ObjectiveTo explore the influencing factors affecting lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) and construct a clinical nomogram prediction model to provide a reference for LN-prRLN dissection decision-making. MethodsThe clinical data of PTC patients admitted to the General Surgery Department of Baoding No.1 Central Hospital from January 2021 to December 2023 were retrospectively analyzed. Among them, 325 patients underwent LN-prRLN dissection, and they were divided into non-metastatic group (269 cases) and metastasis group (56 cases) according to the presence or absence of LN-prRLN metastasis. By comparing the differences of clinical and pathological characteristics between the two groups, the risk factors of LN-prRLN metastasis were analyzed and discussed, and then the nomogram prediction model of LN-prRLN metastasis was constructed with the risk factors, and the effectiveness of the model was verified and evaluated. ResultsIn 325 patients, 56 cases (17.23%) occurred LN-prRLN metastasis. The results of univariate analysis showed that gender, extrathyroidal extension, lymph nodes anterior to right recurrent laryngeal nerve (LN-arRLN) metastasis, location of cancer focus, and lateral lymph node metastasis (LLNM) were related to LN-prRLN metastasis of PTC (P<0.05). Multivariate binary logistic regression analysis showed that male [OR=3.878, 95%CI (1.192, 12.615)], with extrathyroidal extension [OR=2.836, 95%CI (1.036, 7.759)], with LN-arRLN metastasis [OR=10.406, 95%CI (3.225, 33.926)], right cancer focus [OR= 5.632, 95%CI (1.812, 17.504)] and with LLNM [OR=3.426, 95%CI (1.147, 10.231)] were the risk factors of LN-prRLN metastasis. Receiver operating characteristic curves of nomogram prediction model based on the above risk factors showed that the area under the curve was 0.865, 95%CI was (0.795, 0.934), Jordan index was 0.729, sensitivity was 0.873, and specificity was 0.856, which had higher prediction value. The C-index of Bootstrap test was 0.840 [95%CI (0.755, 0.954) ]. Calibration curves showed that predictive value close to the ideal curve, had good consistency. The clinical decision curve analysis showed that the model had good clinical prediction effect on LN-prRLN metastasis of PTC. ConclusionsMale, extrathyroidal extension, LN-arRLN metastasis, right cancer focus and LLNM are independent risk factors for LN-prRLN metastasis of PTC. The nomogram prediction model based on the above independent risk factors has high discrimination and calibration, which is helpful for surgeons to make clinical decisions.
ObjectiveTo investigate the risk factors affecting cervical central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) in patients with papillary thyroid carcinoma (PTC). MethodsThe patients with newly diagnosed with PTC who underwent surgical treatment in this hospital from April 2020 to December 2023 were included. The univariate and multivariate logistic regression analyses were conducted to identify the risk factors affecting the occurrences of CLNM and LLNM in patients with PTC and a prediction model was developed using these risk factors. Additionally, the discriminatory power of the predictive model for CLNM or LLNM was evaluated using the area under the receiver operating characteristic curve (AUC). ResultsA total of 297 patients with PTC were included in this study, among whom 149 (50.2%) cases developed CLNM, and 41 (13.8%) cases developed LLNM. The multivariate analysis indicated that the male, age <36 years old, and maximum tumor diameter >5 mm were the independent risk factors for CLNM in the patients with PTC (P<0.05). The independent risk factors for LLNM in the patients with PTC were the age ≥59 years old, bilateral or isthmus distribution of cancer foci, maximum tumor diameter >5 mm, and invasion of capsule (P<0.05). The AUC (95%CI) of the CLNM prediction model, constructed using three risk factors (gender, age, and maximum tumor diameter), was 0.693 (0.633, 0.752). For the LLNM prediction model, which incorporated four factors [age, distribution of cancer foci, maximum tumor diameter, and capsular invasion], the AUC (95%CI) was 0.776 (0.707, 0.846). ConclusionsThe findings of this study suggest that younger male patients with PTC (age <36 years), and a maximum tumor diameter >5 mm have a higher risk of CLNM. However, the predictive model constructed for CLNM demonstrates only moderate discriminatory power. In contrast, elderly patients (age ≥59 years old) with PTC exhibiting a maximum tumor diameter >5 mm, capsular invasion, and bilateral (or isthmus) lesions are at greater risk of LLNM. The predictive model developed for LLNM shows a certain discriminatory performance.
ObjectiveTo summarize the research progress of related genes in Hashimoto’s thyroiditis with papillary thyroid carcinoma.MethodLiteratures about Hashimoto’s thyroiditis with papillary thyroid carcinoma were reviewed by searching the literatures in domestic and foreign database.ResultsIn recent years, the incidence of Hashimoto’s thyroiditis with thyroid carcinoma (especially papillary thyroid carcinoma) was on the increase, the two might have the same molecular pathology mechanism.ConclusionThere is a close association between Hashimoto’s thyroiditis and papillary thyroid carcinoma, the common molecular genetic changes suggest that Hashimoto’s thyroiditis may have a correlation with papillary thyroid carcinoma.
