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Held every five years 15th International Thyroid Congress
ITC 2015: TIRADS scoring helps sort out malignancy after fine-needle aspiration of thyroid nodule
LAKE BUENA VISTA, FLA. – A scoring system for ultrasound evaluation of thyroid nodules is useful in predicting malignancy in cases of atypia of unknown significance but is less useful for nodules categorized as follicular lesions of undetermined significance.
Dr. Jung Hyun Soon, a radiologist at Severance Hospital, Yonsei University, Seoul, presented these findings at the International Thyroid Congress.
The atypia of unknown significance (AUS) and follicular lesion of undetermined significance (FLUS) subcategories within the Bethesda cytopathology system carry a 5%-15% risk of malignancy. The Bethesda system for assessing fine-needle aspirate (FNA) helps to identify more precisely “the different patterns of atypia associated with higher malignancy risk, and to enable adequate malignancy risk stratification of thyroid nodules,” said Dr. Yoon.
Ultrasonography also contributes to the prediction of malignancy, and the Thyroid Imaging Reporting and Data System (TIRADS) provides a framework to report and score imaging assessment of thyroid nodules. The number of suspicious features is tallied and a TIRADS score is assigned according to the sum: possible scores are 3, 4a, 4b, 4c, or 5, according to number of abnormalities. Categories of abnormalities that are scored include composition, echogenicity, margin characteristics, calcifications, and shape.
To determine whether TIRADS helps predict which patients with AUS and FLUS will have malignancy, Dr. Yoon and her colleagues enrolled 188 patients with a total 192 AUS or FLUS thyroid nodules whose diagnoses had been confirmed by surgery, sequential ultrasound, or repeat FNA. The patients’ mean age was 50.2 years, and the mean nodule size was 14.7 mm, though nodules ranged from 5 to 60 mm.
Of the 192 AUS/FLUS nodules, 82 (42.7%) were malignant and 110 (57.3%) were benign. Of the 149 nodules (77.6%) that were characterized as AUS, 45.6% were assessed as malignant, while the 43 FLUS nodules (22.4%) had a malignancy rate of 32.6%. This difference in malignancy rates was not statistically significant.
In applying TIRADS scoring to the AUS cytological subcategory, significant differences were seen in TIRADS ratings between malignant and benign nodules (P less than .001). As TIRADS scores increased, so did the likelihood of malignancy: only 15.4% of TIRADS 3 AUS nodules were malignant, while, for TIRADS 5 AUS nodules, the probability of malignancy was 80%. Intermediate values carried increasing risk. These differences were not seen, however, for FLUS nodules (P = .414).
“Suspicious ultrasound features are useful in predicting malignancy among the AUS subcategory but not in the FLUS subcategory,” Dr. Yoon said in summarizing her findings at the meeting held by the American Thyroid Association, Asia-Oceania Thyroid Association, European Thyroid Association, and Latin American Thyroid Society.
She noted several study limitations, including the inherent selection bias in the study’s retrospective nature and the fact that AUS and FLUS are not universally accepted subcategories. Additionally, uniform diagnosis could not be assured since five cytopathologists made the original diagnoses from the FNA samples.
Dr. Yoon and her investigators reported no relevant disclosures.
On Twitter @karioakes
LAKE BUENA VISTA, FLA. – A scoring system for ultrasound evaluation of thyroid nodules is useful in predicting malignancy in cases of atypia of unknown significance but is less useful for nodules categorized as follicular lesions of undetermined significance.
Dr. Jung Hyun Soon, a radiologist at Severance Hospital, Yonsei University, Seoul, presented these findings at the International Thyroid Congress.
The atypia of unknown significance (AUS) and follicular lesion of undetermined significance (FLUS) subcategories within the Bethesda cytopathology system carry a 5%-15% risk of malignancy. The Bethesda system for assessing fine-needle aspirate (FNA) helps to identify more precisely “the different patterns of atypia associated with higher malignancy risk, and to enable adequate malignancy risk stratification of thyroid nodules,” said Dr. Yoon.
