Impact of Age-Related Genetic Differences on the Therapeutic Outcome of Papillary Thyroid Cancer

The incidence of papillary thyroid carcinoma (PTC) has been increasing worldwide. PTC is the most common type of differentiated thyroid cancer and usually shows good prognosis. However, some PTC is driven to advanced stage by epithelial-mesenchymal transition (EMT)-mediated drug resistance, which is particularly noticeable in pediatric patients. There are limited options for systemic treatment, necessitating development of new clinical approaches. Here, we aimed to clarify genetic differences due to age of patients with PTC, and thereby aid in developing novel therapeutics. Patients with biochemically and histologically confirmed PTC were included in this study. PTC cells were acquired from young and older patients showing drug resistance, and were compared via microarray analysis. Cellular proliferation and other properties were determined after treatments with lenvatinib and sorafenib. In vivo, tumor volume and other properties were examined using a mouse xenograft model. Lenvatinib-treated group showed obvious suppression of markers of anti-apoptosis, EMT, and the FGFR signaling pathway, compared with control and Sorafenib-treated group. In the xenograft models, lenvatinib treatment induced significant tumor shrinkage and blocked the proto-oncogene Bcl-2 (B cell lymphoma/leukemia gene-2) and FGFR signaling pathway, along with reduced levels of EMT markers, compared with control and Sorafenib-treated group. Our findings clarify the age-dependent characteristics of pediatric PTC, giving insights into the relationship between young age and poor prognosis. Furthermore, it provides a basis for developing novel therapeutics tailored to the age at diagnosis.ope

갑상선암 수술 환자들이 원하는 교육은?

Background and Objectives: To prevent getting wrong information and improve high quality of life, it is necessary to provide accurate information and patient education. This study aimed to collect basic data and develop educational program for thyroid cancer patient by understanding their educational needs. Materials and Methods: Between April 16 and June 15, 2012, 159 patients who underwent thyroid cancer surgery were enrolled. This survey consisted of 5 areas including management of the symptom and the complication after surgery, postoperative wound and dietary management, treatment plan after discharge, medication management, and daily life. Results: The most common way for the patients to acquire information about the disease was Internet and the patients who used INTERNET as their information source were 54.7%. Doctors (76.1%) and nurses (21.4%) were the preferred educators for the patients, and small group education was the preferred education method. Specifically the need for "management of the symptom and the complication after surgery" was the highest (3.33), followed by "treatment plan after discharge" (3.31), "medication management" (3.19), "postoperative wound and dietary management" (3.17). Conclusion: Medical team including doctors and nurses should be the center to activate small group education for patients. Professional and individualized education program should be developed to give the proper education to patients and their family.ope

Factors Affecting Postoperative Occupational Changes and Sick Leave in Patients with Thyroid Cancer

Background and Objectives: Most thyroid cancers progress slowly, have high survival rates, and have good prognosis. Therefore, the management of patients with thyroid cancer should be viewed from a long-term perspective, taking into account a return to normal social life. Cancer patients have a higher risk of unemployment than the general population, and so unemployment can be an economic problem for thyroid cancer patients. However, there have been few studies on factors affecting return to work in thyroid cancer patients. The purpose of this study is to investigate occupational changes and the period of leave of absence for patients with thyroid cancer and to identify factors that affect the return to work after surgery. Materials and Methods: A total of 427 questionnaires of thyroid cancer patients were used for the analysis. The occupational changes and sick leave periods were analyzed according to general characteristics, disease-related characteristics, and side effects. Results: The factors related to occupational change and leave of absence in thyroid cancer patients were sex and type of occupation. Women had more occupational changes and longer leave of absence than men, office workers had the least change in occupation, and professional workers had a longer period of sick leave. Fatigue was the primary side effect that affected the leave of absence. Conclusion: Occupation is very important in the life of a thyroid cancer patient. Informing the patient of possible complications and planning proper leave of absence will help the patient return to work and improve the quality of life.ope

Long-term survival of patients with anaplastic thyroid cancer after multimodal treatment

Background: Anaplastic thyroid cancer (ATC) is among the most aggressive human malignancies, with a mean survival time of 6 months regardless of the treatment. Methods: This retrospective study used the single-centre database system of the Gangnam Severance Hospital. The management and outcome data of 23 patients with a definitive histological diagnosis of ATC were reviewed. Results: The 23 long-term survivors were 11 men and 12 women, with a mean age of 58 years. Nine patients had distant metastases at the time of diagnosis. Surgical debulking or complete resection of the tumour was performed for 19 patients, and chemotherapy was administered to 15 patients, radiotherapy to 18 patients, and tyrosine kinase inhibitors to 6 patients. In total, 14 patients were treated with a combination of surgery and radiotherapy with or without chemotherapy. Only 5 patients were treated with surgery alone. Overall, 15 patients underwent R0 resection, 2 underwent R1 resection, and 2 underwent R2 resection. The median survival was 1,090 days, the median follow-up was 646 days, and the 2- and 3-year survival rates were 59.7% and 35.8%, respectively. A total of 10 patients died: 7 with local disease and 3 with distant metastasis. Conclusions: Although ATC is typically an incurable disease, patients with ATC who underwent multimodality treatments including resection, chemotherapy, radiotherapy, and thyrosine kinase inhibitors would survive more than 1 year.ope

Effect of Afatinib for Lung Cancer on Papillary Thyroid Carcinoma

Papillary thyroid carcinoma is the most common type of thyroid cancer, for which surgery following preoperative staging and risk assessment is the standard treatment. Afatinib is an orally active irreversible ErbB-family inhibitor that binds to the kinase domain of epidermal growth factor receptors (EGFRs), HER2, and HER4, and has been approved as monotherapy for the treatment of locally advanced or metastatic non-small cell lung cancer with activated EGFR mutations. Recently, we observed an unexpected effect of afatinib administered to treat lung cancer on untreated papillary thyroid carcinoma.ope

