• Genomics & Informatics
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• 제11권2호
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• pp.68-75
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• 2013

Anaplastic thyroid cancer (ATC) belongs to the most malignant and rapidly progressive human thyroid cancers and its prognosis is very poor. Also, it shows high resistance to cancer treatments, so that effective treatment for ATC has not been found to date, and virtually all patients terminate their life rapidly after diagnosis. Although targeted treatment of genetic alterations has emerged as an extremely promising approach to human cancers, such as BRAF in metastatic melanoma, it remains unclear that how commonly genomic alterations are influenced in ATC tumorigenesis. In recent years, genome wide approaches have been exploited to find genetic alterations associated with complex diseases, including cancer. Here, we reviewed the comprehensive genetic alterations in ATC and recent approaches in the context of identifying genomic alterations associated with ATC. Since surprisingly few reports have been published on the genome wide study of ATC, this review puts emphasis on the urgent needs of genomic research for the prevention and treatment of ATC.

• International journal of thyroidology
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• 제11권2호
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• pp.75-77
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• 2018

Tyrosine kinase inhibitor is known to prolong progression free survival in radioiodine refractory thyroid cancer patients. Fatigue/asthenia/malaise is one of most common adverse events by the tyrosine kinase inhibitor treatment, and management of the adverse event is important to keep the drug medication longer which is essential for the survival benefit. In the case report, a radioiodine refractory thyroid cancer patient receiving tyrosine kinase inhibitor experienced severe fatigue, and a pathologic fracture of right humerus occurred by slipping down which was tightly linked with the adverse event of the drug. The pathologic fracture was surgically well managed and the adverse event was well controlled by supportive managements combined with dose reduction of the tyrosine kinase inhibitor. The drug administration to the patient was kept more than 1 year without progression of the disease.

• 대한두경부종양학회지
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• 제37권2호
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• pp.25-31
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• 2021

Background/Objectives: Although thyroid lobectomy recently is considered as sufficient for low-risk papillary thyroid carcinoma (PTC), completion thyroidectomy is required due to the insufficiency of the preoperative evaluation. The aim of this study was to investigate recurrence rate and disease free survival depending on the gross extrathyroidal extension (gETE) or the number of metastatic lymph node identified in patients with PTC. Materials & Methods: We assessed 3373 patients with PTC who underwent lobectomy at Seoul St. Mary's Hospital (Seoul, Korea) between January 2009 and December 2014. Clinicopathological characteristics and long-term surgical outcomes were retrospectively analyzed through complete chart reviews. The mean follow-up duration was 97.1 ± 21.4 months. Results: The rate of recurrence was higher in gETE group (1.8% vs. 6.0%, p=0.004), leading to decreased disease free survival in Kaplan-Meier analysis (log-rank p<0.001). N1 group (n=1389) was analyzed into two groups whether the number of positive nodes is more than 5 or less. For the group of the more metastatic nodes, the recurrence rate higher compared to the other group (3.0% vs. 9.3%, p<0.001). DFS was longer in the group that had lesser metastatic nodes (log-rank p<0.001). However, in terms of N1 group over 1cm (n=492), No statistical difference was observed according to the number of positive lymph nodes (4.5% vs. 9.1%, p=0.092) Conclusion: When it comes to node positive PTC, Despite the number of positive lymph nodes was over 5, follow-up with no further surgery can be an option.

• Asian Pacific Journal of Cancer Prevention
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• 제14권2호
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• pp.753-757
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• 2013

Objective: To evaluate the relationships between lymph node ratio (LNR, the ratio of positive lymph nodes in excised axillary lymph nodes) and disease-free survival (DFS) by comparing with traditional absolute positive lymph node number (pN classification) for prediction of breast cancer (BC) progrnosis. Methods and Patients: We retrospectively reviewed patients who received comprehensive therapy in Department of Breast Surgery, Hubei Cancer Hospital, China from Jan 2002 to Dec 2006 (Group A), and Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, China from Jun 2008 to May 2012 (Group B). Patients were allocated to low-risk (${\leq}0.20$), intermediate-risk (> 0.20 but ${\leq}0.65$), high-risk (>0.65) groups by LNR. The primary endpoint was 5-DFS. Results: A total of 294 patients were included in our study. LNR was verified as a negative prognostic factor for DFS (P=0.002 in Group A, P<0.0001 in Group B). Then we found the effects of pN and LNR delamination on disease-free survival (DFS) had statistical significance (P=0.012 for pN and P=0.031 for LNR stratification in Group A, both of them P<0.001 in Group B). Compared to pN staging, LNR staging displayed superior performance in prognosis, the adjusted hazard ratio of recurrence being 2.07 (95%CI, 1.07 to 4.0) for intermediate risk group (P=0.030) and 2.44 (95%CI, 1.21 to 4.92) for high risk group (P=0.013) in Group A. Conclusions: LNR stratification proved an adverse prognostic factor of DFS in lymph nodes positive invasive BC using cut-off values 0.20 and 0.65, and was more predictive than traditional pN classification for 5-DFS.

