Microscopically positive surgical margins and local recurrence in thyroid cancer. A meta-analysis

BackgroundMicroscopically positive surgical margins are a prognostic factor of recurrence in advanced thyroid carcinoma. However, information on early and completely resected thyroid tumors is scarce. Some studies do not identify any association between positive margin and local recurrence. The objective of this study was to perform a meta-analysis to measure the association of microscopically positive surgical margins and local recurrence in patients who underwent total thyroidectomy.MethodsClinical trials assessing the association between microscopically positive surgical margin and local recurrence in patients with early-stage, well-differentiated thyroid carcinoma who underwent total thyroidectomy were evaluated. The outcome measured was local recurrence in the thyroid bed. A systematic review and meta-analysis was done using a random-effects model.ResultsSix studies with 7696 patients were identified. Methodological quality was good, and we did not identify statistical heterogeneity or publication bias. The risk difference for microscopically positive surgical margin and local recurrence was 0% (95% CI 0 to 1).ConclusionMeta-analysis did not find a statistically significant association between microscopically positive surgical margin and local recurrence in this population. A finding of microscopically positive surgical margin in the absence of other adverse factors is not an indication for adjuvant treatment.     

中国甲状腺癌的流行现状和影响因素

近30年,全球甲状腺癌发病率逐年上升,中国甲状腺癌发病率亦呈上升趋势。2012年中国新发病例数和死亡数已占全球15.6%和13.8%;国内甲状腺癌发病率在东部最高而中部最低,城市高于农村,女性高于男性,中年人群高发。电离辐射、碘摄入量、雌激素与遗传因素是甲状腺癌的危险因素。通过核事故服用碘化钾、减少医疗辐射暴露、完善地区碘监测系统及建立适宜碘盐标准来预防甲状腺癌发生。     

腔镜辅助颈部小切口甲状腺切除术治疗甲状腺癌

腔镜甲状腺手术以其美观、微创、并发症少及术后恢复快等优点应用于甲状腺良性疾病的治疗,目前已获得广泛认可,但对于其应用于治疗甲状腺癌的安全性、可行性等问题仍存在争议.我院自2006年1月至2008年12月行腔镜辅助颈部小切口甲状腺术式切除甲状腺癌15例,手术效果良好,现报告如下.     

Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors

Objectives  The present review summarizes epidemiological evidence on risk factors for thyroid cancer (TC), in particular, nutritional factors. Methods  Searches of articles on the issue were conducted using MEDLINE. Results  Exposure to ionizing radiation, particularly during childhood, is the best-established risk factor for TC. There is also a strong association with history of benign nodules/adenoma or goiter. Iodine deficiency may induce an increasing incidence of benign thyroid conditions, but very high iodine intake also affects thyroid function and, possibly, TC risk. Among dietary factors, fish—the major natural source of iodine in human diet—is not consistently related to TC risk. High intake of cruciferous vegetables shows a weak inverse association with TC. Among other food groups, vegetables other than cruciferous are the only food group showing a favorable effect on TC, with an approximate 20% reduction in risk for subjects with the highest consumption. No effect on TC risk of alcohol, coffee, or other food-groups/nutrients emerged. Height and weight at diagnosis show a moderate positive association with TC risk. Conclusion  At present, the only recognized measures for reducing TC risk is to avoid ionizing radiation and iodine deficiency, particularly in childhood and young women, and to increase vegetable consumption.     

老年人甲状腺癌88例临床分析

老年人甲状腺癌较少见。1980年至2004年间,我院收治60岁以上老年甲状腺癌患者88例,占同期834例甲状腺癌患者的10.6%。我们分析探讨老年人甲状腺癌的临床病理特点、治疗及预后,以期提高诊断水平和治疗效果。     

甲状腺癌近期内再手术探讨

目的探讨甲状腺癌近期内再手术的原因、手术指征、手术时机及手术方式.方法回顾性分析1994年1月～2003年6月间33例甲状腺癌患者3个月内再手术的临床资料.结果再手术中发现甲状腺癌残留14例,其中伴颈部淋巴结转移4例,对侧甲状腺腺瘤残留2例.22例获得随访,随访时间6个月～9年,中位随访时间4年,本组未出现肿瘤复发.结论甲状腺癌首次手术时漏诊、误诊及首次手术切除范围不足是导致近期内再手术的主要原因.对明确有再手术指征者,手术应尽早进行.再手术时应选择适当的手术方式,以提高患者的长期生存率,减少并发症的发生.     

