Assuntos
Neoplasias da Glândula Tireoide , Humanos , Estados Unidos/epidemiologia , Neoplasias da Glândula Tireoide/etnologia , Neoplasias da Glândula Tireoide/terapia , Feminino , Masculino , Carcinoma Neuroendócrino/terapia , Carcinoma Neuroendócrino/etnologia , Etnicidade/estatística & dados numéricos , Fatores Sexuais , Tireoidectomia , Grupos Raciais/estatística & dados numéricosRESUMO
BACKGROUND: This study assessed for disparities in the presentation and management of medullary thyroid cancer (MTC). METHODS: Patients with MTC (2010-2020) were identified from the National Cancer Database. Differences in disease presentation and likelihood of guideline-concordant surgical management (total thyroidectomy and resection of ≥1 lymph node) were assessed by sex and race/ethnicity. RESULTS: Of 6154 patients, 68.2% underwent guideline-concordant surgery. Tumors >4 âcm were more likely in men (vs. women: OR 2.47, p â< â0.001) and Hispanic patients (vs. White patients: OR 1.52, p â= â0.001). Non-White patients were more likely to have distant metastases (Black: OR 1.63, p â= â0.002; Hispanic: OR 1.44, p â= â0.038) and experienced longer time to surgery (Black: HR 0.66, p â< â0.001; Hispanic: HR 0.71, p â< â0.001). Black patients were less likely to undergo guideline-concordant surgery (OR 0.70, p â= â0.022). CONCLUSIONS: Male and non-White patients with MTC more frequently present with advanced disease, and Black patients are less likely to undergo guideline-concordant surgery.
Assuntos
Carcinoma Neuroendócrino , Disparidades em Assistência à Saúde , Neoplasias da Glândula Tireoide , Tireoidectomia , Humanos , Neoplasias da Glândula Tireoide/etnologia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/terapia , Neoplasias da Glândula Tireoide/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Carcinoma Neuroendócrino/etnologia , Carcinoma Neuroendócrino/cirurgia , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/terapia , Tireoidectomia/estatística & dados numéricos , Fatores Sexuais , Adulto , Idoso , Estados Unidos/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Estudos RetrospectivosRESUMO
BACKGROUND: Pulmonary high-grade neuroendocrine carcinoma (HGNEC) has a rising incidence of developing second primary malignancies (SPMs). This study is the first population-based analysis to quantify the SPM risks among survivors of lung HGNEC. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database to calculate standardized incidence ratio (SIR) and absolute excess risk (AER) between 2000 and 2016 for patients with pulmonary HGNEC. RESULTS: The data of 1161 patients with SPMs were retrieved from the SEER database. The ratio of observed/expected number of SPMs in pulmonary HGNEC was 1.53. Solid tumours comprised 91% of all second malignancies in lung HGNEC patients, with the most common cancers reported in the oral cavity and pharynx, the urinary and respiratory systems CONCLUSIONS: Our study observed an increased risk of SPMs among patients with pulmongnancies.
