- 著者
- Yasuhiro ITO Hiroshi YOSHIDA Rie MARUO Shinji MORITA Toru TAKANO Mitsuyoshi HIROKAWA Tomonori YABUTA Mitsuhiro FUKUSHIMA Hiroyuki INOUE Chisato TOMODA Minoru KIHARA Takashi URUNO Takuya HIGASHIYAMA Yuuki TAKAMURA Akihiro MIYA Kaoru KOBAYASHI Fumio MATSUZUKA Akira MIYAUCHI
- 出版者
- (社)日本内分泌学会
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- vol.56, no.1, pp.89-97, 2009 (Released:2009-03-12)
- 参考文献数
- 49
- 被引用文献数
- 92 176
Recent studies have demonstrated that BRAFV600E mutation is a common event in papillary thyroid carcinoma and a majority of these lesions have shown a direct relationship between BRAFV600E mutation and aggressive characteristics, including a worse patient prognosis. However, there are no studies from Japan regarding this issue in a large series with adequate postoperative follow-up periods. We investigated BRAFV600E mutation in 631 patients with papillary carcinoma having median follow-up periods of 83 months. The prevalence of BRAFV600E mutation was 38.4%, and the rate was higher in carcinoma larger than 1.0 cm but did not successively increase with tumor size. Furthermore, the prevalence did not significantly increase in cases demonstrating high-risk biological features such as clinically apparent lymph node metastasis, massive extrathyroid extension, advanced age, distant metastasis at surgery, and advanced Stage. The disease-free survival of patients with BRAFV600E mutation did not differ from that of those without BRAFV600E mutation. These findings indicate that, although BRAFV600E mutation may play some roles in local carcinoma development, there is no evidence that BRAFV600E mutation significantly reflects the aggressive characteristics and poor prognosis of patients with papillary carcinoma in Japan.
- 著者
- Hitomi Oda Akira Miyauchi Yasuhiro Ito Hisanori Sasai Hiroo Masuoka Tomonori Yabuta Mitsuhiro Fukushima Takuya Higashiyama Minoru Kihara Kaoru Kobayashi Akihiro Miya
- 出版者
- (社)日本内分泌学会
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- pp.EJ16-0381, (Released:2016-09-22)
- 被引用文献数
- 92
The incidence of thyroid cancer is increasing rapidly in many countries, resulting in rising societal costs of the care of thyroid cancer. We reported that the active surveillance of low-risk papillary microcarcinoma had less unfavorable events than immediate surgery, while the oncological outcomes of these managements were similarly excellent. Here we calculated the medical costs of these two managements. We created a model of the flow of these managements, based on our previous study. The flow and costs include the step of diagnosis, surgery, prescription of medicine, recurrence, salvage surgery for recurrence, and care for 10 years after the diagnosis. The costs were calculated according to the typical clinical practices at Kuma Hospital performed under the Japanese Health Care Insurance System. If conversion surgeries were not considered, the ‘simple cost’ of active surveillance for 10 years was 167,780 yen/patient. If there were no recurrences, the ‘simple cost’ of immediate surgery was calculated as 794,770 yen/patient to 1,086,070 yen/patient, depending on the type of surgery and postoperative medication. The ‘simple cost’ of surgery was 4.7 to 6.5 times the ‘simple cost’ of surveillance. When conversion surgeries and recurrence were considered, the ‘total cost’ of active surveillance for 10 years became 225,695 yen/patient. When recurrence were considered, the ‘total cost’ of immediate surgery was 928,094 yen/patient, which was 4.1 times the ‘total cost’ of the active surveillance. At Kuma Hospital in Japan, the 10-year total cost of immediate surgery was 4.1 times expensive than active surveillance.
- 著者
- Yasuhiro ITO Mitsuhiro FUKUSHIMA Chisato TOMODA Hiroyuki INOUE Minoru KIHARA Takuya HIGASHIYAMA Takashi URUNO Yuuki TAKAMURA Akihiro MIYA Kaoru KOBAYASHI Fumio MATSUZUKA Akira MIYAUCHI
- 出版者
- The Japan Endocrine Society
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- pp.0905250282, (Released:2009-06-09)
- 被引用文献数
- 107 108
Lymph node metastasis is an important clinicopathological feature of papillary thyroid carcinoma (PTC). PTC having clinically apparent lateral node metastasis detectable on preoperative imaging studies (N1b) is known to show a dire prognosis. However, N1b cases include various levels of biological aggressiveness, depending on the size, number, laterality and invasiveness of metastatic nodes. We investigated differences in the prognoses of 621 N1b patients based on these features and compared their prognoses with those of 4297 patients without clinically apparent metastasis (N0) and 125 patients with clinically apparent central node metastasis only (N1a). Disease-free survival (DFS) and cause-specific survival (CSS) of N1b or N1a patients were significantly worse than those of N0 patients, but the prognosis of N1b patients did not differ from that of N1a patients. In the subset of N1b patients, metastatic nodes larger than 3cm, extranodal extension, or 5 or more clinically apparent metastatic nodes independently affected DFS and a combination of the former two features also showed an effect on CSS on multivariate analysis. Prognosis of N1b patients who had none of these features did not differ from that of N1a patients. It is therefore suggested that N1b patients having metastasis larger than 3cm, those showing extranodal extension, and those having 5 or more clinically apparent metastasis should regarded as high-risk, and that careful surgical treatment and postoperative follow-up are necessary.
