Dr Christine O'Neill

Dr Christine O'Neill

Conjoint Associate Professor

School of Medicine and Public Health

Career Summary

Biography

Chris is a subspecialist endocrine, breast and general surgeon. She consults and operates across both the public and private sectors. Her primary appointments are at John Hunter Hospital and the University of Newcastle.

Her research interests are mostly in endocrine cancers and she completed a Masters degree in thyroid cancer genetics in 2010. A decade in clinical practice has lead her interest towards health related quality of life, health behaviour and decision making. These research interests are driven out of a desire to ensure that she is assisting her patients to make well informed and evidence based decisions.

Chris has been an invited speaker at many local and international surgical meetings and is a member of the executive committee for endocrine surgery via the Royal Australian College of Surgeons. She is also the chair of the Hunter New England Endocrine surgery multidisciplinary team and current head of the department of general surgery at John Hunter Hospital.

Chris also has a keen interest in surgical education. She was the supervisor of general surgical training for the Newcastle/Gosford network from 2010-2019 and continues to provide input regarding the implementation of the training program and assists in hospital accreditation.



Qualifications

  • Master of Surgery, University of Sydney
  • Bachelor of Medicine, Bachelor of Surgery, University of Melbourne

Keywords

  • Adrenal Disease
  • Behavioural Science
  • Implementation Science
  • Parathyroid Disease
  • Surgery
  • Thyroid Cancer

Fields of Research

Code Description Percentage
321199 Oncology and carcinogenesis not elsewhere classified 20
420312 Implementation science and evaluation 20
320226 Surgery 60
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Publications

For publications that are currently unpublished or in-press, details are shown in italics.


Journal article (32 outputs)

Year Citation Altmetrics Link
2021 Wiadji E, Mackenzie L, Reeder P, Gani JS, Ahmadi S, Carroll R, et al., 'Patient perceptions of surgical telehealth consultations during the COVID 19 pandemic in Australia: Lessons for future implementation', ANZ Journal of Surgery, 91 1662-1667 (2021)

Introduction: Prior studies of telehealth report high levels of patient satisfaction, but within carefully selected clinical scenarios. The COVID-19 pandemic led to telehealth rep... [more]

Introduction: Prior studies of telehealth report high levels of patient satisfaction, but within carefully selected clinical scenarios. The COVID-19 pandemic led to telehealth replacing face-to-face care for many surgical consultations across a variety of situations. More evidence is needed regarding patient perceptions of telehealth in surgery, in particular, exploring barriers and facilitators associated with its sustained implementation beyond the pandemic. Methods: Survey invitations were emailed to a convenience sample of surgical patients by their surgeon following a telehealth consultation during the COVID-19 pandemic. Surgeons were recruited from a sample (n¿=¿683) who completed a survey on telehealth (distributed via email to all Australian Fellows of the Royal Australasian College of Surgeons). Mixed methods analysis was performed of the patient survey data. Results: A total of 1166 consultations were captured: 50% routine reviews, 17% initial appointments and 20% post-operative reviews. Video-link was used in 49% of consultations. The majority of patients (94%), were satisfied with the quality of their surgical telehealth consultation and 75% felt it delivered the same level of care as face-to-face encounters. Telehealth was convenient to use (96%) and led to cost savings for 60% of patients. When asked about future appointment preferences after the pandemic, 41% indicated they would prefer telehealth (24% video-link and 17% telephone) over face-to-face appointments. There was a perception by patients that telehealth consultation fees should be less than face-to-face consultation fees. Conclusion: Patient satisfaction with surgical telehealth consultations is high. Barriers to more widespread implementation include financial, clinical appropriateness, technical and confidentiality concerns.

DOI 10.1111/ans.17020
Citations Scopus - 1
Co-authors Jonathan Gani, Stephen Smith, Lisa Mackenzie
2021 Wiadji E, Mackenzie L, Reeder P, Gani JS, Carroll R, Smith S, et al., 'Utilization of telehealth by surgeons during the COVID 19 pandemic in Australia: lessons learnt.', ANZ J Surg, 91 507-514 (2021) [C1]
DOI 10.1111/ans.16693
Citations Scopus - 1Web of Science - 2
Co-authors Jonathan Gani, Stephen Smith, Lisa Mackenzie
2021 Papachristos AJ, Cherry TJ, Nyandoro MG, Lisewski D, Stevenson S-J, Mercer P, et al., 'Bi-national Review of Phaeochromocytoma Care: Is ICU Admission Always Necessary? (vol 45, pg 790, 2021)', WORLD JOURNAL OF SURGERY, 45 1252-1253 (2021)
DOI 10.1007/s00268-020-05903-6
2021 Wiadji E, Holmes M, Burnett D, O'Neill CJ, 'Retroperitoneal schwannoma: two cases of complete resection via a posterior retroperitoneoscopic approach.', ANZ J Surg, (2021)
DOI 10.1111/ans.16916
2020 Kim KJ, Kim SG, Tan J, Shen X, Viola D, Elisei R, et al., 'BRAF V600E status may facilitate decision-making on active surveillance of low-risk papillary thyroid microcarcinoma', EUROPEAN JOURNAL OF CANCER, 124 161-169 (2020)
DOI 10.1016/j.ejca.2019.10.017
Citations Scopus - 9Web of Science - 11
2019 Rowe CW, Arthurs S, O Neill CJ, Hawthorne J, Carroll R, Wynne K, Bendinelli C, 'High-dose preoperative cholecalciferol to prevent post-thyroidectomy hypocalcaemia: A randomized, double-blinded placebo-controlled trial', Clinical Endocrinology, 90 343-350 (2019) [C1]

