A Retrospective Cohort Study with Validation of Predictors of Differentiated Thyroid Cancer Outcomes

Wijewardene, Ayanthi; Gill, Anthony J.; Gild, Matti; Learoyd, Diana; Glover, Anthony; Sywak, Mark; Sidhu, Stan; Roach, Paul; Schembri, Geoffrey; Hoang, Jeremy; Robinson, Bruce G.; Tacon, Lyndal; Clifton‐Bligh, Roderick

doi:10.1089/thy.2021.0563

Cited by 6 publications

(4 citation statements)

References 38 publications

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“…Our study of 548 patients demonstrated gender, serum ps-Tg and interval time were independent predictors of a complete short-term response to initial 131 I ablation. This paper indicated female patients were more likely to benefit, which is consistent with the results of previous studies [1,2,17–19]. However, it should be noted that the incidence of thyroid cancer in male patients has increased faster than that in female patients, and the mortality has increased year by year.…”

Section: Discussionsupporting

confidence: 90%

Impact factors of benefiting from initial 131I ablation in patients with intermediate-risk differentiated thyroid carcinoma: a study based on a re-evaluation of therapeutic response

Ren,

Hu,

et al. 2023

Nuclear Medicine Communications

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Objective This study was carried out to confirm whether patients with intermediate-risk differentiated thyroid cancer (DTC) could benefit from initial 131I ablation and to identify the factors that impacted the benefit. Methods We retrospectively assessed a cohort of 548 patients with intermediate-risk DTC who were classified into structural incomplete response (SIR), biochemical incomplete response (BIR), indeterminate response (IDR), and excellent response (ER) groups according to the ATA guidelines (version 2015). A downgrade in the classification, such as from initial SIR to final BIR, IDR, or ER, from BIR to IDR or ER, and from initial IDR to final ER, was defined as benefiting from initial 131I ablation (benefit group). Non-downgraded classification meant non-benefit. Results 64.78% of patients benefited from the initial 131I ablation in the final re-evaluation. Gender (OR = 0.038, P = 0.002), interval time (OR = 0.038, P = 0.002) and serum ps-Tg (OR = 0.961, P = 0.001) were independent prognostic factors for benefiting from initial 131I ablation, with the cutoff value were 5 months and 19.08 ng/ml. Conclusion Patients with intermediate-risk DTC could benefit from initial 131I ablation. Female patients with intermediate-risk DTC whose interval time <5 months and ps-Tg <19.08 ng/ml were more likely to benefit. Early 131I ablation for such patients is beneficial for achieving a complete therapeutic response.

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Section: Discussionsupporting

confidence: 90%

Impact factors of benefiting from initial 131I ablation in patients with intermediate-risk differentiated thyroid carcinoma: a study based on a re-evaluation of therapeutic response

Ren,

Hu,

et al. 2023

Nuclear Medicine Communications

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“…To enable early identification of patients with DM risks, several clinic-pathological features have been proposed. Older age [3], male sex [4], and pathologic factors like T stage [5], lymph node metastasis (LNM) [6], and extrathyroidal extension (ETE) [7] were reported to predict DM. Besides, genetic alterations among candidate genes were also postulated to improve the risk stratification of TC in recent years.…”

Section: Discussionmentioning

confidence: 99%

Risk-stratified Distant Metastatic Thyroid Cancer with Clinicopathological Factors and BRAF/TERT Promoter Mutations

