Outcomes and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Carcinomas

Wassermann, Johanna; Bernier, Marie‐Odile; Spano, Jean‐Philippe; Lepoutre-Lussey, Charlotte; Buffet, C; Simon, Jean‐Marc; Ménégaux, Fabrice; Tissier, Frédérique; Leban, Monique; Leenhardt, Laurence

doi:10.1634/theoncologist.2015-0107

Cited by 50 publications

(41 citation statements)

References 45 publications

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“…Although detection of serum thyroglobulin (Tg) levels was a reliable predictor of DTC DMs, this method is limited by metastatic lesions' ability to release detectable amounts of Tg, loss of the ability of secreting Tg with preserved capability of 131 I trapping, structural changes in Tg, or Tg level decreased by elevated circulating Tg antibodies (TgAb) [7,8] ]. Also, Tg levels do not predict RR-DTC [9] . Therefore, tumor markers that can help detect DTC DMs and predict RR-DTC are sorely needed.…”

Section: Introductionmentioning

confidence: 85%

Circulating Tumor Cells Correlate with Clinicopathological Features and Outcomes in Differentiated Thyroid Cancer

Qiu¹,

Wei²,

Sun³

et al. 2018

Cell Physiol Biochem

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Background/Aims: As biomarkers, circulating tumor cells (CTCs) from solid tumors can predict metastases and prognoses, and help monitor treatment efficacy. However, conventional CellSearch methods have low sensitivity to differentiated thyroid cancer (DTC) CTCs. In this study, for the first time, we used negative enriching (NE) immunofluorescence–in situ hybridization (iFISH) of chromosome 8 to capture and identify CTCs in DTC patients; and investigated how CTCs correlate with clinicopathological factors and prognosis in DTC patients with distant metastases (DM). Methods: In this prospective study, we enrolled 72 patients with DTC before they underwent ¹³¹I treatment, and 30 healthy controls (HC). Their CTCs were measured in 7.5 ml peripheral blood using the NE–iFISH technique. CTC was defined by the aneuploidy. Results: We detected CTCs in 62 (86.1%) of the 72 subjects with DTC. The mean number of CTCs in patients with DTC with DM (DM⁺) was significantly higher than in the HC group (P< 0.001) and DTC patients without DM (DM^-; P=0.0016). We found CTCs ≥ 5 was significantly associated with DM⁺ DTC (P=0.009; sensitivity: 64.3%; specificity: 83.8%); CTCs ≥ 7 was related to poor response to ¹³¹I treatment (sensitivity: 73.7 %; specificity: 69.6 %), and was also associated with worse prognosis in DM⁺ DTC (P< 0.001). Conclusion: We found CTCs ≥ 5 to be a potential predictive index for DM⁺ DTC; and CTCs ≥7 as a possible indicator of poor response to ¹³¹I treatment and worse prognosis in DM⁺ DTC.

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Section: Introductionmentioning

confidence: 85%

Circulating Tumor Cells Correlate with Clinicopathological Features and Outcomes in Differentiated Thyroid Cancer

Qiu¹,

Wei²,

Sun³

et al. 2018

Cell Physiol Biochem

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“…The decision whether to continue radioactive iodine treatment in such patients should be based on their response to previous treatment courses, persistence of a RAI uptake during the previous treatment course, low FDG uptake in tumor foci, and an absence of significant side-effects from RAI treatment. [141] A recent study evaluated RAIR and survival in 153 cases of metastatic DTC [142]. Here, 91 patients (59%) met criteria for RAIR: that is, 60% ( n = 55) had at least 1 metastasis without 131 I uptake; 21% ( n = 19) had progressive disease (PD) despite 131 I; 19% ( n = 17) had persistent disease despite a cumulative activity of 131 I of ≥600 mCi.…”

Section: Adopting Tkis Into Treatment Algorithms For Thyroid Cancermentioning

confidence: 99%

“…In multivariate analyses, PD despite 131 I as one of the criteria for RAIR and the time from initial diagnosis of DTC to diagnosis of RAIR <3 years were the only independent prognostic factors for poor overall survival. The conclusion of the study was that identification of prognostic factors for decreased survival in RAIR-DTC may improve the selection of patients for targeted agents[142]. …”

Section: Adopting Tkis Into Treatment Algorithms For Thyroid Cancermentioning

confidence: 99%

The Treatment of Advanced Thyroid Cancer in the Age of Novel Targeted Therapies

Lirov

Worden

Cohen

2017

Drugs

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Until recently, patients with advanced thyroid cancers had limited options for systemic treatment. With the introduction of tyrosine kinase inhibitors (TKIs) as a promising new class of targeted therapies for thyroid cancer, suddenly patients with advanced disease were given new options to extend survival. Guidelines worldwide have been updated to include general indications for these newer agents, but questions remain regarding which agent(s) to select, when to begin treatment, and how long therapy should continue. Additionally, the true impact of TKIs on overall survival and quality-of-life in thyroid cancer patients needs further clarification. As familiarity with approved agents and longer-term data become available, better strategies for implementation of these targeted drugs will evolve to optimize benefit for patients living with metastatic disease.

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“…Previous studies have shown that an older age (≥60 years) and the male gender were independently related to cancer‐specific survival in RAIR patients . In Johanna's study, progressive disease and a period from the initial DTC diagnosis to the diagnosis of RAIR cancer <3 years were the only independent prognostic factors for poor overall survival and carcinoma‐related death . Meanwhile, numerous studies have investigated mechanisms underlying the process of dedifferentiation and explored various therapeutic strategies to improve iodide uptake .…”

Section: Discussionmentioning

confidence: 99%

Radioiodine refractoriness score: A multivariable prediction model for postoperative radioiodine‐refractory differentiated thyroid carcinomas

Lei

Liu

et al. 2018

Cancer Medicine

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ObjectiveThe purpose of the present study was to evaluate the clinical features of patients with radioiodine refractory (RAIR) differentiated thyroid carcinoma (DTC) and establish an effective risk score for postoperative radioiodine refractoriness.Subjects and methodsData were retrospectively collected from 5163 patients admitted to our center after thyroid surgery. Radioiodine refractoriness was defined according to criteria used in the 2015 American Thyroid Association guidelines. The scoring system was established by independent risk factors identified by univariate and multivariate analyses. The optimal index points for predicting the prevalence of radioiodine refractoriness and the model discriminatory power were assessed by receiver operating characteristic (ROC) curves.ResultsOne hundred and twelve (2.2%) patients developed RAIR DTC. Smoking, tumor type (follicular thyroid cancer), extrathyroid extension, lymph node metastasis number (≥4), lymph node metastasis rate (≥53%), and pN stage (N1) were highly positively correlated with the prevalence of RAIR DTC. The cutoff value of seven points was found to be the best for predicting the prevalence of RAIR DTC, and the scoring system presented better discrimination than other single independent predictors.ConclusionsBased on our multivariable prediction model, patients with ≥7 index points may need to undergo more active surveillance or aggressive treatment due to the high risk of RAIR DTC.

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Outcomes and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Carcinomas

Cited by 50 publications

References 45 publications

Circulating Tumor Cells Correlate with Clinicopathological Features and Outcomes in Differentiated Thyroid Cancer

Circulating Tumor Cells Correlate with Clinicopathological Features and Outcomes in Differentiated Thyroid Cancer

The Treatment of Advanced Thyroid Cancer in the Age of Novel Targeted Therapies

Radioiodine refractoriness score: A multivariable prediction model for postoperative radioiodine‐refractory differentiated thyroid carcinomas

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