Evaluation of the etiological factors of thyroid gland neoplasms: our clinical experience

Yıl 2022, , 26 - 32, 24.03.2022

Salih Celepli , İrem Bigat , Baki Türkoğlu , Pınar Celepli , Mujdat Turan

https://doi.org/10.47582/jompac.1063353

Öz

Objective: Thyroid cancer (TC), the most common endocrine malignancy worldwide, has a 10-year survival rate of more than 90% and a better prognosis than other malignancies. However, there are still conflicting data on the stimulators of cancer development, and benign thyroid diseases, such as goiter, benign thyroid nodules, Graves’ disease, chronic thyroiditis, breast cancer and various factors including age, gender, consumption of vegetables, fiber food, hypercaloric diet, and tobacco and alcohol use are considered to be responsible. In this study, we aimed to evaluate patients with thyroid neoplasms who underwent surgical treatment in terms of etiological factors discussed in light of the literature.
Material and Method: In our study, patients who underwent surgery with the diagnosis of thyroid gland neoplasms between 2010 and 2020 were evaluated. A total of 371 patients were included in the study. Statistical analyses were performed using IBM SPSS Statistics v. 22.
Results: Of the 371 cases included in the study, 78.16% were female and 21.83% were male. The histopathological distribution of diagnoses was as follows: 76.28% papillary thyroid carcinoma (PTC), 4.31% follicular thyroid carcinoma (FTC), 14.29% follicular adenoma (FA), 0.54% Hurthle cell carcinoma (HCC), 3.77% Hurthle cell adenoma (HCA), and 8.08% medullary thyroid carcinoma (MTC). A total of 567 etiological factors were detected in 371 cases, and the highest factors ratio (1.94) being detected in the FTC group and the lowest (1.49) in the FA group. The most common of these factors was chronic lymphocytic thyroiditis (CLT) (35.31%). While the most common etiological factor in the PTC diagnosis group was thyroid and other non-breast cancers and the history of radiotherapy resulting from their treatment, it was a family history of thyroid cancer in the HCA group. Other systematic organ diseases, CLT, and breast cancer were the most common factors. The body mass index was the highest in the MTC group and the lowest in the PTC group.
Conclusion: Increased human development index, technological developments, greater accessibility of ultrasonography, and better diagnostic sensitivity have led to an increase in the detection of TC. Knowledge of the underlying etiological factors is important for the development of preventive measures and achieving more successful results in terms of diagnosis and treatment.

Anahtar Kelimeler

Thyroid Cancer, Thyroid Gland Neoplasms, Etiological Factors.

Tiroid bezi neoplazmalarının etiyolojik faktörlerinin değerlendirilmesi: klinik deneyimimiz

Öz

Amaç: Dünya genelinde en sık karşılaşılan endokrin malignite olan tiroid kanserinde (TK) 10 yıllık sağ kalım oranı %90’dan fazla olup diğer malignitelere göre daha iyi bir prognoza sahiptir. Literatürde TK gelişiminde yaş, cinsiyet, sebze ve lifli besin tüketimi, hiperkalorik diyet,tütün ve alkol kullanımı gibi faktörlerin yanında, kanser gelişimi öncesi guatr, iyi huylu tiroid nodülleri, Graves hastalığı, kronik tiroidit gibi benign tiroid hastalıkları ve meme kanseri birlikteliği konusunda tartışmalar devam etmektedir.Çalışmamızda kliniğimizde cerrahi tedavi uyguladığımız tiroid neoplazmlarını literatür eşliğinde etiyolojik faktörler açısından değerlendirmeyi amaçladık.
Gereç ve Yöntem: Çalışmamızda 2010-2020 yılları arasında tiroid bezi neoplazmı tanısıyla cerrahi tedavi uyguladığımız hastalar değerlendirildi. Çalışmaya 371 hasta dahil edildi. İstatistikler IBM SPSS Statistics 22 kullanılarak yapıldı.
Bulgular: Çalışmaya dahil edilen 371 olgunun %78,16’sı kadın, %21,83’ü erkek cinsiyette olup, tanıların histopatolojik olarak dağılımı %76,28’i papiller tiroid karsinomu (PTK), %4,31’i foliküler tiroid karsinomu (FTK), %14,29’u foliküler adenom (FA), %0,54’ü Hurthle hücreli karsinom (HHK), %3,77’si Hurthle hücreli adenom (HHA) ve %8,08’i medüller tiroid karsinomu (MTK) şeklindeydi. Toplamda 371 olguda 567 etiyolojik faktör tespit edilmiş olup,olgu başına düşen etiyolojik faktör oranı en yüksek (1,94) FTK, en düşük (1,49)FA tanı grubundaydı. Bu faktörler arasında en sık görüleni %35,31 ile kronik lenfositik tiroidit (KLT) idi. PTK tanı grubunda en sık görülen etiyolojik faktör tiroid ve meme dışı diğer kanserler ve bunların tedavisinden kaynaklanan radyoterapi öyküsü iken; HHA’da ailede tiroid kanseri öyküsü olmasıydı. Sistematik diğer organ hastalıkları, KLT ve meme kanseri en sık görülen faktörlerdi. Vücut kitle indeksi (VKİ) değeri ise en yüksek MTK, en düşük PTK tanı grubunda gözlendi.
Sonuç: İnsani gelişmişlik indeksinin yükselmesi, teknolojik gelişmeler, ultrasonografinin erişilebilirliği ve tanı duyarlılığındaki yükselme, TK insidansında artışa neden olmaktadır. Bu artışın zemininde yer alan etiyolojik faktörlerin iyi bilinmesi; koruyucu önlemlerin geliştirilmesi, tanı ve tedavi açısından daha başarılı sonuçlar alınması için önemlidir.

