Novel prognostic nomogram for predicting recurrence-free survival in medullary thyroid carcinoma

AimsRecently, there have been attempts to improve prognostication and therefore better guide treatment for patients with medullary thyroid carcinoma (MTC). In 2022, the International MTC Grading System (IMTCGS) was developed and validated using a multi-institutional cohort of 327 patients. The aim of the current study was to build upon the findings of the IMTCGS to develop and validate a prognostic nomogram to predict recurrence-free survival (RFS) in MTC.Methods and ResultsData from 300 patients with MTC from five centres across the USA, Europe, and Australia were used to develop a prognostic nomogram that included the following variables: age, sex, AJCC stage, tumour size, mitotic count, necrosis, Ki67 index, lymphovascular invasion, microscopic extrathyroidal extension, and margin status. A process of 10-fold cross-validation was used to optimize the model's performance. To assess discrimination and calibration, the area-under-the-curve (AUC) of a receiver operating characteristic (ROC) curve, concordance-index (C-index), and dissimilarity index (D-index) were calculated. Finally, the model was externally validated using a separate cohort of 87 MTC patients. The model demonstrated very strong performance, with an AUC of 0.94, a C-index of 0.876, and a D-index of 19.06. When applied to the external validation cohort, the model had an AUC of 0.9.ConclusionsUsing well-established clinicopathological prognostic variables, we developed and externally validated a robust multivariate prediction model for RFS in patients with resected MTC. The model demonstrates excellent predictive capability and may help guide decisions on patient management. The nomogram is freely available online at .Building upon the International Medullary Thyroid Carcinoma (MTC) Grading System (IMTCGS) developed in 2022, this study presents a prognostic nomogram to predict recurrence-free survival in MTC. The model was created using data from 300 MTC patients and was externally validated in a separate cohort. The nomogram is available at . imag

Association of the Genomic Profile of Medullary Thyroid Carcinoma with Tumor Characteristics and Clinical Outcomes in an International Multicenter Study

Purpose: The prognostic importance of RET and RAS mutations and their relationship to clinicopathologic parameters and outcomes in medullary thyroid carcinoma (MTC) need to be clarified. Experimental Design: A multicenter retrospective cohort study was performed utilizing data from 290 patients with MTC. The molecular profile was determined and associations were examined with clinicopathologic data and outcomes. Results: RET germ line mutations were detected in 40 patients (16.3%). Somatic RET and RAS mutations occurred in 135 (46.9%) and 57 (19.8%) patients, respectively. RETM918T was the most common somatic RET mutation (n = 75). RET somatic mutations were associated with male sex, larger tumor size, advanced American Joint Committee Cancer (AJCC) stage, vascular invasion, and high International Medullary Thyroid Carcinoma Grading System (IMTCGS) grade. When compared with other RET somatic mutations, RETM918T was associated with younger age, AJCC (eighth edition) IV, vascular invasion, extrathyroidal extension, and positive margins. RET somatic or germ line mutations were significantly associated with reduced distant metastasis-free survival on univariate analysis, but there were no significant independent associations on multivariable analysis, after adjusting for tumor grade and stage. There were no significant differences in outcomes between RET somatic and RET germ line mutations, or between RETM918T and other RET mutations. Other recurrent molecular alterations included TP53 (4.2%), ARID2 (2.9%), SETD2 (2.9%), KMT2A (2.9%), and KMT2C (2.9%). Among them, TP53 mutations were associated with decreased overall survival (OS) and disease-specific survival (DSS), independently of tumor grade and AJCC stage. Conclusions: RET somatic mutations were associated with high-grade, aggressive primary tumor characteristics, and decreased distant metastatic-free survival but this relationship was not significant after accounting for tumor grade and disease stage. RETM918T was associated with aggressive primary tumors but was not independently associated with clinical outcomes. TP53 mutation may represent an adverse molecular event associated with decreased OS and DSS in MTC, but its prognostic value needs to be confirmed in future studies

