Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

Yamazaki, Haruhiko; Sugino, Kiminori; Noh, Jaeduk Yoshimura; Katoh, Ryohei; Matsuzu, Kenichi; Masaki, Chie; Akaishi, Junko; Hames, Kiyomi Yamada; Tomoda, Chisato; Suzuki, Akifumi; Ohkuwa, Keiko; Kitagawa, Wataru; Nagahama, Mitsuji; Rino, Yasushi; Ito, Koichi

doi:10.1007/s12020-021-02969-7

Cited by 8 publications

(21 citation statements)

References 26 publications

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“…The results of our study agree with the few available in the literature, all coming from non-European Centers [ 7 , 8 , 9 , 10 , 11 ], and here reviewed, confirming that the vast majority of patients with known biochemical or structural persistence of disease at the time of conception remain stable or slowly progresses during pregnancy.…”

Section: Discussionsupporting

confidence: 91%

“…The complete TNM assessment was performed in three out of five post-surgery studies [ 8 , 11 ], and only three out of five studies assessed ATA risk for patients [ 9 , 10 ], including the present one. The DRS, which evaluates the response to therapy after initial treatments, was evaluated only in the large American series [ 9 ] and in the present study.…”

Section: Resultsmentioning

confidence: 99%

“…Among the available studies, biochemical or structural progression after pregnancy ranged from 0 to 15% and from 8 to 31%, respectively. The mean follow-up was not reported in 2 studies [ 8 , 9 ] and was of few months in 2 additional studies [ 7 , 10 ], while long follow-ups are available only for the Yamazaki’s series (131 months) [ 11 ] and for the present study (97 ± 79.4).…”

Section: Resultsmentioning

confidence: 99%

“…By contrast, for women with biochemical or structural persistence, the available studies are more limited, and the data are controversial. To date, only five studies have been reported on this topic, and the results indicate that pregnancy can occasionally be associated with a slight increase in already existing metastatic lesions, though without a significant impact on progression and mortality risk [ 7 , 8 , 9 , 10 , 11 ]. The study, including the largest series of persistent patients, showed that none of the patients with an excellent, indeterminate, or biochemical incomplete response to therapy prior to pregnancy developed structural persistence during pregnancy or postpartum, while women with structural disease persistence before pregnancy were more likely to have structural disease progression (16%), 8% of them requiring additional therapy [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Persistent Thyroid Carcinoma and Pregnancy: Outcomes in an Italian Series and Review of the Literature

Colombo

Leo

Giancola

et al. 2022

Cancers

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Scanty data are available on the progression risk in patients with persistent thyroid cancer (TC) before pregnancy. We aimed to evaluate this topic in our series and to review available literature data. This was a retrospective study performed in a tertiary care Italian TC center. We included 8 patients with persistent papillary TC who became pregnant after initial treatments (mean time interval of 62 months). Seven patients had the structural disease (lung and/or neck node metastases), while one patient had biochemical persistence. During a mean follow-up of 97 months, none of the patients showed disease progression either during pregnancy or during a follow-up of at least 12 months after delivery, and no additional treatments were needed. A sequential biochemical evaluation showed that thyroglobulin levels can significantly increase during pregnancy, returning to preconception levels after delivery. In conclusion, our data confirm that pregnancy is not associated with disease progression in patients with stable local and/or distant persistence before conception. Thus, pregnancy should not be contraindicated in metastatic women, although a precise clinical characterization, including the disease stage at diagnosis, the ATA risk class, and the dynamic risk stratification, should be conducted before conception.

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Persistent Thyroid Carcinoma and Pregnancy: Outcomes in an Italian Series and Review of the Literature

Colombo

Leo

Giancola

et al. 2022

Cancers

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“…Structural recurrence/progression was defined as appearance of new local/metastasis lesions, or 20% or more increase in size of a pre-pregnancy lesion 12,13 . Biochemical recurrence/progression was defined as 20% or more increase in serum thyroglobulin (Tg) from the pre-pregnancy level and/or consistent increase of 20% or more in serum anti-Tg antibodies 10,12 .…”

Section: Definitions Of Recurrence Risk Stratification and Response T...mentioning

confidence: 99%

Pregnancy and the prognosis of patients previously treated for differentiated thyroid cancer: a systematic review and meta-analysis