Anahtar Kelimeler

Tiroid Kanseri, Tiroid Bezi Neoplazmaları, Etiyolojik Faktörler

Kaynakça

• Vigneri R, Malandrino P, Vigneri P. The changing epidemiology of thyroid cancer: why is incidence increasing? Curr Opin Oncol 2015; 27: 1-7.
• Acquaviva G, Visani M, Repaci A, et al. Molecular pathology of thyroid tumours of follicular cells: a review of genetic alterations and their clinicopathological relevance. Histopathology 2018; 72: 6-31.
• Lupoli GA, Fonderico F, Colarusso S, et al. Current management of differentiated thyroid carcinoma. Med Sci Monit 2005; 11: Ra368-73.
• Preston-Martin S, Bernstein L, Pike MC, Maldonado AA, Henderson BE. Thyroid cancer among young women related to prior thyroid disease and pregnancy history. Br J Cancer 1987; 55: 191-5.
• Haymart MR. Understanding the relationship between age and thyroid cancer. Oncologist 2009; 14: 216-21.
• Prasad ML, Vyas M, Horne MJ, et al. NTRK fusion oncogenes in pediatric papillary thyroid carcinoma in northeast United States. Cancer 2016; 122: 1097-107.
• Nixon IJ, Wang LY, Migliacci JC, et al. An International Multi-Institutional Validation of Age 55 Years as a Cutoff for Risk Stratification in the AJCC/UICC Staging System for Well-Differentiated Thyroid Cancer. Thyroid 2016; 26: 373-80.
• Ito Y, Nikiforov YE, Schlumberger M, Vigneri R. Increasing incidence of thyroid cancer: controversies explored. Nat Rev Endocrinol 2013; 9: 178-84.
• Markaki I, Linos D, Linos A. The influence of dietary patterns on the development of thyroid cancer. Eur J Cancer 2003; 39: 1912-9.
• Büttel I, Fechter A, Schwab M. Common fragile sites and cancer: targeted cloning by insertional mutagenesis. Ann N Y Acad Sci 2004; 1028: 14-27.
• Cho YA, Kim J. Thyroid cancer risk and smoking status: a meta-analysis. Cancer Causes Control 2014; 25: 1187-95.
• Bonora E, Tallini G, Romeo G. Genetic predisposition to familial nonmedullary thyroid cancer: an update of molecular findings and state-of-the-art studies. J Oncol 2010; 2010: 385206.
• Ríos A, Rodríguez JM, Canteras M, Galindo PJ, Balsalobre MD, Parrilla P. Risk factors for malignancy in multinodular goitres. Eur J Surg Oncol 2004; 30: 58-62.
• Bolf EL, Sprague BL, Carr FE. A linkage between thyroid and breast cancer: a common etiology? Cancer Epidemiol Biomarkers Prev 2019; 28: 643-9.
• Lun Y, Wu X, Xia Q, et al. Hashimoto’s thyroiditis as a risk factor of papillary thyroid cancer may improve cancer prognosis. Otolaryngol Head Neck Surg 2013; 148: 396-402.
• Khatami M. Inflammation, aging, and cancer: tumoricidal versus tumorigenesis of immunity: a common denominator mapping chronic diseases. Cell Biochem Biophys 2009; 55: 55-79.
• Lee CY, Snyder SK, Lairmore TC, Dupont SC, Jupiter DC. Utility of surgeon-performed ultrasound assessment of the lateral neck for metastatic papillary thyroid cancer. J Oncol 2012; 2012: 973124.
• Mazzaferri EL, Kloos RT. Clinical review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 2001; 86: 1447-63.
• Cushing SL, Palme CE, Audet N, Eski S, Walfish PG, Freeman JL. Prognostic factors in well-differentiated thyroid carcinoma. Laryngoscope 2004; 114: 2110-5.
• Kim WG, Kim TY, Kim TH, et al. Follicular and Hurthle cell carcinoma of the thyroid in iodine-sufficient area: retrospective analysis of Korean multicenter data. Korean J Intern Med 2014; 29: 325-33.
• Bonnefond S, Terry F Davies TF. Thyroid cancer—risks and causes. Oncol Hematol Rev 2014; 10: 144–51.
• Xing M. Molecular pathogenesis and mechanisms of thyroid cancer. Nat Rev Cancer 2013; 13: 184-99.
• Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab 2006; 91: 4295-301.
• Zhao J, Tian Y, Yao J, et al. Hypercholesterolemia is an associated factor for risk of differentiated thyroid cancer in Chinese population. Front Oncol 2020; 10: 508126.
• Vukasović A, Kuna SK, Ostović KT, Prgomet D, Banek T. Diffuse sclerosing variant of thyroid carcinoma presenting as Hashimoto thyroiditis: a case report. Coll Antropol 2012; 36: 219-21.
