T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?

BackgroundThe 7th edition of the American Joint Committee on Cancer (AJCC) staging system trialed a subdivision of T1 tumors into T1a (<1 cm) and T1b (1.0-2 cm). The 2009 American Thyroid Association (ATA) guidelines recommended total thyroidectomy for tumors >1 cm, and lobectomy for those ≤1 cm. These AJCC staging parameters remain a focus of debate, and ATA guidelines are in transition. The aim of this study was to determine if the T1 staging subdivision is associated with different treatment strategies and patterns of patient survival.MethodsAll adult patients with AJCC pT1 differentiated thyroid cancer (DTC) from the National Cancer Data Base (NCDB; 1998-2012) and Surveillance, Epidemiology, and End Results (SEER) program (2004-2012) were divided into two groups based on tumor size: T1a versus T1b. Demographic, clinical, and pathologic features were evaluated. Multivariate regression analysis was used to determine factors associated with undergoing total thyroidectomy and radioactive iodine. Cox proportional hazards models were performed to determine factors associated with overall and disease-specific survival.ResultsAmong 149,912 DTC patients, 98,111 (65.4%) were T1a and 51,801 (34.6%) T1b in the NCDB; in SEER, among 18,381 patients, 11,208 (61.0%) had T1a and 7173 (39.0%) T1b tumors. Patients with T1b cancers were younger (48 vs. 51 years T1a) and more likely to have private insurance (76.2% vs. 74.1%), no comorbidities (86.0% vs. 83.8%), and undergo treatment at academic medical centers (41.4% vs. 40.3%; all p < 0.01). They also were more likely to undergo total thyroidectomy (87.7% vs. 74.3%), and had more lymphovascular invasion (10.2% vs. 3.3%), positive surgical margins (7.9% vs. 3.8%), metastatic lymph nodes (35.8% vs. 23.8%), and distant metastases (0.4% vs. 0.3%; all p < 0.01). Factors associated with radioactive-iodine use included younger patient age, lower income, having insurance, positive surgical margins, and T1b stage (p < 0.01). After adjustment, overall (p = 0.23) and disease-specific survival (p = 0.93) were similar among patients with T1a versus T1b tumors.ConclusionThese results illustrate that patients with pT1a versus pT1b tumors undergo different treatment strategies. Based on the newly published 2015 ATA guidelines, whereby either lobectomy or total thyroidectomy can be performed for low-risk tumors, it might be anticipated that treatment differences will diminish over time. Therefore, division of AJCC T1 staging into T1a versus T1b subgroups might become obsolete over time

T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?

Background: The 7th edition of the American Joint Committee on Cancer (AJCC) staging system trialed a subdivision of T1 tumors into T1a (<1 cm) and T1b (1.0–2 cm). The 2009 American Thyroid Association (ATA) guidelines recommended total thyroidectomy for tumors >1 cm, and lobectomy for those ≤1 cm. These AJCC staging parameters remain a focus of debate, and ATA guidelines are in transition. The aim of this study was to determine if the T1 staging subdivision is associated with different treatment strategies and patterns of patient survival. Methods: All adult patients with AJCC pT1 differentiated thyroid cancer (DTC) from the National Cancer Data Base (NCDB; 1998–2012) and Surveillance, Epidemiology, and End Results (SEER) program (2004–2012) were divided into two groups based on tumor size: T1a versus T1b. Demographic, clinical, and pathologic features were evaluated. Multivariate regression analysis was used to determine factors associated with undergoing total thyroidectomy and radioactive iodine. Cox proportional hazards models were performed to determine factors associated with overall and disease-specific survival. Results: Among 149,912 DTC patients, 98,111 (65.4%) were T1a and 51,801 (34.6%) T1b in the NCDB; in SEER, among 18,381 patients, 11,208 (61.0%) had T1a and 7173 (39.0%) T1b tumors. Patients with T1b cancers were younger (48 vs. 51 years T1a) and more likely to have private insurance (76.2% vs. 74.1%), no comorbidities (86.0% vs. 83.8%), and undergo treatment at academic medical centers (41.4% vs. 40.3%; all p < 0.01). They also were more likely to undergo total thyroidectomy (87.7% vs. 74.3%), and had more lymphovascular invasion (10.2% vs. 3.3%), positive surgical margins (7.9% vs. 3.8%), metastatic lymph nodes (35.8% vs. 23.8%), and distant metastases (0.4% vs. 0.3%; all p < 0.01). Factors associated with radioactive-iodine use included younger patient age, lower income, having insurance, positive surgical margins, and T1b stage (p < 0.01). After adjustment, overall (p = 0.23) and disease-specific survival (p = 0.93) were similar among patients with T1a versus T1b tumors. Conclusion: These results illustrate that patients with pT1a versus pT1b tumors undergo different treatment strategies. Based on the newly published 2015 ATA guidelines, whereby either lobectomy or total thyroidectomy can be performed for low-risk tumors, it might be anticipated that treatment differences will diminish over time. Therefore, division of AJCC T1 staging into T1a versus T1b subgroups might become obsolete over time

