Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long‐term follow‐up

Sohn, Seo Young; Kim, Hye In; Kim, Young Nam; Kim, Tae Hyuk; Kim, Sun Wook; Chung, Jae Hoon

doi:10.1111/cen.13489

Cited by 30 publications

(40 citation statements)

References 29 publications

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“…Although the incidence of thyroid cancer has increased with time, there has been no increase in mortality rate and still remains low [4][5][6][7]. However, DTC patients who present with advanced stage or distant metastasis and patients with poorly-differentiated thyroid carcinoma (PDTC) or anaplastic thyroid carcinoma (ATC) have poor prognoses, although the number of these patients are limited [8][9][10][11][12]. Considering the long-term survival of most patients with DTC, it is very important to distinguish patients who need aggressive treatment from those who do not.…”

Section: Introductionmentioning

confidence: 99%

BRAF and TERT promoter mutations: clinical application in thyroid cancer

Chung

2020

Endocr J

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Given the long-term survival of most patients with thyroid cancer, it is very important to distinguish patients who need aggressive treatment from those who do not. Conventional clinicopathological prognostic parameters could not completely predict the final outcome of each patient. Recently, molecular marker-based risk stratification of thyroid cancer has been proposed to better estimate the cancer risk. Although BRAF mutation has drawn much attention based on its high prevalence, its association with recurrence or mortality is not clear. Recently, telomerase reverse transcriptase (TERT) promoter mutation has been identified in thyroid cancer. It increases telomerase activity, which allows cancer cells to immortalize. It was found in 10 to 20% of differentiated thyroid carcinoma and 40% of dedifferentiated thyroid carcinoma. It is highly prevalent in old age, large tumor, aggressive histology, advanced stages, and distant metastasis. It is associated with increased recurrence and mortality. Concomitant BRAF and TERT promoter mutations worsen the survival rate. Inclusion of TERT promoter mutation analysis with conventional clinicopathological evaluation can lead to better prognostication and management for individual patients.

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Section: Introductionmentioning

confidence: 99%

BRAF and TERT promoter mutations: clinical application in thyroid cancer

Chung

2020

Endocr J

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“…It accounts for more than 90% in all thyroid cancers, and it has a favorable prognosis [18,19]. However, patients with poorly-differentiated thyroid carcinoma (PDTC) or anaplastic thyroid carcinoma (ATC), and patients who present with advanced stage or distant metastasis have poor prognoses [20][21][22][23][24][25]. Considering the long-term survival in most patients with DTC, it is very important to distinguish patients who need aggressive treatment from those who do not.…”

Section: Introductionmentioning

confidence: 99%

Telomerase reverse transcriptase promoter mutation and its clinical implication in thyroid cancer

Chung¹

2018

Precis Future Med

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Considering the long-term survival in most patients with thyroid cancer, it is very important to distinguish patients who need aggressive treatment from those who do not. Clinicopathological prognostic factors have been used to predict their prognoses, but they could not completely predict the final outcome of each patient. Recently, molecular marker-based risk stratification of thyroid cancer has been proposed to better estimate the risk. BRAF mutation has drawn much attention based on its high prevalence. However, its association with recurrence/mortality is not clear, and it is debatable. Telomerase reverse transcriptase (TERT) promoter mutation has been identified in over 50 human cancers including thyroid cancer after its first discovery in melanoma. It increases telomerase activity, which allows cancer cells to immortalize. It was found in approximately 10% of papillary thyroid carcinoma, 17% of follicular thyroid carcinoma, and 40% of poorly differentiated or anaplastic thyroid carcinoma. It is highly prevalent in old age, large tumors, aggressive histology, advanced stages, and distant metastasis. It is associated with increased recurrence and mortality. Concomitant TERT and BRAF mutations diminished the survival rate. Inclusion of TERT promoter mutation analysis with conventional clinicopathological evaluation could lead to better prognostication and management for individual patients.

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“…Several reasons may account for this phenomenon: rstly, this may imply that the lesions are partially dedifferentiated, which is prone to happen during the process of metastasis or 131 I treatment [21,22] ; in addition, it may also be related to the diameter of the lesion, which is positively correlated with 18 F-FDG uptake. The longer the diameter of the lesion, the more 131 I treatment are required [11,23] . The above factors cause that the absorbed dose fails to eliminate the lesion completely.…”

Section: Discussionmentioning

confidence: 99%

The Value of 18F-FDG PET/CT in avoiding overtreatment of 131l Avidity Pulmonary Metastasis of Differentiated Thyroid Cancer

Xu¹,

Li²,

Fěng³

et al. 2020

Preprint

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Abstract Background: We usually use 131 I whole body scan and serum thyroglobulin (Tg) values to determine whether differentiated thyroid cancer (DTC) patients need to receive 131 I treatment, but not all 131 I-avid (functioning) patients have good responses, which is more likely to cause the 131 I-avid patient to receive overtreatment. Our study aims to assess the date of 18 F-FDG PET/CT to avoid 131 I overtreatment and research the status of 131 I-avid pulmonary metastases (PMs) and the prognosis of the patients. Methods: The 131 I-avid PMs of DTC patients who underwent 18 F-FDG PET/CT scans were included. The SUVmax (maximum standardized uptake value), MTV (metabolic tumour volume) and TLG (total lesion glycolysis) were used to estimate 18 F-FDG uptake. The mean follow-up period was 34.14 ± 18.64months. Progression-free survival (PFS) was estimated by the Kaplan-Meier method.The study was based on per-patient and per-lesion analyses. Results: Among the 42 included patients, 34 (34/42, 81%) showed 18 F-FDG uptake, which was defined as abnormal foci (SUVmax >1.0) in the lungs. SUVmax, MTV and TLG and tumour size were the factors that influenced the outcome of 131 I treatment based on Tg levels (p=0.000,0.016,0.000,0.000). The only independent factor was the size of the lesion. There was a significant difference in response to 131 I therapy between PMs with F-I+ and F+/I+ according to both Tg levels and RECIST (version 1.1) (p= 0.044,0.001), according to the per-lesion analysis. When the changes in size or metabolism of some lesions are inconsistent with therapeutic efficacy of patients, it indicates that these patients have a poor prognosis (P=0.003). Conclusions: We concluded that higher 18 F-FDG uptake and larger tumour size predict poor therapeutic effects and a high risk of disease progression in 131 I-avid PMs of DTC. For evaluating the efficiency of 131 I treatment, per-lesion analyses and assessing the data of 18 F-FDG PET/CT would be more reliable than per-patient evaluation only. The increasing 18 F-FDG uptake or diameter of PMs may lead to a poor prognosis for the patient, and early focal treatment modalities may improve their life span.

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Prognostic indicators of outcomes in patients with lung metastases from differentiated thyroid carcinoma during long‐term follow‐up

Abstract: Patients with DTC and metastatic disease limited to the lungs had favourable long-term outcomes. Age, RAI avidity and timing of metastasis were found to be major factors for predicting prognosis.

Cited by 30 publications

References 29 publications

<i>BRAF</i> and <i>TERT</i> promoter mutations: clinical application in thyroid cancer

<i>BRAF</i> and <i>TERT</i> promoter mutations: clinical application in thyroid cancer

Telomerase reverse transcriptase promoter mutation and its clinical implication in thyroid cancer

The Value of 18F-FDG PET/CT in avoiding overtreatment of 131l Avidity Pulmonary Metastasis of Differentiated Thyroid Cancer

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