In recent years, with the improvement of the sensitivity of examination equipment and the change of people's living environment and diet, the rate of thyroid cancer has risen rapidly, which has increased nearly five folds in 10 years. The pathogenesis, clinical manifestation, biological behavior, treatment and prognosis of thyroid carcinoma of different pathological types are obviously different. Papillary thyroid carcinoma (PTC) can develop at any age, which accounts for about 90% of thyroid cancer. It progresses slowly and has favourable prognosis, but lymph node metastasis appears easily. Whether PTC is accompanied by lymph node metastasis has an important impact on its prognosis and outcome. The Raf murine sarcoma viral oncogene homolog B(BRAF)gene mutation plays a crucial role in PTC lymph node metastasis. Having an in-depth understanding of the specific role and mechanism of BRAF gene mutation in PTC is expected to provide new ideas for diagnosis and treatment of PTC.
ObjectiveTo summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection. MethodsA retrospective review was conducted, we collected clinical data from 47 patients with papillary thyroid carcinoma who underwent transoral endoscopic thyroidectomy and lateral neck lymph node dissection at our hospital from January 2021 to May 2023. A stepwise sequential treatment plan was adopted for patients with postoperative lymphatic leakage: low-fat, low-protein diet, continuous strong negative pressure suction, subcutaneous injection of Group A streptococcus in the surgical cavity, and ligation of the thoracic duct or lymphatic vessels through a small incision. The effectiveness of the sequential treatment plan was summarized. ResultsOut of the 47 patients, lymphatic leakage occurred in 5 cases postoperatively. Patient No.1 was cured of lymphatic leakage after sequential treatments including pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, subcutaneous injection of Group A streptococcus in the surgical cavity, and finally ligation of the thoracic duct or lymphatic vessels through a small incision. Patient No.20 was conservatively cured of lymphatic leakage with an initial surgical procedure involving pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, and subcutaneous injection of Group A streptococcus in the surgical cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1, Patient No.36 was the same as Patient No.20. Through the stepwise sequential treatment measures, all 5 patients successfully recovered from lymphatic leakage; the postoperative hospital stay ranged from 3 to 17 days, with an average of 8.6 days. ConclusionsThe stepwise sequential treatment plan used in this study can effectively prevent and treat lymphatic leakage after transoral endoscopic thyroid cancer lateral neck lymph node dissection. Given the small sample size of this study, we believe that it is necessary to conduct long-term studies to confirm the durability and stability of these measures.
ObjectiveTo systematically evaluate effectiveness and safety of total thyroidectomy(TT) plus prophylactic central neck dissection(PCND) versus TT for stage cN0 papillary thyroid carcinoma(PTC).
MethodsDatabases including PubMed, EMbase, The Cochrane Library(Issue1, 2015), WanFang Data, CBM, and CNKI were searched to collect the randomized controlled trails(RCTs) and non-RCTs about TT+PCND versus TT for stage cN0 PTC. The retrieval time was from inception to March 2015. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated independently by 2 reviewers. Then the meta-analysis was conducted using RevMan 5.1 software.
ResultsA total of 10 non-RCTs involving 3 661 patients were included. There were 1 774 cases in the TT+PCND group and 1 887 cases in the TT group. The results of meta-analysis showed that: Related to postoperative complications, compared with TT group, the postoperative transient hypocalcemia rate〔OR=0.40, 95% CI(0.33, 0.49), P < 0.000 01〕and permanent hypocalcemia rate were higher〔OR=0.32, 95% CI(0.19, 0.55), P < 0.000 1〕, the recurrence rate was lower〔OR=1.51, 95% CI(1.07, 2.13), P=0.02〕in the TT+PCND group. But there were no differences in the transient laryngeal nerve palsy rate〔OR=0.73, 95% CI(0.49, 1.09), P=0.13〕and permanent laryngeal nerve palsy rate〔OR=0.87, 95% CI(0.50, 1.52), P=0.62〕between the 2 groups.
ConclusionsTT+PCND is superior to TT in treating stage cN0 PTC for it's lower recurrence, but it is raising transient hypocalcemia and permanent hypocalcemia rate at the same time. And it is similar as TT in transient laryngeal nerve palsy and permanent laryngeal nerve palsy rate. So TT+PCND is safe and feasible for treating stage cN0 PTC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for stage cN0 PTC patients according to an integrative disease assessment.
Objective
To investigate influence of iodine-131 (131I) treatment following total thyroidectomy on menstrual rhythm and fertility of childbearing age patients with papillary thyroid carcinoma (PTC).
Methods
The clinical data of 342 childbearing age patients with PTC treated with total thyroidectomy from January 2007 to December 2016 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. The patients were designed to 131I treatment group (126 cases) and non-131I treatment group (216 cases) according to the postoperative treatment. The menstrual rhythm and pregnancy after operation were regularly followed-up on postoperative 1 month. The age, nationality, occupation, menstrual rhythm, and pregnancy were analyzed by two independent samples t or Chi-square or Fisher test.
