Top

Published in:

01-03-2006

New Prognostic Scales LAST-1 and LAST-2: Supporting Prediction and Staging of Thyroid Cancer

Authors: Andrzej J. Lachinski, MD, PhD, Tomasz Stefaniak, MD, PhD, Jarek Kobiela, MD, Saxon Connor, MB, ChB, FRACS, Zbigniew Gruca, MD, PhD, Zbigniew Sledzinski, MD, PhD

Published in: World Journal of Surgery | Issue 3/2006

Abstract

Introduction

Epidemiologically, thyroid gland tumors are lesions of the highest importance among endocrine tumors in humans. Although the results of surgical treatment of the highly differentiated (follicular and papillary) tumors seem to be satisfactory, treatment of the poorly differentiated (medullary and anaplastic) tumor still demands clinical and basic investigations. In this study the authors sought to evaluate clinical and molecular factors that could contribute to preoperative detection of more advanced thyroid cancers (i.e., those that exhibit extrathyroid spread and lymph node invasion).

Methods

A total of 27 patients operated on for thyroid cancer were evaluated according to age, sex, time from the onset of the disease, cytogenetic changes, and loss of heterozygosity (LOH) in 14 microsatellite markers. The output variables were defined according to postoperative findings and the TNM 2002 score. The T1-2 N0 M0 cases were defined as local malignancy (LM); and T3-4 any N any M, any T N1 any M, or any T any N M1 were considered advanced malignancy (AM). The control groups consisted of 25 patients with multinodular goiter (MNG) and 32 patients with follicular adenoma (FA). In all cases, clinical and molecular data similar to those listed above were collected, excluding staging and follow-up information.

Results

There was no predominant specific type of chromosomal aberration observed and no marker lost in more than five patients (18%). The logistic regression identified three input variables as contributing significantly to the dichotomized outcome measure (LM vs. AM): LOH in any of the examined loci, age of the patient at the presentation, and the sex of the patient. Furthermore, discriminant analysis revealed four input variables differentiating among TC, FA, and MNG patients. Based on the multivariate analysis results, two numeric prognostic scales were fashioned: LAST-1, a scale applicable to differentiation of thyroid cancers at different degrees of clinical advancement; and LAST-2, a scale applicable to differentiation of any thyroid lumps.

Conclusions

It was concluded that LOH and the age and sex of the patients can provide sufficient data to predict thyroid cancer with a high degree of clinical advancement. LAST-1 scale is a reliable tool for identifying these patients. The LAST-2 scale gives supportive information about the character of thyroid lumps, distinguishing TC from MNG and FA.

Pacini F, De Groot LJ. Thyroid neoplasia. http://www.thyroidmanager.org, 2004

Voutilainen PE, Multanen MM, Leppaniemi AK, et al. Prognosis after lymph node recurrence in papillary thyroid carcinoma depends on age. Thyroid 2001;11:953–957CrossRefPubMed

Antonini P, Venuat AM, Lineares G, et al. Cytogenetic abnormalities in thyroid adenomas. Cancer Genet Cytogenet 1991;52:157–164PubMed

Gertner ME, Kebebew E. Multiple endocrine neoplasia type 2. Curr Treat Options Oncol 2004;5:315–325PubMed

Bornstein-Quevedo L, Garcia-Hernandez ML, Camacho-Arroyo I, et al. Telomerase activity in well-differentiated papillary thyroid carcinoma correlates with advanced clinical stage of the disease. Endocr Pathol 2003;14:213–219CrossRefPubMed

Kimura ET, Nikiforova MN, Zhu Z, et al. High prevalence of BRAF mutations in thyroid cancer: genetic evidence for constitutive activation of the RET/PTC-RAS-BRAF signaling pathway in papillary thyroid carcinoma. Cancer Res 2003;63:1454–1457PubMed

Lacroix L, Mian C, Barrier T, et al. PAX8 and peroxisome proliferator-activated receptor gamma 1 gene expression status in benign and malignant thyroid tissues. Eur J Endocrinol 2004;151:367–374CrossRefPubMed

Anwar F, Emond MJ, Schmidt RA, et al. Retinoblastoma expression in thyroid neoplasms. Mod Pathol 2000;13:562–569PubMed

Granja F, Morari J, Morari EC, et al. Proline homozygosity in codon 72 of p53 is a factor of susceptibility for thyroid cancer. Cancer Lett 2004;210:151–157CrossRefPubMed

10.

Boltze C, Zack S, Quednow C, et al. Hypermethylation of the CDKN2/p16INK4A promotor in thyroid carcinogenesis. Pathol Res Pract 2003;199:399–404PubMed

11.

Putzer BM, Drosten M. The RET proto-oncogene: a potential target for molecular cancer therapy. Trends Mol Med 2004;10:351–357CrossRefPubMed

12.

Tallini G. Molecular pathobiology of thyroid neoplasms. Endocr Pathol 2002;13:271–288CrossRefPubMed

13.

Inaba M, Sato H, Abe Y, et al. Expression and significance of c-met protein in papillary thyroid carcinoma. Tokai J Exp Clin Med 2002;27:43–49PubMed

14.