Objective: Post-thyroidectomy hypocalcaemia is a significant cause of morbidity and prolonged hospitalization, usually due to transient parathyroid gland damage, treated with calc... [more]

Objective: Post-thyroidectomy hypocalcaemia is a significant cause of morbidity and prolonged hospitalization, usually due to transient parathyroid gland damage, treated with calcium and vitamin D supplementation. We present a randomized, double-blinded placebo-controlled trial of preoperative loading with high-dose cholecalciferol (300¿000 IU) to reduce post-thyroidectomy hypocalcaemia. Patients and Measurements: Patients (n¿=¿160) presenting for thyroidectomy at tertiary hospitals were randomized 1:1 to cholecalciferol (300¿000¿IU) or placebo 7¿days prior to thyroidectomy. Ten patients withdrew prior to surgery. The primary outcome was post-operative hypocalcaemia (corrected calcium <2.1¿mmol/L in first 180¿days). Results: The study included 150 patients undergoing thyroidectomy for Graves¿ disease (31%), malignancy (20%) and goitre (49%). Mean pre-enrolment vitamin D was 72¿±¿26¿nmol/L. Postoperative hypocalcaemia occurred in 21/72 (29%) assigned to cholecalciferol and 30/78 (38%) participants assigned to placebo (P¿=¿0.23). There were no differences in secondary end-points between groups. In pre-specified stratification, baseline vitamin D status did not predict hypocalcaemia, although most individuals were vitamin D replete at baseline. Post-hoc stratification by day 1 parathyroid hormone (PTH) (<10¿pg/mL, low vs =10¿pg/mL, normal) was explored due to highly divergent rates of hypocalcaemia in these groups. Using a Cox regression model, the hazard ratio for hypocalcaemia in the cholecalciferol group was 0.56 (95%CI 0.32-0.98, P¿=¿0.04) after stratification for Day 1 PTH. Further clinical benefits were observed in these subgroups. Conclusions: Pre-thyroidectomy treatment with high-dose cholecalciferol did not reduce the overall rate of hypocalcaemia following thyroidectomy. In subgroups stratified by day 1 PTH status, improved clinical outcomes were noted.

DOI 10.1111/cen.13897
Citations Scopus - 3Web of Science - 5
Co-authors Cino Bendinelli, Katie-Jane Wynne, Christopher W Rowe
2018 Huang Y, Qu S, Zhu G, Wang F, Liu R, Shen X, et al., 'BRAF V600E mutation-assisted risk stratification of solitary intrathyroidal papillary thyroid cancer for precision treatment', Journal of the National Cancer Institute, 110 (2018)

Background: Precise risk stratification-based treatment of solitary intrathyroidal papillary thyroid cancer (SI-PTC) that is larger than 1.0cm and 4.0cm or less is undefined. Meth... [more]

Background: Precise risk stratification-based treatment of solitary intrathyroidal papillary thyroid cancer (SI-PTC) that is larger than 1.0cm and 4.0cm or less is undefined. Methods: A genetic-clinical risk study was performed on BRAF V600E in 955 patients (768 women and 187 men) with SI-PTC, with median age of 46 years and median clinical follow-up time of 64 months at 11 medical centers in six countries. The chisquare test or, for analyses with small numbers, Fisher's exact test was performed to compare recurrence rates. Recurrencefree probability was estimated by Kaplan-Meier (KM) analysis, and the independent effect of BRAF mutation on the recurrence was analyzed by Cox regression and Cox proportional hazard analyses. All statistical tests were two-sided. Results: Recurrence of SI-PTC larger than 1.0cm and 4.0cm or less was 9.5% (21/221) vs 3.4% (11/319) in BRAF mutation vs wild-type BRAF patients, with a hazard ratio (HR) of 3.03 (95% confidence interval [CI] = 1.46 to 6.30) and a patient age- and sex-adjusted hazard ratio of 3.10 (95% CI=1.49 to 6.45, P = .002). Recurrence rates of SI-PTC larger than 2.0cm and 4.0cm or less were 16.5% (13/79) vs 3.6% (5/139) in mutation vs wild-type patients (HR=5.44, 95% CI=1.93 to 15.34; and adjusted HR=5.58, 95% CI=1.96 to 15.85, P = .001). Recurrence rates of SI-PTC larger than 3.0cm and 4 cmor less were 30.0% (6/20) vs 1.9% (1/54) in mutation vs wild-type patients (HR=18.40, 95% CI=2.21 to 152.98; and adjusted HR=14.73, 95% CI=1.74 to 124.80, P = .01). Recurrences of mutation-positive SI-PTC were comparable with those of counterpart invasive solitary PTC, around 20% to 30%, in tumors larger than 2.0cm to 3.0 cm. BRAF mutation was associated with a statistically significant decrease in recurrence-free patient survival on KM analysis, particularly in SI-PTC larger than 2.0cm and 4.0cm or less. Similar results were obtained in conventional SI-PTC. The negative predictive values of BRAF mutation for recurrence were 97.8% (95% CI=96.3% to 98.8%) for general SI-PTC and 98.2% (95% CI=96.3% to 99.3%) for conventional SI-PTC. Conclusions: BRAF V600E identifies a subgroup of SI-PTC larger than 1.0cm and 4.0cm or less, particularly tumors larger than 2.0cm and 4.0cm or less, that has high risk for recurrence comparable with that of invasive solitary PTC, making more aggressive treatment reasonable.

