Riesgo de recurrencia y factores de riesgo de invasión del cáncer diferenciado de tiroides / Risk of recurrence and risk factors for invasion of differentiated thyroid cancer

Introducción: El cáncer diferenciado de tiroides (CDT) se encuentra representado por el carcinoma papilar y el carcinoma folicular. Comprende la gran mayoría (>90%) de todos los cánceres de tiroides. Objetivos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Materiales y métodos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Resultados: El 87% fueron del sexo femenino. La edad media fue de 43±14 años. Predominó el riesgo de recurrencia bajo en el 49% de los pacientes, seguido del riesgo intermedio (33%) y riesgo alto (18%). El tamaño tumoral ˃1cm confiere mayor riesgo de ser estratificado como riesgo de recurrencia intermedio/alto (OR 5,7 IC 95% 3,6-9). El sexo masculino representó mayor riesgo de invasión ganglionar (OR 2,8 IC 95% 1,2-6,6); la edad ≥55 años lo fue en la invasión vascular (OR 2,1 IC 95% 1,1-4,1); el tamaño >1cm constituyó un mayor riesgo de manera significativa de invasión capsular (OR 10,5 IC 95% 6,5-17), invasión ganglionar (OR 10,2 IC 95% 3,8-26,9), invasión vascular (OR 30,7 IC 95% 4,2-224) e invasión de tejido peritiroideo (OR 5,2 IC 95% 3,3-8,2). Conclusión: El riesgo de recurrencia inicial más frecuente fue el riesgo bajo. El sexo masculino, la edad ≥55años y el tamaño >1cm constituyen factores de riesgo de invasión a estructuras vecinas.

Introduction: Differentiated thyroid cancer (DTC) is represented by papillary carcinoma and follicular carcinoma. It comprises the vast majority (> 90%) of all thyroid cancers. Objectives: Stratify the risk of initial recurrence of patients with DTC. Relate age, sex, and tumor size to the risk of recurrence, capsular, nodal, vascular, and perithyroid tissue invasion. Materials and methods: Observational, descriptive, retrospective, cross-sectional study with an analytical component. A total of 432 patients with a diagnosis of DTC from Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: 87% were female. The mean age was 43 ± 14 years. Low recurrence risk predominated in 49% of patients, followed by intermediate risk (33%) and high risk (18%). Male sex, age ≥55 years and tumor size ˃1cm confer a higher risk of being stratified as intermediate / high recurrence risk, but only size> 1cm was significantly (OR 5.7 95% CI 3.6-9). Male sex represented a higher risk of lymph node invasion (OR 3.1 95% CI 1.4-2.8) and vascular invasion (OR 2.3 95% CI 1.1-4.8); age ≥55 years was in the vascular invasion (OR 2.6 95% CI 1.4-4.9); size> 1cm constituted a significantly higher risk of capsular invasion (OR 10.7 95% CI 6.7-17.3), nodal invasion (OR 10.5 95% CI 4-27.7), vascular invasion (OR 33 95% CI 4.5-244) and invasion of perithyroid tissue (OR 5.1 95% CI 3.2-8.1). Conclusion: The most frequent initial recurrence risk was low risk. Male sex, age ≥55 years, and size> 1cm are risk factors for invasion of neighboring structures.

Detección ecográfica de remanentes del conducto tirogloso luego de tiroidectomía por cáncer de tiroides / Thyroglossal duct remnants detected by ultrasonography after total thyroidectomy for thyroid carcinoma

Resumen Existen numerosas comunicaciones de hallazgo incidental de remanentes del conducto tirogloso (CTG) posteriores a una tiroidectomía total, pero se desconoce su implicancia en pacientes con cáncer diferenciado de tiroides (CDT). Nuestro objetivo fue determinar frecuencia de detección ecográfica de remanentes del CTG posterior a la tiroidectomía total en pacientes con CDT y evaluar el impacto del hallazgo en la respuesta al tratamiento. Se incluyeron 377 pacientes con CDT tratados con tiroidectomía total entre enero 1994 y enero 2017, con seguimiento de al menos un año posterior a la cirugía. Se detectó la presencia de remanente del CTG en 16/377 (4.2%): 15 de bajo riesgo de recurrencia y uno de riesgo intermedio. Trece recibieron radioyodo. Todos tuvieron un estado sin evidencia de enfermedad al final del seguimiento, excepto uno con riesgo intermedio que presentó una respuesta inicial estructural incompleta e indeterminada posterior al vaciamiento ganglionar. La mediana del tiempo de diagnóstico del remanente del CTG luego de la tiroidectomía fue de 5 años (rango 1-16). Dos pacientes con remanentes del CTG fueron intervenidos quirúrgicamente, ambos presentaron tumoraciones de aparición súbita en región suprahioidea, 2.4 y 4 cm, detectados a los 9 y 16 años luego de la tiroidectomía, respectivamente. La prevalencia de esta condición parece ser poco frecuente. Sin embargo, la aparición de una masa quística en el seguimiento de un paciente con CDT puede ser confundido con enfermedad metastásica y generar ansiedad. El hallazgo de remanentes del CTG parecería no tener ningún impacto en la respuesta al tratamiento.