Assuntos
Carcinoma Neuroendócrino/complicações , Neoplasias Pulmonares/complicações , Segunda Neoplasia Primária/epidemiologia , Adulto , Idoso , Sobreviventes de Câncer , Carcinoma de Células Grandes , Carcinoma Neuroendócrino/etnologia , Carcinoma Neuroendócrino/mortalidade , Carcinoma Neuroendócrino/patologia , Feminino , Humanos , Incidência , Neoplasias Pulmonares/etnologia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Segunda Neoplasia Primária/etnologia , Segunda Neoplasia Primária/mortalidade , Segunda Neoplasia Primária/patologia , Modelos de Riscos Proporcionais , Fatores de Risco , Programa de SEER , Carcinoma de Pequenas Células do Pulmão , Adulto JovemRESUMO
BACKGROUND: Therapeutic options for treating advanced or metastatic medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC) are still limited in Japan, even though vandetanib for MTC and lenvatinib for MTC and ATC have been approved. Sorafenib is an oral multikinase inhibitor approved for the treatment of patients with radioactive iodine-refractory differentiated thyroid cancer (DTC). An uncontrolled, open-label, multicenter, single-arm, Phase 2 clinical study was conducted to evaluate the safety and efficacy of sorafenib in Japanese patients with MTC and ATC. METHODS: Japanese patients with histologically confirmed ATC and locally advanced or metastatic MTC were enrolled from April to September 2014. The primary endpoint was to evaluate the safety of sorafenib. Treatment efficacy variables including progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and maximum reduction in tumor size were evaluated as secondary endpoints. Patients received sorafenib 400 mg orally twice daily on a continuous basis and then continued treatment until the occurrence of disease progression, unacceptable toxicity, or withdrawal of consent. RESULTS: A total of 20 patients were screened, and 18 (8 with MTC and 10 with ATC) were enrolled. The most common drug-related adverse events were palmar-plantar erythrodysesthesia (72%), alopecia (56%), hypertension (56%), and diarrhea (44%). In the ATC patients, median PFS was 2.8 months [confidence interval 0.7-5.6], and median OS was 5.0 months [confidence interval 0.7-5.7]; ORR and DCR were 0% and 40%, respectively. In the MTC population, neither median PFS nor OS had been reached at the time of this analysis; ORR was 25% and DCR was 75%. CONCLUSIONS: The toxicities reported in this study were consistent with the known safety profile of sorafenib. Sorafenib seems to be effective in the treatment of advanced MTC but not ATC, and could be a new treatment option for locally advanced or metastatic MTC and radioactive iodine-refractory DTC.
Assuntos
Antineoplásicos/efeitos adversos , Carcinoma Neuroendócrino/tratamento farmacológico , Niacinamida/análogos & derivados , Compostos de Fenilureia/efeitos adversos , Inibidores de Proteínas Quinases/efeitos adversos , Carcinoma Anaplásico da Tireoide/tratamento farmacológico , Glândula Tireoide/efeitos dos fármacos , Neoplasias da Glândula Tireoide/tratamento farmacológico , Adulto , Alopecia/induzido quimicamente , Alopecia/etnologia , Antineoplásicos/uso terapêutico , Carcinoma Neuroendócrino/etnologia , Carcinoma Neuroendócrino/patologia , Carcinoma Neuroendócrino/secundário , Diarreia/induzido quimicamente , Diarreia/etnologia , Resistencia a Medicamentos Antineoplásicos , Feminino , Síndrome Mão-Pé/etnologia , Síndrome Mão-Pé/etiologia , Humanos , Hipertensão/induzido quimicamente , Hipertensão/etnologia , Japão , Masculino , Gradação de Tumores , Niacinamida/efeitos adversos , Niacinamida/uso terapêutico , Pacientes Desistentes do Tratamento/etnologia , Compostos de Fenilureia/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Sorafenibe , Análise de Sobrevida , Carcinoma Anaplásico da Tireoide/etnologia , Carcinoma Anaplásico da Tireoide/patologia , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/etnologia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/secundário , Carga Tumoral/efeitos dos fármacosRESUMO
BACKGROUNDS: Large cell neuroendocrine carcinoma (LCNEC) is well-known as a lung cancer subtype. This study assessed the prevalence of head and neck mucosal LCNEC (M-LCNEC). METHODS: M-LCNEC was studied clinically, histologically and immunohistochemically. RESULTS: Of 814 surgically resected cases of mucosal head and neck carcinoma, only eight cases (0.98%; all men, mean age 64.6 years) were rediagnosed as M-LCNEC. They occurred in the oropharynx (n=3), larynx (n=4) and hypopharynx (n=1). Seven of the cases had regional lymph node metastases and four resulted in death. Histologically, M-LCNEC had a sheet-like trabacular organoid growth pattern of relatively large basaloid cells in which central necrosis, rosette formation, peripheral palisading and high mitotic figures were evident. M-LCNEC was immunopositive for two or three neuroendocrine markers (CD56, chromogranin-A and synaptophysin). All cases showed high proliferative activity. CONCLUSION: M-LCNEC in the head and neck regions is a distinct histopathological entity whose positivity for neuroendocrine markers makes its diagnosis important. As about half of the patients died of the disease, M-LCNEC has a relatively poor prognosis.