Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador
verfasst von:
Paola Solis-Pazmino, Jorge Salazar-Vega, Eddy Lincango-Naranjo, Cristhian Garcia, Gabriela Jaramillo Koupermann, Esteban Ortiz-Prado, Tannya Ledesma, Tatiana Rojas, Benjamin Alvarado-Mafla, Cesar Carcamo, Oscar J. Ponce, Juan P. Brito
In contrast to the rapid increase in thyroid cancer incidence, the mortality has remained low and stable over the last decades. In Ecuador, however, thyroid cancer mortality has increased. The objective of this study is to determine possible drivers of high rates of thyroid cancer mortality, through a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador.
Methods
From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo, a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. We identified the mechanism of detection, histopathology and treatment modalities from a patient interview and review of clinical records.
Results
Among 452 patients, 74.8% were young adults and 94.2% (426) were female. 13.7% had a family history of thyroid cancer, and patients’ median tumor size was 2 cm. The incidental finding was 54.2% whereas 45.8% was non-incidental. Thyroid cancer histology reported that 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic carcinoma. The mean MACIS (metastasis, age, completeness, invasion, and size) score was 4.95 (CI 4.15–5.95) with 76.2% of the thyroid cancer patients having MACIS score less than or equal to 6. The very low and low risk of recurrence was 18.1% (79) and 62% (271) respectively. An analysis of 319 patients with non-metastatic thyroid cancer showed that 10.7% (34) of patients had surgical complications. Moreover, around 62.5% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a stimulated-thyroglobulin value equal or higher than 2 ng/ml. Overall, a poor surgical outcome was present in 35.1% (112) patients. Out of 436 patients with differentiated thyroid carcinoma, 86% (375) received radioactive iodine.
Conclusion
Thyroid cancer histological characteristics and method of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador.
Hinweise
Paola Solis-Pazmino and Jorge Salazar-Vega contributed equally to this work.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Abkürzungen
TC
Thyroid Cancer
HEEE
Hospital de Especialidades Eugenio Espejo
MACIS
Metastasis, age, completeness, invasion, and size
DTC
Differentiated thyroid carcinoma
RAI
Radioactive iodine
SEER
Surveillance, Epidemiology, and End Results
FNA
Fine-needle aspiration
TSH
Thyroid-stimulating hormone
sTg
Stimulated thyroglobulin
iTg
Inhibited thyroglobulin
aTg
Anti-thyroglobulin antibodies
INEC
National Institute of Statistics and Census
ATA
American Thyroid Association
PTC
Papillary thyroid cancer
SD
Standard deviation
IQR
Interquartile ranges
PR
Prevalence ratio
OR
Odds ratios
GLM
Generalized linear model
Background
The incidence of thyroid cancer (TC) has increased over the last three decades in most countries around the globe [1]. In the United States, an analysis of the Surveillance, Epidemiology, and End Results (SEER) between 1975 and 2015 found that TC incidence has increased from 4.9 to 15 per 100,000 people [2]. Similar epidemiological changes have been observed in Central and South America. From 2008 to 2012, TC rates of incidence in these regions increased 8 to 12 times [3]. In Ecuador, the annual incidence fluctuated from 3 to 22 per 100,000 in the last 16 years, with women having higher rates of incidence than men [4].
Thyroid cancer overdiagnosis seems to be the most important driver of thyroid cancer diagnosis, although the contribution of other risk factors (e.g., obesity) to the rise in thyroid cancer incidence is currently being investigated. In contrast with the rapid increase in TC incidence [5‐8], worldwide thyroid cancer mortality has remained low and stable over the last decades [9‐11]. In Ecuador, however, thyroid cancer incidence and mortality have increased, and the Ecuadorian thyroid cancer mortality rate is one of the highest in the world [4, 9, 10]. The reason for the high thyroid cancer mortality in Ecuador is unknown.
Anzeige
Ideally, a large population-based study examining the thyroid cancer characteristics and treatment trends may help clarify the triggers of the rates of mortality in Ecuador. However, such a study design is not possible with the current TC data infrastructure in Ecuador. Instead, we conducted a cross-sectional analysis of all patients attending a thyroid cancer referral center in Ecuador to determine possible drivers of high rates of thyroid cancer mortality (type of thyroid cancer diagnosis and surgical outcome). This information might help gain insights into what factors could be contributing to thyroid cancer mortality.
