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2.
Am J Surg ; 234: 19-25, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38365554

ABSTRACT

BACKGROUND: This study assessed for disparities in the presentation and management of medullary thyroid cancer (MTC). METHODS: Patients with MTC (2010-2020) were identified from the National Cancer Database. Differences in disease presentation and likelihood of guideline-concordant surgical management (total thyroidectomy and resection of ≥1 lymph node) were assessed by sex and race/ethnicity. RESULTS: Of 6154 patients, 68.2% underwent guideline-concordant surgery. Tumors >4 â€‹cm were more likely in men (vs. women: OR 2.47, p â€‹< â€‹0.001) and Hispanic patients (vs. White patients: OR 1.52, p â€‹= â€‹0.001). Non-White patients were more likely to have distant metastases (Black: OR 1.63, p â€‹= â€‹0.002; Hispanic: OR 1.44, p â€‹= â€‹0.038) and experienced longer time to surgery (Black: HR 0.66, p â€‹< â€‹0.001; Hispanic: HR 0.71, p â€‹< â€‹0.001). Black patients were less likely to undergo guideline-concordant surgery (OR 0.70, p â€‹= â€‹0.022). CONCLUSIONS: Male and non-White patients with MTC more frequently present with advanced disease, and Black patients are less likely to undergo guideline-concordant surgery.


Subject(s)
Carcinoma, Neuroendocrine , Healthcare Disparities , Thyroid Neoplasms , Thyroidectomy , Humans , Thyroid Neoplasms/ethnology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/therapy , Thyroid Neoplasms/pathology , Male , Female , Middle Aged , Healthcare Disparities/ethnology , Healthcare Disparities/statistics & numerical data , Carcinoma, Neuroendocrine/ethnology , Carcinoma, Neuroendocrine/surgery , Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/therapy , Thyroidectomy/statistics & numerical data , Sex Factors , Adult , Aged , United States/epidemiology , Hispanic or Latino/statistics & numerical data , Ethnicity/statistics & numerical data , Retrospective Studies
3.
BMC Cancer ; 20(1): 719, 2020 Aug 03.
Article in English | MEDLINE | ID: mdl-32746796

ABSTRACT

BACKGROUND: Pulmonary high-grade neuroendocrine carcinoma (HGNEC) has a rising incidence of developing second primary malignancies (SPMs). This study is the first population-based analysis to quantify the SPM risks among survivors of lung HGNEC. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database to calculate standardized incidence ratio (SIR) and absolute excess risk (AER) between 2000 and 2016 for patients with pulmonary HGNEC. RESULTS: The data of 1161 patients with SPMs were retrieved from the SEER database. The ratio of observed/expected number of SPMs in pulmonary HGNEC was 1.53. Solid tumours comprised 91% of all second malignancies in lung HGNEC patients, with the most common cancers reported in the oral cavity and pharynx, the urinary and respiratory systems CONCLUSIONS: Our study observed an increased risk of SPMs among patients with pulmongnancies.


Subject(s)
Carcinoma, Neuroendocrine/complications , Lung Neoplasms/complications , Neoplasms, Second Primary/epidemiology , Adult , Aged , Cancer Survivors , Carcinoma, Large Cell , Carcinoma, Neuroendocrine/ethnology , Carcinoma, Neuroendocrine/mortality , Carcinoma, Neuroendocrine/pathology , Female , Humans , Incidence , Lung Neoplasms/ethnology , Lung Neoplasms/mortality , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Grading , Neoplasms, Second Primary/ethnology , Neoplasms, Second Primary/mortality , Neoplasms, Second Primary/pathology , Proportional Hazards Models , Risk Factors , SEER Program , Small Cell Lung Carcinoma , Young Adult
4.
Thyroid ; 27(9): 1142-1148, 2017 09.
Article in English | MEDLINE | ID: mdl-28635560

ABSTRACT

BACKGROUND: Therapeutic options for treating advanced or metastatic medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC) are still limited in Japan, even though vandetanib for MTC and lenvatinib for MTC and ATC have been approved. Sorafenib is an oral multikinase inhibitor approved for the treatment of patients with radioactive iodine-refractory differentiated thyroid cancer (DTC). An uncontrolled, open-label, multicenter, single-arm, Phase 2 clinical study was conducted to evaluate the safety and efficacy of sorafenib in Japanese patients with MTC and ATC. METHODS: Japanese patients with histologically confirmed ATC and locally advanced or metastatic MTC were enrolled from April to September 2014. The primary endpoint was to evaluate the safety of sorafenib. Treatment efficacy variables including progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and maximum reduction in tumor size were evaluated as secondary endpoints. Patients received sorafenib 400 mg orally twice daily on a continuous basis and then continued treatment until the occurrence of disease progression, unacceptable toxicity, or withdrawal of consent. RESULTS: A total of 20 patients were screened, and 18 (8 with MTC and 10 with ATC) were enrolled. The most common drug-related adverse events were palmar-plantar erythrodysesthesia (72%), alopecia (56%), hypertension (56%), and diarrhea (44%). In the ATC patients, median PFS was 2.8 months [confidence interval 0.7-5.6], and median OS was 5.0 months [confidence interval 0.7-5.7]; ORR and DCR were 0% and 40%, respectively. In the MTC population, neither median PFS nor OS had been reached at the time of this analysis; ORR was 25% and DCR was 75%. CONCLUSIONS: The toxicities reported in this study were consistent with the known safety profile of sorafenib. Sorafenib seems to be effective in the treatment of advanced MTC but not ATC, and could be a new treatment option for locally advanced or metastatic MTC and radioactive iodine-refractory DTC.


