Current Guidelines for Postoperative Treatment and Follow-Up of Well-Differentiated Thyroid Cancer

Yoo, Jenny; Stang, Michael T.

doi:10.1016/j.soc.2015.08.002

Cited by 17 publications

(17 citation statements)

References 107 publications

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“…The American Thyroid Association (ATA) risk stratification for well-differentiated thyroid cancer categorizes patients into low, intermediate, and high risk groups based on these factors(7). Patients that fall into ATA intermediate and high risk groups have been shown to have higher rates of recurrence when applied to the clinical setting, with rates the highest in the high risk category (8). …”

Section: Introductionmentioning

confidence: 99%

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Bates

Lamas

Randle

et al. 2018

Surgery

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Background Papillary thyroid carcinoma (PTC) has excellent survival, yet recurrence remains a challenge. We sought to determine the proportion of re-operations performed for persistent, rather than truly recurrent disease. Methods We conducted a retrospective review of a prospectively maintained database. Patients with PTC that had re-operation for disease from 2000–2016 were included. We defined recurrence as disease that developed after a patient had an undetectable thyroglobulin and negative ultrasound within one year of surgery. Results A total of 69 patients underwent 92 re-operations. On initial pathology: mean tumor size was 2.6cm; 50.7% were multifocal; and 42% had extra-thyroidal extension. Half (46%) of the patients underwent a central/lateral neck dissection at initial surgery and 76.8% were treated with post-operative radioactive iodine. The median time to first re-operation was 21 months (range, 1–292), and 41.8% occurred within 1 year. Only three operations met criteria for true “recurrence”, while 71 operations were categorized as persistence. Conclusion Many re-operations for PTC are for management of persistent disease. Over half of the patients required re-operation within the first two years, which strongly suggests that improvements in the pre-operative assessment and adequacy of initial surgery need to be made to improve the care of patients with thyroid cancer.

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Section: Introductionmentioning

confidence: 99%

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Bates

Lamas

Randle

et al. 2018

Surgery

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“…Most thyroid malignancies are differentiated follicular cell-derived thyroid carcinomas (DTCs), comprising the papillary (PTC) and follicular (FTC) thyroid carcinoma subtypes [ 3 , 4 ]. These forms usually respond well to the conventional therapeutic protocol, which consists of thyroidectomy followed by TSH suppressive therapy and, eventually, radioactive iodine ablation therapy in selected patients accordingly to individual risk level [ 5 ]. There are, however, advanced forms of thyroid cancer that are surgically unresectable or unresponsive to radioiodine treatment.…”

Section: Introductionmentioning

confidence: 99%

RAC1b overexpression stimulates proliferation and NF-kB-mediated anti-apoptotic signaling in thyroid cancer cells

Faria¹,

Matos

Pereira³

et al. 2017

PLoS ONE

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Overexpression of tumor-associated RAC1b has been recently highlighted as one of the most promising targets for therapeutic intervention in colon, breast, lung and pancreatic cancer. RAC1b is a hyperactive variant of the small GTPase RAC1 and has been recently shown to be overexpressed in a subset of papillary thyroid carcinomas associated with unfavorable outcome. Using the K1 PTC derived cell line as an in vitro model, we observed that both RAC1 and RAC1b were able to induce a significant increase on NF-kB and cyclin D1 reporter activity. A clear p65 nuclear localization was found in cells transfected with RAC1b-WT, confirming NF-kB canonical pathway activation. Consistently, we observed a RAC1b-mediated decrease in IκBα (NF-kB inhibitor) protein levels. Moreover, we show that RAC1b overexpression stimulates G1/S progression and protects thyroid cells against induced apoptosis, the latter through a process involving the NF-kB pathway. Present data support previous findings suggesting an important role for RAC1b in the development of follicular cell-derived thyroid malignancies and point out NF-kB activation as one of the molecular mechanisms associated with the pro-tumorigenic advantage of RAC1b overexpression in thyroid carcinomas.

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“…25 While these systems are useful for predicting risk of death from thyroid cancer, they are less suitable for predicting risk of recurrence, which has been reported to be as high as 20-30%. [3][4][5]32,[71][72][73] Risk stratification is a dynamic process that should be repeated throughout the follow-up period to determine whether additional intervention is required. 25,32,72,74,75 ATA guidelines for response to therapy reclassification after initial risk stratification has been validated for DTC patients treated with total thyroidectomy and RAI remnant ablation.…”

Section: Postoperative Risk Stratificationmentioning

confidence: 99%

Advancements in the treatment of differentiated thyroid cancer

Stewart

Kuo

2021

Therapeutic Advances in Endocrinology

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Derived from follicular epithelial cells, differentiated thyroid cancer (DTC) accounts for the majority of thyroid malignancies. The threefold increase in DTC incidence over the last three decades has been largely attributed to advancements in detection of papillary thyroid microcarcinomas. Efforts to address the issue of overtreatment have notably included the reclassification of encapsulated follicular variant papillary thyroid cancers (EFVPTC) to non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). In the last 5 years, the overall management approach for this relatively indolent cancer has become less aggressive. Although surgery and radioiodine ablation remain the mainstay of DTC therapy, the role of active surveillance is being explored. Furthermore, the most recent American Thyroid Association (ATA) guidelines offer flexibility between lobectomy and total thyroidectomy for thyroid nodules between 1 cm and 4 cm in the absence of extrathyroidal extension or nodal disease. As our understanding of the natural history and molecular underpinnings of DTC evolves, so might our approach to managing low-risk patients, obviating the need for invasive intervention. Simultaneously, advances in interventional and systemic therapies have greatly expanded treatment options for high-risk surgical candidates and patients with widespread disease, and continue to be areas of active investigation. Continued research efforts are essential to improve our ability to offer effective individualized therapy to patients at all disease stages and to reduce the incidence of recurrent and progressive disease.

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Current Guidelines for Postoperative Treatment and Follow-Up of Well-Differentiated Thyroid Cancer

Cited by 17 publications

References 107 publications

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

Back so soon? Is early recurrence of papillary thyroid cancer really just persistent disease?

RAC1b overexpression stimulates proliferation and NF-kB-mediated anti-apoptotic signaling in thyroid cancer cells

Advancements in the treatment of differentiated thyroid cancer

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