Publications by authors named "Junko Akaishi"
Article Synopsis
- The study investigates management strategies for intermediate-risk papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis, focusing on comparing outcomes between lobectomy plus lateral neck dissection (LND) and total thyroidectomy plus LND.
- The research was conducted at Ito Hospital in Tokyo, Japan, involving patients who underwent surgery from 2005 to 2012, excluding those with high-risk PTCs or concurrent thyroid cancers.
- Findings from 401 patients show that overall survival rates after 5, 10, and 15 years were comparable between the two surgical options, indicating lobectomy plus LND is a viable alternative to total thyroidectomy for certain patients.
Background: Papillary thyroid microcarcinoma (PTMC) management has evolved, with active surveillance (AS) gaining prominence as a management option. However, a key concern for both clinicians and patients is the potential for patient loss to follow-up during AS.
Aims: This study aimed to determine adherence and loss-to-follow-up rates in low-risk PTMC patients undergoing AS versus surgical intervention, in order to gain insights into clinical pathways and safety profiles.
Article Synopsis
- Intraoperative neurophysiological monitoring (IONM) helps prevent damage to the recurrent laryngeal nerve (RLN) during thyroid surgeries, with loss of signal (LOS) indicating potential nerve injury.
- A study of 1,442 patients documented significant differences in recovery based on the type of LOS, revealing that 74.2% of LOS in benign tumors were global type, while cancer patients more often experienced segmental type paralysis.
- Postoperative outcomes showed that patients with global LOS had better recovery rates and lower vocal cord dysfunction compared to those with segmental LOS, particularly in cancer cases where segmental LOS led to a significantly higher rate of vocal cord issues at 6 months.
Purposes: To establish the appropriate staging system and assess the role of curative thyroidectomy alone (Surgery) vs. involved-site radiation therapy after open biopsy (OB-ISRT) in stage IE mucosa-associated lymphoid tissue (MALT) lymphoma.
Methods: We examined the Tokyo Classification as a modified classification.
Article Synopsis
- Age is an important factor in determining treatment strategies for papillary thyroid cancer (PTC), which are often based primarily on disease progression.
- This study analyzed data from 837 patients and found that age, along with extrathyroidal extension and the number of metastatic lymph nodes, significantly affects disease-specific survival and distant metastasis-free survival.
- The findings suggest that younger patients without extrathyroidal extension can avoid aggressive treatment, while older patients with this condition may require more intensive therapies.
Article Synopsis
- - The study assessed the effectiveness of paclitaxel as a neoadjuvant treatment for patients with anaplastic thyroid carcinoma (ATC) and examined factors affecting overall survival (OS) and response to the drug.
- - Results showed that patients who underwent surgical resection after paclitaxel treatment had a significantly longer median OS (14.7 months) compared to those who didn't have surgery (4.2 months).
- - Key independent prognostic factors for OS included a prognostic index (PI) of 2 or higher, positive response to paclitaxel, the ability to undergo resection, and prior radiotherapy, though no baseline characteristics predicted response to paclitaxel.
Article Synopsis
- Lenvatinib, a treatment for differentiated thyroid carcinoma (DTC), often requires dose adjustments to balance effectiveness with adverse events (AEs), prompting exploration of dose escalation (DE) as a potential strategy for improved outcomes after dose reduction.
- In a study involving 70 DE episodes across 33 patients, the median dose was increased from 8.6 mg to 10.1 mg, with a notable decrease in serum thyroglobulin (Tg) levels in many cases, suggesting clinical benefits in 86% of DE episodes.
- Effective management of AEs was observed, with only 16% reporting uncontrolled AEs, and drug holidays seemed to contribute positively to managing side effects while allowing for successful DE treatment
Objective: Parathyroid carcinoma is a rare tumor among parathyroid tumors. Aspiration cytology and needle biopsy are generally not recommended for diagnostic purposes because they cause dissemination. Therefore, it is commonly diagnosed by postoperative histopathological examination.
View Article and Find Full Text PDFBackground And Objectives: Tyrosine kinase inhibitors (TKIs) have provided excellent clinical benefits to patients with advanced differentiated thyroid cancer (DTC): however, the tumor status for which maximum efficacy can be obtained remains controversial. We conducted this study to identify effective clinical predictors, focusing on disease progression.
Methods: Using the data of 42 DTC patients treated with lenvatinib, we investigated the clinical factors related to overall survival (OS) and progression-free survival (PFS), and conducted analyses by the scoring of the factors.
Background: Previous studies have reported an association between four or more foci of vascular invasion (VI) and thyroid cancer prognosis, while the current study aimed to investigate the association between extent of VI and outcome of encapsulated angioinvasive follicular thyroid carcinoma (FTC).
Methods: The records of 303 patients with encapsulated angioinvasive FTC confirmed by surgical specimens at Ito Hospital from January 2005 to December 2014 were retrospectively reviewed. Thirteen patients had distant metastasis at diagnosis and were classified as M1.
Purpose: There is no sufficient data about the clinical course and outcome in thyroid cancer patients who become pregnant after diagnosis of distant metastasis (DM). The current study was conducted to collect information regarding the clinical and reproductive characteristics, and outcomes in thyroid cancer patients who became pregnant after being diagnosed with DM.
Methods: Records of 125 differentiated thyroid cancer (DTC) patients with age ≤45 years at DM diagnosis who had visited Ito Hospital from January 2005 to June 2021 were retrospectively reviewed.
The characteristics of pediatric differentiated thyroid cancer (DTC) are substantially different from those of adult DTC. This study investigated whether the cutoff age of 18 years, as recommended by the American Thyroid Association (ATA) management guidelines for pediatric DTC, is appropriate based on clinical characteristics and outcomes. The medical records of 288 patients aged <21 years with DTC, who underwent initial surgery between 1979 and 2014, were retrospectively reviewed.