• Haymart MR, Repplinger DJ, Leverson GE, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab 2008; 93: 809-14.
• Nielsen SM, White MG, Hong S, et al. The breast-thyroid cancer link: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 2016; 25: 231-8.
• Uhliarova B, Hajtman A. Hashimoto’s thyroiditis - an independent risk factor for papillary carcinoma. Braz J Otorhinolaryngol 2018; 84: 729-35.
• Chung WY, Chang HS, Kim EK, Park CS. Ultrasonographic mass screening for thyroid carcinoma: a study in women scheduled to undergo a breast examination. Surg Today 2001; 31: 763-7.
• Kuo JH, Chabot JA, Lee JA. Breast cancer in thyroid cancer survivors: An analysis of the Surveillance, Epidemiology, and End Results-9 database. Surgery 2016; 159: 23-9.
• Van Fossen VL, Wilhelm SM, Eaton JL, McHenry CR. Association of thyroid, breast and renal cell cancer: a population-based study of the prevalence of second malignancies. Ann Surg Oncol 2013; 20: 1341-7.
• Ngeow J, Sesock K, Eng C. Clinical Implications for Germline PTEN Spectrum Disorders. Endocrinol Metab Clin North Am 2017; 46: 503-517.
• Ikeda Y, Kiyotani K, Yew PY, et al. Germline PARP4 mutations in patients with primary thyroid and breast cancers. Endocr Relat Cancer 2016; 23: 171-9.
• Gore AC, Chappell VA, Fenton SE, et al. EDC-2: The Endocrine Society’s Second Scientific Statement on Endocrine-Disrupting Chemicals. Endocr Rev 2015; 36: E1-e150.
• Weiderpass E. Lifestyle and cancer risk. J Prev Med Public Health 2010; 43: 459-71.
• Kitahara CM, Platz EA, Freeman LE, et al. Obesity and thyroid cancer risk among U.S. men and women: a pooled analysis of five prospective studies. Cancer Epidemiol Biomarkers Prev. 2011; 20: 464-72.
• Rezzónico JN, Rezzónico M, Pusiol E, Pitoia F, Niepomniszcze H. Increased prevalence of insulin resistance in patients with differentiated thyroid carcinoma. Metab Syndr Relat Disord 2009; 7: 375-80.
• Mijović T, How J, Pakdaman M, et al. Body mass index in the evaluation of thyroid cancer risk. Thyroid 2009; 19: 467-72.
• Zhao S, Jia X, Fan X, et al. Association of obesity with the clinicopathological features of thyroid cancer in a large, operative population: A retrospective case-control study. Medicine (Baltimore) 2019; 98: e18213.
• Zhao ZG, Guo XG, Ba CX, et al. Overweight, obesity and thyroid cancer risk: a meta-analysis of cohort studies. J Int Med Res 2012; 40: 2041-50.
• Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371: 569-78.
• Schmid D, Behrens G, Jochem C, Keimling M, Leitzmann M. Physical activity, diabetes, and risk of thyroid cancer: a systematic review and meta-analysis. Eur J Epidemiol 2013; 28: 945-58.
• Xiao Q, Park Y, Hollenbeck AR, Kitahara CM. Dietary flavonoid intake and thyroid cancer risk in the NIH-AARP diet and health study. Cancer Epidemiol Biomarkers Prev 2014; 23: 1102-8.
• Hung SH, Lin HC, Chung SD. Statin use and thyroid cancer: a population-based case-control study. Clin Endocrinol (Oxf) 2015; 83: 111-6.
• Sinnott B, Ron E, Schneider AB. Exposing the thyroid to radiation: a review of its current extent, risks, and implications. Endocr Rev 2010; 31: 756-73.
• Ron E, Lubin JH, Shore RE, et al. Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res 1995; 141: 259-77.
• Tunio MA, Al Asiri M, Bayoumi Y, Stanciu LG, Al Johani N, Al Saeed EF. Is thyroid gland an organ at risk in breast cancer patients treated with locoregional radiotherapy? Results of a pilot study. J Cancer Res Ther 2015; 11: 684-9.
• Wolny-Rokicka E, Tukiendorf A, Wydmański J, Roszkowska D, Staniul BS, Zembroń-Łacny A. Thyroid function after postoperative radiation therapy in patients with breast cancer. Asian Pac J Cancer Prev 2016; 17: 4577-81.
• Inskip PD. Thyroid cancer after radiotherapy for childhood cancer. Med Pediatr Oncol 2001; 36: 568-73.