Wang DG, Liu WH, Johnston CF, et al. Bcl-2 and c-Myc, but not bax and p53, are expressed during human medullary thyroid tumorigenesis. Am J Pathol 1998;152:1407–1413PubMed

15.

Kataki A, Sotirianakos S, Memos N, et al. P53 and C-FOS overexpression in patients with thyroid cancer: an immunohistochemical study. Neoplasma 2003;50:26–30PubMed

16.

Hunt JL, Yim JH, Tometsko M, et al. Loss of heterozygosity of the VHL gene identifies malignancy and predicts death in follicular thyroid tumors. Surgery 2003;134:1043–1047CrossRefPubMed

17.

Jeanpierre M, Junien C. DNA analysis as clinical investigation: when and how? Ann Genet 1984;27:134–147PubMed

18.

Slebos RJ, Umbach DM, Sommer CA, et al. Analytical and statistical methods to evaluate microsatellite allelic imbalance in small amounts of DNA. Lab Invest 2004;84:649–657CrossRefPubMed

19.

Sperling K, Wiesner R. A rapid banding technique for routine use in human and comparative cytogenetics. Humangenetik 1972;15:349–353PubMed

20.

Mitelman F. An International System for Cytogenetic Nomenclature. Basel, Karger, 1995

21.

Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988;104:947–953PubMed

22.

Van Nguyen K, Dilawari RA. Predictive value of AMES scoring system in selection of exent of surgery in well differentiated carcinoma of thyroid. Am J Surg 1995;61:151–155

23.

Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively managed patients. World J Surg 2002;26:879–885CrossRefPubMed

24.

Byar DP, Green SB, Dor P, et al. Prognostic index for thyroid carcinoma: study of the EORTC thyroid cancer cooperative group. Eur J Cancer 1979;15:1033–1041PubMed

25.

Goldgar DE, Easton DF, Cannon-Albright LA, et al. Systematic population-based assessment of cancer risk in first-degree relatives of cancer probands. J Natl Cancer Inst 1994;86:1600–1608PubMed

26.

Fagin JA. Thyroid Cancer. Norwell, MA, Kluwer, pp 59–84

27.

Huang Y, Prasad M, Lemon WJ, et al. Gene expression in papillary thyroid carcinoma reveals highly consistent profiles. Proc Natl Acad Sci USA 2001;98:15044–15049PubMed

28.

Links TP, van Tol KM, Meerman GJ, et al. Differentiated thyroid carcinoma: a polygenic disease. Thyroid 2001;11:1135–1140CrossRefPubMed

29.

Rodrigues RF, Roque L, Rosa-Santos J, et al. Chromosomal imbalances associated with anaplastic transformation of follicular thyroid carcinomas. Br J Cancer 2004;90:492–496CrossRefPubMed

30.

Ito Y, Yoshida H, Tomoda C, et al. Decreased expression of p107 is correlated with anaplastic transformation in papillary carcinoma of the thyroid. Anticancer Res 2003;23:3819–3824PubMed

31.

Nikiforov YE. Genetic alterations involved in the transition from well-differentiated to poorly differentiated and anaplastic thyroid carcinomas. Endocr Pathol 2004;15:319–327CrossRefPubMed

32.

Burzykowski T, Chmielarczyk W. Predicted and observed thyroid cancer incidence in Poland after year 1986. Wiad Lek 2004;57:306–310PubMed

33.

Haigh PI, Urbach DR, Rotstein LE. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol 2005;12:81–89CrossRefPubMed

34.

Clark JR, Lai P, Hall F, et al. Variables predicting distant metastases in thyroid cancer. Laryngoscope 2005;115:661–667CrossRefPubMed

35.

Zedenius J, Wallin G, Svensson A, et al. Deletions of the long arm of chromosome 10 in progression of follicular thyroid tumors. Hum Genet 1996;97:299–303CrossRefPubMed

36.

Cerutti JM, Delcelo R, Amadei MJ, et al. A preoperative diagnostic test that distinguishes benign from malignant thyroid carcinoma based on gene expression. J Clin Invest 2004;113:1234–1242CrossRefPubMed

37.

Rosai J. Immunohistochemical markers of thyroid tumors: significance and diagnostic applications. Tumori 2003;89:517–519PubMed

38.

Sheikh HA, Tometsko M, Niehouse L, et al. Molecular genotyping of medullary thyroid carcinoma can predict tumor recurrence. Am J Surg Pathol 2004;28:101–106PubMed

39.

Hunt JL, Yim JH, Tometsko M, et al. Loss of heterozygosity of the VHL gene identifies malignancy and predicts death in follicular thyroid tumors. Surgery 2003;134:1043–1047CrossRefPubMed

40.

Passler C, Prager G, Scheuba C, et al. Application of staging systems for differentiated thyroid carcinoma in an endemic goiter region with iodine substitution. Ann Surg 2003;237:227–234CrossRefPubMed

41.