View Article and Find Full Text PDFBackground: Because lenvatinib is well known to induce proteinuria by blocking the vascular endothelial growth factor (VEGF) pathway, renal function is a concern with long-term administration of lenvatinib. The long-term effects of lenvatinib on renal function in patients with advanced differentiated thyroid carcinoma (DTC) were analyzed.
Method: This study involved 40 DTC patients who continued lenvatinib therapy for ≥6 months.
Article Synopsis
- - The study examines the effectiveness of radioactive iodine (RAI) therapy in patients with differentiated thyroid cancer (DTC) and lung metastasis, focusing on factors that may predict survival outcomes.
- - Researchers analyzed data from 123 patients, using the neutrophil-to-lymphocyte ratio (NLR) and other variables to identify risk factors and survival rates through statistical models.
- - Findings show that older age, larger tumor size, and high NLR at initial treatment are linked to poorer survival, suggesting high-risk patients might benefit from alternative therapies like tyrosine kinase inhibitors.
Most anaplastic thyroid carcinomas (ATCs) arise from papillary thyroid carcinoma (PTC). This process is also called anaplastic transformation, and the morphological harbingers of this phenomenon in nodal recurrence have not been assessed systematically. For this reason, the current study focused on features of 10 PTCs with regional lymph node recurrence that was accompanied with disease progression due to anaplastic transformation in at least one of the nodal recurrences.
View Article and Find Full Text PDFBackground: Completion total thyroidectomy with radioactive iodine (RAI) therapy is not uniformly recommended for minimally invasive follicular thyroid carcinomas (MI-FTCs) without distant metastasis, but may be considered for cases with a risk factor of recurrence, such as age ≥ 45 years.
Objective: The present study aimed to investigate the outcomes for patients with MI-FTC using a stratification age of 55 years.
Methods: The records of 478 patients with MI-FTC confirmed by surgical specimens at Ito Hospital from January 2005 to December 2014 were retrospectively reviewed.
Context: The specific characteristics of pediatric and adolescent differentiated thyroid cancer (DTC) is the more frequent occurrence of distant metastasis (DM) compared with adult DTC.
Objective: To investigate the clinical outcomes of DM in this population and analyze risk factors related to DM.
Design, Setting, And Participants: Medical records of 171 patients with DTC < 19 years old, who underwent initial surgery between 1979 and 2014 were retrospectively reviewed.
Article Synopsis
- Radioactive iodine (RAI) therapy is typically used for treating papillary thyroid carcinoma (PTC) patients with distant metastasis (DM), but its effectiveness remains uncertain against more recent treatments like tyrosine kinase inhibitors (TKIs).
- A study involving 64 PTC patients treated solely with RAI therapy revealed 10, 15, and 20-year survival rates of 68.2%, 63.6%, and 61.1%, highlighting the long-term risks associated with the disease.
- Key risk factors linked to increased mortality included age over 55, metastasis outside the lungs, and lack of RAI avidity, with specific combinations of these factors significantly raising mortality expectations in patients.
Background: Proteinuria induced by lenvatinib is a class effect that occurs secondary to VEGFR suppression. Withholding of lenvatinib is required in cases with severe proteinuria. Urine protein-creatinine ratio (UPCR, g/gCre) has recently attracted attention as an alternative to 24-h urine collection for assessing proteinuria.
View Article and Find Full Text PDFPurpose: Studies have shown that inflammatory biomarkers, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), are associated with prognosis or treatment efficacy in various cancers. The present study investigated the association between the inflammatory biomarkers and dynamics of NLR, and prognosis or disease progression in anaplastic thyroid carcinoma (ATC).
Methods: This study included 55 patients with ATC who had available complete blood count (CBC) data.
Article Synopsis
- Some thyroid cancer patients experience a rapid deterioration in their condition, known as the flare phenomenon, after stopping lenvatinib, a type of tyrosine kinase inhibitor.
- In this study, about 14.3% of patients (8 out of 56) showed this phenomenon, with symptoms appearing typically around 9 days post-treatment cessation.
- Patients who experienced the flare phenomenon had a median overall survival of 15.1 months, which was notably lower than the 41.9 months seen in those who did not experience the flare, indicating a trend toward poorer outcomes for flare patients.
In the recent American Thyroid Association (ATA) guidelines for adult differentiated thyroid carcinoma (DTC) patients, risk stratification is clearly defined and lobectomy is acceptable for low-risk DTC. However, risk stratification for children with DTC in the ATA pediatric guidelines is rather unclear, and total thyroidectomy is recommended for all patients with any risk. The aim of this study was to attempt risk stratification based on our experience and to consider the appropriate extent of thyroidectomy, especially for low-risk DTC in the pediatric population.
View Article and Find Full Text PDFArticle Synopsis
- Sarcopenia, or loss of muscle mass, is linked to poorer survival and treatment results in cancer patients, prompting a study on its impact on metastatic thyroid cancer patients undergoing TKIs (tyrosine kinase inhibitors).
- The observational study included 54 patients, revealing that those with sarcopenia had significantly lower progression-free survival (PFS) compared to those without it.
- Results indicate that sarcopenia may serve as an independent predictive factor for TKI treatment outcomes, highlighting the need for further research to explore its implications for patient management.
The ultimate clinical goal of advanced cancer treatment is improvement of survival. Tyrosine kinase inhibitors (TKIs) were recently approved for radioiodine-refractory differentiated thyroid carcinoma (RR-DTC) that is resistant to conventional therapies since they have significant potential to improve survival in patients who previously had no more treatment strategies available. However, eligible patients are limited in clinical practice, making it difficult to accurately determine the efficacy of TKIs.
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