Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach

Abstract

Differentiated thyroid cancers (DTCs) are slow-growing malignant tumours, including papillary and follicular carcinomas. Overall, prognosis is good, although it tends to worsen when local invasion occurs with bulky cervical nodes, or in the case of distant metastases. Surgery represents the main treatment for DTCs. However, radical excision is challenging and significant morbidity and functional loss can follow the treatment of the more advanced forms. Literature on advanced thyroid tumours, both differentiated and undifferentiated, does not provide clear and specific guidelines. This emerges the need for a tailored and multidisciplinary approach. In the present study, we report our single-centre experience of 111 advanced (local, regional, and distant) DTCs, investigating the rate of radical excision, peri-procedural and post-procedural complications, quality of life, persistence, recurrence rates, and survival rates. Results are critically appraised and compared to the existing published evidence review.

Molecular features of aggressive thyroid cancer

“…De-differentiated TC and ATC have a worse prognosis with respect to WDTC and the loss of the capability of up-taking 131 I is one of the main features characterizing de-differentiated and aggressive TC. The knowledge of the genomic landscape of TC can help clinicians to discover the responsible alterations underlying more advance diseases and to address more tailored therapy (103)(104)(105)(106)(107)(108)(109). In fact, to date, the aaMKIs sorafenib, lenvatinib, and cabozantinib, have been approved for the therapy of aggressive RAI-resistant PTC or FTC.…”

Risk prediction for central lymph node metastasis in isolated isthmic papillary thyroid carcinoma by nomogram: A retrospective study from 2010 to 2021

“…Some studies consider total thyroidectomy as a safe surgical approach for isthmic thyroid cancer ( 12 , 13 ). However, for locally advanced or metastatic thyroid cancer, the surgical extent and surgical approach should be decided according to patients’ condition ( 14 ). On the other hand, several studies regard lobectomy with isthmusectomy or isthmusectomy alone as an alternative for selected low-risk patients, with advantages such as fewer surgical complications and better-preserved thyroid function ( 15 , 16 ).…”

Preoperative prognostic risk stratification model for papillary thyroid carcinoma based on clinical and ultrasound characteristics

“…Majority of PTC cases have indolent characteristics and slow progression, which are usually associated with a favorable prognosis. However, some PTC cases exhibit aggressive characteristics (such as vascular invasion, extrathyroidal extension, lymph node metastasis, disease recurrence, or distant metastasis), which could lead to a poor clinical outcome (3)(4)(5).…”

“…Recently, ultrasound imaging-guided thermal ablation has been performed on thyroid cancer, which is less damaging, has a faster recovery, and is more aesthetically pleasing than invasive surgery. The clinical management of patients with PTC should be tailored to their specific condition according to the prognostic risk stratification (3). The 2015 American Thyroid Association (ATA) guidelines are generally used to predict disease-specific mortality (7), and the American Joint Committee on Cancer (AJCC)/TNM classification is used to predict the risk of disease recurrence or persistence (8).…”