Rodriguez-Cuevas S, Labastida-Almendaro S, Cortes-Arroyo H, et al. Multifactorial analysis of survival and recurrences in differentiated thyroid cancer: comparative evaluation of usefulness of AGES, MACIS, and risk group scores in Mexican population. J Exp Clin Cancer Res 2002;21:79–86PubMed

42.

Hadjieva T. Scoring patients’ risk in differentiated thyroid cancer. Onkologie 2001;24:561–568CrossRefPubMed

43.

Khalid A, Pal R, Sasatomi E, et al. Use of microsatellite marker loss of heterozygosity in accurate diagnosis of pancreaticobiliary malignancy from brush cytology samples. Gut 2004;53:1860–1865CrossRefPubMed

44.

Ward LS, Brenta G, Medvedovic M, et al. Studies of allelic loss in thyroid tumors reveal major differences in chromosomal instability between papillary and follicular carcinomas. J Clin Endocrinol Metab 1998;83:525–530CrossRefPubMed

45.

Oriola J, Halperin I, Mallofre C, et al. Screening of selected genomic areas potentially involved in thyroid neoplasms. Eur J Cancer 2001;37:2470–2474CrossRefPubMed

46.

Grebe SK, McIver B, Hay ID, et al. Frequent loss of heterozygosity on chromosomes 3p and 17p without VHL or p53 mutations suggests involvement of unidentified tumor suppressor genes in follicular thyroid carcinoma. J Clin Endocrinol Metab 1997;82:3684–3691PubMed

47.

Trovato M, Fraggetta F, Villari D, et al. Loss of heterozygosity of the long arm of chromosome 7 in follicular and anaplastic thyroid cancer, but not in papillary thyroid cancer. J Clin Endocrinol Metab 1999;84:3235–3240PubMed

48.

Kitamura Y, Shimizu K, Ito K, et al. Allelotyping of follicular losses in chromosome arms 7q, 11p and 22q. J Clin Endocrinol Metab 2001;86:4268–4272CrossRefPubMed

49.

Zedenius J, Wallin G, Svensson A, et al. Deletions of the long arm of chromosome 10 in progression of follicular thyroid tumors. Hum Genet 1996;97:299–303CrossRefPubMed

50.

Yeh JJ, Marsh DJ, Zedenius J, et al. Fine-structure deletion mapping of 10q22-24 identifies regions of loss of heterozygosity and suggests that sporadic follicular thyroid adenomas and follicular thyroid carcinomas develop along distinct neoplastic pathways. Genes Chromosome Cancer 1999;26:322–328

51.

Sobin LH, Wittekind C, editors. TNM Classification of Malignant Tumors, 6th edition. New York: Wiley-Liss, 2002:52–56

52.

Witt RL, McNamara AM. Prognostic factors in mortality and morbidity in patients with differentiated thyroid cancer. Ear Nose Throat J 2002;81:856–863PubMed

53.

Alzahrani AS, Al Mandil M, Chaudhary MA, et al. Frequency and predictive factors of malignancy in residual thyroid tissue and cervical lymph nodes after partial thyroidectomy for differentiated thyroid cancer. Surgery 2002;131:443–449CrossRefPubMed

54.

Shaha AR. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope 2004;114:393–402PubMed

55.

D’Avanzo A, Treseler P, Ituarte PH, et al. Follicular thyroid carcinoma: histology and prognosis. Cancer 2004;100: 1123–1129PubMed

56.

Rios A, Rodriguez JM, Canteras M, et al. Risk factors for malignancy in multinodular goitres. Eur J Surg Oncol 2004;30:58–62PubMed

57.

Eichhorn W, Tabler H, Lippold R, et al. Prognostic factors determining long-term survival in well-differentiated thyroid cancer: an analysis of four hundred eighty-four patients undergoing therapy and aftercare at the same institution. Thyroid 2003;13:949–958CrossRefPubMed

Title: New Prognostic Scales LAST-1 and LAST-2: Supporting Prediction and Staging of Thyroid Cancer
Authors: Andrzej J. Lachinski, MD, PhD
Tomasz Stefaniak, MD, PhD
Jarek Kobiela, MD
Saxon Connor, MB, ChB, FRACS
Zbigniew Gruca, MD, PhD
Zbigniew Sledzinski, MD, PhD
Publication date: 01-03-2006
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 3/2006
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-005-0277-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

New Prognostic Scales LAST-1 and LAST-2: Supporting Prediction and Staging of Thyroid Cancer

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2006

To the Editor: Surgical Infection Nomenclature

Invited Commentary to “Prognostic Factors of Primary Small Bowel Adenocarcinoma: Univariate and Multivariate Analysis”

Prospective Comparison of Laparoscopic Left Hemicolectomy for Colon Cancer with Laparoscopic Left Hemicolectomy for Benign Colorectal Disease

Characteristics of Perianal Abscess and Fistula-in-Ano in Healthy Children

Tissue Oxygen Saturation during Colorectal Surgery Measured by Near-infrared Spectroscopy: Pilot Study to Predict Anastomotic Complications

Carbon Dye Staining of Sentinel Lymph Nodes Facilitates Microstaging of Colon Cancer Patients