Decision making for the central compartment in differentiated thyroid cancer

The central compartment is a common site for nodal spread from differentiated thyroid carcinoma, often occurring in patients without clinical or ultrasonographic (US) evidence of neck lymph node metastasis (cN0). However, the role of elective central compartment neck dissection (CND) among patients with DTC remains controversial. We performed a systematic literature review, also including review of international guidelines, with discussion of anatomic and technical aspects, as well as risks and benefits of performing elective CND. The recent literature does not uniformly support or refute elective CND in patients with DTC, and therefore an individualized approach is warranted which considers individual surgeon experience, including individual recurrence and complication rates. Patients (especially older males) with large tumors (>4 cm) and extrathyroidal extension are more likely to benefit from elective CND, but elective CND also increases risk for hypoparathyroidism and recurrent nerve injury, especially when operated by low-volume surgeons. Individual surgeons who perform elective CND must ensure the number of central compartment dissections needed to prevent one recurrence (number needed to treat) is not disproportionate to their individual number of central compartment dissections per related complication (number needed to harm).     

A systematic review of generic and breast cancer specific life expectancy models in the elderly

Introduction

The use of primary endocrine therapy (PET) in managing breast cancer in the elderly has become common practice. Whilst there appears to be no difference in overall survival in comparison with surgery, PET has been found to be inferior in local disease control with a limited duration of efficacy (2–3 years). The International Society of Geriatric Oncology (SIOG) state that PET may be considered in patients with a short life expectancy (<2 years) or considered unfit for surgery. Frequently, decision making for PET allocation is a subjective process by the clinician.

中国近30年间结直肠癌死亡趋势分析

背景与目的：随着我国人民生活水平的提高及饮食习惯的改变,结直肠癌死亡率有升高趋势,该研究旨在分析中国近30年结直肠癌死亡的时间变化趋势。方法：分层汇总中国大陆居民1987—2015年结肠、直肠和肛门癌死亡率数据,利用Joinpoint模型估算各人群及各年龄组死亡率的时间变化趋势,利用负二项回归模型分析其死亡在人群水平上的危险因素。结果：男性结肠、直肠和肛门癌死亡率呈上升趋势［城市死亡率平均年度变化百分比（average annual percent change,AAPC）=0.50%,农村AAPC=0.57%］,女性死亡率小幅度下降［城市AAPC=-0.59%,农村AAPC=-0.45%］;65岁以下男性和75岁以下女性居民死亡率基本呈下降趋势,65岁以上男性和75岁以上女性居民基本呈上升趋势。结直肠癌的死亡风险,城市居民是农村居民的1.46倍（95%CI：1.40~1.52）,男性是女性的1.38倍（95%CI：1.32~1.42）,每增加5岁,死亡风险平均增大51%（OR=1.50,95%CI：1.49~1.51）,每过1年,死亡风险平均增加0.08%,但差异无统计学意义（OR=1.00,P=0.47）。结论：中国结直肠癌死亡率的变化趋势有地区、性别及年龄差异,男性居民呈上升趋势,女性居民呈小幅度下降趋势;高年龄组居民结直肠癌死亡率呈上升趋势。     

Recombinant human thyrotropin-aided versus thyroid hormone withdrawal-aided radioiodine treatment for differentiated thyroid cancer after total thyroidectomy: A meta-analysis

Background and purpose

We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effects of recombinant human thyrotropin (rhTSH) and thyroid hormone withdrawal (THW) on thyrotropin stimulation prior to remnant ablation of differentiated thyroid cancer (DTC).

Material and methods

A comprehensive search was conducted for articles discussing rhTSH and THW prior to December 2012. After applying the inclusion criteria, all the available data were summarized to analyze the efficacy of rhTSH and THW for stimulating TSH.