Methods
Setting and participants
From June 2014 to December 2017, a cross-sectional study was conducted at the Hospital de Especialidades Eugenio Espejo (HEEE), a regional reference public hospital for endocrine neoplasia in adults in Quito, Ecuador. Ecuador is geographically divided into four major natural regions (Coast, Highland, Amazon, and Galapagos Islands). Due to HEEE being located within the Highland region, its patients come mostly from this area. All the patients who were seen for thyroid cancer at HEEE were included, except the patients who did not have the histopathology report. Patients who had initial management (including surgery) outside HEEE were also included.
Data collection and variables
Two sources of data were used to collect the variables of interest. First, a study coordinator interviewed eligible patients during their first postsurgical appointment at the endocrine clinic. During this process, the study coordinator captured: 1) demographic characteristics such as age, degree of education, region of residence (Coast, Highland, Amazon, or Galapagos Islands), age at diagnosis, and ethnicity; 2) family history of TC; 3) environmental risk factors; 4) methods of diagnosis (incidental or non-incidental findings). Second, study team members reviewed medical records of included patients to extract the following information: 1) thyroid gland functionality (euthyroid, hypothyroidism, or hyperthyroidism), thyroid ultrasound characteristics, and thyroid nodule fine-needle aspiration(FNA) cytologic results based on Bethesda System; 2) surgical characteristics such as type and extension of surgery; 3) thyroid gland histopathological features including tumor size, type, focality, minor or gross local invasion, and cervical lymph node involvement or distant metastases; 4) TC markers measured after thyroidectomy and before radioactive iodine therapy, including thyroid-stimulating hormone (TSH), stimulated thyroglobulin (sTg), inhibited thyroglobulin (iTg), and anti-thyroglobulin antibodies (aTg); 5) surgical characteristics such as type and extension of surgery, and complications (hypocalcemia < 6 months and > 6 months after procedure, recurrent laryngeal nerve injury); and finally 6) the radioactive iodine treatment, its doses, and scan results.
Data management
Baseline characteristics data were managed as follows: employment and education were classified according to the National Institute of Statistics and Census (INEC) from Ecuador [11], and thyroid surgery settings were grouped as tertiary (hospitals providing specialized TC management) and non-tertiary hospitals. Furthermore, patients were considered to have a family history of TC when first and second generation-degree relatives had the disease. Based on thyroid histopathologic features, patients were diagnosed as medullary or non-medullary TC, the latter being further classified as differentiated (papillary and follicular), poorly differentiated, undifferentiated (anaplastic), or squamous cell carcinoma [12]. The risk of recurrence in differentiated TC was calculated by using the American Thyroid Association (ATA) 2009 risk stratification system, which classifies patients’ risk of recurrence as low, intermediate, or high [13]. Due to the overwhelming increasing incidence of patients with papillary thyroid cancer (PTC) with an intrathyroidal tumor size of < 1 cm, a new category was included to the ATA risk of recurrence calculator: “very low risk” [14]. Furthermore, the risk of mortality in patients with PTC was estimated based on MACIS score (metastasis, age, completeness, invasion, and size) [15]. A cutoff of 6 was employed to group patients as either low (MACIS < 6) or high risk (MACIS ≥6) of mortality.
Anzeige
Thyroid cancer method of detection was divided in two groups: non-incidental diagnosis (when the TC was found in a symptomatic patient) and incidental diagnosis when a thyroid nodule harboring TC is found during the workup of non-nodular thyroid disease, or during an imaging test requested for reasons unrelated to a thyroid disorder or symptom (e.g., preventive ultrasound), or TC is found incidentally in the histological examination of the thyroid gland removed for a benign condition (Fig. 1) [16].
×
We classified the setting of the surgery as either tertiary hospital (HEEE and Hospital SOLCA) or non-tertiary hospital. Moreover, we evaluated the quality of thyroidectomy based on post-operative sTg levels (at least 6 weeks after the procedure) [17‐19], and the frequency of surgical complications [20‐22]. We considered that the quality of surgery was optimal when there were no post-surgical complications and when patients had a sTg ≤2 ng/dl, and poor when patients had at least one permanent surgical complication or post-operative sTg > 2 ng/dL. Given that surgical complications and post-operative sTg levels could be affected by the presence of metastatic disease, we limited the assessment of the quality of surgical outcomes to patients with non-metastatic differentiated TC undergoing initial thyroid surgery (total thyroidectomy and prophylactic central neck dissection). Before 2016, the criteria for using iodotherapy included the ATA 2009 guidelines; after 2016, the ATA 2015 guidelines were considered.
