Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution

Sciuto, Rosa; Romano, Lucas Martín; Rea, Sandra; Marandino, Ferdinando; Sperduti, Isabella; Maini, C.L.

doi:10.1093/annonc/mdp050

Cited by 161 publications

(131 citation statements)

References 22 publications

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“…The mean age at presentation of 44 years and female predominance were also consistent with findings from different international studies [16][17][18]. In contrast, the mean duration of the goiter before initial consult of 6 years and larger mean tumor size reflect the limited access to medical care typical of most patients seen at our institution.…”

Section: Discussionsupporting

confidence: 89%

Well-differentiated thyroid cancer: the Philippine General Hospital experience

Maningat

2015

EJEA

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Background: Well-differentiated thyroid cancer (WDTC) is the most common form of thyroid malignancy. While it is typically associated with good prognosis, it may exhibit higher recurrence and mortality rates in selected groups, particularly Filipinos. This paper aims to describe the experience of a Philippine Hospital in managing patients with differentiated thyroid cancer. Methods:We performed a retrospective cohort study of 723 patients with WDTC (649 papillary and 79 follicular), evaluating the clinicopathologic profiles, ultrasound features, management received, tumor recurrence, and eventual outcome over a mean follow-up period of 5 years. Results: The mean age at diagnosis was 44±13 years (range, 18 to 82), with a majority of cases occurring in the younger age group (<45 years). Most tumors were between 2 and 4 cm in size. The majority of papillary thyroid cancers (PTCs, 63.2%) and follicular thyroid cancers (FTCs, 54.4%) initially presented as stage 1, with a greater proportion of FTC cases (12.7% vs. 3.7%) presenting with distant metastases. Nodal metastases at presentation were more frequent among patients with PTC (29.9% vs. 7.6%). A majority of cases were treated by complete thyroidectomy, followed by radioactive iodine therapy and thyroid stimulating hormone suppression, resulting in a disease-free state. Excluding patients with distant metastases at presentation, the recurrence rates for papillary and FTC were 30.1% and 18.8%, respectively. Conclusion: Overall, PTC among Filipinos was associated with a more aggressive and recurrent behavior. FTC among Filipinos appeared to behave similarly with other racial groups.

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Section: Discussionsupporting

confidence: 89%

Well-differentiated thyroid cancer: the Philippine General Hospital experience

Maningat

2015

EJEA

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“…Although the impact of years since diagnosis is not an established stratification variable for IRPTC, it is at least plausible that patients farther into their disease course might be expected to have overall worse outcomes including rapid progression. Other factors including patient age and particularly male gender are reported to convey increased risk in IRPTC and were the most unfavorably represented in the current cohort relative to the 3 comparators (30). Finally, a plausible explanation for differences in outcomes across the studies is differences in the effectiveness of therapies.…”

Section: Discussionmentioning

confidence: 90%

Phase II Efficacy and Pharmacogenomic Study of Selumetinib (AZD6244; ARRY-142886) in Iodine-131 Refractory Papillary Thyroid Carcinoma with or without Follicular Elements

Hayes

Lucas

Tanvetyanon

et al. 2012

Clinical Cancer Research

141

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Purpose A multicenter, open-label, phase II trial was conducted to evaluate the efficacy, safety, and tolerability of selumetinib in iodine-refractory papillary thyroid cancer (IRPTC). Experimental Design Patients with advanced IRPTC with or without follicular elements and documented disease progression within the preceding 12 months were eligible to receive selumetinib at a dose of 100 mg twice daily. The primary endpoint was objective response rate using Response Evaluation Criteria in Solid Tumors. Secondary endpoints were safety, overall survival, and progression-free survival (PFS). Tumor genotype including mutations in BRAF, NRAS, and HRAS was assessed. Results Best responses in 32 evaluable patients out of 39 enrolled were 1 partial response (3%), 21 stable disease (54%), and 11 progressive disease (28%). Disease stability maintenance occurred for 16 weeks in 49%, 24 weeks in 36%. Median PFS was 32 weeks. BRAF V600E mutants (12 of 26 evaluated, 46%) had a longer median PFS compared with patients with BRAF wild-type (WT) tumors (33 versus 11 weeks, respectively, HR = 0.6, not significant, P = 0.3). The most common adverse events and grades 3 to 4 toxicities included rash, fatigue, diarrhea, and peripheral edema. Two pulmonary deaths occurred in the study and were judged unlikely to be related to the study drug. Conclusions Selumetinib was well tolerated but the study was negative with regard to the primary outcome. Secondary analyses suggest that future studies of selumetinib and other mitogen-activated protein (MAP)/extracellular signal-regulated kinase (ERK; MEK) inhibitors in IRPTC should consider BRAF V600E mutation status in the trial design based on differential trends in outcome.

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“…Although the majority of DTC has a favorable prognosis, up to 15% of cases do not respond completely to radioiodine ablation, including 4% that exhibit no tumor reduction or progressive disease (Sciuto et al 2009). In cases that no longer concentrate radioiodine, the twin utility of radioiodine as a true theranostic agent (a modality with both diagnostic and therapeutic utility) is absent.…”

Section: Tshr As a Theranostic Target For Drug Deliverymentioning

confidence: 99%

Targeting the TSH receptor in thyroid cancer

Rowe¹,

Paul²,

Gedye³

et al. 2017

Endocrine-Related Cancer

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Recent advances in the arena of theranostics have necessitated a re-examining of previously established fields. The existing paradigm of therapeutic thyroid-stimulating hormone receptor (TSHR) targeting in the post-surgical management of differentiated thyroid cancer using levothyroxine and recombinant human thyroid-stimulating hormone (TSH) is well understood. However, in an era of personalized medicine, and with an increasing awareness of the risk profile of longstanding pharmacological hyperthyroidism, it is imperative clinicians understand the molecular basis and magnitude of benefit for individual patients. Furthermore, TSHR has been recently re-conceived as a selective target for residual metastatic thyroid cancer, with pilot data demonstrating effective targeting of nanoparticles to thyroid cancers using this receptor as a target. This review examines the evidence for TSHR signaling as an oncogenic pathway and assesses the evidence for ongoing TSHR expression in thyroid cancer metastases. Priorities for further research are highlighted.

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Natural history and clinical outcome of differentiated thyroid carcinoma: a retrospective analysis of 1503 patients treated at a single institution

Abstract: A rigorous initial therapeutic approach leads to a better survival and a very low morbidity. Patients who do not respond to radioiodine treatment have a worse prognosis.

Cited by 161 publications

References 22 publications

Well-differentiated thyroid cancer: the Philippine General Hospital experience

Well-differentiated thyroid cancer: the Philippine General Hospital experience

Phase II Efficacy and Pharmacogenomic Study of Selumetinib (AZD6244; ARRY-142886) in Iodine-131 Refractory Papillary Thyroid Carcinoma with or without Follicular Elements

Targeting the TSH receptor in thyroid cancer

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