Results

Seven RCTs that involved a total of 1535 patients, were included in the analysis. The ablation rates of the rhTSH group and the THW group were not significantly different (RR = 0.97, 95% CI: 0.94–1.01, p = 0.1). Patients in the rhTSH group had a better quality of life (QoL) than those in the THW group on the day of ablation (RR = 3.92, 95% CI: 3.44–5.40, p < 0.00001). However, there was no difference in the QoL 3 months after ablation (RR = −0.9, 95% CI: −2.20–0.39, p = 0.17). Additionally, there were no significant differences in serum thyroglobulin (Tg) levels measured just before radioiodine remnant ablation (preablation thyroglobulin levels) (RR = −0.14, 95% CI: −0.73–0.45, p = 0.65), or in days of hospital isolation (RR = −10.51, 95% CI: −32.79–11.73, p = 0.35)

Conclusions

Our findings indicate that the administration of rhTSH had resulted in an ablation rate similar to that of THW for DTC patients, but rhTSH provided a better QoL at the time of ablation.     

A radiotherapy technique for thyroid cancer

A treatment technique for treating patients with cancer of the thyroid is presented. This is a modification of “the bar-arc” technique that uses a centrally blocked moving field. We have introduced wedges and partial midline block to achieve uniform dose within the treatment volume. This enables the desired dose to be delivered to the primary, the lymph nodes and the cervical soft tissues at risk, yet keeping the dose to the spinal cord to a minimum in the cervical region and to acceptable levels in the superior mediastinum.     

双侧甲状腺癌外科治疗的术式选择

目的：探讨双侧甲状腺癌外科治疗的术式选择。方法：对21例双侧甲腺癌病例中3例进行近全甲状腺切除术，18例行全甲状腺切除术。行一侧功能性颈清扫术5例，一侧传统性颈清扫术2例，双侧功能性颈清扫术7例，一侧传统性颈清扫术加对侧功能性颈清扫术1例，双侧传统性颈清扫术1例。结果：21例随访2-13年，平均5年2个月，死亡1例，20例无瘤生存。术后无一例出现永久性甲状旁腺功能减退和喉返神经麻痹。结论：双阅甲状腺癌为多发癌，主张行全甲状腺切除术。保持清楚的解剖层次，保护喉返神经和甲状旁腺是全甲状腺切除术的关键。如术前发现颈部淋巴结肿大，应同时行一侧或双侧颈清扫术，对N0患者不必常规行颈清扫术，提倡长期密切观察。     

The risk of thyroid cancer and obesity: A nationwide population-based study using the Korea National Health Insurance Corporation cohort database

Introduction

In recent years, the incidence of thyroid cancer and obesity has increased rapidly worldwide. Many studies have been conducted on the relationship between thyroid cancer and obesity; however, the potential mechanisms are not well understood, and few studies have been performed in Asia. This study aimed to identify the relationship between the risk of thyroid cancer and obesity in the Korean population based on a large cohort of data.

Permanent hypocalcemia in patients operated for thyroid carcinoma

Aim and objective

The incidence and risk factors for permanent hypocalcemia in thyroid carcinoma were investigated.

Materials and methods

The records of 417 patients were reviewed retrospectively at tertiary oncology referral center. Total or subtotal thyroidectomy patients constituted group I (n = 225), reoperative thyroid surgery patients constituted group II (n = 106), and therapeutic neck dissection cases constituted group III (n = 86). Age, gender, thyroid functions, pathologically verified tumor type, differentiation, localization and size, multicentricity, thyroid capsule invasion, extrathyroidal soft tissue invasion, coexistence of lymphocytic thyroiditis, metastatic lymph nodes dissected, incidental parathyroidectomy, and the type of surgery were investigated.

Re sults

Permanent hypocalcemia was seen in 32 (7.7%) patients. The incidence of permanent hypocalcemia for each group was 1.7%, 10.3% and 19.7%, respectively. Related risk factors were hyperthyroidism for group I [adjusted relative risk (RR) = 21.1, 95% confidence interval (CI) = 2.6–165, p = 0.01] incidental parathyroidectomy for group II (RR = 7.8, 95% CI = 1.9–31.0, p = 0.004), and extrathyroidal soft tissue invasion (RR = 3.1, 95% CI = 1.1–9.5, p = 0.03) for group III.