Cheng,

Zhou,

et al. 2023

Exp Clin Endocrinol Diabetes

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Objective To assess the prognostic value of clinicopathological factors as well as BRAF and TERT promoter mutations in predicting distant metastasis in patients with papillary thyroid cancer. Design The status of BRAF and TERTp mutations were available in 1,208 thyroid cancer patients who received thyroidectomy at Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine from January 2008 to December 2021. Based on inclusion criteria, 99 distant metastasis thyroid cancers (DM-TCs) and 1055 patients without DM (Non-DM-TCs) were retrospectively reviewed. Results After univariate and multivariate analyses, a risk model was established for DM prediction based on factors: T3/T4 stage, lymph node metastasis (LNM) number over 5, and BRAF/TERT mutations (TLBT). It was defined based on the number of TLBT factors: low risk (no risk factor, n=896), intermediate risk (1 risk factor, n=199), and high risk (≥2 risk factors, n=59). Notably, compared with patients with low and intermediate risks, patients assigned to high TLBT risk have a shorter time of DM disease-free survival. Except for gene mutation, other factors were also included in the 2015 American Thyroid Association (ATA) risk guideline. Comparing with the ATA risk category, this risk model showed a better performance in predicting DM-TCs. Conclusions This study proposes a TLBT risk classifier consisting of T3/T4 stages, LNM (n>5), and BRAF+TERTp mutations for predicting DM-TCs. TLBT risk stratification may help clinicians make personalized treatment management and follow-up strategies.

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“…It considers risk of DTC recurrence as a continuum but also classifies DTC into low-, intermediate- and high risk for recurrence ( 7 , 45 ). Several studies have shown the robustness of this system for predicting recurrence and it is currently the most widely used system in clinical practice and research communication ( 10 , 11 , 46 , 47 ). The AJCC TNM system is one of the mortality-predicting staging systems and is based on age and several histopathological features including tumor size, extrathyroidal invasion, lymph node and distant metastasis ( 8 , 48 ).…”

Section: Discussionmentioning

confidence: 99%

How do BRAFV600E and TERT promoter mutations interact with the ATA and TNM staging systems in thyroid cancer?

Mukhtar,

Alhamoudi,

Alswailem

et al. 2023

Front. Endocrinol.

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ContextThe American Thyroid Association risk stratification (ATA) and the American Joint Committee on Cancer Tumor Node Metastases (TNM) predict recurrence and mortality of differentiated thyroid cancer (DTC). BRAFV600E and TERT promoter mutations have been shown to correlate with the histopathological features and outcome of DTC. Our objectives were to study the correlation of these molecular markers with these clinicopathological-staging systems.Patients and methodsWe studied 296 unselected patients, 214 females and 82 males with a median age of 36 years (IQR 23.3-49.0). BRAFV600E and TERT promoter mutations were tested by PCR-based Sanger sequencing. Data were extracted from medical records and analysed using Chi-Square and Fisher Exact tests and Kaplan Meier analysis.ResultsOf 296 patients tested, 137 (46.3%) had BRAFV600E-positive tumors and 72 (24.3%) were positive for TERT promoter mutations. The BRAFV600E mutation did not correlate with the ATA and TNM staging, being non-significantly different in various stages of these systems and did not predict the development of persistent disease (PD) (P 0.12). Unlike BRAFV600E, TERT promoter mutations were more frequent in the ATA high-risk than in intermediate- or low-risk tumors (P 0.006) and in TNM stages III and IV than lower stages (P <0.0001). TERT promoter mutations also predicted the outcome, being present in 37.2% of patients with PD compared to only 15.4% in those without evidence of disease (P <0.0001). The same pattern was also seen when BRAFV600E and TERT promoter mutations were combined.ConclusionTERT promoter mutations alone or in combination with BRAFV600E mutation, but not BRAFV600E mutation alone, correlated well with the ATA and TNM staging and predicted development of PD, especially in higher stages of these systems.

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A Retrospective Cohort Study with Validation of Predictors of Differentiated Thyroid Cancer Outcomes

Cited by 6 publications

References 38 publications

Impact factors of benefiting from initial 131I ablation in patients with intermediate-risk differentiated thyroid carcinoma: a study based on a re-evaluation of therapeutic response

Impact factors of benefiting from initial 131I ablation in patients with intermediate-risk differentiated thyroid carcinoma: a study based on a re-evaluation of therapeutic response

Risk-stratified Distant Metastatic Thyroid Cancer with Clinicopathological Factors and BRAF/TERT Promoter Mutations

How do BRAFV600E and TERT promoter mutations interact with the ATA and TNM staging systems in thyroid cancer?

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