• Endocrinology and Metabolism
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• 제33권4호
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• pp.459-465
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• 2018

Background: Differentiated thyroid carcinoma (DTC) shows a very good prognosis, but older patients have a higher recurrence rate and those show poor prognosis than younger patients. The aim of this study was to determine the clinical outcomes of thyroid cancer patients who experienced recurrence in old age according to the treatment strategy used. Methods: This retrospective observational cohort study was conducted at Asan Medical Center, Seoul, Korea. Among DTC patients with no evidence of disease after initial treatment, we enrolled 86 patients who experienced recurrence at an age >65 years from 1994 to 2012. Sixty-nine patients had local recurrence and 17 patients showed distant metastasis. Results: The mean age of patients at recurrence was 72 years. Patients were followed up for a median of 4.1 years after recurrence. Sixty-three of the 69 patients with local recurrence received additional treatment, while the other six received conservative care. The cancer-specific mortality rate was 15.5% in the local recurrence group. Airway problems were the main cause of death in patients who did not receive further treatment for local recurrence. Among the 17 patients with distant metastasis, 10 underwent specific treatment for metastasis and seven received only supportive management. Seven of those 17 patients died, and the cancer-specific mortality rate was 35% in the distant metastasis group. Conclusion: The overall cancer-specific mortality rate was 20% in DTC patients in whom recurrence was first detected at an age >65 years. Mortality due to uncontrolled local disease occurred frequently in patients who did not receive definitive management for recurrence.

• 대한암한의학회지
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• 제19권1호
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• pp.53-59
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• 2014

Objectives : Thyroid cancer is one of the most common and rapid increases of malignancy worldwide. It is the aim of the present a case of papillary thyroid microcarcinoma (PTMC) treated with acupuncture alone to derive further studies of the determination of treatment options for PTMC, such as surgery, acupuncture and observation alone, etc. Method : A 51-year-old woman with malignancy of thyroid nodule ($0.89{\times}0.59cm$) was referred to our hospital on January 2010. We applied to the acupuncture alone three times weekly by the patient's decision from January 2010 to November 2014. Blood tests were conducted three times during the treatment period and ultrasonography was performed every 6 months. Results : Both laboratory data and tumor size results showed no deteriorations as compared with those of initial examination. The patients has been survived in healthy state without any metastasis or disease progression on November, 2014. Conclusion : This case presents a possibility that acupuncture or observation alone can be provided as an option in the treatment means for patients with PTMC. Further study will need to study more longer follow-up and a large number of patients for PTMC using acupuncture or observation alone.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5565-5570
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• 2014

Objectives: This study aimed to characterize the histopathological pattern of thyroid lesions among Saudi patients and to highlight the age and gender variations of these lesions as base line data. Materials and Methods: We retrospectively analyzed the data from thyroid specimens received at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia from January 2006 to December 2013. Results: The 292 thyroidectomy specimens received during the study period came from 230 (78.8%) females and 62 (21.2%) males giving a female: male ratio of 3.7:1. Age of the patients ranged from 14 to 95 years with a mean age 39.7 years. Two hundred and eleven (72.3%) cases were found to be non-neoplastic and 81 (27.7%) cases were neoplastic. The non-neoplastic group included: colloid goiter, including both diffuse and nodular goiter (170 cases; 58.2%), nodular hyperplasia (28 cases; 9.6%), Hashimoto/chronic lymphocytic thyroiditis (12 cases; 4.1%), and Grave's disease (1 case; 0.3%). In neoplastic lesions, there were 7 benign tumors and 74 malignant tumors. Among the benign tumors, 5 were follicular adenomas and 2 were Hurthle cell adenomas. Papillary carcinoma was the commonest malignant tumor accounting for 87.8% of all thyroid malignancies, followed by lymphoma, follicular carcinoma and medullary carcinoma. The size of papillary carcinoma was more than 2 cm in 40 cases (76.9%). Conclusions: Non-neoplastic thyroid lesions were more common than neoplastic ones. Colloid goiter was the most common lesion. Follicular adenoma was the commonest benign tumor and papillary carcinoma was the commonest malignant lesion. There appears to be a slightly increased trend of papillary carcinoma diagnosis, most being diagnosed at an advanced stage.

