IsBRAFmutation screening useful for preoperative risk stratification in papillary thyroid cancer?

2009 ◽  
Vol 5 (8) ◽  
pp. 1225-1229 ◽  
Author(s):  
Paula Soares ◽  
Manuel Sobrinho-Simões
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Papillary Thyroid ◽  
Preoperative Risk ◽  
Preoperative Risk Stratification

scholarly journals BRAF Mutation Predicts a Poorer Clinical Prognosis for Papillary Thyroid Cancer

2005 ◽  
Vol 90 (12) ◽  
pp. 6373-6379 ◽  
Author(s):  
Mingzhao Xing ◽  
William H. Westra ◽  
Ralph P. Tufano ◽  
Yoram Cohen ◽  
Eli Rosenbaum ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Thyroid Cancer ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Braf Mutation ◽  
Advanced Tumor Stage ◽  
Papillary Thyroid ◽  
Clinical Prognosis ◽  
Mutation Status ◽  
Predictors Of Recurrence

Context: Use of BRAF mutation in papillary thyroid cancer (PTC) has the potential to improve risk stratification of this cancer. Objective: The objective of the study was to investigate the prognostic value of BRAF mutation in patients with PTC. Design, Setting, and Subjects: In a multicenter study of 219 PTC patients, data on their clinicopathological characteristics and clinical courses between 1990 and 2004 were retrospectively collected, and their tumor BRAF mutation status was determined. Associations of BRAF mutation with initial tumor characteristics and subsequent recurrence were analyzed. Main Outcome Measure: Relationships between the BRAF mutation status and clinicopathological outcomes, including recurrence, were measured. Results: We found a significant association between BRAF mutation and extrathyroidal invasion (P < 0.001), lymph node metastasis (P < 0.001), and advanced tumor stage III/IV (P = 0.007) at initial surgery. This association remained significant on multivariate analysis, adjusting for conventional clinicopathological predictors of recurrence excluding the histological PTC subtype, but was lost when the tumor subtype was included in the model. BRAF mutation was also significantly associated with tumor recurrence, 25 vs. 9% with and without mutation, respectively (P = 0.004), during a median of 15 (interquartile range, 3–29) months of follow-up. This association remained significant on multivariate analysis adjusting for conventional clinicopathological predictors of recurrence, even including the PTC subtype (odds ratio, 4.0; 95% confidence interval, 1.1–14.1; P = 0.03). BRAF mutation was even an independent predictor of recurrence in patients with stage I/II disease, 22 vs. 5% with and without BRAF mutation, respectively (P = 0.002). BRAF mutation was also more frequently associated with absence of tumor I-131 avidity and treatment failure of recurrent disease. Conclusions: In patients with PTC, BRAF mutation is associated with poorer clinicopathological outcomes and independently predicts recurrence. Therefore, BRAF mutation may be a useful molecular marker to assist in risk stratification for patients with PTC.

scholarly journals The Age Threshold of the 8th Edition AJCC Classification Is Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice. 

2020 ◽  
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Łukasz Nowak ◽  
Beata Wojtczak ◽  
Jerzy Rudnicki
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Papillary Thyroid ◽  
Locally Advanced Disease ◽  
In Series ◽  
8Th Edition

Abstract Background: Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classification is to increase the age cut off for risk stratification in PTC from 45 to 55 years. However, whether this cut off is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC.Methods: We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n=523) were divided in 2 groups according to age cut off. In the first series (cut off 45) patients <45 (n=193) vs. ≥45 (n=330) were compared, and in the second series (cut off 55) patients <55 (n=306) vs. ≥55 (n=217) were compared.Results: The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p=0.013). No significant differences were found for this parameter in series with cut off point 45 years old. A significantly higher risk of locally advanced disease T3+T4 (OR=4.87) and presence of LNM (N1) (OR=3.78) was observed in ≥45 years old group (p=0.021 and p<0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3+T4) was higher (OR=5.21) and LNM presence was OR=4.76 (p<0.001 and p<0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p<0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals.Conclusions: The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

scholarly journals Detailed characterization of metastatic lymph nodes improves the prediction accuracy of currently used risk stratification systems in N1 stage papillary thyroid cancer

2020 ◽  
Vol 183 (1) ◽  
pp. 83-93
Author(s):  
Jandee Lee ◽  
Chan Hee Kim ◽  
In Kyung Min ◽  
Seonhyang Jeong ◽  
Hyunji Kim ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Risk Stratification ◽  
Lymph Nodes ◽  
Papillary Thyroid Cancer ◽  
Predictive Value ◽  
Maximum Diameter ◽  
Papillary Thyroid ◽  
Detailed Characterization ◽  
Risk Of Recurrence