Statistical methods
For categorical variables, frequencies and percentages were reported. For numerical variables, we used mean and median with their corresponding standard deviation (SD) or interquartile ranges (IQR), as measurements of central tendency and dispersion. Normal distribution was determined by visual inspection and by using the Kolmogorov-Smirnov test. Our dependent variables used for exploratory analysis were incidental findings and quality of surgery, which are dichotomous variables. For our bivariate and multivariate analysis, we decided to use prevalence ratio (PR) instead of odds ratios (OR) because PR is easier to interpret and OR tend to overestimate the results [23]. To calculate this PR, we planned to use a generalized linear model (GLM) with the binomial family and the log link. However, convergence problems were found with some of the variables. Such issues are common [24, 25]. At the end we chose, from all possible solutions, to use Poisson as the family for the GLM with robust variance. For the multivariate analyses, we decided to include in the models for incidental findings and poor quality of surgery all variables in which p-value was less than 0.05 and those considered to be important by the investigators. The results are reported as PR and their respective 95% confidence intervals. Statistical analysis was performed with STATA [26].
Results
From 2014 to 2017, 452 TC patients were included, with 74.8% of the patients between the ages of 20 and 54 years old. The median tumor size of patients was 2 cm [IQ 1.2, 3.1]. Around 94.2% of TC patients were female and 13.7% had a family history of TC (Table 1). Thyroid cancer histology was: 93.3% had papillary thyroid cancer (PTC), 2.7% follicular, 1.5% Hurtle cells, 1.6% medullary, 0.7% poor differentiated, and 0.2% anaplastic. The mean MACIS score was 4.95 (IQ 4.15, 5.95) with 76.2% of the TCs having MACIS score equal or less than 6 (Table 2).
Table 1
Characteristics of Thyroid Cancer Patients Before Thyroidectomy
Variablea
Total (n = 452) n (%)
Sex
Female
426
94.2
Males
26
5.8
Age at diagnosis (mean: 44.6, SD: 14.56)
< 20 years old
17
3.8
20–34 years old
106
23.5
35–44 years old
104
23
45–54 years old
128
28.3
55–64 years old
53
11.7
65–74 years old
26
5.8
75–84 years old
16
3.5
> 84 years old
2
0.4
Residence
Coast
49
10.8
Highland
389
86.1
Amazon
14
3.1
Galapagos
0
0
Employment
Domestic chores
332
73.5
Student
20
4.4
Labor
100
22.1
Education level
None
22
4.9
Elementary School
267
59.1
High school
132
29.2
College
31
6.9
Family history of thyroid cancer
Yes
62
13.7
No
390
86.3
BMI (n = 298) (mean: 28.75, SD: 5.53)
Normal
76
25.5
Overweight
113
37.9
Obesity
109
36.6
Self-reported exposure to (n = 63)
Radiation
4
6.3
Chemicals in agriculture
59
93.7
Cigarette Smoking (n = 393)
Yes
17
4.3
No
376
95.7
Thyroid function
Euthyroid
372
82.3
Hypothyroidism
72
15.9
Hyperthyroidism
8
1.8
Methods of detection
Non-incidental (palpable nodule)
207
45.8
Incidental
245
54.2
- Ultrasound
229
93.5
- Histology
13
5.3
- Unrelated test
3
1.2
Setting of thyroid surgery (n = 450)
Tertiary Hospital
270
60
Non- tertiary hospital
180
40
Size of tumor (n = 406) (median = 2 cm [IQ 1.2, 3.1])
aAll variables without a specific number of patients were calculated from the whole population (n = 452). All the others show the number of people from which the variables were available
Table 2
Factors associated with the prevalence of diagnosis
Incidental
Univariate analysis
Multivariate analysis
Variables
No
Yes
PR (95% CI)
p
n = 206
n = 246
Age, mean (SD)
43.0 (16.1)
46.3 (13.4)
1.01 (1.00,1.01)
0.037
1.01 (1.00, 1.02)
0.033
Sex, n (%)
Male
14 (6.8)
12 (4.9)
Reference
0.433
Female
192 (93.2)
234 (95.1)
1.19 (0.78, 1.81)
Positive Family history n (%)
No
179 (86.5)
211 (86.1)
Reference
0.914
Yes
28 (13.6)
34 (13.8)
1.01 (0.79, 1.29)
BMI, (n = 299) mean, (SD)
n = 142
28.6 (5.7)
n = 157
29.2 (5.8)
1.00 (0.99, 1.02)
0.630
Tumor size in mm, (n = 406) mean, (SD)
n = 177
