ago to avoid heterogeneity of prognostic classification schemes used for differentiated thyroid cancers. To date, however, clinical data based on this classification are lacking. We retrospectively evaluate the prognosis of 700 patients (208 men and 492 women) with papillary (89%) and follicular (11%) thyroid cancers according to the pathological TNM (pTNM) staging system, treated over a 25-yr period (1970 -1995). Patients who received primary treatment at our center constituted 87.4% of the cases; the majority underwent total thyroidectomy, followed by 131 I ablative therapy in high risk groups, as standard treatment. Clinical and follow-up data were obtained from the medical records and our cancer registry. Disease-free and cancer-specific survival data were analyzed by Kaplan-Meier product limit estimates and Cox proportional hazard models.Patient distribution by the pTNM system were: stage I, 516 patients; stage II, 57 patients; stage III, 104 patients; and stage IV, 23 patients. Over a mean Ϯ SE follow-up of 11.3 Ϯ 0.3 yr, the overall cancer recurrence and mortality rates were 20.5% and 8.4%, respectively. However, the respective cancer recurrence and mortality rates were distinctly different in the various pTNM stages: 15.4% and 1.7% in stage I, 22% and 15.8% in stage II, 46.4% and 30% in stage III, and 66.7% and 60.9% in stage IV tumors. Using actuarial survival plots, a clear separation in both disease-free survival and cancer-specific survival was noted among all the stages (P Ͻ 0.0001). Risk factors analyses showed a significant association between all the prognostic variables used in TNM staging (age, tumor size, extent of primary tumor, and presence of nodal or distant metastases) and the observed end points of recurrence or death from thyroid cancer. After correcting for TNM stages, the risk of cancer recurrence was halved in female compared to male patients, whereas this was 1.7-fold higher in multifocal than unifocal tumors. Conversely, cancer mortality was 3.4-fold higher in follicular than papillary thyroid cancer.In the analysis of effect of primary treatment among 492 patients with tumor more advanced than the T1N0M0 category, patients who underwent less extensive surgery (lobectomy or subtotal thyroidectomy) had a 2.5-fold risk of cancer recurrence (P Ͻ 0.0001) and a 2.2-fold risk of death (P Ͻ 0.01) compared to those who underwent total or near-total thyroidectomy. Patients not treated with 131 I ablation had a 2.1-fold greater risk of cancer recurrence (P Ͻ 0.0001) than those given 131 I ablation, although no difference was noted in deaths from thyroid cancer.Based on our data, the pTNM classification is useful in distinguishing patients with different prognostic outcomes. However, the small patient numbers in pTNM stages other than stage I precludes us from evaluating its usefulness as a guide for therapy. Until prospective data co...

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Section: Discussionsupporting

confidence: 91%

Pathological Tumor-Node-Metastasis (pTNM) Staging for Papillary and Follicular Thyroid Carcinomas: A Retrospective Analysis of 700 Patients

Loh¹,

Greenspan²,

Gee³

et al. 1997

The Journal of Clinical Endocrinology & Metabolism

274

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“…Essa análise pode permitir o diagnóstico e o tratamento do câncer da tireóide em fase precoce ou ainda antes de seu estabelecimento, com impacto significativo no controle do carcinoma medular da tireóide 2 . Embora o carcinoma bem diferenciado da tireóide tenha comportamento menos agressivo que o carcinoma medular da tireóide, em geral, os resultados de seu tratamento estão ainda relacionados à completa extirpação dessas lesões neoplásicas 11 . Desse modo, o diagnóstico precoce desses tumores também pode representar maior chance de cura.…”

Section: Discussionunclassified

“…O reconhecimento de fatores de risco para câncer da tireóide, como irradiação cervical prévia ou exposição ambientes com contaminação de material radioativo, permite maior atenção nesses indivíduos sob risco e definição de estratégi-as terapêuticas 11 . Há evidências de que fatores genéticos participam no desenvolvimento de doentes com carcinoma papilífero ou folicular da tireóide, como na polipose colônica familiar (síndrome de Gardner) e na Doença de Cowden.…”

Section: Discussionunclassified

“…Há evidências de que fatores genéticos participam no desenvolvimento de doentes com carcinoma papilífero ou folicular da tireóide, como na polipose colônica familiar (síndrome de Gardner) e na Doença de Cowden. O carcinoma papilífero também tem sido observado com freqüência mais alta em algumas famílias com câncer de mama, ovário, rim e sistema nervoso central, com possível relação genética 11 . Diferente do reconhecimento da alteração das paratireóides associada a carcinoma medular da tireóide na NEM tipo IIa, a ocorrência de carcinoma papilífero da tireóide em doentes com HPT ainda está mal compreendida.…”

Section: Discussionunclassified

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Associação de carcinoma papilífero da tireóide e hiperparatireoidismo

Montenegro

Smith

Castro

et al. 2005

Rev. Col. Bras. Cir.

