How do etiological factors can explain the different clinical features of patients with differentiated thyroid cancer and their histopathological findings?

Abstract

The aim was to retrospectively analyse the clinical-histopathological characteristics of patients with newly diagnosis of differentiated thyroid cancer (DTC) referred to two Italian centres, one in Northern and the other in Southern Italy, between 2000 and 2013. 1081 patients were included and subdivided into two groups: group A (474 patients from Novara) and group B (607 patients from Naples). The group A came from the industrial area of Novara, while the Group B came from the areas around Vesuvius and Campi Flegrei. The two groups were comparable for iodine levels, body mass index, diagnostic timing and clinical procedures. For all patients, demographic and clinical data were collected. No difference was found in gender, whereas the age at diagnosis was later in the group A (group A 53.1 ± 15.16 years, group B 41.9 ± 14.25 years, p < 0.001). In both groups, the most frequent histotype was papillary thyroid cancer (PTC) with prevalence of follicular variant in group A (p < 0.0001) and classical variant in group B (p < 0.0001). Aggressive histological features were mainly seen in group A (bilaterality p < 0.0001, multifocality p < 0.0001 and thyroid capsular invasion p < 0.0001). Microcarcinomas were more frequent in group A (p < 0.0001) but mostly characterized by bilaterality (p < 0.001) and multifocality (p < 0.04). In both groups, tumour-associated thyroiditis showed a significant increase over the years (group A p < 0.05, group B p < 0.04). Environmental factors could justify the differences found in our study. These preliminary data should stimulate the need for an Italian Cancer Registry of DTC in order to allow an epidemiological characterization, allowing the identification of specific etiological factors and an improvement in the management of the disease.

Circulating adipokines and metabolic setting in differentiated thyroid cancer

“…In the past few decades, the incidence of DTC has shown a steady increase worldwide (2, 8). Some evidence suggests that environmental and lifestyle factors can play an important role (2, 28).…”

“…In the past few decades, the incidence of DTC has shown a steady increase worldwide (2, 8). Some evidence suggests that environmental and lifestyle factors can play an important role (2, 28). Among the potential risk factors involved in the changing epidemiology of TC, particular attention has been accorded to IR and the metabolic syndrome, which have been also rapidly increasing worldwide due to widespread dietary and lifestyle changes (29).…”

“…The incidence rates of differentiated thyroid cancer (DTC) have been rising in many countries over the last few decades (1, 2) along with a parallel increase in obesity and metabolic disorders (3).…”

“…An epidemiological link between metabolic derangement associated with excess body weight and thyroid cancers has been highlighted in cross-sectional studies and confirmed in meta-analyses of cross-sectional and prospective studies. Many advocate that environmental and lifestyle factors, such as obesity and insulin resistance (IR), could be implicated in the pathogenesis of thyroid cancer (2, 9, 10). Although the pathways linking obesity and IR to thyroid cancer remain largely unknown, a potential role for insulin, growth hormone (GH) secretagogues and adipokines has been postulated (10).…”

Molecular characterisation and clinical correlation of papillary thyroid microcarcinoma

“…In our previous study on patients affected by differentiated thyroid cancer (DTC), subanalysis of mPTCs showed a high rate of histological features of aggressiveness [5]. Based on this evidence, we decided to deepen the analysis of those more aggressive mPTCs.…”