35.7 (17.9)
n = 229
22.3 (12.3)
0.96 (0.95, 0.97)
0.000
0.96 (0.94, 0.97)
0.000
Multifocal (n = 328), n (%)
Unifocal, n (%)
103 (55.4)
127 (55.2)
Reference
0.974
Reference
0.000
Multifocal, n (%)
83 (44.6)
103 (44.8)
1.00 (0.84, 1.19)
1.32 (1.13, 1.54)
Positive Cervical Lymph nodes, n (%)
No
93 (46.3)
132 (56.2)
Reference
0.041
Reference
0.305
Yes
108 (53.7)
103 (43.8)
0.83 (0.70, 0.99)
1.09 (0.93, 1.27)
MACIS score (n = 406), mean (SD)
5.6 (1.6)
4.9 (1.4)
0.86 (0.79, 0.92)
0.000
0.92 (0.81, 1.04)
0.184
Risk recurrence (n = 437)
Very low risk
0
79 (33)
Referencea
Low risk
147 (73.5)
124 (52.3)
Intermediate risk
33 (16.5)
16 (6.8)
0.56 (0.37, 0.85)
0.006
0.98 (0.67, 1.43)
0.902
High risk
20 (10.0)
18 (7.6)
0.77 (0.54, 1.11)
0.163
1.04 (0.82, 2.16)
0.239
a For univariate and multivariate analysis low and very low risk categories were combined and taken as reference
Mechanism of detection
The methods of TC diagnosis were: 54.2% incidental (93.5% by ultrasound, 5.3% histology, and 1.2% unrelated test) and 45.8% non-incidental (palpable and symptomatic nodule) (Fig. 1). Furthermore, 100% of patients with microcarcinoma (≤10 mm) were incidental finding; the proportions further fell to 68.4, 43.7, 9.3, and 23% for the 11-20 mm, 21-30 mm, 31-40 mm and ≥ 41 mm groups, respectively (Fig. 2). The univariate analysis showed that age, tumor size, and MACIS score were associated with the mechanism of detection (Table 3).
Table 3
Factors associated with poor optimal surgical outcomes
Univariate analysis
Multivariate analysis
PR (95% CI)
P value
PR (95% CI)
P value
Sex
Male
Reference
0.295
Female
0.74 (0.42, 1.30)
Age, mean (SD)
1.00 (0.99, 1.01)
0.684
BMI
1.02 (0.99, 1.05)
0.191
Setting of Surgery
- Tertiary Hospital
Reference
0.878
Reference
0.947
- Non- tertiaty hospital
0.98 (0.71, 1.32)
1.01 (0.75, 1.37)
Tumor size(n = 306),mean (SD)
1.01 (1.00, 1.02)
0.001
1.01 (1.00, 1.02)
0.182
Tumor focality, n (%)
- Unifocal
Reference
0.425
- Multifocal
1.13 (0.84, 1.53)
Positive Central Cervical Lymph nodes metastasis, n (%)
- No
Reference
0.004
Reference
0.017
- Yes
1.54 (1.15, 2.06)
1.45 (1.07, 1.97)
MACIS score
1.14 (1.02, 1.28)
0.017
1.08 (0.94, 1.24)
0.285
Histology variant
- Non- aggresive
Reference
0.651
- Aggresive
1.11 (0.70, 1.79)
Risk recurrence
Very low risk
Referencea
Low risk
Indeterminate risk
0.95 (0.51, 1.77)
0.861
High risk
0.95 (0.19, 4.73)
0.946
a For univariate and multivariate analysis low and very low risk categories were combined and taken as reference
×
Treatment modalities
Surgical characteristics and outcomes
All patients were treated with total thyroidectomy. The operations were performed by the HEEE surgery team (7 surgeons) in 46% (205) of patients. Other patients had operations in other institutions and were transferred to the HEEE to continue the follow-up. The neck dissection was performed as follows: 46% (209) central compartment, 22% (97) lateral compartment, and 32% (146) did not have neck dissection. Of patients with central compartment neck dissection, 16% (34) had more than 5 positive lymph nodes removed. An analysis of 319 patients with non-metastatic differentiated thyroid carcinoma (DTC) showed that 10.7% (34) of patients had surgical complications, 7.8% (25) of patients developed permanent hypoparathyroidism, 2.2% (7) had recurrent laryngeal nerve injury, and 0.6% (2) showed spinal nerve injury. Moreover, around 61% (80 from 128 patients with thyroglobulin laboratory results) of TC patients had a sTg value equal or higher than 2 ng/ml. By using both surgical complications and sTg values, the percentage of patients who had a poor surgical outcome was 35%. The univariate analysis showed that the tumor size, MACIS score and the presence of metastatic cervical lymph nodes in the central compartment were associated with poor surgical outcome. However, in multivariate analysis, only metastatic cervical lymph nodes were associated with poor surgical outcome (PR = 1.45 [IC:1.07, 1.97]) (Table 4).
