دورية أكاديمية
Prognostic Value of Preoperative Molecular Testing and Implications for Initial Surgical Management in Thyroid Nodules Harboring Suspected (Bethesda V) or Known (Bethesda VI) Papillary Thyroid Cancer.
| العنوان: | Prognostic Value of Preoperative Molecular Testing and Implications for Initial Surgical Management in Thyroid Nodules Harboring Suspected (Bethesda V) or Known (Bethesda VI) Papillary Thyroid Cancer. |
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| المؤلفون: | Schumm MA; Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California., Shu ML; Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California., Hughes EG; Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California., Nikiforov YE; Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Nikiforova MN; Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Wald AI; Department of Pathology and Laboratory Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania., Lechner MG; Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California., Tseng CH; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California., Sajed DP; Department of Pathology and Laboratory Medicine, UCLA David Geffen School of Medicine, Los Angeles, California., Wu JX; Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California., Yeh MW; Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California., Livhits MJ; Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California. |
| المصدر: | JAMA otolaryngology-- head & neck surgery [JAMA Otolaryngol Head Neck Surg] 2023 Aug 01; Vol. 149 (8), pp. 735-742. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Medical Association Country of Publication: United States NLM ID: 101589542 Publication Model: Print Cited Medium: Internet ISSN: 2168-619X (Electronic) Linking ISSN: 21686181 NLM ISO Abbreviation: JAMA Otolaryngol Head Neck Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Chicago, IL : American Medical Association, [2013]- |
| مواضيع طبية MeSH: | Thyroid Nodule*/genetics , Thyroid Nodule*/surgery , Thyroid Nodule*/diagnosis , Thyroid Neoplasms*/genetics , Thyroid Neoplasms*/surgery , Thyroid Neoplasms*/pathology, Humans ; Male ; Female ; Adult ; Thyroid Cancer, Papillary/genetics ; Thyroid Cancer, Papillary/surgery ; Prognosis ; Cohort Studies ; Retrospective Studies ; Iodine Radioisotopes ; Proto-Oncogene Proteins B-raf/genetics |
| مستخلص: | Importance: Molecular testing is commonly used in the diagnosis of thyroid nodules with indeterminate cytology. The role of molecular testing in prognosticating oncologic outcomes in thyroid nodules with suspicious or malignant cytology is unclear. Objective: To determine whether molecular profiling of Bethesda V (suspicious for thyroid cancer) and VI (thyroid cancer) nodules is associated with improved prognostication and whether it may inform initial treatment. Design, Setting, and Participants: This retrospective cohort study included consecutive patients with Bethesda V or VI nodules who underwent surgery, with histopathology showing differentiated thyroid cancer, between May 1, 2016, and July 31, 2019 in the University of California, Los Angeles health system. Data were analyzed between April 2, 2021, and January 18, 2023. Exposures: Masked ThyroSeq, version 3 molecular analysis after completion of initial treatment and acquisition of follow-up data. Main Outcomes and Measures: Structural disease persistence or recurrence, distant metastasis, and recurrence-free survival were assessed using ThyroSeq Cancer Risk Classifier (CRC) molecular risk groups (low, RAS-like; intermediate, BRAF-like; high, combination of BRAF/RAS plus TERT or other high-risk alterations) using Cox proportional hazards regression models. Results: In 105 patients with papillary thyroid cancer (median [IQR] follow-up, 3.8 [3.0-4.7] years), ThyroSeq identified genomic alterations in 100 (95%) samples (6 [6%] low risk, 88 [88%] intermediate risk, and 6 [6%] high risk; median [IQR] age, 44 [34-56] years; 68 [68%] female and 32 [32%] male). No patients with low-risk or negative results experienced recurrence. Of the 88 patients with intermediate risk, 6 (7%) experienced local recurrence, with 1 of them also developing distant metastasis. The 6 patients with high risk (all with BRAF V600E plus TERT mutation) underwent total thyroidectomy followed by radioactive iodine (RAI) ablation. Four patients with high risk (67%) experienced local recurrence, with 3 of them also developing distant metastasis. Thus, patients with high-risk alterations were more likely to experience persistence or recurrence and distant metastasis than patients with intermediate risk. In a multivariable analysis incorporating patient age, sex, cancer size, ThyroSeq molecular risk group, extrathyroidal extension, lymph node positivity, American Thyroid Association risk, and RAI ablation, only cancer size (hazard ratio, 1.36; 95% CI, 1.02-1.80) and ThyroSeq CRC molecular risk group (high vs intermediate and low: hazard ratio, 6.22; 95% CI, 1.04-37.36) were associated with structural recurrence. Conclusions and Relevance: Among the 6% of patients with high-risk ThyroSeq CRC alterations in this cohort study, the majority experienced recurrence or distant metastasis despite initial treatment with total thyroidectomy and RAI ablation. In contrast, patients with low- and intermediate-risk alterations had a low recurrence rate. Preoperative knowledge of molecular alteration status at diagnosis may allow for deescalation of initial surgery and refining of the intensity of postoperative surveillance in patients presenting with Bethesda V and VI thyroid nodules. |
| المشرفين على المادة: | 0 (Iodine Radioisotopes) EC 2.7.11.1 (Proto-Oncogene Proteins B-raf) |
| تواريخ الأحداث: | Date Created: 20230629 Date Completed: 20230811 Latest Revision: 20240630 |
| رمز التحديث: | 20240630 |
| مُعرف محوري في PubMed: | PMC10311424 |
| DOI: | 10.1001/jamaoto.2023.1494 |
| PMID: | 37382944 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 2168-619X |
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| DOI: | 10.1001/jamaoto.2023.1494 |