Subject(s)
Antineoplastic Agents/adverse effects , Carcinoma, Neuroendocrine/drug therapy , Niacinamide/analogs & derivatives , Phenylurea Compounds/adverse effects , Protein Kinase Inhibitors/adverse effects , Thyroid Carcinoma, Anaplastic/drug therapy , Thyroid Gland/drug effects , Thyroid Neoplasms/drug therapy , Adult , Alopecia/chemically induced , Alopecia/ethnology , Antineoplastic Agents/therapeutic use , Carcinoma, Neuroendocrine/ethnology , Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/secondary , Diarrhea/chemically induced , Diarrhea/ethnology , Drug Resistance, Neoplasm , Female , Hand-Foot Syndrome/ethnology , Hand-Foot Syndrome/etiology , Humans , Hypertension/chemically induced , Hypertension/ethnology , Japan , Male , Neoplasm Grading , Niacinamide/adverse effects , Niacinamide/therapeutic use , Patient Dropouts/ethnology , Phenylurea Compounds/therapeutic use , Protein Kinase Inhibitors/therapeutic use , Sorafenib , Survival Analysis , Thyroid Carcinoma, Anaplastic/ethnology , Thyroid Carcinoma, Anaplastic/pathology , Thyroid Gland/pathology , Thyroid Neoplasms/ethnology , Thyroid Neoplasms/pathology , Thyroid Neoplasms/secondary , Tumor Burden/drug effects
5.
J Clin Pathol ; 65(8): 704-9, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22718848

ABSTRACT

BACKGROUNDS: Large cell neuroendocrine carcinoma (LCNEC) is well-known as a lung cancer subtype. This study assessed the prevalence of head and neck mucosal LCNEC (M-LCNEC). METHODS: M-LCNEC was studied clinically, histologically and immunohistochemically. RESULTS: Of 814 surgically resected cases of mucosal head and neck carcinoma, only eight cases (0.98%; all men, mean age 64.6 years) were rediagnosed as M-LCNEC. They occurred in the oropharynx (n=3), larynx (n=4) and hypopharynx (n=1). Seven of the cases had regional lymph node metastases and four resulted in death. Histologically, M-LCNEC had a sheet-like trabacular organoid growth pattern of relatively large basaloid cells in which central necrosis, rosette formation, peripheral palisading and high mitotic figures were evident. M-LCNEC was immunopositive for two or three neuroendocrine markers (CD56, chromogranin-A and synaptophysin). All cases showed high proliferative activity. CONCLUSION: M-LCNEC in the head and neck regions is a distinct histopathological entity whose positivity for neuroendocrine markers makes its diagnosis important. As about half of the patients died of the disease, M-LCNEC has a relatively poor prognosis.


Subject(s)
Asian People , Carcinoma, Large Cell/secondary , Carcinoma, Neuroendocrine/secondary , Head and Neck Neoplasms/pathology , Mucous Membrane/pathology , Aged , Biomarkers, Tumor/analysis , CD56 Antigen/analysis , Carcinoma, Large Cell/chemistry , Carcinoma, Large Cell/ethnology , Carcinoma, Large Cell/mortality , Carcinoma, Large Cell/surgery , Carcinoma, Neuroendocrine/chemistry , Carcinoma, Neuroendocrine/ethnology , Carcinoma, Neuroendocrine/mortality , Carcinoma, Neuroendocrine/surgery , Chromogranin A/analysis , Head and Neck Neoplasms/chemistry , Head and Neck Neoplasms/ethnology , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/surgery , Humans , Hypopharyngeal Neoplasms/chemistry , Hypopharyngeal Neoplasms/ethnology , Hypopharyngeal Neoplasms/pathology , Immunohistochemistry , Japan/epidemiology , Laryngeal Neoplasms/chemistry , Laryngeal Neoplasms/ethnology , Laryngeal Neoplasms/pathology , Male , Middle Aged , Mucous Membrane/chemistry , Mucous Membrane/surgery , Oropharyngeal Neoplasms/chemistry , Oropharyngeal Neoplasms/ethnology , Oropharyngeal Neoplasms/pathology , Predictive Value of Tests , Prevalence , Retrospective Studies , Synaptophysin , Treatment Outcome , Vesicular Transport Proteins/analysis
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