HESEB The Helmholtz state of the art Soft X Ray Undulator beamline at SESAME

SESAME and a consortium of five Helmholtz Centers are designing and installing a state of the art soft X Ray undulator beamline at the SESAME light source in Amman, Jordan. Funding is provided by the Helmholtz Association over a four year project cycle that started in January 2019. This is an interim report covering the first 36 months of the project where the construction and installation has been almost completed and commissioning and characterization of the beamline is about to start. Additionally, seminars, workshops, and a training program are part of the project aimed at establishing a broad user communit

HESEB Soft X ray Beamline ID11 L at SESAME Performance and First User Experiments

The ID11 L HESEB Soft X ray beamline and end station significantly enhance soft X ray research capabilities. Operating in an energy range of 90 1800 eV, extendable to 70 2000 eV, the beamline achieves high performance with an energy resolution of E amp; 916;E gt; 8000 and a photon flux of 1010 to 3.4 1012 photons s. Its 500 250 amp; 956;m lt; beam spot size allows for precise measurements, including studies on magnetic materials using variable circular polarization. This paper presents the end station s design, including the receptacle, magnetic sample holder, and ambient pressure capabilities, along with experimental results that demonstrate the beamline s potential for diverse scientific application

Electronic Learning Platforms and Their Impact on Education Quality at Faculties of Tourism and Hospitality during Corona Pandemic

To effectively educate educations students, online platforms are crucial. Unfortunately, they might not be well- represented in universities. The goals of the study are determined in this light. The purpose of this paper is to analyze how the use of e-Learning has affected the quality of education in Jordans tourism and hospitality colleges during the recent Corona virus pandemic. Before doing regression analysis, a survey was sent out to faculty and employees at tourism and hospitality schools. Using SPSS version 22, researchers analyzed responses made on a 37-point Likert scale. An evaluation procedure was performed on it. The initial belief that ELPs are more effective and acceptable reduces the drive to keep taking them. According to linear regression analysis, investments in training, incentives, and assistive technology have a favorable and statistically significant effect on the quality of education provided by tourism and hospitality programs at the university level. Future research should compare results before and after COVID, as suggested by our findings

International Medullary Thyroid Carcinoma Grading System: A Validated Grading System for Medullary Thyroid Carcinoma

PURPOSE Medullary thyroid carcinoma (MTC) is an aggressive neuroendocrine tumor (NET) arising from the calcitonin-producing C cells. Unlike other NETs, there is no widely accepted pathologic grading scheme. In 2020, two groups separately developed slightly different schemes (the Memorial Sloan Kettering Cancer Center and Sydney grade) on the basis of proliferative activity (mitotic index and/or Ki67 proliferative index) and tumor necrosis. Building on this work, we sought to unify and validate an internationally accepted grading scheme for MTC. PATIENTS AND METHODS Tumor tissue from 327 patients with MTC from five centers across the United States, Europe, and Australia were reviewed for mitotic activity, Ki67 proliferative index, and necrosis using uniform criteria and blinded to other clinicopathologic features. After reviewing different cutoffs, a two-tiered consensus grading system was developed. High-grade MTCs were defined as tumors with at least one of the following features: mitotic index ≥ 5 per 2 mm2, Ki67 proliferative index ≥ 5%, or tumor necrosis. RESULTS Eighty-one (24.8%) MTCs were high-grade using this scheme. In multivariate analysis, these patients demonstrated decreased overall (hazard ratio [HR] = 11.490; 95% CI, 3.118 to 32.333; P &lt; .001), disease-specific (HR = 8.491; 95% CI, 1.461 to 49.327; P = .017), distant metastasis-free (HR = 2.489; 95% CI, 1.178 to 5.261; P = .017), and locoregional recurrence-free (HR = 2.114; 95% CI, 1.065 to 4.193; P = .032) survivals. This prognostic power was maintained in subgroup analyses of cohorts from each of the five centers. CONCLUSION This simple two-tiered international grading system is a powerful predictor of adverse outcomes in MTC. As it is based solely on morphologic assessment in conjunction with Ki67 immunohistochemistry, it brings the grading of MTCs in line with other NETs and can be readily applied in routine practice. We therefore recommend grading of MTCs on the basis of mitotic count, Ki67 proliferative index, and tumor necrosis. </jats:sec