DOI 10.1093/jnci/djx227
Citations Scopus - 32Web of Science - 30
2018 Shen X, Zhu G, Liu R, Viola D, Elisei R, Puxeddu E, et al., 'Patient age-associated mortality risk is differentiated by BRAF V600E status in papillary thyroid cancer', Journal of Clinical Oncology, 36 438-445 (2018)

Purpose For the past 65 years, patient age at diagnosis has been widely used as a major mortality risk factor in the risk stratification of papillary thyroid cancer (PTC), but whe... [more]

Purpose For the past 65 years, patient age at diagnosis has been widely used as a major mortality risk factor in the risk stratification of papillary thyroid cancer (PTC), but whether this is generally applicable, particularly in patients with different BRAF genetic backgrounds, is unclear. The current study was designed to test whether patient age at diagnosis is a major mortality risk factor. Patients and Methods We conducted a comparative study of the relationship between patient age at diagnosis and PTCspecific mortality with respect to BRAF status in 2,638 patients (623 men and 2,015 women) with a median age of 46 years (interquartile range, 35 to 58 years) at diagnosis and a median follow-up time of 58 months (interquartile range, 26 to 107 months). Eleven medical centers from six countries participated in this study. Results There was a linear association between patient age and mortality in patients with BRAF V600E mutation, but not in patients with wild-type BRAF, in whom the mortality rate remained low and flat with increasing age. Kaplan-Meier survival curves rapidly declined with increasing age in patients with BRAF V600E mutation but did not decline in patients with wild-type BRAF, even beyond age 75 years. The association between mortality and age in patients with BRAF V600E was independent of clinicopathologic risk factors. Similar results were observed when only patients with the conventional variant of PTC were analyzed. Conclusion The long-observed age-associated mortality risk in PTC is dependent on BRAF status; age is a strong, continuous, and independent mortality risk factor in patients with BRAF V600E mutation but not in patients with wild-type BRAF. These results question the conventional general use of patient age as a high-risk factor in PTC and call for differentiation between patients with BRAF V600E and wild-type BRAF when applying age to risk stratification and management of PTC.

DOI 10.1200/JCO.2017.74.5497
Citations Scopus - 52Web of Science - 49
2018 Wang F, Zhao S, Shen X, Zhu G, Liu R, Viola D, et al., 'BRAF V600E confers male sex disease-specific mortality risk in patients with papillary thyroid cancer', Journal of Clinical Oncology, 36 2787-2795 (2018)

Purpose To test whether the prognostic risk of male sex in papillary thyroid cancer (PTC) is determined by BRAF V600E and can thus be stratified by BRAF status. Patients and Metho... [more]

Purpose To test whether the prognostic risk of male sex in papillary thyroid cancer (PTC) is determined by BRAF V600E and can thus be stratified by BRAF status. Patients and Methods We retrospectively investigated the relationship between male sex and clinicopathologic outcomes in PTC, particularly mortality, with respect to BRAF status in 2,638 patients (male, n = 623; female, n = 2,015) from 11 centers in six countries, with median age of 46 years (interquartile range, 35-58 years) at diagnosis and median follow-up time of 58 months (interquartile range, 26-107 months). Results Distant metastasis rates in men and women were not different in wild-type BRAF PTC but were different in BRAF V600E PTC: 8.9% (24 of 270) and 3.7% (30 of 817; P = .001), respectively. In wild-type BRAF PTC, mortality rates were 1.4% (five of 349) versus 0.9% (11 of 1175) in men versus women (P = .384), with a hazard ratio (HR) of 1.59 (95% CI, 0.55 to 4.57), which remained insignificant at 0.70 (95% CI, 0.23 to 2.09) after clinicopathologic multivariable adjustment. In BRAF V600E PTC, mortality rates were 6.6% (18 of 272) versus 2.9% (24 of 822) in men versus women (P = .006), with an HR of 2.43 (95% CI, 1.30 to 4.53), which remained significant at 2.74 (95% CI, 1.38 to 5.43) after multivariable adjustment. In conventional-variant PTC, male sex similarly had no effect in wild-type BRAF patients; mortality rates in BRAF V600E patients were 7.2% (16 of 221) versus 2.9% (19 of 662) in men versus women (P = .004), with an HR of 2.86 (95% CI, 1.45 to 5.67), which remained significant at 3.51 (95% CI, 1.62 to 7.63) after multivariable adjustment. Conclusion Male sex is a robust independent risk factor for PTC-specific mortality in BRAF V600E patients but not in wild-type BRAF patients. The prognostic risk of male sex in PTC can thus be stratified by BRAF status in clinical application.