Abstract There are numerous reports of incidental findings of thyroglossal duct remnants (TGDR) after total thyroidectomy, but its implication on the outcome of patients with differentiated thyroid cancer (DTC) is unknown. The aim of this study was to determine the frequency of TGDR detected by ultrasonography after total thyroidectomy in patients with DTC and to evaluate the impact of this finding on the response to treatment. A total of 377 records of patients with DTC who received total thyroidectomy between January 1994 and January 2017 were reviewed. Patients with less than one year of follow-up after surgery were excluded. TGDR was diagnosed in 16 out of 377 (4.2%). Fifteen had a low risk of recurrence DTC and 13 of them were treated with radioactive iodine. All low risk patients had an excellent response to treatment. Only one with an intermediate risk of recurrence DTC had an initial structural incomplete response which changed to an indeterminate response after a modified central lymph node dissection. The median time of TGDR diagnosis after thyroidectomy was 5 years (1-16). Two patients underwent TGDR surgery due to the presence of a rapidly growing neck mass, 2.4 and 4 cm in size, detected 9 and 16 years after thyroidectomy, respectively. The prevalence of this condition seems to be rare. However, the appearance of a cystic mass during the follow-up of a patient with DTC cancer could be confused with metastatic disease. The diagnosis of TGDR seems not to have an impact on the response to treatment.

Monitoring analysis of tuberculosis-related antibodies and and risk assessment of tuberculosis in Baotou region , 2012-2016 / 公共卫生与预防医学

Objective To explore the monitoring analysis of pulmonary tuberculosis related antibodies and conduct and risk assessment of tubercuosis. Methods A total of 39 605 patients who were treated in Baotou tuberculosis prevention and treatment center from January 2012 to December 2016 were enrolled for epidemiological investigation. Smear, imaging, tuberculin test, clinical signs and anti-TBGL and anti-LAM antibody tests were used to diagnose the effective serum samples, and drug sensitivity tests were conducted to record the positive rate and drug resistance of the patients. Univariate and multivariate analyses were performed on all the factors influencing the recurrence of the patients including the gender, age, marriage, nutritional status, initial lesion range, regular treatment, drug withdrawal residual cavity, drug resistance, treatment style, course of treatment, and comorbidities. Results There were significant differences in epidemiological survey results in age, occupation and detection methods (P<0.05). A total of 22 703 strains were obtained in the drug sensitivity test, 19.99% of which were isoniazid resistance, 15.54% were streptomycin resistance, and 15.19% were multi-drug resistance.. In the process of antibody diagnosis, the positive rate of the parallel test was significantly higher than that of the single test and the series test, with a statistically significant difference (P<0.05). The results of risk factor analysis showed that age, drug withdrawal residual cavity, and drug resistance were important risk factors influencing the recurrence of the patients (P<0.05). Conclusion The incidence rate of tuberculosis in Baotou from 2012 to 2016 was affected by age, occupation and other factors. It is of great significance to develop diagnostic methods with higher sensitivity. The parallel detection of anti-TBGL and anti-LAM antibodies had high sensitivity and specificity, which is an important diagnostic method for tuberculosis with high application value. At the same time, the recurrence of tuberculosis is affected by many factors, which requires patients to be cooperative with treatment in order to improve the cure rate

Score ihc 4 + c y riesgo de recurrencia en pacientes con cáncer de mama / Score ihc 4 + c and Risk of Recurrence (rr) in breast cancer

Introducción Las plataformas genéticas estiman el riesgo de recurrencia (rr) en cáncer de mama. La más utilizada es Oncotype DX. Una herramienta de bajo costo es ihc 4 + c que proporciona información pronóstica sobre el rr a distancia similar a Oncotype DX®. Objetivo Evaluar riesgo de recurrencia local y a distancia según ihc 4 + c. Material y método La población accesible estuvo constituida por 61 historias clínicas de pacientes con cáncer de mama con receptores hormonales positivos, a las que se le aplicó el score y se evalúo rr. Resultados El 64% de las pacientes tuvieron bajo rr. 7 pacientes (12%) presentó recidiva. De las pacientes del grupo que recibió quimioterapia (Q1), 5 (31%) tenían alto rr según ihc 4 + c. Del grupo que no recibió quimioterapia (Q2), solo 6 (13%) presentaban alto rr (p= 0,08). De las pacientes con bajo riesgo según ihc 4 + c, solo 1 (3%) tuvo recidiva (p=0,015). Conclusiones En este trabajo se encontró asociación estadísticamente significativa entre rr por ihc 4 + c y tasa de recurrencia. El ihc 4 + c podría ayudar en la toma de decisiones en aquellas pacientes en las cuales no está claro si se beneficiarán con el uso de la quimioterapia