Ultrasonography also contributes to the prediction of malignancy, and the Thyroid Imaging Reporting and Data System (TIRADS) provides a framework to report and score imaging assessment of thyroid nodules. The number of suspicious features is tallied and a TIRADS score is assigned according to the sum: possible scores are 3, 4a, 4b, 4c, or 5, according to number of abnormalities. Categories of abnormalities that are scored include composition, echogenicity, margin characteristics, calcifications, and shape.
To determine whether TIRADS helps predict which patients with AUS and FLUS will have malignancy, Dr. Yoon and her colleagues enrolled 188 patients with a total 192 AUS or FLUS thyroid nodules whose diagnoses had been confirmed by surgery, sequential ultrasound, or repeat FNA. The patients’ mean age was 50.2 years, and the mean nodule size was 14.7 mm, though nodules ranged from 5 to 60 mm.
Of the 192 AUS/FLUS nodules, 82 (42.7%) were malignant and 110 (57.3%) were benign. Of the 149 nodules (77.6%) that were characterized as AUS, 45.6% were assessed as malignant, while the 43 FLUS nodules (22.4%) had a malignancy rate of 32.6%. This difference in malignancy rates was not statistically significant.
In applying TIRADS scoring to the AUS cytological subcategory, significant differences were seen in TIRADS ratings between malignant and benign nodules (P less than .001). As TIRADS scores increased, so did the likelihood of malignancy: only 15.4% of TIRADS 3 AUS nodules were malignant, while, for TIRADS 5 AUS nodules, the probability of malignancy was 80%. Intermediate values carried increasing risk. These differences were not seen, however, for FLUS nodules (P = .414).
“Suspicious ultrasound features are useful in predicting malignancy among the AUS subcategory but not in the FLUS subcategory,” Dr. Yoon said in summarizing her findings at the meeting held by the American Thyroid Association, Asia-Oceania Thyroid Association, European Thyroid Association, and Latin American Thyroid Society.
She noted several study limitations, including the inherent selection bias in the study’s retrospective nature and the fact that AUS and FLUS are not universally accepted subcategories. Additionally, uniform diagnosis could not be assured since five cytopathologists made the original diagnoses from the FNA samples.
Dr. Yoon and her investigators reported no relevant disclosures.
On Twitter @karioakes
LAKE BUENA VISTA, FLA. – A scoring system for ultrasound evaluation of thyroid nodules is useful in predicting malignancy in cases of atypia of unknown significance but is less useful for nodules categorized as follicular lesions of undetermined significance.
Dr. Jung Hyun Soon, a radiologist at Severance Hospital, Yonsei University, Seoul, presented these findings at the International Thyroid Congress.
The atypia of unknown significance (AUS) and follicular lesion of undetermined significance (FLUS) subcategories within the Bethesda cytopathology system carry a 5%-15% risk of malignancy. The Bethesda system for assessing fine-needle aspirate (FNA) helps to identify more precisely “the different patterns of atypia associated with higher malignancy risk, and to enable adequate malignancy risk stratification of thyroid nodules,” said Dr. Yoon.
Ultrasonography also contributes to the prediction of malignancy, and the Thyroid Imaging Reporting and Data System (TIRADS) provides a framework to report and score imaging assessment of thyroid nodules. The number of suspicious features is tallied and a TIRADS score is assigned according to the sum: possible scores are 3, 4a, 4b, 4c, or 5, according to number of abnormalities. Categories of abnormalities that are scored include composition, echogenicity, margin characteristics, calcifications, and shape.
To determine whether TIRADS helps predict which patients with AUS and FLUS will have malignancy, Dr. Yoon and her colleagues enrolled 188 patients with a total 192 AUS or FLUS thyroid nodules whose diagnoses had been confirmed by surgery, sequential ultrasound, or repeat FNA. The patients’ mean age was 50.2 years, and the mean nodule size was 14.7 mm, though nodules ranged from 5 to 60 mm.
Of the 192 AUS/FLUS nodules, 82 (42.7%) were malignant and 110 (57.3%) were benign. Of the 149 nodules (77.6%) that were characterized as AUS, 45.6% were assessed as malignant, while the 43 FLUS nodules (22.4%) had a malignancy rate of 32.6%. This difference in malignancy rates was not statistically significant.