Table 4
Radioactive Iodine and risk of recurrence
Risk recurrence
Yes n = 375 (89.3%)
No n = 45 (10.7%)
PR (95% CI)
P value
Very low risk (micro PTC) n (%)
49 (63.6)
28 (36.4)
0.2 (0.13, 0.35)
0.001
Low risk
248 (95)
13 (5)
Indeterminate risk
43 (91.5)
4 (8.5)
High risk
35 (100)
0 (0)
Iodine therapy
Out of 436 patients with DTC, 86% (375) received RAI. The median dose of RAI was 100 mCi (IQR: 100–150) and the median lapse between surgery and RAI therapy was 4 months (IQR: 3–7 months). 95% of people with very low risk and low risk received RAI treatment (Table 5).
Table 5
Radioactive Iodine Treatment in patients with thyroid cancer by their risk of recurrence
Variables
Radioactive Iodine Treatment
Yes
No
PR (95% CI)
p value
n = 375 (89.3%)
n = 45 (10.7%)
Risk of recurrence
- Very low risk (micro PTC) n (%)
49 (63.6)
28 (36.4)
0.2 (0.13, 0.35)
0.001
- Low risk
248 (95)
13 (5)
- Indeterminate risk
43 (91.5)
4 (8.5)
- High risk
35 (100)
0 (0)
Discussion
We conducted a cross-sectional analysis of all TC patients receiving care at a regional reference hospital in Ecuador. This analysis revealed that 74.8% of TC patients were between 20 and 54 years old, and the majority was papillary thyroid cancer at low or very low risk of recurrence. Approximately half of these cases were found incidentally, and a quarter of TC patients had a poor surgical outcome. Despite being mostly low risk for cancer, all patients received total thyroidectomy, and the majority received RAI.
Although this sample only represents a small subset of all thyroid cancers in Ecuador, histological characteristics and methods of diagnosis are similar to the ones described in other reports [27‐31]. We did not see an increased frequency of aggressive thyroid cancer histological findings that might explain the increase in thyroid cancer mortality in Ecuador. We observed that the majority of thyroid cancer cases were of low risk of recurrence and mortality. Moreover, we found that more than half of thyroid cancers were diagnosed incidentally, and the minority of patients presented with symptoms resembling findings in countries where thyroid cancer overdiagnosis drives increasing incident trends [32‐35]. The driver of incidental thyroid cancer in this cohort was the used of neck ultrasound. This finding is consistent with other studies that shows that the use of thyroid ultrasound has increased at a rate of 20% per year from 2002 through 2013 in the United States [36, 37] and was associated with more thyroid cancer diagnosis, this cancer found by neck ultrasound was mostly of low risk. Although thyroid cancer histology and mode of presentation did not show any hint to explain thyroid cancer increased mortality, we found that there was evidence of overtreatment and poor surgical outcomes. One-third of patients had either surgical adverse events or a post-surgical Tg value that suggested residual benign or malignant thyroid tissue. Persistent thyroglobulin in our cohort may be the result of both insufficient surgical treatment of cervical lymph node metastases and a significant remnant of thyroid tissue in the glandular bed. The high frequencies of poor surgical outcomes suggest a lack of surgical thyroid cancer expertise [38‐40]. In Ecuador, there are no residency programs dedicated to training surgeons about the treatment of TC. The few existing thyroid focused surgeons are insufficient in covering the rising demand for new patients with this tumor; therefore, before 2017 most of our patients underwent a thyroidectomy with a general surgeon and most of the patients underwent prophylactic central or lateral neck dissection (68%). In light of this, a retrospective study assessed the safety and efficiency of thyroid surgery, it found more hypocalcemia < 2.0 mmol/l (32.8 vs. 22.0%) and postoperative hemorrhage (5.6% vs. 1.9%) in surgeries performed by general surgeons [40]. These poor surgical outcomes might be higher among countries affected by higher rates of TC diagnosis that have limited thyroid surgical expertise [21] (e.g., Ecuador). Yet, most TC patients do not receive care or treatment in a reference hospital, and thus, they may be at higher risk of complications (e.g., hypocalcemia, recurrent laryngeal nerve injury, etc.) and perhaps unrecognized death due to thyroid cancer surgery.