Shan

Xiao

et al. 2023

Preprint

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IMPORTANCE Differentiated thyroid cancer (DTC) is commonly diagnosed in women of child-bearing age, but whether pregnancy influences the prognosis of DTC remained controversial. OBJECTIVE This systematic review and meta-analysis aimed to summarize and appraise the existing evidence of the impact of pregnancy on the prognosis of patients previously treated for DTC. DATA SOURCES We searched PubMed, Embase, Web of Science, Cochrane, and Scopus until February 2023. STUDY SELECTION Studies of patients diagnosed and treated for DTC before pregnancy reporting the recurrence/progression condition of DTC were included. Case reports and studies failing to identify the time of diagnosis or initial treatment were excluded. DATA EXTRACTION AND SYNTHESIS Meta-analyses were conducted according to MOOSE guideline. Data extraction was conducted by two independent investigators with a standard form. Pooled effect estimates were calculated in a random-effects model. MAIN OUTCOMES AND MEASURES DTC recurrence/progression and the type of recurrence/progression (structural or biochemical). RESULTS Among the 10 included studies (n = 625), 4 (n = 143) of them compared the pregnancy group with the non-pregnancy group while the remaining 6 (n = 482) only included the pregnant patients. The pooled proportion of recurrence/progression in all pregnant patients was 13% (95% CI, 6%, 25%). Compared with the non-pregnancy group, the pooled odds ratio of recurrence/progression in the pregnancy group was 0.75 (95% CI, 0.45, 1.23). Two included studies focused on patients with distant metastasis and also did not observe difference in disease recurrence/progression between the pregnancy group and the non-pregnancy group [OR, 0.51 (95% CI, 0.14-1.87)]. Six included studies also reported response to therapy status prior to pregnancy, and the pooled proportion for recurrence/progression in pregnant DTC patients with excellent response (n=287), indeterminate response (n=44), biochemical incomplete response (n=41) and structural incomplete response (n=70) was 0.00 (95% CI, 0.00-0.86), 0.09 (95% CI, 0.00-0.99), 0.20 (95% CI, 0.06-0.46) and 0.45 (95% CI, 0.17-0.76), respectively. There was a trend for an increasingly higher risk of recurrence/progression from excellent, indeterminate, biochemical incomplete to structural incomplete response to therapy (P<0.05). CONCLUSIONS AND RELEVANCE: Pregnancy appears to have a minimal impact on the prognosis of DTC with initial treatment. Clinicians may pay more attention to the progression of DTC among pregnant women with biochemical and/or structural persistence.

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The Association of Pregnancy with Disease Progression in Patients Previously Treated for Differentiated Thyroid Cancer: A Propensity Score-Matched Retrospective Cohort Study

Li,

Xiao,

Mei

et al. 2023

Journal of Women's Health

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IMPORTANCE Differentiated thyroid cancer (DTC) is increasingly common in women of reproductive age. However, whether pregnancy increases the risk of progression/recurrence of DTC after treatment remains controversial due to the effect of confounding. OBJECTIVE To assess the effect of pregnancy on structural or biochemical progression in patients previously treated for DTC in a retrospective cohort using propensity score matching (PSM). DESIGN, SETTING, AND PARTICIPANTS This cohort study included 123 pregnantwomen and 1,376 non-pregnant women after initial treatment for DTC at Peking University Third Hospital between January 2012 and December 2022. To control the effect of confounding, we carefully matched pregnancy (n = 102) and non-pregnancy groups (n = 297) in terms of age, Hashimoto's thyroiditis, lymph node dissection, extra-thyroid invasion, initial risk of recurrence after treatment, and time interval between treatment and last follow up by using PSM.EXPOSURES DTC patients became pregnant after previous treatment. MAIN OUTCOMES AND MEASURESThe risk of structural or biochemical progression was assessed in the pregnancy and PSM matched non-pregnancy groups, respectively.Conditional logistics regression models were used to control important confounders and consider the matching properties of the data. RESULTSAt baseline, the pregnancy (n = 102) and non-pregnancy groups (n = 297) were balanced in all matched variables (standardized differences <10% and P > 0.05). After a mean follow-up of approximately 4.5 years, we observed no evidence of difference between the two groups in growth in the size of existing metastatic foci [2 (2.0 %) vs. 2 (0.7 %); P = 0.346], percentage of patients developing new lymph node metastases [4 (3.9 %) vs. 21 (7.1 %); P = 0.519], node growth in the contralateral thyroid lobe [4 (3.9 %) vs. 16 (5.4 %); P = 0.324 ], or biochemical progression [2 (2.0 %) vs. 9 (3.0 %); P = 0.583]. Results from conditional logistic regressions and several sensitivity analyses also showed no evidence of association of pregnancy with the risk of progression, after adjusting for potential confounders of age, tumor size, initial risk stratification, Hashimoto's thyroiditis, lymph node dissection, the time interval between treatment and follow-up, and achievement of TSH inhibition target (P = 0.354). The pregnancy-progression association observed longer than 4.5 years showed no evidence of difference with that observed shorter than 4.5 years (P for interaction was 0.283).We further classified the pregnancy patients into 3 subgroups based on the time interval between treatment and pregnancy (< 1 year, 1-2 years, ≥ 2 years) and found that the shorter the time interval, the higher the risk of DTC progression (P for trend was 0.043). CONCLUSIONS AND RELEVANCEThe risk of DTC progression/recurrence in the pregnant women was not higher than that in the well-matched, non-pregnant women. For young women previously treated for DTC, disease progression might not be a concern for their future pregnancy plan, but it seems ...

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Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

Cited by 8 publications

References 26 publications

Persistent Thyroid Carcinoma and Pregnancy: Outcomes in an Italian Series and Review of the Literature

Persistent Thyroid Carcinoma and Pregnancy: Outcomes in an Italian Series and Review of the Literature

Pregnancy and the prognosis of patients previously treated for differentiated thyroid cancer: a systematic review and meta-analysis

The Association of Pregnancy with Disease Progression in Patients Previously Treated for Differentiated Thyroid Cancer: A Propensity Score-Matched Retrospective Cohort Study

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