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RESUMO: Objetivo: A ocorrência de carcinoma papilífero da tireóide (CPT) em doentes com hiperparatireoidismo (HPT) suscita dúvidas quanto a ser apenas coincidência ou apresentar relação causal. O objetivo deste trabalho é verificar se a incidência de CPT em diferentes formas de HPT é semelhante entre si e à incidência de CPT em achados de necropsias, assim como em doentes submetidos à tireoidectomia na mesma região. Método: Os dados de 222 pacientes consecutivos tratados por HPT foram revistos e foi analisada a incidência de CPT. Os pacientes foram estratificados em HPT primário (107) e HPT secundário (115). Os laudos anatomopatológicos foram revistos, a incidência de CPT foi pesquisada e suas características nesses indivíduos foram estudadas. Esses dados foram comparados a dados encontrados em casos de necrópsia e em 89 casos de bócio compressivo/mergulhante. Empregou-se o teste exato de Fisher e o teste t não pareado. Resultados: Os laudos foram passíveis de análise em 103 casos de HPT primário, com 10 pacientes com CPT (9,7%) e em 111 portadores de HPT secundário, com três CPT associados (2,7%). Houve diferença entre o HPT primário e HPT secundário (p=0,04). Essa diferença também foi significativa em relação aos 1% de CPT achados em necrópsia na região (p=0,0001). Não houve diferença com relação à incidência de 11,2% de CPT no grupo operado por compressão e também em relação às características dos tumores, apesar de haver 80% de multicentricidade no CPT de doentes com HPT primário. Conclusões: A ocorrência de CPT em HPT primário é maior que em HPT secundário e que em achados de necropsia (Rev. Col. Bras. Cir. 2005; 32(3): 115-119 A partir do relato de quatro casos de carcinoma papilífero da tireóide em doentes com HPT, a associação de neoplasia maligna diferenciada da tireóide tem gerado discussões quanto à sua incidência e mecanismo fisiopatológico nos portadores de HPT 3 . Essa associação varia em diferentes casuísticas entre nenhum caso até cerca de 10,7% de carcinoma bem diferenciado da tireóide em HPT, com média de 5,39% 4 . LiVolsi e Feind 5 acreditavam haver incidência aumentada de câncer da tireóide sem suspeita clínica em doentes com HPT, mas não conseguiam relacionar nenhuma explicação satisfatória para o fato. Lever et al. 6 , ainda que propensos a acreditarem numa correlação fortuita entre os dois problemas, tiveram o achado de carcinoma bem diferenciado da tireóide em 5,6% de seus casos de HPT. Essa incidência foi diferente, com significância estatística, daquela encontrada para o câncer da tireóide achado em necropsia na sua região. Em 1994, Fedorak et al. 7 , com 7% de carcinoma de tireóide não medular em pacientes com HPT, confirmaram a diferença em relação ao achado de necrópsia, mencionaram que os motivos para essa associação ainda eram obscuros e que maiores esclarecimentos eram necessários. Em 1997, entretanto, Burmeister et al. 8 analisaram doentes operados por HPT primário e doentes com HPT secundário/terciário e concluíram que dada a incidência semelhante de câncer da tireói...

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“…Although ten-year survival is more than 90%, according to some researchers, it is the worst prognostic factor, which decreases survival rate [1,2]. Nodal metastases in papillary thyroid cancer (PTC) are frequent (20-50%), and up to 15% of the patients who undergo total thyroidectomy will develop a nodal relapse [3].…”

Section: Introductionmentioning

confidence: 99%

Lymph node metastases in papillary thyroid cancer detected by quantitative real-time polymerase chain reaction for thyroglobulin and cytokeratine-19

Kaczka¹,

Fendler²,

Borowiec³

et al. 2013

pjp

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Papillary thyroid cancer (PTC) metastases in the lymph nodes (LNs) were detected by real-time polymerase chain reaction (PCR) for TG and cytokeratin 19 (CK19), and the obtained results were compared with histopathology. 107 LNs from 34 PTC patients were divided into four blocks by a special cutting device -2 for histopathology, while the other 2 were tested by quantitative real-time PCR. Metastases were detected in 20 nodes from 10 (29.4%) patients. TG and CK19 expression levels differed vastly between nodes with and without metastatic cells. ddCt of TG in the genetic material extracted from N0 nodes was 9.97 ±4.20, while in nodes with metastases ddCt was 0.91±4.20 (p < 0.0001). Cytokeratin 19 showed similar results with expression level (ddCt) in N0 nodes of 10.96 ±2.58 vs. 7.73 ±3.63 in nodes with metastases (p < 0.0001). Evaluation of the utility of both parameters showed efficient differentiation of node involvement in the case of TG, with area under the ROC curve (AUC) equal to 0.91 (95% CI: 0.85-0.96). Cytokeratin 19 also allowed for a degree of differentiation but its diagnostic efficacy was lower (AUC 0.76, 95% CI: 0.64-0.88). The combined TG and CK19 quantitative real-time PCR could be used to select a previously missed group of patients with nodal involvement undetectable by standard histopathology.

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Changing concepts in the pathogenesis and management of thyroid carcinoma

Cited by 47 publications

References 92 publications

Pathological Tumor-Node-Metastasis (pTNM) Staging for Papillary and Follicular Thyroid Carcinomas: A Retrospective Analysis of 700 Patients

Pathological Tumor-Node-Metastasis (pTNM) Staging for Papillary and Follicular Thyroid Carcinomas: A Retrospective Analysis of 700 Patients

Associação de carcinoma papilífero da tireóide e hiperparatireoidismo

Lymph node metastases in papillary thyroid cancer detected by quantitative real-time polymerase chain reaction for thyroglobulin and cytokeratine-19

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