Results
① There were no significant differences in the age, nationality, and occupation between the 131I treatment group and the non-131I treatment group (P>0.05). ② Compared with the non-131I treatment group, the proportions of the irregular menstruation were significantly increased on the 1st month and 3rd month of follow-up (P<0.05) in the131I treatment group, which had no statistically significant differences on the 6th month and 12th month of follow-up in two groups (P>0.05). Further the analysis results of the age stratification showed that had no significant differences at different follow-up time in these two groups (P>0.05). ③ The success rate of pregnancy also had no significant differences in these two groups both in the general and the age stratification analysis results (P>0.05).
Conclusions
131I treatment following total thyroidectomy can affect menstrual rhythm of women in childbearing age at the early stage (within 6 months), but there is no abnormal menstruation on 6 months later, which dosen’t effect on pregnancy in women of childbearing age, and it is recommended that pregnancy should be renewed in 1-year after 131I treatment.
ObjectiveTo investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.ResultsCLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.ConclusionsCLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.
ObjectiveTo compare the differences of curative effect, cosmetic effect, and shoulder-neck function protection effect between video-assisted lateral neck dissection (VALND) and traditional open thyroid surgery (OTS) in the treatment of papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis. MethodsFifty patients with unilateral PTC accompanied by ipsilateral cervical lymph node metastasis who underwent sternal incision approach VALND at Cancer Hospital Affiliated to Fudan University and Pudong Hospital Affiliated to Fudan University from January 2013 to December 2019 were collected. And 100 patients with unilateral PTC and ipsilateral cervical lymph node metastasis who underwent OTS during the same period were randomly selected at a ratio of 1∶2 using the random number method. All patients underwent unilateral thyroid lobectomy (or total thyroid lobectomy) + isthmus resection + central area (zone Ⅵ) and cervical lymph node dissection on the affected side (zones Ⅱ–Ⅴ). The therapeutic effect was compared between the two groups. ResultsCompare to OTS group, the operation time of VALND group was longer ［(218.3±86.6) min vs. (185.7±42.8) min, P=0.002］, but the hospital stay was shortened ［(6.1±2.2) d vs. (7.3±1.6) d, P<0.001］. In terms of surgical efficacy, there were no statistically significant differences between VALND group and OTS group in the number of lymph node dissections, the number of lymph node metastases, and the postoperative tumor recurrence rate (P>0.05). As for surgical safety, the two groups had similar rates of postoperative complications including recurrent laryngeal nerve injury, hypoparathyroidism, postoperative hematoma and infection(P>0.05). In terms of postoperative recovery, the scar color, vascular distribution, thickness, and softness, as well as in shoulder stiffness, tightness, pain, and numbness scores of VALND group were significantly lower than those in OTS group (P<0.05). ConclusionsFor PTC patients with lateral cervical lymph node metastasis, there is no significant difference in surgical efficacy and safety between VALND and OTS. However, VALND shows obvious advantages in reducing the length of cervical incisions, improving cosmetic effects, and protecting cervical and shoulder functions. Therefore, VALND through the sternal notch approach has certain promotion and application value in clinical practice.
ObjectiveTo investigate the correlation between the expressions of bone morphogenetic protein 4 (BMP4) and sma and mad homologue 4 (Smad4) and their clinicopathological features in papillary thyroid carcinoma (PTC).MethodsEighty patients with PTC confirmed by pathology in the Pingdingshan Second People’s Hospital from March 2018 to March 2020 were selected as the research objects, the cancer tissues and adjacent tissues removed during surgery were collected. The mRNA expression levels of BMP4 and Smad4 were detected by real-time quantitative PCR (qRT-PCR). The correlation between BMP4 and Smad4 mRNA expression levels was analyzed by Pearson method. The expressions of BMP4 and Smad4 protein were detected by immunohistochemistry. The correlation between the expressions of BMP4 and Smad4 protein and clinicopathological features of PTC was analyzed.ResultsThe mRNA expression levels of BMP4 and Smad4 in PTC tissues were lower than those in adjacent tissues (P<0.05). Pearson analysis showed that there was a positive correlation between expressions of BMP4 mRNA and Smad4 mRNA in PTC cancer (r=0.660, P<0.05). BMP4 and Smad4 protein were localized in cytoplasm, and the cytoplasm was stained yellow or brown yellow. The results of immunohistochemistry showed that the expression positive rate of BMP4 in cancer tissues of PTC patients was lower than that in adjacent tissues (18.8% vs 97.5%, χ2=101.916, P<0.05), and the expression positive rate of Smad4 protein in cancer tissues of PTC patients was also lower than that in adjacent tissues (11.3% vs 93.8%, χ2=109.173, P<0.05). The expressions of BMP4 and Smad4 protein in PTC patients were correlated with the tumor size, TNM stage, lymph node metastasis, degree of infiltration and multiple foci (P<0.05).ConclusionsThe expression levels of BMP4 mRNA and Smad4 mRNA in PTC tissues are decreased, and the expression of BMP4 protein and Smad4 protein are closely related to tumor size, TNM stage and lymph node metastasis, which may be used as new therapeutic targets.
