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Bo Youn Cho,
Hoonsung Choi,
Young Joo Park,
Jung Ah Lim,
Hwa Young Ahn, Eun Kyung Lee,
Kyung Won Kim,
Ka Hee Yi,
June-Key Chung,
Yeo Kyu Youn,
Nam Han Cho,
Do Joon Park,
Chang-Soon Koh
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ABSTRACT: Background: Thyroid cancer has increased globally, with a prominent increase in small, papillary thyroid cancers. The Korean population shows a high iodine intake, high prevalence of BRAF V600E mutations, and family histories of thyroid cancer. We examined the clinicopathological characteristics and outcomes of thyroid cancers in Korean patients over 4 decades. Methods: The medical records of 4500 thyroid cancer patients, between 1962 and 2009 at a single center, including 3147 papillary thyroid cancers, were reviewed. Results: The mean age of the patients was 46.8 ± 13.2 years; women accounted for 82.9% of the patients and the median follow up duration was 4.8 years (mean 7.0 ± 5.8 years, range 1-43 years). The number of patients visiting the clinic increased from 411 during 1962-1990 to 2900 during 2000-2009, age at diagnosis increased from 39.6 ± 12.9 to 48.6 ± 12.4 years, and the male to female ratio increased from 1:6 to 1:4.5. The proportion of small (<1 cm) tumors increased from 6.1% to 43.1%, and the proportion of cancers with lymph node (LN) involvement or extrathyroidal extension (ETE) decreased from 76.4% to 44.4% and from 65.5% to 54.8%, respectively. Although there were decreases in the proportion of LN involvement and ETE, these decreasing rates were not proportional to the expected rates based on decreased proportion of large tumor. The overall recurrence and mortality rates were 13.3% and 1.4%. The 5-year recurrence rate significantly reduced (from 11.0 to 5.9%), and the 5-year mortality also improved (from 1.5 to 0.2%). Conclusions: Thyroid cancer was rapidly increased, with decreasing tumors with large size, LN involvement and ETE, although the decreasing rates of LN involvement and ETE were not as prominent as the decreasing rates of large size tumor. The mortality and recurrence rates also have decreased. Future long-term follow up of patients diagnosed at recent decade is needed to confirm the prognostic characteristics of Korean PTC patients.
Thyroid: official journal of the American Thyroid Association 02/2013; · 2.60 Impact Factor
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Do Joon Park,
Jung Ah Lim,
Tae Hyuk Kim,
Hoon Sung Choi,
Hwa Young Ahn, Eun Kyung Lee,
You Jin Lee,
Kyung Won Kim,
Young Joo Park,
Ka Hee Yi,
Bo Youn Cho
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ABSTRACT: The best treatment option for recurrent papillary thyroid carcinoma (PTC) is reoperation when the recurrent lesion is locoregional. The prognostic significance of serum Tg levels before reoperation and the association between the outcome of reoperation and Tg level remain unclear. Our study aimed to determine the outcomes of patients who underwent reoperation and their association with serum Tg levels. We retrospectively studied 79 patients with PTC with locoregional recurrence whose whole-body scan results were negative for any recurrence but whose serum Tg levels were detectable after first-line treatment. All the patients underwent reoperation and follow-up examinations, which involved serial serum Tg measurements after thyroxine withdrawal (T4-off Tg), neck ultrasonography, chest computed tomography, and/or fluorodeoxyglucose-positron emission tomography, to detect further recurrence. During the median follow-up duration of 89 months (range, 38-332 months), 30 patients (38.0%) experienced a second recurrence even after the reoperation. Among all patients, only 12 whose Tg levels decreased postoperatively to undetectable levels showed no recurrence. Most recurrences were detected in the patients with high T4-off Tg levels after the reoperation (T4-off Tg level [ng/mL], number of patients with recurrence [%]: <1, 0/12 [0]; 1-10, 9/31 [33.3]; >10, 16/22 [72.7]; p < 0.001). In conclusion, recurrence occurred in 38.0% of the patients even after the reoperation. The postoperative T4-off Tg level was a good indicator of recurrence after the reoperation. Therefore, patients who experience recurrence should undergo follow-up examinations that involve routine measurements of T4-off Tg levels, especially when postreoperative values exceed 10 ng/mL.