Introduction Genetic platforms estimate the risk of recurrence (rr) in breast cancer. The most used is Oncotype DX. A low-cost tool is ihc 4 + c that provides prognostic information about rr remotely similar to Oncotype DX®. Objective To evaluate the risk of local and distant recurrence according to ihc 4 + c. Materials and method The accessible population consisted of 61 clinical histories of patients with breast cancer with positive hormone receptors, to whom the score was applied and rr was evaluated. Results 64% of the patients had low rr. 7 (12%) had recurrence. The group who receiving chemotherapy (Q1), 5 (31%) had high rr according to ihc 4 + c. The group that did not receive chemotherapy (Q2), only 6 (13%) had high rr p = 0.08. The patients with low risk according to ihc 4 + c, only 1 (3%) had recurrence (p = 0.015). Conclusions This study found a statistically significant association between rr by ihc 4 + c and recurrence rate. The ihc 4 + c could help in decision-making in those patients in whom it is not clear if they will benefit from the use of chemotherapy

Impact of historic histopathologic sample review on the risk of recurrence in patients with differentiated thyroid cancer

ABSTRACT Objective To compare the historic risk of recurrence (RR) and response to therapy to risk stratification estimated with historical pathology reports (HPRs) and contemporary re-review of the pathological slides in patients with differentiated thyroid cancer (DTC). Subjects and methods Out of 210 DTC patients with low and intermediate RR who underwent total thyroidectomy and remnant ablation in our hospital, 63 available historic pathologic samples (HPS) were reviewed. The RR and the response to therapy were evaluated considering historical histological features (histological type, tumor size, capsular invasion, number of lymph node metastases) and then, reassessed after observing additional histological features (vascular invasion, extrathyroidal extension, size of lymph node metastases, presence of extranodal extension, and/or status of the resection margins). Results A change in the RR category was observed in 16 of 63 cases (25.4%). Out of 46 patients initially classified as low RR, 2 patients were reclassified as intermediate RR, 4 as high RR, and 1 as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Out of 17 patients initially classified as intermediate RR, 3 were reassigned to the low RR group, 5 as high RR, and 1 as NIFTP. The percentages of structural incomplete response at final follow-up changed from 2.2 to 0% (p = 1) in patients with low RR and from 6.3 to 20% (p = 0.53) in patients with intermediate RR. Conclusion A detailed report of specific features in the HPR of patients with DTC might give a more accurate RR classification and a better estimation of the response to treatment.

The efficacy and safety of high-dose adjuvant chemotherapy with paclitaxel and thiotepa in postoperative breast cancer patients with high risk of recurrence / 肿瘤

Objective: Patients with high-risk breast cancer has a high recurrence rate. The clinical value of high-dose adjuvant chemotherapy supported by autologous HSCT (hematopoietic stem cell transplantation) for postoperative breast cancer patients with high risk of recurrence remains controversial. This study was to explore the efficacy and safety of high-dose adjuvant chemotherapy with paxlitaxel and thiotepa supported by autologous HSCT for postoperative breast cancer patients with high risk of recurrence. Methods: Twenty-four postoperative breast cancer patients (stages II-III) with high risk of recurrence were enrolled in this study. The patients received paclitaxel 175 mg/m2 and G-CSF (granulocyte colony-stimulating factor) 5 μg/kg for mobilization and collection of peripheral blood CD34+ stem cells. Then two cycles of high-dose adjuvant chemotherapy were given subsequently [11 patients: paclitaxel 175 mg/m2 + thiotepa 150 mg/m2 + carboplatin (area under curve = 6; 300 mg/m2 divided in two days); 13 patients: paclitaxel 175 mg/m2 + thiotepa 150 mg/m2) every 28 d]. The CD34+ stem cells were infused for an autologous HSCT on day 2 after chemotherapy, and the G-CSF was started on day 3 after chemotherapy and discontinued until the peripheral WBC (white blood cell) count reached over 10.0×109/L continuously for three days. The adverse effects of high-dose adjuvant chemotherapy were observed. The median DFS (disease-free survival) and the three-year DFS rate were calculated. Results: The median follow-up was 32 months (3-62 months). The median DFS was 32 months. The three-year DFS rate was 56.3%. High-dose chemotherapy had a good safety profile and no treatment-related death. Conclusion: High-dose chemotherapy with paclitaxel and thiotepa supported by autologous HSCT in postoperative breast cancer patients with high risk of recurrence has a good safety profile and can obtain a better benefit of DFS as compared with standard-dose chemotherapy. These results suggest that this treatment strategy deserves further exploration. Copyright © 2013 by TUMOR.