DOI 10.1200/JCO.2018.78.5097
Citations Scopus - 25Web of Science - 24
2016 Shi X, Liu R, Basolo F, Giannini R, Shen X, Teng D, et al., 'Differential clinicopathological risk and prognosis of major papillary thyroid cancer variants', Journal of Clinical Endocrinology and Metabolism, 101 264-274 (2016)

Context: Individualized management, incorporating papillary thyroid cancer (PTC) variant-specific risk, is conceivably a useful treatment strategy for PTC, which awaits comprehens... [more]

Context: Individualized management, incorporating papillary thyroid cancer (PTC) variant-specific risk, is conceivably a useful treatment strategy for PTC, which awaits comprehensive data demonstrating differential risks of PTC variants to support. Objective: This study sought to establish the differential clinicopathological risk of major PTC variants: conventional PTC (CPTC), follicular-variant PTC (FVPTC), and tall-cell PTC (TCPTC). Methods: Thiswasa retrospective study of clinicopathological outcomes of 6282 PTC patients (4799 females and 1483 males) from 26 centers and The Cancer Genome Atlas in 14 countries with a median age of 44 years (interquartile range, 33â¿"56 y) and median follow-up time of 37 months (interquartile range, 15â¿"82 mo). Results: The cohort consisted of 4702 (74.8%) patients with CPTC, 1126 (17.9%) with FVPTC, and 239 (3.8%) with TCPTC. The prevalence of high-risk parameters was significantly different among the three variants, including extrathyroidal invasion, lymph node metastasis, stages III/IV, disease recurrence, mortality, and the use (need) of radioiodine treatment (all P > .001), being highest in TCPTC, lowest in FVPTC, and intermediate in CPTC, following an order of TCPTC>CPTC¿FVPTC. Recurrence and mortality in TCPTC, CPTC, and FVPTC were 27.3 and 6.7%, 16.1 and 2.5%, and 9.1 and 0.6%, corresponding to events per 1000 person-years (95% confidence interval [CI]) of 92.47 (64.66â¿"132.26) and 24.61 (12.31â¿" 49.21), 34.46 (30.71â¿"38.66), and 5.87 (4.37â¿"7.88), and 24.73 (18.34 â¿"33.35) and 1.68 (0.54 â¿"5.21), respectively. Mortality hazard ratios of CPTC and TCPTC over FVPTC were 3.44 (95% CI, 1.07â¿"11.11) and 14.96 (95% CI, 3.93â¿"56.89), respectively. Kaplan-Meier survival analyses showed the best prognosis in FVPTC, worst in TCPTC, and intermediate in CPTC in disease recurrence-free probability and disease-specific patient survival. This was particularly the case in patients at least 45 years old. Conclusion: This large multicenter study demonstrates differential prognostic risks of the three major PTC variants and establishes a unique risk order of TCPTC > CPTC ¿ FVPTC, providing important clinical implications for specific variant-based management of PTC.

DOI 10.1210/jc.2015-2917
Citations Scopus - 127Web of Science - 120
2016 Bullock M, Ren Y, O'Neill C, Gill A, Aniss A, Sywak M, et al., 'TERT promoter mutations are a major indicator of recurrence and death due to papillary thyroid carcinomas', Clinical Endocrinology, 85 283-290 (2016)

Context: TERT promoter mutations have been associated with adverse prognosis in papillary thyroid carcinomas (PTCs). Objective: We investigated the association between TERT promot... [more]

Context: TERT promoter mutations have been associated with adverse prognosis in papillary thyroid carcinomas (PTCs). Objective: We investigated the association between TERT promoter mutations and survival from PTC. Design: Retrospective observational cohort study. Patients: Eighty consecutive patients with PTC who underwent surgery between 1990 and 2003. Measurements: TERT promoter was genotyped in DNA from 80 archival PTCs by Sanger sequencing. Median follow-up was 106¿months (range 1¿270). Outcomes analysis was stratified according to disease and overall survival status. For each parameter, relative risk (RR) adjusted for age at first surgery and gender was estimated. Both univariate and multivariate analyses were performed using logistic regression, Kaplan¿Meier survival analysis and Cox regression models. Results: PTCs from 11 patients (14%) contained either C228T or C250T TERT promoter mutation. TERT mutations were significantly associated with adverse prognostic features such as older age (P¿=¿0·002), male gender (P¿=¿0·01) and Stage IV disease (P¿=¿0·03). Four patients died from PTC during follow-up: 3 patients with TERT mutations (27%) and one without (1·5%). Disease-related mortality rate with or without TERT mutations was 33·7 vs 1·6 per 1000 patient-years respectively, that is 10 (95% CI¿=¿1·0¿104·1, P¿=¿0·05) fold higher, after adjustment for age at first surgery and gender. The combination of TERT promoter mutation and BRAFV600E significantly increased disease-related death risk (P¿=¿0·002). TERT mutations increased expression of a reporter gene in thyroid cells containing BRAFV600E. Conclusions: TERT promoter mutations are a major indicator of death due to PTCs. Conversely, absence of TERT mutations portends better survival.