Endocrine Journal 07/2012; · 2.03 Impact Factor
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ABSTRACT: Clinical hypothyroidism affects various metabolic processes including drug metabolism. CYP2B and CYP3A are important cytochrome P450 drug metabolizing enzymes that are regulated by the xenobiotic receptors constitutive androstane receptor (CAR, NR1I3) and pregnane X receptor (PXR, NR1I2). We evaluated the regulation of the hepatic expression of CYPs by CAR and PXR in the hypothyroid state induced by a low-iodine diet containing 0.15% propylthiouracil. Expression of Cyp3a11 was suppressed in hypothyroid C57BL/6 wild type (WT) mice and a further decrement was observed in hypothyroid CAR-/- mice, but not in hypothyroid PXR-/- mice. In contrast, expression of Cyp2b10 was induced in both WT and PXR-/- hypothyroid mice, and this induction was abolished in CAR-/- mice and in and CAR-/- PXR-/- double knockouts. CAR mRNA expression was increased by hypothyroidism, while PXR expression remained unchanged. Carbamazepine (CBZ) is a commonly used antiepileptic that is metabolized by CYP3A isoforms. After CBZ treatment of normal chow fed mice, serum CBZ levels were highest in CAR-/- mice and lowest in WT and PXR-/- mice. Hypothyroid WT or PXR-/- mice survived chronic CBZ treatment, but all hypothyroid CAR-/- and CAR-/- PXR-/- mice died, with CAR-/-PXR-/- mice surviving longer than CAR-/- mice (12.3±3.3 days vs. 6.3±2.1 days, p=0.04). All these findings suggest that hypothyroid status affects xenobiotic metabolism, with opposing responses of CAR and PXR and their CYP targets that can cancel each other out, decreasing serious metabolic derangement in response to a xenobiotic challenge.
Toxicology and Applied Pharmacology 04/2012; 263(2):131-7. · 4.45 Impact Factor
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Tae Hyuk Kim,
Young Joo Park,
Jung Ah Lim,
Hwa Young Ahn, Eun Kyung Lee,
You Jin Lee,
Kyung Won Kim,
Seo Kyung Hahn,
Yeo Kyu Youn,
Kwang Hyun Kim,
Bo Youn Cho,
Do Joon Park
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ABSTRACT: The effects of the BRAF(V600E) mutation on prognostic factors and poor clinical outcomes in papillary thyroid cancer (PTC) have not been fully quantified. The authors performed comprehensive meta-analysis to assess the strength of associations between these conditions and the BRAF(V600E) mutation.
The authors identified the clinical studies that examined the association of the BRAF(V600E) mutation in surgical specimens with clinicopathologic outcomes between January 2003 and October 2010 using the Medline database. One hundred thirty-one relevant studies were hand-searched. The authors selected 27 studies that included 5655 PTC patients. They calculated the pooled odds ratios (ORs) or risk ratios with 95% confidence intervals (CIs) for each study using a random effect model.
The average prevalence rate of the BRAF(V600E) mutation was 49.4%. In 26 studies, compared with the patients who had the wild-type BRAF genes, the PTC patients with the BRAF(V600E) mutation had increased ORs of an extrathyroidal invasion (OR, 2.14; 95% CI, 1.68-2.73), a lymph node metastasis (OR, 1.54; 95% CI, 1.21-1.97), and an advanced TNM stage (OR, 2.00; 95% CI, 1.61-2.49). In 8 studies, patients with the mutation had 2.14-fold increased risk of recurrent and persistent disease (95% CI, 1.67-2.74). The associations were generally consistent across the different study populations.
This meta-analysis demonstrates that the BRAF(V600E) mutation is closely related to the high-risk clinicopathological factors and poorer outcome of PTC. The results obtained here suggest that the BRAF(V600E) mutation should be considered as a poor prognostic marker in PTC and may lead to better management for individual patients.
Cancer 08/2011; 118(7):1764-73. · 4.77 Impact Factor
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Tae Hyuk Kim,
Jung Ah Lim,
Hwa Young Ahn, Eun Kyung Lee,
Hye Sook Min,
Kyung Won Kim,
Yun-Hee Choi,
Young Joo Park,
Do Joon Park,
Kwang Hyun Kim,
Yeo Kyu Youn,
Bo Youn Cho
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ABSTRACT: The majority of patients having a diagnosis of Hürthle cell neoplasm (HCN) on fine-needle aspiration (FNA) of a thyroid nodule have a diagnostic thyroid lobectomy to make the final diagnosis. If the nodule is malignant, they require a completion thyroidectomy. The objective of this study was to devise a simple clinical scheme capable of predicting malignancy in patients with cytologic diagnosis of HCN and, therefore, guide the extent of initial thyroid surgery.
A total of 57 patients who underwent thyroid surgery after an FNA diagnosis of HCN were retrospectively studied. The patients were examined for clinical features, preoperative imaging studies, and pathology reports. The risk of malignancy was calculated using a multiple logistic regression model.
The overall rate of malignancy in patients with HCN was 46% (26/57). The predictors of malignancy based on multiple logistic regression analysis were tumor size >1.5 cm (odds ratio [95% confidence interval] = 8.0 [1.9-33.4]) and patient age >45 years (odds ratio [95% confidence interval] = 2.3 [0.6-8.6]). In patients with nodules larger than 1.5 cm, the predicted probability of malignancy was greater in patients over 45 years than in younger patients (65% for >45 years vs. 44% for ≤45 years). In patients with a nodule 1.5 cm or less, the probability of malignancy was relatively low and not significantly different between the two age categories (18% for >45 years vs. 10% for ≤45 years).
This study suggests that tumor size and age can be integrated into decision making for patients with an FNA diagnosis of HCN to facilitate patient selection for surgical referral and, particularly, to determine in which patients a thyroidectomy rather than a lobectomy should be the initial surgery.
Thyroid: official journal of the American Thyroid Association 10/2010; 20(11):1229-34. · 2.60 Impact Factor
