An increased calcitonin serum level is suggestive of a medullary thyroid cancer (MTC), but is not pathognomonic. The possibility of false positives or other calcitonin-secreting neuroendocrine neoplasms (NENs) should be considered. Serum calcitonin levels are generally assessed by immunoradiometric and chemiluminescent assays with high sensitivity and specificity; however, slightly moderately elevated levels could be attributable to various confounding factors. Calcitonin values >100 pg/mL are strongly suspicious of malignancy, whereas in patients with moderately elevated values (10-100 pg/mL) a stimulation test may be applied to improve diagnostic accuracy. Although the standard protocol and the best gender-specific cut-offs for calcium-stimulated calcitonin are still controversial, the fold of the calcitonin increase after stimulation seems to be more reliable. Patients with MTC show stimulated calcitonin values at least three to four times higher than the basal values, whereas calcitonin-secreting NENs can be distinguished from a C-cell disease by the absence of or
5.
Surufatinib in Chinese Patients with Locally Advanced or Metastatic Differentiated Thyroid Cancer and Medullary Thyroid Cancer: A Multicenter, Open-Label, Phase II Trial.
Chen, J, Ji, Q, Bai, C, Zheng, X, Zhang, Y, Shi, F, Li, X, Tang, P, Xu, Z, Huang, R, et al
Thyroid : official journal of the American Thyroid Association. 2020;(9):1245-1253
Abstract
Background: Thyroid cancer is the most common endocrine tumor with an increasing incidence. Limited treatment options are available for patients with advanced or recurrent metastatic disease, resulting in a poor prognosis. Surufatinib targets multiple kinases (vascular endothelial growth factor receptors, fibroblast growth factor receptor-1, and colony-stimulating factor-1 receptor) involved in tumor angiogenesis and tumor immune evasion. Surufatinib has demonstrated promising antitumor activity in various advanced solid tumors. This study aimed to determine the objective response rate (ORR) of surufatinib in patients with locally advanced or distant metastatic differentiated thyroid cancer (DTC) or medullary thyroid cancer (MTC). Methods: This Phase II open-label study by Simon's two-stage design was conducted at 10 sites across China. Patients with radioiodine (RAI)-refractory DTC with locally advanced disease or distant metastasis (DTC1 group); patients who received limited initial surgery and then developed locally advanced unresectable recurrences and were not considered candidates for RAI therapy due to residual normal thyroid tissue (DTC2 group); or patients with MTC with locally advanced disease or distant metastasis (MTC group) were enrolled. A total of 59 patients were enrolled (26 in DTC1, 6 in DTC2, and 27 in MTC) and received 300 mg surufatinib daily in 28-day cycles. The primary endpoint was ORR as determined by the investigators. Results: Overall ORR was 23.2% [95% confidence interval, CI 12.98-36.42]: 21.7% in the DTC1 cohort, 33.3% in the DTC2 cohort, and 22.2% in the MTC cohort. Forty-nine patients achieved disease control (87.5% [CI 75.93-94.82]): 87.0% in the DTC1 cohort, 83.3% in the DTC2 cohort, and 88.9% in the MTC cohort. Median time to response was 59.0 days, and 59.0, 85.5, and 59.0 days in the DTC1, DTC2, and MTC cohorts. Overall median progression-free survival was 11.1 months [CI 5.98-16.69]; 11.1 months in DTC1 and MTC cohorts, while the DTC2 cohort had not reached the median at the data cutoff. The most common treatment-emergent adverse events grade ≥3 were hypertension (20.3%), proteinuria (11.9%), and then elevated blood pressure, hypertriglyceridemia, and pulmonary inflammation (5.1% each). Conclusions: Surufatinib demonstrated promising efficacy with a tolerable and manageable safety profile for patients with locally advanced or metastatic MTC, RAI-refractory DTC, or locally advanced unresectable recurrences unable to receive RAI.
6.
Thyroid nodules: diagnostic evaluation based on thyroid cancer risk assessment.
Singh Ospina, N, Iñiguez-Ariza, NM, Castro, MR
BMJ (Clinical research ed.). 2020;:l6670
Abstract
Thyroid nodules are extremely common and can be detected by sensitive imaging in more than 60% of the general population. They are often identified in patients without symptoms who are undergoing evaluation for other medical complaints. Indiscriminate evaluation of thyroid nodules with thyroid biopsy could cause a harmful epidemic of diagnoses of thyroid cancer, but inadequate selection of thyroid nodules for biopsy can lead to missed diagnoses of clinically relevant thyroid cancer. Recent clinical guidelines advocate a more conservative approach in the evaluation of thyroid nodules based on risk assessment for thyroid cancer, as determined by clinical and ultrasound features to guide the need for biopsy. Moreover, newer evidence suggests that for patients with indeterminate thyroid biopsy results, a combined assessment including the initial ultrasound risk stratification or other ancillary testing (molecular markers, second opinion on thyroid cytology) can further clarify the risk of thyroid cancer and the management strategies. This review summarizes the clinical importance of adequate evaluation of thyroid nodules, focuses on the clinical evidence for diagnostic tests that can clarify the risk of thyroid cancer, and highlights the importance of considering the patient's values and preferences when deciding on management strategies in the setting of uncertainty about the risk of thyroid cancer.
