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Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status
BACKGROUND: A stepwise surgical approach with hemithyroidectomy and completion thyroidectomy was used to achieve definite characterization of follicular thyroid carcinoma (FTC). Choosing appropriate candidates for completion thyroidectomy has been controversial. OBJECTIVE: The aim of this study was...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9838536/ https://www.ncbi.nlm.nih.gov/pubmed/36637642 http://dx.doi.org/10.1245/s10434-022-13089-5 |
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author | Park, Hyunju Heo, Jung Ki, Chang-Seok Shin, Jung Hee Oh, Young Lyun Son, Young Ik Kim, Jee Soo Kim, Sun Wook Chung, Jae Hoon Kim, Tae Yong Kim, Tae Hyuk Kim, Jung-Han |
author_facet | Park, Hyunju Heo, Jung Ki, Chang-Seok Shin, Jung Hee Oh, Young Lyun Son, Young Ik Kim, Jee Soo Kim, Sun Wook Chung, Jae Hoon Kim, Tae Yong Kim, Tae Hyuk Kim, Jung-Han |
author_sort | Park, Hyunju |
collection | PubMed |
description | BACKGROUND: A stepwise surgical approach with hemithyroidectomy and completion thyroidectomy was used to achieve definite characterization of follicular thyroid carcinoma (FTC). Choosing appropriate candidates for completion thyroidectomy has been controversial. OBJECTIVE: The aim of this study was to clarify the selection criteria for completion thyroidectomy using telomerase reverse transcriptase (TERT) promoter mutation. METHODS: A total of 87 FTC patients who had information about TERT promoter mutation from August 1995 to November 2020 were investigated. The cumulative risk of initial distant metastasis, disease recurrence, and cancer-specific death according to primary tumor size in each of the World Health Organization (WHO) 2017 classifications were calculated. RESULTS: Of the 87 patients, 8 (9.2%) had initial distant metastasis and 15 (17.2%) had persistent disease or developed structural recurrence. The threshold diameter for initial distant metastasis, disease recurrence, and cancer-specific death was 2 cm in minimally invasive FTC (MI-FTC) with mutant TERT (M-TERT) and in encapsulated angioinvasive FTC (EA-FTC) with M-TERT, while that in MI-FTC with wild-type TERT (WT-TERT) and EA-FTC with WT-TERT was 4 cm. The cumulative risk of initial distant metastasis, disease recurrence, and cancer-specific death according to primary tumor size in each WHO 2017 classification was significantly different only in patients with WT-TERT (p = 0.001, p = 0.019, and p = 0.005, respectively). CONCLUSIONS: The data suggest 2 cm as a critical threshold diameter for performance of completion thyroidectomy in MI-FTC with M-TERT and EA-FTC with M-TERT. TERT promoter mutational status can help select candidates for completion thyroidectomy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-022-13089-5. |
format | Online Article Text |
id | pubmed-9838536 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-98385362023-01-17 Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status Park, Hyunju Heo, Jung Ki, Chang-Seok Shin, Jung Hee Oh, Young Lyun Son, Young Ik Kim, Jee Soo Kim, Sun Wook Chung, Jae Hoon Kim, Tae Yong Kim, Tae Hyuk Kim, Jung-Han Ann Surg Oncol Endocrine Tumors BACKGROUND: A stepwise surgical approach with hemithyroidectomy and completion thyroidectomy was used to achieve definite characterization of follicular thyroid carcinoma (FTC). Choosing appropriate candidates for completion thyroidectomy has been controversial. OBJECTIVE: The aim of this study was to clarify the selection criteria for completion thyroidectomy using telomerase reverse transcriptase (TERT) promoter mutation. METHODS: A total of 87 FTC patients who had information about TERT promoter mutation from August 1995 to November 2020 were investigated. The cumulative risk of initial distant metastasis, disease recurrence, and cancer-specific death according to primary tumor size in each of the World Health Organization (WHO) 2017 classifications were calculated. RESULTS: Of the 87 patients, 8 (9.2%) had initial distant metastasis and 15 (17.2%) had persistent disease or developed structural recurrence. The threshold diameter for initial distant metastasis, disease recurrence, and cancer-specific death was 2 cm in minimally invasive FTC (MI-FTC) with mutant TERT (M-TERT) and in encapsulated angioinvasive FTC (EA-FTC) with M-TERT, while that in MI-FTC with wild-type TERT (WT-TERT) and EA-FTC with WT-TERT was 4 cm. The cumulative risk of initial distant metastasis, disease recurrence, and cancer-specific death according to primary tumor size in each WHO 2017 classification was significantly different only in patients with WT-TERT (p = 0.001, p = 0.019, and p = 0.005, respectively). CONCLUSIONS: The data suggest 2 cm as a critical threshold diameter for performance of completion thyroidectomy in MI-FTC with M-TERT and EA-FTC with M-TERT. TERT promoter mutational status can help select candidates for completion thyroidectomy. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1245/s10434-022-13089-5. Springer International Publishing 2023-01-13 2023 /pmc/articles/PMC9838536/ /pubmed/36637642 http://dx.doi.org/10.1245/s10434-022-13089-5 Text en © Society of Surgical Oncology 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Endocrine Tumors Park, Hyunju Heo, Jung Ki, Chang-Seok Shin, Jung Hee Oh, Young Lyun Son, Young Ik Kim, Jee Soo Kim, Sun Wook Chung, Jae Hoon Kim, Tae Yong Kim, Tae Hyuk Kim, Jung-Han Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status |
title | Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status |
title_full | Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status |
title_fullStr | Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status |
title_full_unstemmed | Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status |
title_short | Selection Criteria for Completion Thyroidectomy in Follicular Thyroid Carcinoma Using Primary Tumor Size and TERT Promoter Mutational Status |
title_sort | selection criteria for completion thyroidectomy in follicular thyroid carcinoma using primary tumor size and tert promoter mutational status |
topic | Endocrine Tumors |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9838536/ https://www.ncbi.nlm.nih.gov/pubmed/36637642 http://dx.doi.org/10.1245/s10434-022-13089-5 |
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