In applying TIRADS scoring to the AUS cytological subcategory, significant differences were seen in TIRADS ratings between malignant and benign nodules (P less than .001). As TIRADS scores increased, so did the likelihood of malignancy: only 15.4% of TIRADS 3 AUS nodules were malignant, while, for TIRADS 5 AUS nodules, the probability of malignancy was 80%. Intermediate values carried increasing risk. These differences were not seen, however, for FLUS nodules (P = .414).
“Suspicious ultrasound features are useful in predicting malignancy among the AUS subcategory but not in the FLUS subcategory,” Dr. Yoon said in summarizing her findings at the meeting held by the American Thyroid Association, Asia-Oceania Thyroid Association, European Thyroid Association, and Latin American Thyroid Society.
She noted several study limitations, including the inherent selection bias in the study’s retrospective nature and the fact that AUS and FLUS are not universally accepted subcategories. Additionally, uniform diagnosis could not be assured since five cytopathologists made the original diagnoses from the FNA samples.
Dr. Yoon and her investigators reported no relevant disclosures.
On Twitter @karioakes
AT ITC 2015
Key clinical point: An imaging scoring system helped predict malignancy after fine-needle aspiration for some thyroid nodules.
Major finding: Higher severity in a radiology scoring system predicted malignancy in thyroid nodules with atypia of unknown significance.
Data source: Retrospective study of 192 nodules in 188 patients with indeterminate cytology after fine-needle aspiration.
Disclosures: The study was supported by Yonsei University. Dr. Yoon and her colleagues reported no relevant disclosures.
Cabozantinib boosts survival for some patients with RET+ medullary thyroid cancer
LAKE BUENA VISTA, Fla. – The tyrosine kinase inhibitor cabozantinib significantly extended overall survival for patients with RET-M918T–positive medullary thyroid cancer.
The placebo-controlled EXAM trial did not show any significant differences in overall survival among the entire group, Dr. Steven Sherman said at the International Thyroid Congress. But in a subgroup analysis, those with RET-M918T mutations who received the drug had the best outcomes by far, with a mean overall survival 2 years longer than that of similar patients who received placebo (44 vs. 19 months; HR 0.60; P = .026).
Cabozantinib (COMETRIQ) delivers a three-way punch to thyroid tumors, said Dr. Sherman of MD Anderson Cancer Center, Houston. It inhibits tyrosine kinase, vascular endothelial growth factor receptors, and mutant RET. But EXAM does not provide any clues about the exact mechanism by which it subdued this particular class of tumors.
“We may well be targeting mutant RET as well as tyrosine kinase and VEGF-R. But the other possibility is that these RET tumors are highly dependent on VEGF for angiogenesis and that inhibiting that is the key element. The data from this study don’t allow us to speculate on which is the most important,” said Dr. Sherman.
The 2-year trial randomized 330 patients with progressive medullary thyroid cancer to cabozantinib (140 mg per day) or placebo. If patients taking placebo progressed, they were not allowed to cross over to cabozantimib. The primary endpoint was progression-free survival (PFS); results were published in 2013 in the Journal of Clinical Oncology (doi: 10.1200/JCO.2012.48.4659).
Dr. Sherman presented the final results on overall survival at the meeting, which was held by the American Thyroid Association, Asia-Oceania Thyroid Association , European Thyroid Association, and Latin American Thyroid Society.
Almost half of the cohort had received prior therapy, and 21%, a prior tyrosine kinase inhibitor. About half had RET mutations; 12% were RET negative, and genomic status was unknown in the remainder. M918T was the predominant RET mutation (74%). The main sites of metastasis were lymph nodes, liver, lung, and bone.
PFS was significantly better in those taking the study drug (11 vs. 4 months; HR 0.28; P equal to or less than .01). Significant PFS benefits were seen regardless of age, prior treatment, and RET status.
In the overall survival analysis, however, cabozantinib conferred no significant benefit over placebo across the entire cohort (26.6 vs 21 months; HR 0.85; P = .24).
RET mutation profiles were available for 65% of patients. The drug did not confer significant overall survival benefit to all those with RET mutations (31.6 vs. 24.8 months; HR 0.79; P = .24). However, those with the M918T mutation who took cabozantinib survived significantly longer than did those who took placebo.
