Temporal analysis of thyroid cancer management in a Melbourne tertiary centre.

BACKGROUND: The American Thyroid Association (ATA) management guidelines for thyroid cancer were revised in 2009. The aim of this study was to determine if management of thyroid cancer in our institution has changed in accordance with the introduction of the revised ATA guidelines (ATA2009 ), and to compare the characteristics and management of thyroid cancer in a Melbourne endocrine surgery unit over a 7-year period. METHODS: All patients treated by the Monash University Endocrine Surgery Unit for thyroid cancer between 2007 and 2013 were divided into two groups - the pre-ATA2009 group (2007-2010) and the post-ATA2009 group (2011-2013). Comparisons were made of the demographics, cytology, pathology, surgical outcome and adjuvant therapy using t-test and chi-squared tests. RESULTS: There were 333 patients in the pre-ATA2009 group and 342 patients in the post-ATA2009 group. Fewer non-diagnostic fine-needle aspiration cytology results were identified in the post-ATA2009 group (4% versus 0.9%; P = 0.01), while the rates of other fine-needle aspiration cytology categories were similar. There was a reduction in the use of radioactive iodine ablation in the post-ATA2009 group, both in the proportion of patients being treated (66% versus 48%; P < 0.001) and the dosages used (mean 96 mCi versus 80 mCi; P < 0.01), despite similar tumour size in both groups. CONCLUSION: The key changes in practice thought to be attributable to the 2009 revised ATA guidelines were the reduction in the use and dosage of radioactive iodine in the management of differentiated thyroid cancer.

Body weight change is unpredictable after total thyroidectomy.

BACKGROUND: There is a common perception that total thyroidectomy causes weight gain beyond expected age-related changes, even when thyroid replacement therapy induces a euthyroid state. The aim of this study was to determine whether patients who underwent total thyroidectomy for a wide spectrum of conditions experienced weight gain following surgery. METHODS: We retrospectively studied 107 consecutive total thyroidectomy patients treated between January 2013 and June 2014. Medical records were reviewed to determine underlying pathology, thyroid status, use of antithyroid drugs and preoperative weight. Follow-up data were obtained from 79 patients at least 10 months post-operatively to determine current weight, the type of clinician managing thyroid replacement therapy and patient satisfaction with post-thyroidectomy management. RESULTS: The cohort was 73% female, with a mean age of 55.8 ± 15.7 years and a mean preoperative weight of 78.8 ± 17.5 kg. Commonest pathologies were multinodular goitre, Graves' disease, thyroid cancer and Hashimoto's thyroiditis. Preoperatively, 63.2% of patients were hyperthyroid. Mean weight change at follow-up was a non-significant increase of 0.06 ± 6.9 kg (P = 0.094). Weight change was not significant regardless of preoperative thyroid function status. This study did not demonstrate any significant differences in clinical characteristics (including post-operative thyroid-stimulating hormone) between the group with >2% weight gain and those who did not. CONCLUSIONS: This study did not reveal significant weight gain following thyroidectomy for a wide spectrum of pathologies. Specifically, preoperative hyperthyroidism, female gender and use of antithyroid medications do not predict weight gain after thyroid surgery.

RNA interference: a promising therapy for gastric cancer.

Gastric cancer (GC) remains a virtually incurable disease when metastatic and requires early screening tools for detection of early tumor stages. Therefore, finding effective strategies for prevention or recurrence of GC has become a major overall initiative. RNA-interference (RNAi) is an innovative technique that can significantly regulate the expression of oncogenes involved in gastric carcinogenesis, thus constituting a promising epigenetic approach to GC therapy. This review presents recent advances concerning the promising biomolecular mechanism of RNAi for GC treatment.

Association between the C3435T single-nucleotide polymorphism of multidrug resistance 1 gene and risk of gastric cancer.

The multidrug resistance 1 (MDR1) gene encodes P-glycoprotein, which confers resistance to antineoplastic drugs, but also affects the kinetic disposition of certain drugs and carcinogens. The C3435T polymorphism of the MDR1 gene may influence the transport and excretion of carcinogens, increasing the risk of cancer. The aim of this study was to evaluate the association between this polymorphism and the risk of gastric cancer (GC). Ninety-eight patients with non-cardia GC and 203 healthy subjects participated in the study. DNA was extracted from leukocytes and the MDR1 polymorphism was analyzed using PCR-RFLP. Serology was performed by ELISA for the investigation of infection with Helicobacter pylori. No significant difference in the genotype (p=0.668) or allele (p=0.745) frequency of the C3435T polymorphism was observed between the GC and control groups. There was no association between the genotypes studied and the risk of GC in patients infected with H. pylori (p=0.662). Patient survival was not correlated with the genotypes studied (p=0.454). No correlation was observed between the C3435T polymorphism of the MDR1 gene and GC risk or prognosis in the population studied.