Referral Practice for Radioactive Iodine Ablation (RAI) after ATA guidelines 2015: results from a Tertiary Cancer Care Centre.
ATA 指南 2015 后放射性碘消融 (RAI) 的转诊实践: 三级癌症护理中心的结果。
- 作者列表："Dhar H","Thiagarajan S","Yousuf A","Nayyar SS","Chaukar D
INTRODUCTION:The ATA guidelines for differentiated thyroid cancer (DTC) are one of the most widely referred to. Their 2015 edition proposed a new risk stratification system and modified the indications for radioactive iodine (RAI) ablation especially for the low risk category. We attempted to analyze whether the new guidelines altered referral practices for RAI ablation at our institute. METHODOLOGY:Patients who underwent total or completion thyroidectomy for DTC during 2016-2017 were included. Relevant demographical and pathological data was tabulated. Patients were classified as per the new stratification system and referral practice for RAI ablation documented. RESULTS:238 patients were included. Of these 20.6% were low risk, 44.1% were intermediate and 35.3% were high risk as per modified guidelines. All patients within the intermediate and high-risk group and 77.8% of the low risk group were referred for RAI ablation. Analysis of risk factors revealed that within the low risk group there were three patients with < 5 metastatic nodes, all within 3 cm in size-a category that the ATA failed to stratify appropriately. Among those labeled as Intermediate risk due to microscopic extra thyroidal extension (ETE), 85% had no other risk factors and were upstaged solely due to microscopic ETE, which is interestingly no longer included in the TNM staging. CONCLUSION:Majority of low risk patients continue to receive RAI ablation due to persistent belief emanating from literature that remnant ablation improves outcomes and aids in follow up. The issue of RAI ablation for low risk group and prognostic implications of microscopic ETE and limited nodal disease need to be revisited.
简介: 分化型甲状腺癌 (DTC) 的 ATA 指南是参考最广泛的指南之一。他们的 2015 版提出了新的风险分层系统，并修改了放射性碘 (RAI) 消融的适应症，特别是对于低风险类别。我们试图分析新指南是否改变了我们研究所 RAI 消融的转诊实践。 方法: 纳入 2016-2017 期间因 DTC 行全甲状腺切除术或完成甲状腺切除术的患者。将相关人口学和病理学资料制成表格。患者按照新的分层系统分类，并记录 RAI 消融的转诊实践。 结果: 共纳入 238 例患者。根据修改后的指南，这 20.6% 为低风险，44.1% 为中等风险，35.3% 为高风险。中高危组和低危组 77.8% 的患者均转诊进行 RAI 消融。危险因素分析显示，在低风险组中，有 3 例患者的转移淋巴结 <5 个，均在 3厘米大小内-这是 ATA 未能适当分层的类别。在因显微镜下甲状腺外延伸 (ETE) 而被标记为中间风险的人群中，85% 没有其他危险因素，仅因显微镜下 ETE 而被抢有趣的是不再包括在 TNM 分期中。 结论: 大多数低风险患者继续接受 RAI 消融，原因是文献中持续认为残余消融改善了随访结果和艾滋病。需要重新审视低风险组的 RAI 消融问题以及显微镜下 ETE 和局限性淋巴结疾病的预后意义。
METHODS:OBJECTIVES:To assess the prevalence of Hashimoto thyroiditis (HT) in primary thyroid lymphoma (PTL) and whether it differs between mucosa-associated lymphoid tissue (MALT) lymphoma and diffuse large B-cell lymphoma (DLBCL). METHODS:Electronic databases were searched for studies assessing HT prevalence in PTL, based on antithyroid antibodies, clinical history, or pathology. Pooled prevalence of HT and its association with histotype (MALT or DLBCL) were calculated. RESULTS:Thirty-eight studies with 1,346 PTLs were included. Pooled prevalence results were 78.9% (any HT evidence), 65.3% (antithyroid antibodies), 41.7% (clinical history), and 64% (pathology). HT prevalence was significantly higher in MALT lymphoma than in DLBCL (P = .007) and in mixed DLBCL/MALT than in pure DLBCL (P = .002). CONCLUSIONS:Overall, 78.9% of patients with PTL have any HT evidence, but only half of these had been clinically followed. The difference in HT prevalence suggests that a subset of DLBCL may not derive from MALT lymphoma.
METHODS:Background Whether chronic lymphocytic thyroiditis (CLT) influences the risk of development and the progression of papillary thyroid cancer (PTC) remains uncertain. We investigated the effects of CLT on the clinicopathologic features and prognosis of PTC. Methods Two thousand nine hundred twenty-eight consecutive patients with PTC treated between 2009 and 2017 were divided into two groups: one with chronic lymphocytic thyroiditis and one without; 1174 (40%) of the patients had coincident CLT. Results In univariate analysis, CLT correlated positively with small tumor size, frequent extrathyroidal extension, multifocal diseases, and p53 but negatively with central lymph node (LN) metastasis and BRAF mutation. In multivariate analysis, CLT was associated with extrathyroidal extension and multifocal disease; however, it was not a prognostic factor for recurrence even though it was associated with two aggressive factors. Compared with patients with PTC alone, there were more retrieved central LNs in the PTC + CLT group, and these patients also underwent more invasive diagnostic tests such as fine needle aspiration cytology and frozen biopsy of LN. Conclusions The CLT patients with PTC had better behavior features and prognoses than did those with PTC alone despite frequent multifocality and extrathyroidal extension. However, precaution may be necessary to avoid performing invasive diagnostic procedures for lateral LN metastasis and to manage the patients appropriately.
METHODS::PTPN2 is one of the members of the protein Tyrosine Phosphatases (PTPs) family. To explore the promotive effect of upregulated PTPN2 induced by inflammatory response or oxidative stress on the progression of thyroid cancer. PTPN2 level in thyroid cancer tissues and cell lines was detected. Kaplan-Meier method was applied for evaluating the prognostic value of PTPN2 in thyroid cancer patients. After stimulation of inflammatory response (treatment of IFN-γ and TNF-α), or oxidative stress (treatment of H2O2), protein level of PTPN2 in K1 cells was measured by Western blot. Regulatory effects of PTPN2 on EdU-positive staining and Ki-67 positive cell ratio in K1 cells either with H2O2 stimulation or not were determined. PTPN2 was upregulated in thyroid cancer tissues and cell lines. Its level was higher in metastatic thyroid cancer patients than those of non-metastatic ones. High level of PTPN2 predicted worse prognosis of thyroid cancer. Treatment of either IFN-γ or TNF-α upregulated protein level of PTPN2 in K1 cells. Meanwhile, H2O2 stimulation upregulated PTPN2, which was reversed by NAC administration. With the stimulation of increased doses of H2O2, EdU-positive staining and Ki-67 positive cell ratio were dose-dependently elevated. Silence of PTPN2 attenuated proliferative ability and Ki-67 expression in K1 cells either with H2O2 stimulation or not. Inflammatory response or oxidative stress induces upregulation of PTPN2, thus promoting the progression of thyroid cancer.