DOI 10.1111/cen.12999
Citations Scopus - 34Web of Science - 37
2015 Chou A, Fraser S, Toon CW, Clarkson A, Sioson L, Farzin M, et al., 'A detailed clinicopathologic study of ALK-translocated papillary thyroid carcinoma', American Journal of Surgical Pathology, 39 652-659 (2015)

Pathogenic ALK translocations have been reported in papillary thyroid carcinoma (PTC). We developed and validated a screening algorithm based on immunohistochemistry (IHC), follow... [more]

Pathogenic ALK translocations have been reported in papillary thyroid carcinoma (PTC). We developed and validated a screening algorithm based on immunohistochemistry (IHC), followed by fluorescence in situ hybridization (FISH) in IHC-positive cases to identify ALK-rearranged PTC. IHC and FISH were performed in a cohort of 259 thyroid carcinomas enriched for aggressive variants. IHC was positive in 8 cases, 6 confirmed translocated by FISH (specificity 75%). All 251 IHC-negative cases were FISH negative (sensitivity 100%). Having validated this approach, we performed screening IHC, followed by FISH in IHC-positive cases in an expanded cohort. ALK translocations were identified in 11 of 498 (2.2%) of all consecutive unselected PTCs and 3 of 23 (13%) patients with diffuse sclerosing variant PTCs. No ALK translocations were identified in 36 PTCs with distant metastases, 28 poorly differentiated (insular) carcinomas, and 20 anaplastic carcinomas. All 14 patients with ALK translocations were female (P=0.0425), and translocations occurred at a younger age (mean 38 vs. 48 y, P=0.0289 in unselected patients). ALK translocation was an early clonal event present in all neoplastic cells and mutually exclusive with BRAF V600E mutation. ALK translocation was not associated with aggressive clinicopathologic features (size, stage, metastasis, vascular invasion, extrathyroidal extension, multifocality, risk for recurrence, radioiodine resistance). We conclude that 2.2% of PTCs are ALK-translocated and can be identified by screening IHC followed by FISH. ALK translocations may be more common in young females and diffuse sclerosing variant PTC but do not connote more aggressive disease.

DOI 10.1097/PAS.0000000000000368
Citations Scopus - 55Web of Science - 52
2015 Xing M, Alzahrani AS, Carson KA, Shong YK, Kim TY, Viola D, et al., 'Association between BRAF V600E mutation and recurrence of papillary thyroid cancer', Journal of Clinical Oncology, 33 42-50 (2015)

Purpose: To investigate the prognostic value of BRAFV600E mutation for the recurrence of papillary thyroid cancer (PTC) Patients and Methods: This was a retrospective multicenter ... [more]

Purpose: To investigate the prognostic value of BRAFV600E mutation for the recurrence of papillary thyroid cancer (PTC) Patients and Methods: This was a retrospective multicenter study of the relationship between BRAF V600E mutation and recurrence of PTC in 2,099 patients (1,615 women and 484 men), with a median age of 45 years (interquartile range [IQR], 34 to 58 years) and a median follow-up time of 36 months (IQR, 14 to 75 months) Results: The overall BRAF V600E mutation prevalence was 48.5% (1,017 of 2,099). PTC recurrence occurred in 20.9% (213 of 1,017) of BRAFV600E mutation-positive and 11.6% (125 of 1,082) of BRAFV600E mutation-negative patients. Recurrence rates were 47.71 (95% CI, 41.72 to 54.57) versus 26.03 (95% CI, 21.85 to 31.02) per 1,000 person-years in BRAF mutation-positive versus - Negative patients (P <.001), with a hazard ratio (HR) of 1.82 (95% CI, 1.46 to 2.28), which remained significant in a multivariable model adjusting for patient sex and age at diagnosis, medical center, and various conventional pathologic factors. Significant association between BRAF mutation and PTC recurrence was also found in patients with conventionally low-risk disease stage or II and micro-PTC and within various subtypes of PTC. For example, in BRAF mutation-positive versus - Negative follicular-variant PTC, recurrence occurred in 21.3% (19 of 89) and 7.0% (24 of 342) of patients, respectively, with recurrence rates of 53.84 (95% CI, 34.34 to 84.40) versus 19.47 (95% CI, 13.05 to 29.04) per 1,000 person-years (P <.001) and an HR of 3.20 (95% CI, 1.46 to 7.02) after adjustment for clinicopathologic factors. BRAF mutation was associated with poorer recurrence-free probability in Kaplan-Meier survival analyses in various clinicopathologic categories. Conclusion: This large multicenter study demonstrates an independent prognostic value of BRAF V600E mutation for PTC recurrence in various clinicopathologic categories.