Thyroid Nodules in Patients with Secondary Hyperparathyroidism

Purpose: An association between primary hyperparathyroidism and well differentiated thyroid carcinoma has been frequently reported. However, there have been few reports of secondary hyperparathyroidism associated with thyroid carcinoma. This study was performed to evaluate the prevalence of thyroid nodule including thyroid carcinoma in patients with secondary hyperparathyroidism and to suggest more proper diagnostic approach for such cases. Methods: A retrospective study was performed on fifty-two patients who underwent parathyroid surgery for secondary hyperparathyroidism between March, 1986 and December, 2003. Results: In 20 patients (38.5%), thyroid surgery was added because of coexistent thyroid nodules. Five (25%) out of the 22 patients with coexistent thyroid nodule had thyroid carcinoma. Among the 5 thyroid carcinoma patients, 4 had papillary carcinomas and one had a follicular carcinoma. Mean size of thyroid carcinomas was 1.4 cm (0.3∼3.0 cm). Conclusion: The prevalence of thyroid carcinoma in patients with secondary hyperparathyroidism was higher than that in the general population. An aggressive diagnostic approach (ultrasonography and FNAB) should be considered when the patients with secondary hyperparathyroidism present with thyroid nodules.ope

Thyroid Cancer Arising from Thyroglossal Duct Cyst

Purpose: Thyroglossal duct cyst is the most common congenital anomaly of the neck, and malignancy arising from a thyroglossal duct cyst occurs only in approximately 1% of patients. Ultrasound examination and fine-needle aspiration should be performed to make an accurate diagnosis before surgery. Sistrunk operation is known as a surgical treatment for thyroglossal duct cyst. We describe the clinical characteristics of thyroglossal duct cyst carcinoma in eight cases and the treatment methods for each. Methods: This is a retrospective study of thyroglossal duct cyst detected in patients undergoing surgery at two separate tertiary medical institutions in Korea from July 2006 to August 2020. Results: Among 346 patients with thyroglossal duct cyst, eight were diagnosed with thyroglossal duct cyst carcinoma. In four out of these eight patients, cysts and thyroid nodules were observed, and thyroidectomy and Sistrunk operation were performed together. Modified radical neck dissection was performed only in two patients with confirmed lymph node metastasis before surgery. All four patients who underwent total thyroidectomy and Sistrunk operation received radioactive iodine treatment and did not receive radiation therapy. None of the patients had distant metastasis. Conclusion: Thyroglossal duct cyst carcinoma is rare, and an initial evaluation is critical in determining the extent of surgery. Fine needle aspiration should be performed in patients who are clinically diagnosed with thyroglossal duct cyst, and a thyroid ultrasound scan should also be performed.ope

PPARγ Targets-Derived Diagnostic and Prognostic Index for Papillary Thyroid Cancer

In most cases, papillary thyroid cancer (PTC) is highly curable and associated with an excellent prognosis. Yet, there are several clinicopathological features that lead to a poor prognosis, underscoring the need for a better genomic strategy to refine prognostication and patient management. We hypothesized that PPARγ targets could be potential markers for better diagnosis and prognosis due to the variants found in PPARG in three pairs of monozygotic twins with PTC. Here, we developed a 10-gene personalized prognostic index, designated PPARGi, based on gene expression of 10 PPARγ targets. Through scRNA-seq data analysis of PTC tissues derived from patients, we found that PPARGi genes were predominantly expressed in macrophages and epithelial cells. Machine learning algorithms showed a near-perfect performance of PPARGi in deciding the presence of the disease and in selecting a small subset of patients with poor disease-specific survival in TCGA-THCA and newly developed merged microarray data (MMD) consisting exclusively of thyroid cancers and normal tissues.ope

Factors affecting online health community participation behavior in patients with thyroid cancer

Globally, cancer patients obtain much of their disease information online. Online health communities allow patients to share questions and information about diseases. However, there have been few studies on the factors affecting online health community participation behavior in cancer patients. Online social networking is associated with mental health problems, and patients with thyroid cancer experience high levels of distress, anxiety and depression. The purpose of this study was to investigate factors associated with use of online health communities by patients with thyroid cancer to understand the characteristics of patients participating in such online communities. A questionnaire survey was completed by 114 thyroid cancer patients admitted for surgery at a general hospital in Seoul, Korea. General characteristics, clinical characteristics, attitude toward cancer, distress, and anxiety and depression scores of patients who joined an online health community (user group) and patients who did not (non-user group) were compared. The factors affecting online health community participation were education (p = 0.049), tumor size (p = 0.010), attitude toward cancer (p = 0.022), and anxiety and depression (p = 0.021). The average score of satisfaction with the online health community was 4.25 of 5. The user group had larger tumors, a high awareness of the risk of thyroid cancer, and high levels of anxiety and depression. Patients who actively used the online health community have relatively larger cancer size and had higher levels of mental stress. As such patients are often very anxious and depend heavily on the gathered information, the quality of this information is important. Healthcare professionals need to develop appropriate interventions for patients participating in the online health community.ope

A Rare Case of Myxoid Liposarcoma Combined With Papillary Carcinoma in the Same Thyroid Gland

Myxoid liposarcoma is a rare soft-tissue sarcoma that is usually observed in the retroperitoneum and extremities. In this case report, we describe a 39-year-old female patient who presented with myxoid liposarcoma of the thyroid and papillary thyroid carcinoma with recurrent lesions in the lung and retroperitoneum.ope