Second primary malignancy risk after primary thyroid cancer: A systematic review and meta-analysis

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Copyright

Second primary malignancy risk after primary thyroid cancer: A systematic review and meta-analysis

Marie Odile Bernier, Martha Linet, Sara Schonfeld, Daphne Villoing, Amy Berrington de Gonzalez, Cari Kitahara

To cite this version:

Marie Odile Bernier, Martha Linet, Sara Schonfeld, Daphne Villoing, Amy Berrington de Gonzalez, et al.. Second primary malignancy risk after primary thyroid cancer: A systematic review and meta- analysis. European Radiation Protection Week 2019, ERPW 2019, Oct 2019, STOCKHOLM, Sweden.

2019. �hal-02635564�

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Results Context

Second primary malignancy risk after primary thyroid cancer:

A systematic review and meta-analysis



Thyroid cancer is the most common endocrine malignancy and generally comes with an excellent prognosis.



Primary treatment of thyroid cancer is based on thyroidectomy with or without adjuvant radioiodine (RAI) therapy depending on histological information and pathologic stage.



Trends of use of RAI are nowadays decreasing according to the recent published guidelines of DTC treatment as survival rate of patients at low risk seems not to be influence by the use of RAI [Augen et al, 2016].



Second primary malignancies (SPM) after primary thyroid cancer have been reported in several studies.



The relative contribution of shared genetic and environmental risk factors versus late effects of RAI treatment to these risks is still debated.



Systematic review has been performed according to PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) guidelines [Liberati A 2009].



English epidemiological studies (cohort and case-control) including at least 200 thyroid cancers (except for paediatric thyroid cancer >100 cases) and published between 1975 and 2019 were retrieved from online databases.



The main outcome considered was standardized incidence ratio (SIR) of SPM following thyroid cancer diagnosis. Analyses of risk by site, gender, and ¹³¹I treatment status were also performed



Random effect model was used to estimate pooled risk [DerSimonian and Laird 1986].



Statistical analysis were performed with STATA software.

Figure 1 : Studies’ selection flow diagram

Conclusion

Selected: 19 All searches: 1287 Clinical studies on

radioiodine treatment: 65

Excluded:8 reviews and meta-analysis

Inclusion criteria

statisfied: 57 Exclusion : 28 overlapping; 7 no statistical

analysis; 2 mortality analyses only; 1 study with cases < 200.



This systematic review and meta-analysis aims to synthesize the published studies on SPM risk among thyroid cancer survivors and to provide site- specific SPM risk estimates.

Specifically



Review of published data



Ascertain the overall risk associated

Objectives

Material and methods

Figure 2: SIR of SPM and pooled SIR in patients with thyroid cancer/general population

Table 1 : Characteristics of the selected studies

Risk compared to the general population

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^SIR_pooled=1.24 (95% confidence interval [CI], 1.16-1.31)

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^SIR_women=1.29 (95%CI 1.14-1.45), SIR _men=1.15 (95%CI, 0.98-1.35)

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Increased SIRs for 17 out of 25 site-specific SPMs

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Highest increased SIRs observed for:

 Salivary gland: SIR=5.60, 95% CI 2.74-11.48

 Adrenal gland: SIR=5.48, 95% CI 1.67-17.99

 Leukaemia: SIR=1.94, 95% CI 1.60-2.35



Thyroid cancer survivors are at increased risk of SPMs compared with the general population.

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Analyses by treatment suggest that RAI may highly contribute to this risk, but pooled analyses were not possible based on available data.

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More research is needed to better characterize the risk of SPMs from RAI, including the shape and magnitude of the dose-response relationship, ideally in large studies with precise estimates of the absorbed doses to target organs.

Treatment by RAI

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7 out of 8 studies showed increased risks in the treated group with highest activities.

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No pooled RR could be obtained due to the lack of comparable categories of delivered activities

.

Marie-Odile Bernier

¹

, Martha S. Linet

²

, Sara Schonfeld

²

, Daphné Villoing

²

, Amy Berrington de González

^2,

Cari M. Kitahara

²

.