Extracellular Matrix Protection Factor: A Novel Class of Post-Traumatic Osteoarthritis Therapeutic

Injury-related, post-traumatic osteoarthritis (PTOA) is a disease of the joints caused by an imbalance between extracellular matrix destruction and production. We have developed an innovative disease modifying therapeutic technology to treat PTOA. Extracellular matrix protection factor (ECPF-1) is a novel, safe and effective intra-articular injection that reduces the pain and damage caused by OA. Utilizing the peptide as an early intervention therapeutic, we have assessed its effects on the progression of PTOA. Peptide or control saline was injected into the injured knee joint for four consecutive weeks. Endpoint assessment of: toxicity, measured by CBC and serum chemistry; joint space narrowing, measured by Xray; joint functionality, measured by stride test; and tissue pathology, measured by micro computed tomography and histology were completed. Intra-articular injections of ECPF-1 in a rat model of PTOA demonstrated no cellular toxicity, normal serum chemistry following 4 weekly injections, diminished tissue destruction and increased animal mobility. All data indicates that ECPF-1 is non-toxic and diminishes the pathology associated with OA. This work was supported, in part, by intramural funding

Extracellular matrix protection factor 1 (ECPF-1): A novel osteoarthritis therapeutic demonstrates chondroprotective properties in a rat model of osteoarthritis; a quantitative micro computed tomography study of the tibia and femur

Introduction: Osteoarthritis (OA) is one of the most prevalent joint diseases, affecting millions of people and yet there is currently no cure. Finding a therapeutic that can cure OA would be beneficial for millions of people and those prone to a future degenerative disease. Objective: Current therapeutics for OA are focused on relieving symptoms for late stages of the disease. Extracellular Matrix Protection Factor-1 (ECPF-1), is a novel, highly specific Matrix metalloprotease-13 (MMP-13) inhibitor that blocks extracellular matrix degradation. Methods: A chemically-induced rat model of knee OA was used to study the effects of ECPF-1 in early stage OA progression. Micro computed tomography (µCT) images of the rat knee joints were quantified by measuring bone volume, spacing and total joint volume and trabecular spacing, thickness and number. Results: Data collected focuses on the treatment effects of ECPF-1 in the acute stage of OA after a loading phase (4 weekly injections of ECPF-1) and an 8-week protection-extension phase. For the femur, all ECPF-1 treated µCT measurements trended toward the values in the normal age-matched rat at both 4 and 8 weeks. For the tibia, all ECPF-1 treated µCT measurements trended toward the values in the normal age-matched rat at 8 weeks. The trabecular number values in both the femur and the tibia were most prominent in the 8-week samples of animals treated with ECPF-1 and exhibited the most progress toward normal, age-matched rat readings. Conclusions: This model showed that using an MMP inhibitor such as ECPF-1 could help in treating acute, post-traumatic OA. This is a potential new treatment for OA that indicates the ability to slow the disease progression