A small number of patients (16) had RAS mutations, and those who took cabozantinib did have better overall survival than did those who took placebo, although the difference was not statistically significant.
Adverse events were more common in the cabozantinib arm and included pneumonia (4.2%), pulmonary embolism (3.3%), mucosal inflammation (2.8%), hypocalcemia (2.8%), hypertension, dysphagia, dehydration, and lung abscess (2.3% each).
The EXAM study was sponsored by Exelixis. Dr. Sherman had no financial disclosures.
On Twitter @Alz_Gal
LAKE BUENA VISTA, Fla. – The tyrosine kinase inhibitor cabozantinib significantly extended overall survival for patients with RET-M918T–positive medullary thyroid cancer.
The placebo-controlled EXAM trial did not show any significant differences in overall survival among the entire group, Dr. Steven Sherman said at the International Thyroid Congress. But in a subgroup analysis, those with RET-M918T mutations who received the drug had the best outcomes by far, with a mean overall survival 2 years longer than that of similar patients who received placebo (44 vs. 19 months; HR 0.60; P = .026).
Cabozantinib (COMETRIQ) delivers a three-way punch to thyroid tumors, said Dr. Sherman of MD Anderson Cancer Center, Houston. It inhibits tyrosine kinase, vascular endothelial growth factor receptors, and mutant RET. But EXAM does not provide any clues about the exact mechanism by which it subdued this particular class of tumors.
“We may well be targeting mutant RET as well as tyrosine kinase and VEGF-R. But the other possibility is that these RET tumors are highly dependent on VEGF for angiogenesis and that inhibiting that is the key element. The data from this study don’t allow us to speculate on which is the most important,” said Dr. Sherman.
The 2-year trial randomized 330 patients with progressive medullary thyroid cancer to cabozantinib (140 mg per day) or placebo. If patients taking placebo progressed, they were not allowed to cross over to cabozantimib. The primary endpoint was progression-free survival (PFS); results were published in 2013 in the Journal of Clinical Oncology (doi: 10.1200/JCO.2012.48.4659).
Dr. Sherman presented the final results on overall survival at the meeting, which was held by the American Thyroid Association, Asia-Oceania Thyroid Association , European Thyroid Association, and Latin American Thyroid Society.
Almost half of the cohort had received prior therapy, and 21%, a prior tyrosine kinase inhibitor. About half had RET mutations; 12% were RET negative, and genomic status was unknown in the remainder. M918T was the predominant RET mutation (74%). The main sites of metastasis were lymph nodes, liver, lung, and bone.
PFS was significantly better in those taking the study drug (11 vs. 4 months; HR 0.28; P equal to or less than .01). Significant PFS benefits were seen regardless of age, prior treatment, and RET status.
In the overall survival analysis, however, cabozantinib conferred no significant benefit over placebo across the entire cohort (26.6 vs 21 months; HR 0.85; P = .24).
RET mutation profiles were available for 65% of patients. The drug did not confer significant overall survival benefit to all those with RET mutations (31.6 vs. 24.8 months; HR 0.79; P = .24). However, those with the M918T mutation who took cabozantinib survived significantly longer than did those who took placebo.
A small number of patients (16) had RAS mutations, and those who took cabozantinib did have better overall survival than did those who took placebo, although the difference was not statistically significant.
Adverse events were more common in the cabozantinib arm and included pneumonia (4.2%), pulmonary embolism (3.3%), mucosal inflammation (2.8%), hypocalcemia (2.8%), hypertension, dysphagia, dehydration, and lung abscess (2.3% each).
The EXAM study was sponsored by Exelixis. Dr. Sherman had no financial disclosures.
On Twitter @Alz_Gal
LAKE BUENA VISTA, Fla. – The tyrosine kinase inhibitor cabozantinib significantly extended overall survival for patients with RET-M918T–positive medullary thyroid cancer.
The placebo-controlled EXAM trial did not show any significant differences in overall survival among the entire group, Dr. Steven Sherman said at the International Thyroid Congress. But in a subgroup analysis, those with RET-M918T mutations who received the drug had the best outcomes by far, with a mean overall survival 2 years longer than that of similar patients who received placebo (44 vs. 19 months; HR 0.60; P = .026).