• International journal of thyroidology
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• 제11권2호
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• pp.137-142
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• 2018

Background and Objectives: Radioactive iodine therapy (RAI) is an important treatment modality of Graves' disease (GD), but there is still not a consensus on the optimal dosage regimen. We studied the treatment success rate of different RAI doses, and examined which clinical markers were useful for determining the optimal RAI dosage for successful therapy in Korean patients. Materials and Methods: We retrospectively studied 123 patients with GD treated with RAI between 2004 and 2014 at Chonnam National University Hwasun Hospital. The responder group was defined as patients who developed hypothyroidism requiring levothyroxine replacement following RAI, regardless of the RAI dosage. Results: A total of 54 patients (43.9%) became hypothyroid after the first dose, and 31 needed two to four additional doses to achieve hypothyroidism. In the responder group as a whole (85 patients), the mean total dose of RAI was $15.5{\pm}7.0mCi$ and the mean thyroid volume (TV) was $35.4{\pm}23.4mL$. When divided into low dose (<15 mCi, n=46) and high dose (${\geq}15mCi$, n=39) responder groups, TV was significantly lower in the low-dose responder group ($25.7{\pm}11.4$ vs. $48.4{\pm}31.3$, p<0.001). The optimal cut-off TV for the low-dose responder group was <32.37 mL (sensitivity 80.9%, specificity 76.7%). Conclusion: TV had significant effects on the outcome of RAI in GD patients. The optimal fixed RAI dose for Korean GD patients with a large goiter (${\geq}33mL$) should be at least 15 mCi to achieve the best outcome.

• 한국정보통신학회논문지
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• 제26권7호
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• pp.956-962
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• 2022

미만성 갑상샘 질환은 그 진단 기준이 모호하고 숙련자의 주관적인 진단에 따라 오류가 많이 발생한다. 초음파 영상에 영상처리기술을 적용하고 정량적 데이터를 추출하여 컴퓨터 보조 진단 시스템에 적용하게 되면 보다 정확하고 정략적인 진단이 가능하다. 본 논문에서는 갑상샘 질환 환자를 정상, 경도, 중등도로 분류된 초음파 영상에 GLCM 알고리즘을 적용하여 19개의 파라미터를 추출하였다. 이들 파라미터를 이용하여 인공신경망을 적용하여 미만성 갑상샘 초음파 영상을 분류하여 최종 96.9%의 분류율을 얻었다. 본 연구의 결과를 이용하여 갑상샘 질환의 진단에 있어 육안 판독에 따른 오류를 감소시키고, 미만성 갑상샘 질환 진단의 2차적인 수단으로 활용 가능할 것으로 기대된다.

• Journal of Endocrine Surgery
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• 제18권4호
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• pp.219-227
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• 2018

Purpose: The primary objective of the present study was to investigate the course of anxiety and depression in thyroidectomy. The second objective was to investigate the association between somatic symptoms and psychological symptoms, and the final objective was to identify the sociodemographic, clinical, and psychosocial factors that affect psychiatric morbidity. Methods: This prospective study, 101 patients who were admitted to the Endocrine Surgery Clinic of the Department of General Surgery, Istanbul Faculty of Medicine, University of Istanbul, with thyroid pathology were included in the study. Data were collected before surgery, and in the early, and late periods after surgery. Data were collected using a semi-structured interview form, a visual analogue scale, and the Hospital Anxiety and Depression Scale. Results: The average scores of anxiety and depression before surgery were statistically significantly higher compared with the early and late periods after surgery (P<0.001). Psychological morbidity was identified about 10% of patients before surgery and remained after thyroidectomy. A poor positive correlation founded between somatic symptoms and psychological condition in period surgery (P<0.05). Various sociodemographic features and psychosocial parameters affected anxiety and depression level (P<0.05). Conclusion: Anxiety and depression level in thyroid diseases decreased after thyroidectomy. These patients may express psychologic distress through somatic symptoms. Screening of psychological morbidity is suggested in patients planned thyroid surgery, especially in women, low-educated, inadequate social support, attributed to psychological causes.