Objective The characteristics of metastatic lymph nodes (MLNs) have been investigated as important predictors of recurrence and progression in papillary thyroid cancer (PTC). However, clinically applicable risk stratification systems are limited to the assessment of size and number of MLNs. This study investigated the predictive value of detailed characteristics of MLNs in combination with currently used risk stratification systems. Design and methods We retrospectively characterized 2811 MLNs from 9014 harvested LNs of 286 patients with N1 PTC according to the maximum diameter of MLN (MDLN), maximum diameter of metastatic focus (MDMF), ratio of both diameters (MDMFR), lymph node ratio (LNR, number of MLNs/number of total harvested LNs), presence of extranodal extension (ENE), desmoplastic reaction (DR), cystic component, and psammoma body. Results Factors related to the size and number of MLNs were associated with increased risk of recurrence and progression. Extensive presence of ENE (>40%) and DR (≥50%) increased the risk of recurrence/progression. The combination of MDLN, LNR, ENE, and DR had the highest predictive value among MLN characteristics. Combination of these parameters with ATA risk stratification or 1-year response to therapy improved the predictive power for recurrence/progression from a Harrell’s C-index of 0.781 to 0.936 and 0.867 to 0.960, respectively. Conclusions The combination of currently used risk stratification systems with detailed characterization of MLNs may improve the predictive accuracy for recurrence/progression in N1 PTC patients.

scholarly journals The Age Threshold of the 8th Edition AJCC Classification Is Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice. 

2020 ◽  
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Łukasz Nowak ◽  
Beata Wojtczak ◽  
Jerzy Rudnicki
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Papillary Thyroid ◽  
Locally Advanced Disease ◽  
In Series ◽  
8Th Edition

Abstract Background: Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classification is to increase the age cut off for risk stratification in PTC from 45 to 55 years. However, whether this cut off is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC.Methods: We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n=523) were divided in 2 groups according to age cut off. In the first series (cut off 45) patients <45 (n=193) vs. ≥45 (n=330) were compared, and in the second series (cut off 55) patients <55 (n=306) vs. ≥55 (n=217) were compared.Results: The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p=0.013). No significant differences were found for this parameter in series with cut off point 45 years old. A significantly higher risk of locally advanced disease T3+T4 (OR=4.87) and presence of LNM (N1) (OR=3.78) was observed in ≥45 years old group (p=0.021 and p<0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3+T4) was higher (OR=5.21) and LNM presence was OR=4.76 (p<0.001 and p<0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p<0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals.Conclusions: The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

scholarly journals The Age Threshold of the 8th Edition AJCC ClassificationIs Useful for Indicating Patients with Aggressive Papillary Thyroid Cancer in Clinical Practice.

2020 ◽  
Author(s):  
Krzysztof Kaliszewski ◽  
Dorota Diakowska ◽  
Łukasz Nowak ◽  
Beata Wojtczak ◽  
Jerzy Rudnicki
Keyword(s):  
Thyroid Cancer ◽  
Clinical Practice ◽  
Risk Stratification ◽  
Papillary Thyroid Cancer ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Papillary Thyroid ◽  
Locally Advanced Disease ◽  
In Series ◽  
8Th Edition

Abstract Background: Papillary thyroid cancer (PTC) is unique among cancers in that patient age is a consideration in staging. One of the most important modifications in the 8th Edition of the American Joint Committee on Cancer (AJCC) classificationis to increase the age cutoff for risk stratification in PTC from 45 to 55 years. However, whether this cutoff is useful in clinical practice remains controversial. In the present study, we assessed how well this new age threshold stratifies patients with aggressive PTC.Methods: We retrospectively analyzed the clinicopathological features and overall survival rate of patients with PTC admitted to and surgically treated at a single surgical center. The study protocol was divided into two series. In each series all patients (n=523) were divided in 2 groups according to age cutoff. In the first series (cutoff 45) patients <45 (n=193) vs. ≥45 (n=330) were compared, and in the second series (cutoff 55) patients <55 (n=306) vs. ≥55 (n=217) were compared.Results: The rate of the prevalence of locally advanced disease (pT3 and pT4) was significantly higher in the patients above 55 years old than in those below 55 years old (p=0.013). No significant differences were found for this parameter in series with cutoff point 45 years old. A significantly higher risk of locally advanced disease T3+T4 (OR=4.87) and presence of LNM (N1) (OR=3.78) was observed in ≥45 years old group (p=0.021 and p<0.0001, respectively). More expressive results were found for the patients ≥55 years old group, where the risk of locally advanced disease (T3+T4) was higher (OR=5.21) and LNM presence was OR=4.76 (p<0.001 and p<0.0001, respectively). None of the patients below 55 years old showed distant metastasis, but 19 patients above 55 years old showed M1 (p<0.0001). In older patients group (≥55 years old) we observed deaths related thyroid cancer in 11 individuals.Conclusions: The age cut off of 55 years old for risk stratification proposed by the 8th Edition of AJCC effectively stratifies PTC patients with a poor prognosis, indicating it is likely to be useful in clinical practice.

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