Cabozantinib (COMETRIQ) delivers a three-way punch to thyroid tumors, said Dr. Sherman of MD Anderson Cancer Center, Houston. It inhibits tyrosine kinase, vascular endothelial growth factor receptors, and mutant RET. But EXAM does not provide any clues about the exact mechanism by which it subdued this particular class of tumors.
“We may well be targeting mutant RET as well as tyrosine kinase and VEGF-R. But the other possibility is that these RET tumors are highly dependent on VEGF for angiogenesis and that inhibiting that is the key element. The data from this study don’t allow us to speculate on which is the most important,” said Dr. Sherman.
The 2-year trial randomized 330 patients with progressive medullary thyroid cancer to cabozantinib (140 mg per day) or placebo. If patients taking placebo progressed, they were not allowed to cross over to cabozantimib. The primary endpoint was progression-free survival (PFS); results were published in 2013 in the Journal of Clinical Oncology (doi: 10.1200/JCO.2012.48.4659).
Dr. Sherman presented the final results on overall survival at the meeting, which was held by the American Thyroid Association, Asia-Oceania Thyroid Association , European Thyroid Association, and Latin American Thyroid Society.
Almost half of the cohort had received prior therapy, and 21%, a prior tyrosine kinase inhibitor. About half had RET mutations; 12% were RET negative, and genomic status was unknown in the remainder. M918T was the predominant RET mutation (74%). The main sites of metastasis were lymph nodes, liver, lung, and bone.
PFS was significantly better in those taking the study drug (11 vs. 4 months; HR 0.28; P equal to or less than .01). Significant PFS benefits were seen regardless of age, prior treatment, and RET status.
In the overall survival analysis, however, cabozantinib conferred no significant benefit over placebo across the entire cohort (26.6 vs 21 months; HR 0.85; P = .24).
RET mutation profiles were available for 65% of patients. The drug did not confer significant overall survival benefit to all those with RET mutations (31.6 vs. 24.8 months; HR 0.79; P = .24). However, those with the M918T mutation who took cabozantinib survived significantly longer than did those who took placebo.
A small number of patients (16) had RAS mutations, and those who took cabozantinib did have better overall survival than did those who took placebo, although the difference was not statistically significant.
Adverse events were more common in the cabozantinib arm and included pneumonia (4.2%), pulmonary embolism (3.3%), mucosal inflammation (2.8%), hypocalcemia (2.8%), hypertension, dysphagia, dehydration, and lung abscess (2.3% each).
The EXAM study was sponsored by Exelixis. Dr. Sherman had no financial disclosures.
On Twitter @Alz_Gal
AT ITC 2015
Key clinical point: Cabozantinib improved overall survival in RET-M918T–positive progressive medullary thyroid cancers.
Major finding: Compared to placebo, cabozantinib conferred a 2-year overall survival advantage upon patients with RET-M918T–positive medullary thyroid tumors.
Data source: The EXAM study, which randomized 330 patients to cabozantinib or placebo for 24 months.
Disclosures: Exelixis sponsored the study. Dr. Sherman had no financial disclosures.
Obesity linked with more aggressive papillary thyroid carcinoma
LAKE BUENA VISTA, FLA. – Obesity was strongly associated with more aggressive papillary thyroid carcinoma features, but not with a greater likelihood of disease recurrence in a review of nearly 7,300 patients.
Of the 7,284 consecutive surgery patients included in the study, 5,283 had normal weight (body mass index less than 25 kg/m2), 1,731 were overweight (BMI of 25 to less than 30 kg/m2), and 270 were obese (BMI of 30 kg/m2 or greater). The obese patients were significantly more likely than the normal-weight and overweight patients to have a number of features associated with more aggressive disease, Dr. Eun Jeong Ban of Yonsei University Health System in Seoul, South Korea, reported at the International Thyroid Congress.