7.
[Progress of risk factors for thyroid tumors].
Liu, S, Song, JY, Zhang, JQ
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2020;(8):897-901
Abstract
In recent years, both benign and malignant thyroid tumors have grown rapidly in the world, and have become one of the most common tumors in the endocrine system. At present, the pathogenesis of thyroid tumor is still unclear, but more and more studies have found that certain factors are related to the occurrence and development of thyroid tumors. It is of great significance to summarize and analyze these risk factors. This article reviews the research progress of its risk factors reported in recent years, so as to provide a basis for the accuracy and scientific prevention and control of thyroid tumors.
8.
Review of Factors Contributing to Nodular Goiter and Thyroid Carcinoma.
Yildirim Simsir, I, Cetinkalp, S, Kabalak, T
Medical principles and practice : international journal of the Kuwait University, Health Science Centre. 2020;(1):1-5
Abstract
There is an increased incidence of thyroid nodules and cancer. In this article, the reasons for this increase are evaluated and discussed. The factors causing increases in the incidence of nodules are the same as those causing increases in thyroid cancer. There are publications from all over the world regarding the rising incidence of thyroid cancer; it is especially associated with papillary cancer. The literature was reviewed and evaluated with regard to this significant phenomenon. Thyroid-stimulating hormone (TSH) is the main mitotic factor. Any agent that elevates TSH will stimulate nodule formation. Therefore, the incidence of thyroid nodules is high in endemic goiter regions due to iodine deficiency. This paper has described many of the factors causing this higher incidence. Of note, metabolic syndrome and insulin resistance are important factors associated with the increased incidence of nodular goiter and papillary thyroid cancer today. However, these data must be confirmed by other studies in the future.
9.
A dose-response meta-analysis of coffee consumption and thyroid cancer occurrence.
Shao, CC, Luo, D, Pang, GD, Xiao, J, Yang, XR, Zhang, Y, Jia, HY
International journal of food sciences and nutrition. 2020;(2):176-185
Abstract
The relationship between coffee consumption and thyroid cancer (TC) occurrence has been evaluated in several observational studies with controversial results. The study aims to examine the associations between coffee consumption and TC occurrence. Systematic searches up to February 2019 were conducted. We estimated summary adjusted relative risks (RRs) and the corresponding 95% confidence intervals (CIs). The dose-response analysis was conducted by using generalised least square trend estimation. A total of ten studies involving 379,825 participants and 1,254 TC cases were included. The total summary RR showed that high coffee consumption was a protection factor of TC (RR = 0.75; 95% CI, 0.62-0.91). With the linear cubic spline model, the occurrence of TC was reduced by 5% with each one cup/day increment of coffee consumption (RR = 0.95; 95% CI, 0.91-0.99).This meta-analysis provides quantitative evidence that coffee consumption was inversely associated with the TC occurrence in a linear dose-response manner.
10.
Circular RNAs: New players in thyroid cancer.
Borran, S, Ahmadi, G, Rezaei, S, Anari, MM, Modabberi, M, Azarash, Z, Razaviyan, J, Derakhshan, M, Akhbari, M, Mirzaei, H
Pathology, research and practice. 2020;(10):153217
Abstract
The prevalence of thyroid cancer the most frequent endocrine malignancy, is rapidly increasing. Most of thyroid cancers are relatively indolent, however, some cases still possess a risk of developing into lethal types of thyroid cancer. Regarding its multistep tumorigenesis, the determination of the underlying mechanisms is a vital issue for thyroid cancer therapy. Circular RNAs (circRNAs) are a type of non-coding RNAs with a closed loop structure. Numerous circRNAs have been identified in cancerous tissues. Mounting data recommends that the biological activities of circRNAs, such as serving as microRNA or ceRNAs sponges, interacting with proteins, modulating gene translation and transcription, suggesting that circRNAs will be potential targets as well as agents for the prognosis and diagnosis of diseases, including cancer. Given that circular RNAs acts as oncogenes or tumor suppressors in the thyroid cancer. Several studies documented that circular RNAs via microRNA and protein sponges could regulate a sequences of cellular and molecular mechanisms e.g., apoptosis, angiogenesis, tumor growth, and invasion that are involved in thyroid cancer pathogenesis. Herein, we summarized the role of circular RNAs as therapeutic and diagnostic biomarkers in the thyroid cancer. Moreover, we highlighted the role of these molecules in the pathogenesis of various cancers.