Minimal Extrathyroidal Extension in Predicting 1-Year Outcomes: A Longitudinal Multicenter Study of Low-to-Intermediate-Risk Papillary Thyroid Carcinoma (ITCO#4)

Background: The role of minimal extrathyroidal extension (mETE) as a risk factor for persistent papillary thyroid carcinoma (PTC) is still debated. The aim of this study was to assess the clinical impact of mETE as a predictor of worse initial treatment response in PTC patients and to verify the impact of radioiodine therapy after surgery in patients with mETE. Methods: We reviewed all records in the Italian Thyroid Cancer Observatory (ITCO) database and selected 2237 consecutive patients with PTC who satisfied the inclusion criteria (PTC with no lymph node metastases and at least 1 year of follow-up). For each case, we considered initial surgery, histological variant of PTC, tumor diameter, recurrence risk class according to the American Thyroid Association (ATA) risk stratification system, use of radioiodine therapy, and initial therapy response, as suggested by ATA guidelines. Results: At 1-year follow-up, 1831 patients (81.8%) had an excellent response, 296 (13.2%) had an indeterminate response, 55 (2.5%) had a biochemical incomplete response, and 55 (2.5%) had a structural incomplete response. Statistical analysis suggested that mETE (odds ratio [OR] 1.16, p=0.65), tumor size >2 cm (OR 1.45, p=0.34), aggressive PTC histology (OR 0.55, p=0.15), and age at diagnosis (OR 0.90, p=0.32) were not significant risk factors for a worse initial therapy response. When evaluating the combination of mETE, tumor size, and aggressive PTC histology, the presence of mETE with a >2 cm tumor was significantly associated with a worse outcome (OR 5.27, 95% CI, p=0.014). The role of radioiodine ablation in patients with mETE was also evaluated. When considering radioiodine treatment, propensity score-based matching was performed, and no significant differences were found between treated and non-treated patients (p=0.24). Conclusions: This study failed to show the prognostic value of mETE in predicting initial therapy response in a large cohort of PTC patients without lymph node metastases. The study suggests that the combination of tumor diameter and mETE can be used as a reliable prognostic factor for persistence and could be easily applied in clinical practice to manage PTC patients with low-to-intermediate risk of recurrent/persistent disease

Habitar a metrópole: os apartamentos quitinetes de Adolf Franz Heep

The restructuring of the housing market and the emergence of a new housing typology in Sao Paulo from the mid-1940s, the kitchenette apartment, coincided with changes in the parameters that guided disciplinary discourse and architectural practice in Brazil. Analyze the moment the new typology was formulated, their initial motivations and subsequent developments, allows not only to recover the trajectory of the German architect Adolf Franz Heep (1902-1978) as investigate the dialogue between European architectural avant-garde, the North-American experiences, the local architectural production and the local demands

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Endocrine Disorders in Autoimmune Rheumatological Diseases: A Focus on Thyroid Autoimmune Diseases and on the Effects of Chronic Glucocorticoid Treatment

Autoimmune rheumatological diseases’ incidence and prevalence have risen over the last decades and they are becoming increasingly important worldwide. Thyroid autoimmune diseases share with them an imbalance in the immune system that lead to a pro-inflammatory environment. Usually this is the result of a multi-factorial process. In fact, it includes not only a possible genetic predisposition, but also environmental causes like microbiota dysbiosis, diet rich in processed foods, exposure to toxicants and infections. However, many aspects are currently under study. This paper aims to examine the factors that participate in the developing of rheumatological and thyroid autoimmune diseases. Moreover, as glucocorticoids still represent a leading treatment for systemic autoimmune rheumatological diseases, our secondary aim is to summarize the main effects of glucocorticoids treatment focusing on iatrogenic Cushing’s syndrome and glucocorticoids’ withdrawal syndrome

8th edition of AJCC/TNM staging system of thyroid cancer: what to expect (ITCO#2)

The 8th edition of AJCC/TNM staging system for differentiated thyroid cancer (DTC) has recently been published. The aim of this study was to compare AJCC/TNM staging 7th and 8th edition in terms of tumor stage distribution in a multicenter, consecutive and prospective cohort of newly diagnosed DTC collected in a web-based observational database. Additional information concerning the extent of minimal extrathyroidal extension was collected. A cohort of 1765 DTC patients (76% females, median age 48 years, 94% papillary histotype) was analyzed. Younger patients (<45 years or <55 years according to 7th and 8th edition, respectively) were in stage II (presence of distant metastases) in 2% of the cases with both classifications. According to TNM 7th edition in patients aged ≥45 years (N=1067), stage distribution was: stage I 595 (56%), stage II 85 (8%), stage III 283 (26%), and stage IV 104 (10%). According to TNM 8th edition in patients aged ≥55 years (N=615) was: stage I 391 (64%), II 193 (31%), III 15 (2%) and IV 16 (3%). The 27% of the patients were downstaged with TNM 8th edition. The majority of newly diagnosed DTC patients are in low-risk stages. An important downstaging is observed applying TNM 8th edition