For example, tumors of 1 cm or greater were present in 43% of obese patients, compared with 31% of normal-weight patients and 34% of overweight patients. Multiple tumors were present in 15% of obese patients, compared with 11% of normal-weight patients and 10% of overweight patients, and bilateral tumors were present in 31% of obese patients, compared with 20% of normal-weight patients and 25% of overweight patients, Dr. Ban said.
Further, stage T3 disease was present in 62%, 51%, and 55% of obese, normal-weight and overweight patients, respectively; stage T4a disease was present in 4.4%, 1.7%, and 2.5% of the patients in the groups, respectively; stage T4b disease was present in 0.4%, 0%, and 0.1% of patients; and TNM stage IVa disease was present in 10%, 4.5%, and 7.3% of patients.
The groups did not differ with respect to regional lymph node stage or distant metastases.
They also did not differ with respect to recurrence rates, which were 1.5% in the obese patients and 1.6% and 1.7% in the normal-weight and overweight patients, respectively.
BMI was not found on multivariate analysis to predict risk for recurrence (odds ratios, 0.908 and 0.677 for BMI of 25-29 kg/m2 and BMI of 30 or greater, respectively). Only tumor multiplicity (OR, 2.463) and stage N1a (OR, 3.421) and N1b disease (OR, 4.246) were found to predict recurrence.
Although epidemiologic studies have suggested that obesity increases the risk of thyroid cancer, the association between BMI and the aggressiveness of papillary thyroid carcinoma remained unclear. These findings suggest that obesity also may increase the likelihood of a more aggressive disease course, Dr. Ban said at the meeting held by the American Thyroid Association, Asia-Oceania Thyroid Association, European Thyroid Association, and Latin American Thyroid Society.
Dr. Ban reported having no disclosures.
LAKE BUENA VISTA, FLA. – Obesity was strongly associated with more aggressive papillary thyroid carcinoma features, but not with a greater likelihood of disease recurrence in a review of nearly 7,300 patients.
Of the 7,284 consecutive surgery patients included in the study, 5,283 had normal weight (body mass index less than 25 kg/m2), 1,731 were overweight (BMI of 25 to less than 30 kg/m2), and 270 were obese (BMI of 30 kg/m2 or greater). The obese patients were significantly more likely than the normal-weight and overweight patients to have a number of features associated with more aggressive disease, Dr. Eun Jeong Ban of Yonsei University Health System in Seoul, South Korea, reported at the International Thyroid Congress.
For example, tumors of 1 cm or greater were present in 43% of obese patients, compared with 31% of normal-weight patients and 34% of overweight patients. Multiple tumors were present in 15% of obese patients, compared with 11% of normal-weight patients and 10% of overweight patients, and bilateral tumors were present in 31% of obese patients, compared with 20% of normal-weight patients and 25% of overweight patients, Dr. Ban said.
Further, stage T3 disease was present in 62%, 51%, and 55% of obese, normal-weight and overweight patients, respectively; stage T4a disease was present in 4.4%, 1.7%, and 2.5% of the patients in the groups, respectively; stage T4b disease was present in 0.4%, 0%, and 0.1% of patients; and TNM stage IVa disease was present in 10%, 4.5%, and 7.3% of patients.
The groups did not differ with respect to regional lymph node stage or distant metastases.
They also did not differ with respect to recurrence rates, which were 1.5% in the obese patients and 1.6% and 1.7% in the normal-weight and overweight patients, respectively.
BMI was not found on multivariate analysis to predict risk for recurrence (odds ratios, 0.908 and 0.677 for BMI of 25-29 kg/m2 and BMI of 30 or greater, respectively). Only tumor multiplicity (OR, 2.463) and stage N1a (OR, 3.421) and N1b disease (OR, 4.246) were found to predict recurrence.
Although epidemiologic studies have suggested that obesity increases the risk of thyroid cancer, the association between BMI and the aggressiveness of papillary thyroid carcinoma remained unclear. These findings suggest that obesity also may increase the likelihood of a more aggressive disease course, Dr. Ban said at the meeting held by the American Thyroid Association, Asia-Oceania Thyroid Association, European Thyroid Association, and Latin American Thyroid Society.
Dr. Ban reported having no disclosures.
LAKE BUENA VISTA, FLA. – Obesity was strongly associated with more aggressive papillary thyroid carcinoma features, but not with a greater likelihood of disease recurrence in a review of nearly 7,300 patients.