DOI 10.1200/JCO.2014.56.8253
Citations Scopus - 316Web of Science - 302
2014 O'Neill CJ, Coorough N, Lee JC, Clements J, Delbridge LW, Sippel R, et al., 'Disease outcomes and nodal recurrence in patients with papillary thyroid cancer and lateral neck nodal metastases', ANZ Journal of Surgery, 84 240-244 (2014)

Background: The prognostic influence of lateral neck nodal metastases present at the time of diagnosis of papillary thyroid cancer (PTC) remains controversial. This study aims to ... [more]

Background: The prognostic influence of lateral neck nodal metastases present at the time of diagnosis of papillary thyroid cancer (PTC) remains controversial. This study aims to document disease outcomes and nodal recurrence rates in such patients. Methods: Patients with PTC and lateral neck nodal metastases who underwent concurrent total thyroidectomy, central and lateral compartment neck dissection between 2000 and 2010 were identified from the prospectively maintained surgical databases of The University of Sydney and University of Wisconsin Endocrine Surgical Units. Disease outcomes and nodal recurrence rates were compared at 12 months post-operatively and in longer-term follow-up. Results: During this 11-year period, 121 patients were identified. Mean age was 45 years; 58% were female and 98% underwent post-operative radioactive iodine ablation. At a median follow-up of 31 months (range 12-140), there were no disease-specific deaths and disease-free survival (defined by stimulated serum thyroglobulin (Tg) < 2.0µg/L, negative clinical and radiological examination) was 66%. Of the 50 patients with persistently elevated Tg measured 12 months post-operatively, 15 developed clinical lateral neck nodal recurrence. All have undergone re-operative surgery. Elevated stimulated Tg at 12 months post-operatively and a nodal ratio of >30% were significantly associated with an increased risk of lateral neck nodal recurrence. Conclusion: With total thyroidectomy, formal compartmental neck dissection and radioactive iodine treatment, disease-free survival can be achieved in the majority of patients with PTC and synchronous lateral neck nodal metastases. A persistently elevated Tg post-operatively and a high ratio of metastatic nodes identify patients at increased risk of locoregional recurrence. © 2013 Royal Australasian College of Surgeons.

DOI 10.1111/ans.12045
Citations Scopus - 14Web of Science - 12
2013 Xing MM, Alzahrani AS, Carson KA, Viola D, Elisei R, Bendlova B, et al., 'Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer', JAMA - Journal of the American Medical Association, 309 1493-1501 (2013)

Importance: BRAF V600E is a prominent oncogene in papillary thyroid cancer (PTC), but its role in PTC-related patient mortality has not been established. Objective: To investigate... [more]

Importance: BRAF V600E is a prominent oncogene in papillary thyroid cancer (PTC), but its role in PTC-related patient mortality has not been established. Objective: To investigate the relationship between BRAF V600E mutation and PTC-related mortality. Design, Setting, and Participants: Retrospective study of 1849 patients (1411 women and 438 men) with amedian age of 46 years (interquartile range, 34-58 years) and an overall median follow-up time of 33 months (interquartile range, 13-67 months) after initial treatment at 13 centers in 7 countries between 1978 and 2011. Main Outcomes and Measures: Patient deaths specifically caused by PTC. Results: Overall, mortality was 5.3% (45/845; 95% CI, 3.9%-7.1%) vs 1.1% (11/1004; 95% CI, 0.5%-2.0%) ( P < .001) in BRAF V600E-positive vs mutationnegative patients. Deaths per 1000 person-years in the analysis of all PTC were 12.87 (95% CI, 9.61-17.24) vs 2.52 (95% CI, 1.40-4.55) in BRAF V600E-positive vs mutation-negative patients; the hazard ratio (HR) was 2.66 (95% CI, 1.30-5.43) after adjustment for age at diagnosis, sex, and medical center. Deaths per 1000 person-years in the analysis of the conventional variant of PTC were 11.80 (95% CI, 8.39-16.60) vs 2.25 (95% CI, 1.01-5.00) in BRAF V600E-positive vs mutation-negative patients; the adjusted HR was 3.53 (95% CI, 1.25-9.98). When lymph node metastasis, extrathyroidal invasion, and distant metastasis were also included in the model, the association of BRAF V600E with mortality for all PTC was no longer significant (HR, 1.21; 95% CI, 0.53-2.76). A higher BRAF V600E-associated patient mortality was also observed in several clinicopathological subcategories, but statistical significance was lost with adjustment for patient age, sex, and medical center. For example, in patients with lymph node metastasis, the deaths per 1000 person-years were 26.26 (95% CI, 19.18-35.94) vs 5.93 (95% CI, 2.96-11.86) in BRAF V600E-positive vs mutation-negative patients (unadjusted HR, 4.43 [95% CI, 2.06-9.51]; adjusted HR, 1.46 [95% CI, 0.62-3.47]). In patients with distant tumor metastasis, deaths per 1000 person-years were 87.72 (95% CI, 62.68-122.77) vs 32.28 (95% CI, 16.14-64.55) in BRAF V600E-positive vs mutation-negative patients (unadjusted HR, 2.63 [95% CI, 1.21-5.72]; adjusted HR, 0.84 [95% CI, 0.27-2.62]). Conclusions and Relevance: In this retrospective multicenter study, the presence of the BRAF V600E mutation was significantly associated with increased cancer-related mortality among patients with PTC. Because overall mortality in PTC is low and the association was not independent of tumor features, how to use BRAF V600E to manage mortality risk in patients with PTC is unclear. These findings support further investigation of the prognostic and therapeutic implications of BRAF V600E status in PTC. ©2013 American Medical Association. All rights reserved.

