Stato nutrizionale e risposta al trattamento con inibitori tirosino-chinasici nel carcinoma tiroideo avanzato

L’utilizzo di inibitori tirosino-chinasici (TKI) rappresenta un’importante opzione terapeutica nel trattamento del carcinoma tiroideo metastatico. Il trattamento con tali farmaci è frequentemente associato alla comparsa di eventi avversi che possono compromettere uno stato nutrizionale già precario, tipico di questi pazienti, peggiorandone quindi anche la prognosi. Diversi studi hanno valutato l’impatto dello stato nutrizionale e della presenza di sarcopenia sulla risposta al trattamento e sulla sopravvivenza dei pazienti oncologici. Tali parametri sembrano correlare con la prognosi e la sopravvivenza nei pazienti oncologici

Monitoraggio del nodulo tiroideo benigno in accordo con la classe di rischio ecografica

L’ecografia è il principale strumento diagnostico nell’ambito della patologia nodulare tiroidea. Negli ultimi anni si sono susseguite diverse linee guida finalizzate a standardizzare la descrizione ecografica e a modulare la gestione del nodulo tiroideo sulla base delle caratteristiche ecografiche. Tra le più utilizzate a livello internazionale vi sono quelle dell’American Association of Clinical Endocrinologists/American College of Endocrinology/Associazione Medici Endocrinologi (AACE/ACE/AME) [1], le linee guida 2015 dell’American Thyroid Association (ATA) [2], le linee guida della European Thyroid Association (ETA) (European Thyroid Imaging Reporting and Data System) [3] e l’American College of Radiology (ACR) TIRADS [4]. L’obiettivo primario di queste linee guida è quello di identificare, sulla base delle caratteristiche ecografiche, i noduli a maggior rischio di malignità da sottoporre ad agoaspirato (FNAC) e di ridurre il numero di agoaspirazioni tiroidee non necessarie, senza tuttavia aumentare il numero di mancate diagnosi di cancro tiroideo. La definizione del rischio ecografico del nodulo è inoltre utilizzata per modulare il follow-up a breve e a lungo termine dei noduli tiroidei citologicamente o ecograficamente benigni [4]

CONUT Score: A New Tool for Predicting Prognosis in Patients with Advanced Thyroid Cancer Treated with TKI

(1) Background: The Controlling Nutritional Status (CONUT) score is an immuno-nutritional screening tool based on serum albumin, total cholesterol, and lymphocyte count. The aim of the study was to assess the CONUT score as a potential prognostic factor of response to therapy in patients with advanced thyroid cancer treated with tyrosine kinase inhibitors (TKIs). (2) Methods: We retrospectively evaluated 42 metastatic thyroid cancer patients (54.8% female). The median age at the time of TKI treatment was 69 years. Histological diagnosis was differentiated thyroid cancer in 66.7%, poorly differentiated thyroid cancer in 21.4%, and medullary thyroid cancer in 11.9% of patients. CONUT score was assessed before starting TKI therapy. (3) Results: Progression-free survival (PFS) and overall survival (OS) were significantly influenced by baseline CONUT score. The best CONUT cut-off able to predict the response to treatment was 3. Both PFS and OS were better in patients with CONUT score <3 than in those with CONUT score ≥3 (p < 0.0001). CONUT score was the only independent prognostic factor associated with PFS (p = 0.021) and OS (p = 0.007). (4) Conclusions: CONUT score represents a relatively new screening tool, easily applicable in clinical practice and potentially useful in predicting prognosis in thyroid cancer patients treated with TKIs

Dynamic Risk Stratification Integrated with ATA Risk System for Predicting Long-Term Outcome in Papillary Thyroid Cancer

Background: In recent years, there has been a renewed interest in thyroid cancer management paradigms that use individualized risk assessments as the basis for treatment and follow-up recommendations. In this study, we assumed that the long-term follow-up of differentiated thyroid cancer patients might be better tailored by integrating the response to initial therapy with the America Thyroid Association (ATA) risk classes. Methods: This retrospective study included low- and intermediate-risk papillary thyroid cancer (PTC) patients followed up for a median time of 8 years and classified according to the response to initial therapy assessed 6–12 months after initial treatment. Results: After a median follow-up of 8 years, in the initial excellent response subgroup of PTC patients (n = 522), the rate of recurrent disease was significantly higher in intermediate-risk patients than in low-risk PTC patients (6.9% versus 1.2%, p = 0.0005). Similarly, in the initial biochemical incomplete response subgroup (n = 82), the rate of excellent response was significantly higher in low-risk PTC patients (58.0%) than in intermediate-risk PTC patients (33.3%) (p = 0.007). Finally, in the initial structural incomplete response subgroup (n = 66), the rate of excellent response was higher in low-risk patients (80.0%) than in intermediate-risk patients (46.4%) (p = 0.08). Moreover, all patients with initial indeterminate response had an excellent response at the last follow-up visit. ATA risk classes were independently associated with long-term outcome in each subgroup of patients classified dynamically after initial therapy and the overall prognostic performance, defined via ROC curve analysis, of response to initial therapy integrated with the ATA risk system (AUC: 0.89; 95% CI: 0.86–0.92) was significantly higher compared to the ATA risk stratification (AUC 0.69; 95% CI: 0.65–0.74, p p = 0.007). Conclusions: This study of a large cohort of PTC patients showed that the initial ATA risk criteria may be useful for improving the risk-adapted management of PTC patients based on the response to initial therapy

Effect of Pre-Existent Sarcopenia on Oncological Outcome of Advanced Thyroid Cancer Patients Treated with Tyrosine Kinase Inhibitors

(1) Background: Sarcopenia is associated with poor survival and treatment outcomes in several human cancers. The aim of the study was to investigate the prevalence of sarcopenia in a cohort of 58 Caucasian patients with advanced thyroid cancer before and during TKI treatment. The impact of this condition on the outcome of patients was also evaluated. (2) Methods: Sarcopenia was evaluated using the Skeletal Muscle Index (SMI). (3) Results: Pre-treatment sarcopenia was found in 20.7% of patients and this condition significantly affected treatment outcome, emerging as the parameter that has the greatest impact on Progression Free Survival (PFS) (HR 4.29; 95% CI, 1.21–15.11, p = 0.02). A significant reduction in SMI values was observed 3 (p = 0.002) and 12 months (p < 0.0001) after TKI treatment. At a 12-month follow-up, sarcopenia prevalence increased up to 38.5%. Here, 12-month sarcopenia was predicted by a lower SMI (p = 0.029), BMI (p = 0.02) and weight (p = 0.04) and by the presence of bone metastases (p = 0.02). (4) Conclusions: This is the first study that evaluated sarcopenia prevalence and its change over time in Caucasian patients with advanced thyroid cancer under TKI therapy. Sarcopenia seems to be a prognostic factor of TKI treatment outcome, suggesting the importance of the assessment of the nutritional status and body composition in advanced thyroid cancer patients