Of the 7,284 consecutive surgery patients included in the study, 5,283 had normal weight (body mass index less than 25 kg/m2), 1,731 were overweight (BMI of 25 to less than 30 kg/m2), and 270 were obese (BMI of 30 kg/m2 or greater). The obese patients were significantly more likely than the normal-weight and overweight patients to have a number of features associated with more aggressive disease, Dr. Eun Jeong Ban of Yonsei University Health System in Seoul, South Korea, reported at the International Thyroid Congress.
For example, tumors of 1 cm or greater were present in 43% of obese patients, compared with 31% of normal-weight patients and 34% of overweight patients. Multiple tumors were present in 15% of obese patients, compared with 11% of normal-weight patients and 10% of overweight patients, and bilateral tumors were present in 31% of obese patients, compared with 20% of normal-weight patients and 25% of overweight patients, Dr. Ban said.
Further, stage T3 disease was present in 62%, 51%, and 55% of obese, normal-weight and overweight patients, respectively; stage T4a disease was present in 4.4%, 1.7%, and 2.5% of the patients in the groups, respectively; stage T4b disease was present in 0.4%, 0%, and 0.1% of patients; and TNM stage IVa disease was present in 10%, 4.5%, and 7.3% of patients.
The groups did not differ with respect to regional lymph node stage or distant metastases.
They also did not differ with respect to recurrence rates, which were 1.5% in the obese patients and 1.6% and 1.7% in the normal-weight and overweight patients, respectively.
BMI was not found on multivariate analysis to predict risk for recurrence (odds ratios, 0.908 and 0.677 for BMI of 25-29 kg/m2 and BMI of 30 or greater, respectively). Only tumor multiplicity (OR, 2.463) and stage N1a (OR, 3.421) and N1b disease (OR, 4.246) were found to predict recurrence.
Although epidemiologic studies have suggested that obesity increases the risk of thyroid cancer, the association between BMI and the aggressiveness of papillary thyroid carcinoma remained unclear. These findings suggest that obesity also may increase the likelihood of a more aggressive disease course, Dr. Ban said at the meeting held by the American Thyroid Association, Asia-Oceania Thyroid Association, European Thyroid Association, and Latin American Thyroid Society.
Dr. Ban reported having no disclosures.
AT ITC 2015
Key clinical point: Obesity was strongly associated with more aggressive papillary thyroid carcinoma features, but not with a greater likelihood of disease recurrence in a review of nearly 7,300 patients.
Major finding: Tumors of 1 cm or greater were present in 43% of obese patients, compared with 31% of normal-weight patients and 34% of overweight patients.
Data source: A review of 7,284 patients.
Disclosures: Dr. Ban reported having no disclosures.
Look for tweaks to RAI, genomic analyses, and targeted treatment for thyroid cancer at ATA
Sessions during the upcoming 15th International Thyroid Congress and annual meeting of the American Thyroid Association will be hitting several hot topics in the treatment of thyroid cancer, including refinement of radioactive iodine treatment, genomic analyses, and targeted treatment. Investigators will be presenting data on the impact of RET and RAS mutation status on overall survival in the EXAM trial, a phase III study of cabozantinib in patients with progressive, metastatic medullary thyroid cancer (Abstract #51).
Investigators will present anticipated results from another phase III study looking at outcomes by site of metastasis for patients with radioiodine-refractory differentiated thyroid cancer treated with lenvatinib vs. placebo (Abstract #55). A comparison of empiric fixed dosing with a whole body/blood clearance dosimetry-based management approach to radioactive iodine treatment in patients with radioiodine-avid distant metastases from differentiated thyroid cancer is also highly anticipated (Abstract #52) at the 85th Annual Meeting of the AT
Of note, several sessions (abstract 89), including an plenary presentation by Dr. Shigenobu Nagataki on “Radiation and the Thyroid: From Nagasaki/Hiroshima, Chernobyl to Fukushima.” Dr. Nagataki, who is professor emeritus at Nagasaki (Japan) University School of Medicine, will focus on lessons learned about mass exposure to radiation from these catastrophes. The meeting is being held jointly in Lake Buena Vista, Fla., with the 15th International Thyroid Congress, Oct. 18-23.