DOI 10.1001/jama.2013.3190
Citations Scopus - 586Web of Science - 559
2012 Vasica G, O'Neill CJ, Sidhu SB, Sywak MS, Reeve TS, Delbridge LW, 'Reoperative surgery for bilateral multinodular goitre in the era of total thyroidectomy', BRITISH JOURNAL OF SURGERY, 99 688-692 (2012)
DOI 10.1002/bjs.8684
Citations Scopus - 27Web of Science - 26
2012 Bullock M, Duncan EL, O'Neill C, Tacon L, Sywak M, Sidhu S, et al., 'Association of FOXE1 Polyalanine Repeat Region with Papillary Thyroid Cancer', JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 97 E1814-E1819 (2012)
DOI 10.1210/jc.2012-1456
Citations Scopus - 47Web of Science - 40
2012 Prichard RS, O'Neill CJ, Oucharek JJ, Sippel RS, Delbridge LW, Sidhu SB, Chen H, 'Is Focused Minimally Invasive Parathyroidectomy Appropriate for Patients With Familial Primary Hyperparathyroidism?', ANNALS OF SURGICAL ONCOLOGY, 19 1264-1268 (2012)
DOI 10.1245/s10434-011-2092-6
Citations Scopus - 4Web of Science - 4
2012 Prichard RS, O'Neill CJ, Oucharek JJ, Colinda YH, Delbridge LW, Sywak MS, 'A Prospective Study of Heart Rate Variability in Endocrine Surgery: Surgical Training Increases Consultant's Mental Strain', JOURNAL OF SURGICAL EDUCATION, 69 453-458 (2012)
DOI 10.1016/j.jsurg.2012.04.002
Citations Scopus - 10Web of Science - 12
2012 Bullock M, O'Neill C, Chou A, Clarkson A, Dodds T, Toon C, et al., 'Utilization of a MAB for BRAF(V600E) detection in papillary thyroid carcinoma', ENDOCRINE-RELATED CANCER, 19 779-784 (2012)
DOI 10.1530/ERC-12-0239
Citations Scopus - 58Web of Science - 58
2011 O'Neill CJ, Chan C, Symons J, Learoyd DL, Sidhu SB, Delbridge LW, et al., 'Parathyroid Carcinoma Encountered After Minimally Invasive Focused Parathyroidectomy may not Require Further Radical Surgery', WORLD JOURNAL OF SURGERY, 35 147-153 (2011)
DOI 10.1007/s00268-010-0826-4
Citations Scopus - 10Web of Science - 9
2011 O'Neill CJ, Vaughan L, Learoyd DL, Sidhu SB, Delbridge LW, Sywak MS, 'Management of follicular thyroid carcinoma should be individualised based on degree of capsular and vascular invasion', EJSO, 37 181-185 (2011)
DOI 10.1016/j.ejso.2010.11.005
Citations Scopus - 75Web of Science - 72
2011 Oucharek JJ, O'Neill CJ, Suliburk JW, Sywak MS, Delbridge LW, Sidhu SB, 'Durability of Focused Minimally Invasive Parathyroidectomy in Young Patients with Sporadic Primary Hyperparathyroidism', ANNALS OF SURGICAL ONCOLOGY, 18 1290-1292 (2011)
DOI 10.1245/s10434-010-1417-1
Citations Scopus - 1Web of Science - 1
2011 Prichard RS, O'Neill CJ, O'Hara JL, Atmore BB, Hassall M, 'Pseudoangiomatous stromal hyperplasia of the breast: an unusual pathology necessitating bilateral mastectomy during pregnancy', ANZ JOURNAL OF SURGERY, 81 304-305 (2011)
DOI 10.1111/j.1445-2197.2011.05688.x
Citations Scopus - 6Web of Science - 5
2011 Chang L-Y, O'Neill C, Suliburk J, Sidhu S, Delbridge L, Sywak M, 'Sutureless total thyroidectomy: a safe and cost-effective alternative', ANZ JOURNAL OF SURGERY, 81 510-514 (2011)
DOI 10.1111/j.1445-2197.2010.05492.x
Citations Scopus - 36Web of Science - 35
2011 O'Neill CJ, Chang L-Y, Suliburk JW, Sidhu SB, Delbridge LW, Sywak MS, 'Sutureless thyroidectomy: surgical technique', ANZ JOURNAL OF SURGERY, 81 515-518 (2011)
DOI 10.1111/j.1445-2197.2010.05493.x
Citations Scopus - 18Web of Science - 11
2011 Brown S, O'Neill C, Suliburk J, Sidhu S, Sywak M, Gill A, et al., 'Parathyroid carcinoma: increasing incidence and changing presentation', ANZ JOURNAL OF SURGERY, 81 528-532 (2011)
DOI 10.1111/j.1445-2197.2010.05594.x
Citations Scopus - 26Web of Science - 18
2010 O'Neill CJ, Spence A, Logan B, Suliburk JW, Soon PS, Learoyd DL, et al., 'Adrenal Incidentalomas: Risk of Adrenocortical Carcinoma and Clinical Outcomes', JOURNAL OF SURGICAL ONCOLOGY, 102 450-453 (2010)
DOI 10.1002/jso.21553
Citations Scopus - 30Web of Science - 26
2010 O'Neill CJ, Bullock M, Chou A, Sidhu SB, Delbridge LW, Robinson BG, et al., 'BRAF(V600E) mutation is associated with an increased risk of nodal recurrence requiring reoperative surgery in patients with papillary thyroid cancer', SURGERY, 148 1139-1145 (2010)
DOI 10.1016/j.surg.2010.09.005
Citations Scopus - 87Web of Science - 78
2010 O'Neill CJ, Oucharek J, Learoyd D, Sidhu SB, 'Standard and Emerging Therapies for Metastatic Differentiated Thyroid Cancer', ONCOLOGIST, 15 146-156 (2010)
DOI 10.1634/theoncologist.2009-0190
Citations Scopus - 47Web of Science - 45
2008 O'Neill CJ, Gillies DM, Gani JS, 'Choledocholithiasis: Overdiagnosed endoscopically and undertreated laparoscopically', ANZ JOURNAL OF SURGERY, 78 487-491 (2008) [C1]
DOI 10.1111/j.1445-2197.2008.04540.x
Citations Scopus - 28Web of Science - 20
Co-authors Jonathan Gani
2008 O'Neill CJ, Gan J, 'Ischaemic colitis in an ironman triathlete: A case report and review of the literature', SURGICAL PRACTICE, 12 71-72 (2008)
DOI 10.1111/j.1744-1633.2008.00398.x
Citations Scopus - 1
Show 29 more journal articles

