Current controversies and future directions in the diagnosis and management of differentiated thyroid cancers

Abstract

Despite the development of novel diagnostic, surgical, and chemotherapeutic approaches to differentiated thyroid cancers (DTCs), the diagnosis and management of these tumors remains controversial. The most recent American Thyroid Association (ATA) guidelines, released in 2015, reflect a recent shift towards less aggressive management for patients with DTCs. However, many clinicians have expressed concern that more conservative management will put patients at risk for disease recurrence and metastasis. In particular, the management of indeterminate nodules on fine needle aspiration (with special attention to genetic and epigenetic markers of malignancy), the extent of surgery for known differentiated cancers, the role of adjuvant radioactive iodine (RAI) therapy, and novel targeted treatments with tyrosine kinase inhibitors (TKIs) represent current areas of uncertainty and opportunities for future research. In this review, we examine the current state of the art in these areas, and address some of the questions that remain.

APOE is a Prognostic Biomarker and Correlates With Immune Infiltrates in Papillary Thyroid Carcinoma

“…Although some mechanisms have been clari ed, including growth factors, ionizing radiation, iodine intake, gender, and genetic factors, these have not yet speci cally clari ed the mechanism of PTC occurrence and cannot be used as a speci c target for clinical treatment for PTC. At the same time, the tumor recurrence rate, distant metastasis rate and mortality rate will be signi cantly increased of the PTC patients with lymph node metastasis compared to those without metastasis (5,6). Thus, excavation a novel biomarker for assisting screening diagnosis, predicting PTC prognosis and blocking PTC lymph node metastasis.…”

Identification of key genes of papillary thyroid carcinoma by integrated bioinformatics analysis

“…The annual rate of thyroid cancer has more than doubled within the past two decades, with the vast majority of this increase being ascribed to PTC, which accounts for 80-85% of all thyroid carcinomas [1]. In addition, patients with PTC suffer from cervical lymph nodes metastasis or remote metastasis, which leads to unfavorable results, and approximately 10-15% of cases may progress to a potentially fatal recurrent ailment [3,4]. Due to these reasons, uncovering the causes of PTC and its fundamental mechanisms and finding molecular biomarkers for early diagnosis and customized treatment are significant and important tasks.…”

ADORA1 is a diagnostic-related biomarker and correlated with immune infiltrates in papillary thyroid carcinoma

“…The incidence of PTC has been steadily increasing, and the incidence rate reached 6.20 per 100,000 in females and 1.80 per 100,000 in males on a world-wide scale [2]. Patients suffering from PTC with cervical lymph node metastases or distant metastases usually have a poor prognosis, and a small percentage of patients (about 10-15%) may develop into a life-threatening recurrent disease [3][4][5][6]. Although the evolution of PTC is thought to be influenced by many factors such as genetic factors, hormone levels and ionizing radiation, the specific pathogenesis of PTC is still unclear, especially the underlying mechanism of immune regulation of specific genes [7][8][9].…”