Changes in the Clinicopathological Characteristics and Outcomes of Thyroid Cancer in Korea over the Past Four Decades

Cho, Bo Youn; Choi, Hoon; Park, Young Joo; Lim, Joo Hyun; Ahn, Hwa Young; Lee, Eun Kyung; Kim, Kyung Won; Yi, Ka Hee; Chung, June Key; Youn, Yeo-Kyu; Cho, Nam Han; Park, Do Joon; Koh, Chang Soon

doi:10.1089/thy.2012.0329

Cited by 173 publications

(141 citation statements)

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“…As described in our previous study (4), the use of total thyroidectomy has gradually increased from 22.5% (pre-1990) to 49.1% (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) and, finally, 94.3% (post-1999) ( Table 1). The use of prophylactic central or anterior neck LN dissection began in 2003 and has been increasingly performed in most patients with PTC R1 cm in our hospital starting in 2007.…”

Section: Treatment and Follow-upsupporting

confidence: 58%

“…As the proportion of patients diagnosed through screening tests has increased, epidemiologic studies have also indicated an increase in the proportion of smaller tumors (!1 cm diameter), a decrease in LN involvement, a decrease in ETE, and improved prognostic outcomes (4,9). These changes might also be related with temporal changes in the previously well-known prognostic factors.…”

Section: Introductionmentioning

confidence: 77%

“…Among the 4500 thyroid cancer patients who underwent thyroidectomy from 1962 to 2009 in the Seoul National University Hospital Thyroid Clinic, 4074 patients had confirmed papillary thyroid cancer (PTC) (4). We included 3149 patients, excluding those who were followed up !12 months without evidence of recurrence.…”

Section: Subjectsmentioning

confidence: 99%

“…During the study period, biochemical test methodologies were changed several times, as described in our previous study (4). Serum thyroglobulin (Tg) was measured using a commercial IRMA Kit (Diasorin, Saluggia, Italy) until 2004; thereafter, it was measured by a specific, highsensitivity IRMA (Tg-plus; BRAHMS Diagnostica GmbH, Berlin, Germany).…”

Section: Biochemical Testsmentioning

confidence: 99%

“…However, some thyroid cancer patients still experience aggressive clinical outcomes (3,4,5,6); thus, it is important to understand the prognostic factors for a poor prognosis. Previous studies have reported older age, male sex, large tumor size, lymph node (LN) involvement, extrathyroidal extension (ETE), and distant metastasis as poor prognostic factors (7).…”

Section: Introductionmentioning

confidence: 99%

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Secular trends in the prognostic factors for papillary thyroid cancer

Choi

Lim

Ahn

et al. 2014

European Journal of Endocrinology

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Objective: With the recent increasing rates of screening for thyroid cancer, the cancers now tend to be smaller and less aggressive than those that are diagnosed when presented with symptoms, suggesting changes in the clinical validity of conventional prognostic factors for outcomes. We performed the retrospective study to identify the secular trends in the prognostic factors of thyroid cancer. Methods: We used medical records of 3147 patients diagnosed with papillary thyroid cancer (PTC) at the Seoul National University Hospital Thyroid Cancer Clinic between 1962 and 2009. Results: During the median 5.1-year follow-up, the overall recurrence rate was 13.3%, and male sex, tumor size, lymph node (LN) involvement, and extrathyroidal extension (ETE) were the significant prognostic factors for recurrence. Thyroid cancer-specific mortality was 1.4%, and the associated prognostic factors were older age, male sex, and LN involvement. For tumor recurrence, the hazard ratio (HR) for male sex decreased from 2.809 (95% CI, 1.497-5.269) in the pre-1989 period to 1.142 (95% CI, 0.736-1.772) in the post-1999 period. The pathologic characteristics, such as tumor size, LN involvement, and ETE, showed similar or increasing HRs over the time periods. For cancer-specific mortality, the HR for male sex decreased from 6.460 (95% CI, 1.714-24.348) in the pre-1990 period to 0.781 (95% CI, 0.083-7.379) in the post-1999 period. Conclusion: The risk for poor outcomes in PTC associated with male sex decreased over time; in contrast, the risk associated with pathologic characteristics remained the same or increased over time. These trends might be associated with recent changes in the characteristics of patients with thyroid cancer.

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Section: Treatment and Follow-upsupporting

confidence: 58%

Section: Introductionmentioning

confidence: 77%

Section: Subjectsmentioning

confidence: 99%

Section: Biochemical Testsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Secular trends in the prognostic factors for papillary thyroid cancer

Choi

Lim

Ahn

et al. 2014

European Journal of Endocrinology

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Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma

Kim

Kwon

Moon

2021

JAMA Otolaryngol Head Neck Surg

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hyroid cancer is the ninth most frequent cancer worldwide, and its incidence has risen dramatically. 1,2 There were 567 233 patients with newly diagnosed thyroid cancer in 2018, representing 3.1% of all cancer cases worldwide. Papillary thyroid carcinoma (PTC) comprises more than 80% of all thyroid cancers, and is usually associated with an excellent prognosis; 3 however, up to 30% of patients experience significant disease progression, including regional recurrences and distant metastases. [4][5][6] Researchers have tried to identify the patients at high-risk from among the population with favorable outcomes; 7-9 clinicopathological factors, including tumor size, extrathyroidal extension, lymph node metastasis, and multifocality, have been thoroughly evaluated in an effort to predict recurrence and mortality.Multifocality in thyroid cancer is defined as the simultaneous presence of more than 1 tumor focus within the thyroid gland. 10 Multifocality in PTC occurred in 18% to 87% of the cases in the literature. 10,11 Several studies have demonstrated that multifocality is associated with high-risk features of PTC, including aggressive histologic subtype, extrathyroidal extension, lymph node involvement, distant metastasis, and recurrences. 12-14 Some researchers have further demonstrated that multifocal PTCs could decrease overall and cancer-specific survival. 11,15 Other researchers have indicated that patients with multifocal diseases showed a similar clinical course or comparable recurrence rates as those with unifocal disease. [16][17][18] These conflicting results indicate a need IMPORTANCE Multifocality is common in papillary thyroid carcinoma (PTC), but it is unclear whether multifocal tumors are associated with tumor recurrence or cancer-specific survival. OBJECTIVE To compare tumor recurrence rates in patients with multifocal vs unifocal PTCs. DATA SOURCES We searched PubMed, SCOPUS, Web of Science Core Collection, and Cochrane Database of Systematic Reviews for pertinent studies published in English from inception to June 30, 2020. STUDY SELECTION The search strategy yielded 26 studies that compared tumor recurrence in patients with multifocal vs unifocal PTC. DATA EXTRACTION AND SYNTHESIS Data was extracted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Characteristics of study populations and hazard ratio (HR) of multifocality were independently extracted by 2 investigators. MAIN OUTCOMES AND MEASURESThe primary outcome was tumor recurrence and the secondary outcome was cancer-specific survival. Subgroup analysis of the primary outcome was based on primary tumor size, number of tumor foci, and patient age. RESULTS Among 26 studies with a total of 33 976 patients, recurrence rates were significantly higher in patients with multifocal PTC than in those with unifocal PTC (pooled HR, 1.81; 95% CI, 1.52-2.14). Cancer-specific survival was comparable between the groups (HR, 1.19; 95% CI, 0.85-1.68). In subgroup analyses, the HRs of m...

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Prognostic effects of TERT promoter mutations are enhanced by coexistence with BRAF or RAS mutations and strengthen the risk prediction by the ATA or TNM staging system in differentiated thyroid cancer patients

Song

Lim

Choi

et al. 2016

Cancer

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BACKGROUND: Recent reports suggest that mutations in the promoter of the gene encoding telomerase reverse transcriptase (TERT) affect thyroid cancer outcomes. METHODS: In all, 551 patients with differentiated thyroid cancer (DTC) enrolled in this study. The median follow-up duration was 4.8 years (interquartile range, 3.4-10.6 years). RESULTS: TERT promoter mutations were detected in 25 DTCs (4.5%): 2.8% in neither BRAF-mutated nor RAS-mutated tumors, 4.8% in BRAF-mutated tumors, and 11.3% in RAS-mutated tumors. Moreover, they were frequently observed in American Thyroid Association (ATA) high-risk and TNM stage III/IV groups (9.1% and 12.9%, respectively). The coexistence of BRAF or RAS with TERT promoter mutations increased aggressive clinicopathologic features, recurrence (hazard ratio [HR] for BRAF, 4.64; 95% confidence interval [CI], 1.42-15.18; HR for RAS, 5.36; 95% CI, 1.20-24.02), and mortality (HR for BRAF, 15.13; 95% CI, 1.55-148.23; HR for RAS, 14.75; 95% CI, 1.30-167.00), even after adjustments for the age at diagnosis and sex, although the significance was lost after additional adjustments for pathologic characteristics. Furthermore, TERT promoter mutations significantly increased the risk of both recurrence and mortality in the ATA high-risk (HR for recurrence, 5.79; 95% CI, 2.07-16.18; HR for mortality, 16.16; 95% CI, 2.10-124.15) and TNM stage III/IV groups (HR for recurrence, 3.60; 95% CI, 1.19-10.85; HR for mortality, 9.06; 95% CI, 2.09-39.26). CONCLUSIONS: The coexistence of BRAF or RAS mutations enhanced the prognostic effects of TERT promoter mutations. Furthermore, TERT promoter mutations strengthened the predictions of mortality and recurrence by the ATA and TNM staging systems, particularly for high-risk patients with DTC. Cancer 2016;122:1370-9.

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Changes in the Clinicopathological Characteristics and Outcomes of Thyroid Cancer in Korea over the Past Four Decades

Cited by 173 publications

References 48 publications

Secular trends in the prognostic factors for papillary thyroid cancer

Secular trends in the prognostic factors for papillary thyroid cancer

Association of Multifocality With Prognosis of Papillary Thyroid Carcinoma

Prognostic effects of TERT promoter mutations are enhanced by coexistence with BRAF or RAS mutations and strengthen the risk prediction by the ATA or TNM staging system in differentiated thyroid cancer patients

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