Beyond thyroid cancer, investigators will present an analysis of the TACT (Taxotere as Adjuvant Chemotherapy) trial, looking at thyroid autoimmunity as a biomarker of outcome in women with breast cancer (Abstract #23) and a look at second primary malignancies among patients with post-Chernobyl papillary thyroid carcinoma (Abstract #53).
A full look at the program can be found here.
On Twitter @NikolaidesLaura
Sessions during the upcoming 15th International Thyroid Congress and annual meeting of the American Thyroid Association will be hitting several hot topics in the treatment of thyroid cancer, including refinement of radioactive iodine treatment, genomic analyses, and targeted treatment. Investigators will be presenting data on the impact of RET and RAS mutation status on overall survival in the EXAM trial, a phase III study of cabozantinib in patients with progressive, metastatic medullary thyroid cancer (Abstract #51).
Investigators will present anticipated results from another phase III study looking at outcomes by site of metastasis for patients with radioiodine-refractory differentiated thyroid cancer treated with lenvatinib vs. placebo (Abstract #55). A comparison of empiric fixed dosing with a whole body/blood clearance dosimetry-based management approach to radioactive iodine treatment in patients with radioiodine-avid distant metastases from differentiated thyroid cancer is also highly anticipated (Abstract #52) at the 85th Annual Meeting of the AT
Of note, several sessions (abstract 89), including an plenary presentation by Dr. Shigenobu Nagataki on “Radiation and the Thyroid: From Nagasaki/Hiroshima, Chernobyl to Fukushima.” Dr. Nagataki, who is professor emeritus at Nagasaki (Japan) University School of Medicine, will focus on lessons learned about mass exposure to radiation from these catastrophes. The meeting is being held jointly in Lake Buena Vista, Fla., with the 15th International Thyroid Congress, Oct. 18-23.
Beyond thyroid cancer, investigators will present an analysis of the TACT (Taxotere as Adjuvant Chemotherapy) trial, looking at thyroid autoimmunity as a biomarker of outcome in women with breast cancer (Abstract #23) and a look at second primary malignancies among patients with post-Chernobyl papillary thyroid carcinoma (Abstract #53).
A full look at the program can be found here.
On Twitter @NikolaidesLaura
Sessions during the upcoming 15th International Thyroid Congress and annual meeting of the American Thyroid Association will be hitting several hot topics in the treatment of thyroid cancer, including refinement of radioactive iodine treatment, genomic analyses, and targeted treatment. Investigators will be presenting data on the impact of RET and RAS mutation status on overall survival in the EXAM trial, a phase III study of cabozantinib in patients with progressive, metastatic medullary thyroid cancer (Abstract #51).
Investigators will present anticipated results from another phase III study looking at outcomes by site of metastasis for patients with radioiodine-refractory differentiated thyroid cancer treated with lenvatinib vs. placebo (Abstract #55). A comparison of empiric fixed dosing with a whole body/blood clearance dosimetry-based management approach to radioactive iodine treatment in patients with radioiodine-avid distant metastases from differentiated thyroid cancer is also highly anticipated (Abstract #52) at the 85th Annual Meeting of the AT
Of note, several sessions (abstract 89), including an plenary presentation by Dr. Shigenobu Nagataki on “Radiation and the Thyroid: From Nagasaki/Hiroshima, Chernobyl to Fukushima.” Dr. Nagataki, who is professor emeritus at Nagasaki (Japan) University School of Medicine, will focus on lessons learned about mass exposure to radiation from these catastrophes. The meeting is being held jointly in Lake Buena Vista, Fla., with the 15th International Thyroid Congress, Oct. 18-23.
Beyond thyroid cancer, investigators will present an analysis of the TACT (Taxotere as Adjuvant Chemotherapy) trial, looking at thyroid autoimmunity as a biomarker of outcome in women with breast cancer (Abstract #23) and a look at second primary malignancies among patients with post-Chernobyl papillary thyroid carcinoma (Abstract #53).
A full look at the program can be found here.
On Twitter @NikolaidesLaura