Another driver of the increased thyroid cancer mortality in Ecuador, not assessed in this study, may be attribution bias. That is, patients with thyroid cancer who died, and the cause of death is attributed to thyroid cancer even if cancer was likely not the cause of death [41]. This misclassification bias exaggerates cancer-specific mortality. Morticians not familiar with thyroid cancer prognosis may be more willing to allocate cause of death to thyroid cancer when the chain of events leading to death is unclear or unknown. Moreover, we observed that the majority of thyroid cancer cases were of low or very low risk of recurrence, however, most of them received high doses of RAI therapy. In our study, it is not clear if the rise observed in the use of RAI is associated with diagnosis of higher-risk tumors or if clinicians continue to prescribe RAI due to a lack of knowledge or for thyroid remnant ablation. Although RAI use would not have a detrimental impact on thyroid cancer mortality, its use adds to the patient’s burden of treatment and risk of adverse events [42‐44].
Anzeige
Limitations and strengths
This study has several limitations. This is not a population-based study; therefore, selection bias may influence our results. Furthermore, there were patients with missing data, lowering our sample size and confidence in the estimates. Information about the histopathological characteristics and post-surgical treatment were unavailable because not all patients began the treatment in HEEE and some of them came to this hospital after surgery or after radioactive therapy was performed. Moreover, in the interview of the patients, the question of family history was exposed to recall bias. Finally, we were not able to provide information about the outcomes for these patients as this data is currently being collected as data for a subsequent study. Despite these limitations, this study has several strengths. First, patient data was collected by extractors trained in thyroid cancer treatment and diagnosis using a well-designed extraction form. Second, our inclusion criteria and case finding process secured that all patients treated at the hospital were include for analysis. Finally, our team included a multidisplinary team of clinicians, thyroid cancer researched and epidemiologists who contributed to planning, execution, and dissemination of study’s results.
Conclusion
Considering the paucity of population-based cancer registries in Ecuador, this study provides additional information about the thyroid cancer diagnosis and treatment in a tertiary referral center in Ecuador. We observed that thyroid cancer histological characteristics and methods of diagnosis are like those described in other reports without any evidence of the high frequency of aggressive thyroid cancer histology. However, we observed evidence of overtreatment and poor surgical outcomes that demand additional studies to understand their association with thyroid cancer mortality in Ecuador. This study is significant because it shows the high rate of overtreatment for patients seen in a tertiary care center for thyroid cancer in Ecuador, particularly the high frequency of surgical adverse outcomes among patients with low-risk thyroid cancer, who may benefit from non-surgical options for their management. These results further invite to better understand the potential association of overtreatment and thyroid cancer mortality.
Acknowledgements
The authors thank the patients and their families who contributed to the completion of this analysis.
Ethics approval and consent to participate
All data were collected from the patient’s medical records after obtaining written informed consent. The study was approved by the Hospital Eugenio Espejo review board. All data was anonymized, and all identifiable information and biological samples were stored according to the local guidelines.
Anzeige
Consent for publication
Written informed consent was obtained from every patient in the study.
Competing interests
The authors declare that they have no competing interests.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Thyroid cancer overdiagnosis and overtreatment: a cross- sectional study at a thyroid cancer referral center in Ecuador
verfasst von
Paola Solis-Pazmino Jorge Salazar-Vega Eddy Lincango-Naranjo Cristhian Garcia Gabriela Jaramillo Koupermann Esteban Ortiz-Prado Tannya Ledesma Tatiana Rojas Benjamin Alvarado-Mafla Cesar Carcamo Oscar J. Ponce Juan P. Brito
In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.
Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.
Darmkrebserkrankungen in jüngeren Jahren sind ein zunehmendes Problem, das häufig längere Zeit übersehen wird, gerade weil die Patienten noch nicht alt sind. Welche Anzeichen Ärzte stutzig machen sollten, hat eine Metaanalyse herausgearbeitet.
Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.
Update Onkologie
Bestellen Sie unseren Fach-Newsletterund bleiben Sie gut informiert.