- 著者
- Yasuhiro Ito Akira Miyauchi Mitsuyoshi Hirokawa Masatoshi Yamamoto Hitomi Oda Hiroo Masuoka Hisanori Sasai Mitsuhiro Fukushima Takuya Higashiyama Minoru Kihara Akihiro Miya
- 出版者
- The Japan Endocrine Society
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- pp.EJ17-0524, (Released:2018-04-04)
- 被引用文献数
- 9
Follicular thyroid carcinoma (FTC), a form of differentiated thyroid carcinoma, is the second most common malignancy arising from thyroid follicular cells. Recently, the tumor-node-metastasis (TNM) classification for differentiated thyroid carcinoma was revised from the 7th to the 8th edition. The diagnostic criteria for poorly differentiated carcinoma (PDC) were also updated in the latest World Health Organization (WHO) classification. In this study, we investigated whether these changes are appropriate for accurately predicting prognosis. Three hundred and twenty-nine patients diagnosed with postoperative pathologically confirmed FTC, who underwent initial surgery at our hospital between 1984 and 2004, were enrolled. For this study, patients were re-evaluated and diagnosed with FTC (N = 285) or PDC (N = 44) without typical nuclear findings of papillary thyroid carcinoma. For FTC, the 8th TNM classification was a more accurate predictor of prognosis than the 7th TNM classification. In the 8th TNM classification, cause-specific survival became significantly poorer from Stage I to IVB. The cause-specific survival of PDC based on the latest WHO classification was worse than, but did not significantly differ from, that of PDC based only on the former WHO classification. For PDC, neither of the TNM classifications could accurately predict prognosis. Taken together, we conclude that (1) the 8th TNM classification more accurately reflects the prognosis of FTC than the 7th TNM classification; (2) PDC based on the former WHO classification should be retained, at least in Japan; and (3) the TNM classification may not be suitable for predicting the prognosis of PDC.
- 著者
- Yasuhiro ITO Takuya HIGASHIYAMA Mitsuyoshi HIROKAWA Mitsuhiro FUKUSHIMA Hiroyuki INOUE Tomonori YABUTA Chisato TOMODA Takashi URUNO Minoru KIHARA Yuuki TAKAMURA Akihiro MIYA Kaoru KOBAYASHI Fumio MATSUZUKA Akira MIYAUCHI
- 出版者
- The Japan Endocrine Society
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- vol.55, no.6, pp.985-989, 2008 (Released:2008-12-27)
- 参考文献数
- 17
- 被引用文献数
- 4 20
Anaplastic carcinoma arises from differentiated carcinoma and generally shows a dire prognosis. Anaplastic transformation may occur not only in primary tumors but also in metastatic lymph nodes. We encountered 5 cases of papillary carcinoma showing anaplastic transformation in lymph nodes that were curatively resected. Patient ages ranged from 67 to 85 years. Two of these patients showed anaplastic transformation at the initial surgery and the remaining 3 showed anaplastic transformation after repeated recurrence to the lymph nodes. After resection of anaplastic lesions of the nodes, 2 patients underwent radiation therapy, whereas the remaining 3 did not receive any adjuvant therapy. One patient died of rapid growth of lung metastasis 5 months after the resection. One patient died of carcinoma 63 months after surgery. Two patients have survived to date, 6 and 85 months after resection, respectively. The remaining one patient died of heart failure 11 months after surgery. It is therefore suggested that long-term survival can be expected for patients with differentiated carcinoma showing anaplastic transformation in the lymph node if the lesions can be curatively resected.
- 著者
- Yasuhiro ITO Mitsuhiro FUKUSHIMA Chisato TOMODA Hiroyuki INOUE Minoru KIHARA Takuya HIGASHIYAMA Takashi URUNO Yuuki TAKAMURA Akihiro MIYA Kaoru KOBAYASHI Fumio MATSUZUKA Akira MIYAUCHI
- 出版者
- (社)日本内分泌学会
- 雑誌
- Endocrine Journal (ISSN:09188959)
- 巻号頁・発行日
- vol.56, no.6, pp.759-766, 2009 (Released:2009-09-25)
- 参考文献数
- 15
- 被引用文献数
- 55 108
Lymph node metastasis is an important clinicopathological feature of papillary thyroid carcinoma (PTC). PTC having clinically apparent lateral node metastasis detectable on preoperative imaging studies (N1b) is known to show a dire prognosis. However, N1b cases include various levels of biological aggressiveness, depending on the size, number, laterality and invasiveness of metastatic nodes. We investigated differences in the prognoses of 621 N1b patients based on these features and compared their prognoses with those of 4297 patients without clinically apparent metastasis (N0) and 125 patients with clinically apparent central node metastasis only (N1a). Disease-free survival (DFS) and cause-specific survival (CSS) of N1b or N1a patients were significantly worse than those of N0 patients, but the prognosis of N1b patients did not differ from that of N1a patients. In the subset of N1b patients, metastatic nodes larger than 3cm, extranodal extension, or 5 or more clinically apparent metastatic nodes independently affected DFS and a combination of the former two features also showed an effect on CSS on multivariate analysis. Prognosis of N1b patients who had none of these features did not differ from that of N1a patients. It is therefore suggested that N1b patients having metastasis larger than 3cm, those showing extranodal extension, and those having 5 or more clinically apparent metastasis should regarded as high-risk, and that careful surgical treatment and postoperative follow-up are necessary.