Conference (2 outputs)

Year Citation Altmetrics Link
2020 Wiadji E, Blefari N, Rowe CW, Fradgley E, O'Neill CJ, '2020 Hunter Cancer Research Symposium Program', ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY (2020)
DOI 10.1111/ajco.13467
Co-authors Christopher W Rowe, Elizabeth Fradgley
2020 Rowe C, Blefari N, Rutherford N, Bendinelli C, O'Neill C, 'Quality of Life Following Treatment for Graves Disease: A Comparison of Radioactive Iodine Ablation and Surgery', San Fransisco, USA (2020)
DOI 10.1210/jendso/bvaa046
Co-authors Cino Bendinelli, Christopher W Rowe
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Grants and Funding

Summary

Number of grants 4
Total funding $55,223

Click on a grant title below to expand the full details for that specific grant.


20202 grants / $14,242

Mitochondrial Mass and Activity in Parathyroid Disease$12,162

Funding body: John Hunter Charitable Trust

Funding body John Hunter Charitable Trust
Project Team

Dr Cino Bendinelli, Dr Christine O'Neill

Scheme John Hunter Charitable Trust Grant
Role Investigator
Funding Start 2020
Funding Finish 2020
GNo
Type Of Funding Internal
Category INTE
UON N

Quality of Life after Thyroid Disease $2,080

Funding body: HCRA Hunter Cancer Research Alliance

Funding body HCRA Hunter Cancer Research Alliance
Project Team

Dr Christine O'Neill, Dr Nicholas Blefari, Dr Christopher Rowe, Rosemary Carroll, Dr Elvina Wiadji

Scheme Statistical Support
Role Lead
Funding Start 2020
Funding Finish 2020
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

20192 grants / $40,981

Quality of Life Assessment in Thyroid Cancer – A Pilot Study to Evaluate Quality of Life Assessment Tools$20,918

Funding body: HCRA Hunter Cancer Research Alliance

Funding body HCRA Hunter Cancer Research Alliance
Project Team

Dr Christine O'Neill, Dr Liz Fradgley, Dr Nicholas Blefari, Dr Christopher Rowe, Rosemary Carroll

Scheme Implementation Science and Impact Flagship Program
Role Lead
Funding Start 2019
Funding Finish 2020
GNo
Type Of Funding C1700 - Aust Competitive - Other
Category 1700
UON N

Quality of Life After Thyroid Disease$20,063

Funding body: John Hunter Charitable Trust Grant

Funding body John Hunter Charitable Trust Grant
Project Team

Dr Cino Bendinelli, Dr Christine O'Neill

Scheme John Hunter Charitable Trust Grant
Role Investigator
Funding Start 2019
Funding Finish 2019
GNo
Type Of Funding Internal
Category INTE
UON N
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Dr Christine O'Neill

Position

Conjoint Associate Professor
School of Medicine and Public Health
College of Health, Medicine and Wellbeing

Contact Details

Email christine.oneill@newcastle.edu.au
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