Insular thyroid cancer: a population-level analysis of patient characteristics and predictors of survival.

Department of Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Cancer (Impact Factor: 4.89). 01/2012; 118(13):3260-7.
Source: PubMed


Insular thyroid cancer (ITC) is an uncommon, poorly differentiated thyroid malignancy. To date, there have been no population-level studies of the characteristics and outcomes of patients with ITC.
The authors used the Surveillance, Epidemiology, and End Results (SEER) database from 1999 to 2007 to compare the characteristics and prognosis of patients who had ITC with those of patients who had well differentiated thyroid cancer (WDTC) and anaplastic thyroid cancer (ATC). Data analyses were performed using chi-square tests, analyses of variance, log-rank tests, and multivariate regression.
There were 114 patients with ITC, 497 patients with ATC, and 34,021 patients with WDTC. The mean age of patients with ITC was 62.1 years versus 48.1 years for patients with WDTC and 69.5 years for patients with ATC (P < .001). The mean ITC tumor size was 5.9 cm versus 2.0 cm for WDTC and 6.4 cm for ATC (P < .001). Distant metastasis occurred in 31% of patients with ITC versus 4.5% of patients with WDTC and 59.1% of patients with ATC (P < .001). Insular histology was associated independently with compromised survival in the overall study sample (hazard ratio [HR], 2.1; P = .001). The 5-year disease-specific survival rate was 72.6%, 97.2%, and 9.1% for patients with ITC, WDTC, and ATC, respectively (P < .001). After adjustment, radioiodine therapy (HR, 0.15; 95% confidence interval, 0.04-0.5) and distant metastasis (HR, 15.3; 95% confidence interval, 3.7-62.2) were associated independently with ITC survival. The mortality rate was 7.1%, 12%, and 54.3% for patients with localized, regional, and distant stage ITC, respectively (P < .001). For patients who had ITC with distant metastasis, thyroidectomy and radioiodine therapy independently improved survival.
ITC is rare and aggressive. The current results indicated that its treatment should include total thyroidectomy and high-dose radioiodine for all patients and neck dissections for patients with lymph node disease. Early diagnosis and close surveillance are essential in the management of patients with ITC.

14 Reads

  • Nature Reviews Endocrinology 07/2012; 8(8):454-5. DOI:10.1038/nrendo.2012.112 · 13.28 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The mainstay of treatment for differentiated thyroid carcinomas is surgery. There is hardly any room for radiation therapy in differentiated thyroid carcinomas. We aimed to update recommendations for RT in the context of histological variants, increased use of radioiodine and new irradiations techniques. Materials and methods: A search of the French and English literature was performed using thyroid carcinoma, radiation therapy, surgery, variants and radioiodine. Results: Papillary, follicular, Hürthle and medullary carcinomas represent about 80%, 11%, 3% and 4% of all thyroid carcinomas, respectively. Ten-year survival rates for patients with papillary, follicular and Hürthle cell carcinomas are 93%, 85%, and 76%, respectively. The occurrence of criteria such as older age (45 or 60 years-old), massive primary disease, extensive extracapsular spread and macroscopic iodine-negative components inconsistently indicate external beam irradiation (EBRT). The impact of EBRT on poorer-prognosis histological variants is an emerging issue. Noteworthy, the incidence of laryngeal and wound healing complications has been an important limitation to EBRT. However, intensity modulated radiation therapy (IMRT) offers clear dosimetric advantages on tumor coverage and organ sparing such as the larynx, thus reducing late toxicities to less than 5%. Iodine contrast agents should be avoided during 4-6 weeks before radioiodine. PET CT is increasingly used in iodine-negative tumors. Conclusion: There are elective indications for EBRT and IMRT has the potential to improve local control.
    Critical reviews in oncology/hematology 10/2012; 86(1). DOI:10.1016/j.critrevonc.2012.09.007 · 4.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of review: Aggressive variants of papillary thyroid cancer (PTC) have been recognized with increasing frequency. The most common of these include the diffuse sclerosing variant, tall cell variant, and insular thyroid cancer. These tumors may represent a spectrum of dedifferentiation from classic PTC to anaplastic thyroid cancers. Recent findings: Pathologists are reaching consensus in the diagnosis of these variants, recognizing their important distinction in clinical behavior. Preoperative studies such as ultrasonography, fine-needle aspiration, and better molecular and genetic markers help raise the suspicion of a thyroid nodule possibly harboring an aggressive cancer; this in turn allows the surgeons and endocrinologists to formulate a more complete operative plan, including thyroidectomy, possible lymphadenectomy, and postoperative radioactive iodine administration. In the past, most studies on these variants have relied on single institution and small clinical series; however, recent population-level analyses using national databases such as Surveillance, Epidemiology and End Result have included larger numbers of cases collected over many years. Summary: These studies have allowed for the identification of temporal trends in tumor incidence, and long-term analyses of the clinical, pathological, and survival outcomes of patients with these aggressive variants.
    Current opinion in oncology 11/2012; 25(1). DOI:10.1097/CCO.0b013e32835b7c6b · 4.47 Impact Factor
Show more