1

Laboratory of Epidemiology, IRSN,Fontenay-aux-Roses, France;

²

Division of Cancer Epidemiology and Genetics, NCI, Bethesda, USA.

Author, Year, Country

Study type (Origin of data)

Study period

N of patients

(%

women)

Specific characteristics

Mean (median)

age at PTC

Mean (median) F-U since PTC (yrs)

Mean (median) time (yr) between

PTC and SPM/minimal latency period

N of SPC (%)

Rubino,2003, France, Italy, and Sweden

Cohort (Hospital

and cancer reg) 1934-1997 6841

(77) 44 13 15/2 576(8)

Sandeep, 2006, Europe, Canada, Australia and Singapore

Cohort (Cancer

reg) 1943-1998* 39002

(74) NA NA NA 1310(3)

**

Verkoojen,2006,

Netherlands Cohort (Hospital) 1985-1999 282 (78) 47.5 10.6 6.7/NA 20(7)

Fallahi,2011, Iran Cohort (Hospital) ^1978-2004 973 (75) (39.8) 7.5 (6) 7.5/3 11(1) Lang, 2012, Hong-

Kong Cohort (Hospital) 1971-2009 895 (81)

Exclusion of µcarcinoma (N=98)

or EBT (N=41)

(44) (7.8) NA/1 64(7)

Alqahtani, 2015,

Saudi Arabia Cohort (Hospital) 2000-2012 823 (86) (50) (8) (6.4) /0.5 25 (3) Cho, 2015, Korea Cohort (Cancer

reg) 1993-2010 178844

(85) (47) (3) 3.3/0.2 2895

(2) Seo,2015, Korea Cohort (Health

Care) 2008-2013 211360

(82) Leukemia outcome 48 (2.4) NA/0 NA

Teng, 2016, Taiwan Cohort (Health

Care) 1997-2010 20235 (80)

> 20 yrs at DTC

diagnosis (46) (5.91) ^NA/1 692(3)

Souza,2016, Brazil

exposed/non exposed cohort

(Hospital)

1979-2009 413 (88) (44.1) 11 NA/1 17(4)

Hakala,2016, Finland

Case/ control population based

(Hospital and population reg)

1981-2011 910 (82) 49 16.2 10.7/1 109(12)

Izkhakov,2017, Israel Cohort (Cancer

reg) 1980-2011 11538 (74)

separate analysis for Jews and Arabs

51.1 Jews/44.

4 Arabs

9.7 8.6/1 1032(9)

Silva-Veira,2017,

Portugal Cohort (Hospital) 1998-2009 2031

(83) (48) 9.4(8.8) 5.1(5.4) RAI+

6.2 (6.4) RAI-/1 130(6) Albano, 2017, Italy Cohort (Hospital) 1980-2015 105 (73) < 18 years at DTC

diagnosis 15 12.5 NA/NA 4(4)

Molenaar 2018, USA Cohort (Cancer

reg) 1973-2014 148215 (54)

Haematologic

outcomes only NA NA (6.6)/1 783

(0.5) Molenaar 2018, USA Cohort (Cancer

reg) 1973-2014 148215

(54) MDS and MPN only NA NA (6.6)/1 77 MDS

66 MPN Adly, 2018, USA Cohort (Cancer

reg) 1973-2013 1769 (91)

< 2O yrs at DTC

diagnosis NA NA 24(0.9) 45(2)

Endo 2018, USA Cohort (Cancer

reg) 1992-2013 66873 Papillary histology

only NA NA NA/0.5 3200

(5) Bright 2019, England,

Wales (77)

Cohort (Cancer

reg) 1971-2006 7809 (80)

< 40 years at DTC

diagnosis NA NA NA/5 473 (4)

*various period of follow-up according to the countries;**latency period 1-9 years; EBT: external beam radiotherapy; MDS: myelodysplasic syndroms; MPN:

myeloproliferative neoplasms