REVISTA ARGENTINA DE ENDOCRINOLOGÍA Y METABOLISMO
DANILOWICZ, Ka,b; SOSA, Sa,b; GONZALEZ PERNAS, M Sa,b,c; AGÜERO, Ma,d; ALFIERI, Aa,e; BALLARINO, M Ca,f; BATTISTONE, MFa,g; BOERO, LEa,b; CHERVIN, Aa,h; DIEZ, SMa,i; FAINSTEIN DAY, Pa,j; FURIOSO, Aa,k; GARCÍA BASAVILBASO, N Xa,l; GLEREAN, Ma,j; GUITELMAN, Ma,l; KATZ, Da,c; LOTO, M Ga,m; LOWENSTEIN, As,k; MALLEA GIL, MSa,f; MARTINEZ, Ma,n; MIRAGAYA, Ka,o; PIGNATTA, Aa,p; REYES, As,k; ROGOZINSKI, ASa,k; SABATE, MIa,g; SERVIDIO, Ma,q; SLAVINSKY, Pa,c; SZUMAN, Ga,c,r; TKATCH, Ja,i; VITALE, NMa,h; PITOIA, Fs,b.
Introducción
La acromegalia se asocia con un mayor riesgo de morbilidad y mortalidad por cáncer. Sin embargo, los datos respecto de la incidencia de cáncer en acromegalia son controvertidos.
Objetivos
Describir las características clínicas, bioquímicas e imagenológicas de un grupo de pacientes acromegálicos con carcinoma diferenciado de tiroides (CDT). Analizar las características de riesgo de recurrencia (RR) y respuesta en el seguimiento (RtaSg) y comparar la evolución con la de pacientes con CDT no acromegálicos.
Materiales y métodos
Se realizó un análisis retrospectivo multicéntrico de pacientes con diagnóstico de acromegalia y CDT. Se realizó un análisis comparativo entre los pacientes de bajo RR inicial acromegálicos con una muestra aleatoria de pacientes no acromegálicos con CDT de bajo RR inicial (1:4).
Resultados
Se analizaron 16 pacientes con diagnóstico de CDT y acromegalia. En 93,8% se hizo el diagnóstico por ecografía, sólo el 50% tenían un nódulo tiroideo palpable. En el momento del diagnóstico del CDT, los valores de IGF-1 fueron 1,8 ± 1,3 LSN, con 62,5% con acromegalia activa. La histología fue papilar en todos los casos, el 56,3% variedad clásica y el resto papilar variedad folicular. El 75% de los pacientes presentó un Estadio I (12/16), sólo 3 pacientes Estadio II y 1 Estadio IVb. El RR inicial fue bajo en el 87,6% (14/16), intermedio en 1 paciente y alto en 1 paciente. Las respuestas al final del seguimiento fueron: 86,7% (13/15) sin evidencia de enfermedad, 1 paciente bioquímica incompleta y 1 estructural incompleta. La RtaSg no tuvo diferencias con los no acromegálicos.
Conclusiones
Los pacientes acromegálicos con CDT presentaron predominantemente un bajo RR inicial. Al realizar la comparación con el grupo control, se puede concluir que el CDT en pacientes acromegálicos no presentó una evolución más agresiva.
Introduction
Acromegaly is associated with higher morbidity and mortality due to malignant neoplasms. However, data on the incidence and evolution of thyroid cancer in acromegaly is controversial.
Objetives
To describe the clinical and biochemical characteristics of a group of acromegalic patients with differentiated thyroid carcinoma (DTC). Analyze risk of recurrence (RR), initial response to treatment and response at the end of follow-up (RFU), comparing the outcomes with non-acromegalic patients with DTC.
Patients and methods
Retrospective, multicenter study of 16 acromegalic patients with DTC. Acromegaly control or remission was defined with an IGF-1 ≤1 ULN with or without medical treatment (MT) respectively. AJCC Staging System 8th Edition was used for TNM staging, and the initial RR, initial response and RFU were defined according to ATA Guidelines 2015. As a control group, 56 patients with DTC without acromegaly were selected. Statistical analyses were done using SPSS Statistics 2.0.
Results
Median age of patients at the diagnosis of acromegaly was 44 years (range 12-69). Delay in diagnosis of acromegaly was a median of 2.5 years (range 0.5-10). Basal mean IGF-1 level was 3.2 ± 1.2 xULN. Surgery was performed in 85.7%. Post surgically, the best mean IGF-1 was 1.24 ± 0.34 xULN. Control with MT was achieved in 80%, with a median time to control since diagnosis of 21 months (6-132).
Mean age at CDT diagnosis was 46.5 years (18-69). No patient had personal history of cervical irradiation. Most patients (86.7%) had normal thyroid function tests
At the moment of diagnosis of DTC 62.5% of the patients had active acromegaly, IGF-1 of 2.5 ± 1.4 xULN. Median time from CDT diagnosis to acromegaly control was 1 year (0.5-7). Mean DTC tumor diameter of the bigger lesion was 13.7 ± 7.4 mm, being multifocal in 40% of the cases. All were papillary carcinoma, one case an aggressive variety. In 6/15 lymph node dissection was done, 50% with metastasis. One patient had distant metastasis. Radioiodine ablation was given to 87.5%, mean dose 115 ± 64.5 mCi. Twelve of the patients were stage I, 3 stage II y 1 IVb.
Initial RR was low in 14/16, intermediate in 1 and high in 1 patient. RFU was: 13/15 with no evidence of disease, 1 patient with biochemical incomplete response and 1 with structural incomplete response, on average at 47.7 ± 33.3 months of FU.
No statistically significant correlations were found between characteristics of the acromegalics and DTC outcomes.
When comparing response on FU between acromegalics and controls no statistically significant differences were found.
Conclusions
The acromegalics with DTC had a low initial RR, that could be related to an early diagnosis of DTC (anticipated bias). We did not find any predisposing factor for unfavourable evolution.
When comparing with the control group, we can conclude that DTC in acromegaly does not have a worse evolution.