Conclusion

Permanent hypocalcemia rate was increased with reoperative thyroid surgery and neck dissection added to total thyroidectomy. Hyperthyroidism, incidental parathyroidectomy and extrathyroidal extension were related risk factors.     

甲状腺癌患者术后复发风险预测的列线图模型建立

目的 建立预测甲状腺癌患者术后复发风险的列线图模型.方法 回顾性分析2015年7月—2017年12月因甲状腺癌于沈阳医学院附属中心医院普外科行手术治疗的患者临床资料,筛选甲状腺癌术后复发的独立危险因素,基于筛选结果建立列线图预测模型,并对模型的预测准确性进行内外部验证.结果 Logistic回归分析结果显示,肿瘤大小≥...     

Anthropometric factors at age 20 years and risk of thyroid cancer

Effect of anthropometric factors at adolescence and the change since young age on thyroid cancer risk is unclear. Here, we conducted a case–control study to investigate the association between anthropometric factors at the time of diagnosis and age 20 years and risk of thyroid cancer. A total of 173 patients with thyroid cancer (papillary carcinoma, n = 167 and follicular carcinoma, n = 6) and 865 age- and sex-matched controls were included. Anthropometric factors were assessed using a validated self-administered questionnaire and categorized into three groups. Odd ratios (ORs) with 95% confidence intervals (CIs) were estimated using conditional logistic models adjusted for potential confounders. Results showed a positive association between current weights, weight at age 20 years and height, and thyroid cancer risk. Adjusted ORs in the top tertiles were 2.46 (95% CI, 1.54–3.94; trend p < 0.001) for current weight, 2.69 (95% CI, 1.71–4.25; trend p < 0.001) for weight at age 20 years and 2.44 (95% CI, 1.52–3.93; trend p < 0.001) for height compared with the lowest tertile. A positive association with current body surface area (BSA), BSA at age 20 years, and current body mass index was also observed, with respective adjusted ORs in the top tertile of 1.96 (95% CI, 1.23–3.11; trend p = 0.007), 1.82 (95% CI, 1.15–2.88; trend p = 0.007) and 1.71 (95% CI, 1.06–2.78; trend p = 0.034). In contrast, no association with risk was seen for a change in anthropometric factors since age 20 years. These findings suggested that body size in early life as well as in adult is associated with an increased risk of thyroid cancer.     

Cancer in the elderly: pancreatic cancer

Pancreatic cancer remains a devastating and difficult disease to diagnose and successfully treat. Its incidence increases with age, with 60% of patients being over the age of 65 at presentation. Due to the insidious nature and asymptomatic onset of pancreatic cancer approximately 85% of patients present with disseminated or locally advanced disease resulting in a very poor prognosis. In the past the elderly patient, who may be felt to be too frail for operative procedures or further therapy, may have missed out on optimal treatment. In this article we review the investigation and treatment of pancreatic cancer and examine current evidence with regard to pancreatic cancer in the elderly. The evidence suggests that surgical resection can be performed safely in patients who are fit for surgery in specialist centres but may require more intensive post-operative rehabilitation.     

18FDG PET-CT for detecting gastric cancer recurrence after surgical resection: A meta-analysis

BackgroundWe performed a meta-analysis to evaluate the value of ¹⁸FDG PET-CT for the detection of gastric cancer recurrence after surgical resection.MethodsA systematic literature search was performed in the MEDLINE and EMBASE databases. We calculated the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for ¹⁸FDG PET-CT. We also constructed summary receiver operating characteristic curves for ¹⁸FDG PET-CT.ResultsEight studies (500 patients) were included. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of ¹⁸FDG PET-CT were 0.86 (95% confidence interval [CI] = 0.71–0.94), 0.88 (95% CI = 0.75–0.94), 17.0 (95% CI = 3.5–14.0), and 0.16 (95% CI = 0.07–0.34), respectively. Overall weighted area under the curve was 0.93 (95% CI = 0.91–0.95).Conclusions¹⁸FDG PET-CT has moderate sensitivity and specificity for detection of gastric cancer recurrence after surgical resection.