Transcriptomic Classification of Thyroid Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • The trans-genomic classification of thyroid cancer, particularly papillary thyroid carcinoma (PTC):
    • Has significant clinical implications, as it enables personalized diagnosis, prognosis, and treatment strategies
  • Recent studies have identified molecular subtypes of PTC based on genomic and transcriptomic profiling:
    • Which provide insights into tumor behavior and therapeutic responses
  • Key Molecular Subtypes
    • Immune-Enriched Subtype (Subtype 2):
      • High immune infiltration and overexpression of immune checkpoints
      • Potential candidates for immunotherapy.
    • BRAF-Enriched Subtype (Subtype 4):
      • Associated with aggressive features like:
        • Extrathyroidal extension
        • Advanced TNM stages
    • Enriched in MAPK and PI3K / AKT signaling pathways:
      • Suggesting targeted therapy options
    • Stromal Subtype (Subtype 3):
      • High stromal content with distinct microenvironmental features
    • CNV-Enriched Subtype (Subtype 6):
      • Characterized by copy number variations with unique genetic drivers
  • Clinical Implications:
    • Prognostic Value:
      • Molecular subtypes correlate with survival outcomes
      • Type 3 subtypes (high-risk):
        • Show poorer progression-free survival compared to Type 1 (low-risk)
    • Therapeutic Guidance:
      • Subtypes like the Immune-Enriched or Ras-like Type 1:
        • May benefit from immunotherapy or radioactive iodine (RAI) therapy, respectively
      • BRAF-mutant subtypes:
        • May require targeted tyrosine kinase inhibitors due to RAI resistance
    • Preoperative Decision-Making:
      • Genomic classifiers applied to fine needle aspirates can help stratify patients for active surveillance or surgery
    • Tailored Treatments:
      • Understanding subtype-specific pathways enables the development of novel therapies, such as EZH2 inhibitors for aggressive subtypes
  • This classification system bridges the gap between molecular biology and clinical practice, paving the way for precision medicine in thyroid cancer management
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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