ObjectiveTo develop and validate a nomogram for predicting overall survival among patients with breast apocrine carcinoma (BAC). MethodsThe patients diagnosed with BAC from 2010 to 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database and then randomly divided into a training set and a validation set by a 7∶3 ratio. Additionally, external validation of the nomogram was conducted on BAC patients admitted to the Dongfeng Hospital Affiliated to Hubei Medical College from January 1, 2010 to December 31, 2018. The risk factors affecting the overall survival of BAC patients were determined by univariate and multivariate Cox regression analyses, which were used to develop the nomogram prediction model. The discriminative abilities of the nomogram for the 3- and 5-year overall survival rates were evaluated by the C-index and area under receiver operating characteristic curve (AUC), and the fit of actual data and nomogram-predicted data for calibrators should be evaluated. ResultsA total of 649 BAC patients who met the included criterion for this study were enrolled from the SEER database (including 454 in the training set and 195 in the internal validation set), and 21 BAC patients from the Dongfeng Hospital (external validation set) were included. The multivariate Cox regression analysis showed that the age, T stage, M stage, S stage, surgical method, and chemotherapy were the risk factors affecting the overall survival of BAC patients. The C-index values of the nomogram prediction model based on these risk factors was 0.76, 0.77, and 0.88 in the training set, internal validation set, and external validation set, respectively. The calibration curves of the actual 3- and 5-year overall survival rates and nomogram-predicted 3- and 5- year overall survival rates were close to the ideal curve. The AUCs (95%CI) of the nomogram prediction model for evaluating the 3-year and 5-year overall survival rates of BAC patients were 0.84 (0.78, 0.89) and 0.76 (0.71, 0.83) in the training set, 0.81 (0.73, 0.91) and 0.84 (0.77, 0.91) in the internal validation set, and 0.80 (0.70, 0.91) and 0.84 (0.76, 0.91) in the external validation set, respectively. ConclusionNomogram based on the SEER database to predict the overall survival of BAC patients has a good predictive effect for BAC patients.
ObjectiveTo analyze the clinical and pathological features of multifocal papillary thyroid carcinoma, and to assess the value and safety of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma. MethodsClinical data of 103 patients with multifocal papillary thyroid carcinoma, who underwent total thyroidectomy plus prophylactic central lymph node dissection in Affliated Dongfeng Hospital from June 2011 to February 2015 were collected retrospectively. Preoperative ultrasound showed that all patients didn't suffered from cervical lymph node metastasis. ResultsAmong 103 patients who underwent total thyroidectomy plus central lymph node dissection, the unilateral multiple lesions were found in 55 patients (53.40%), and the bilateral multiple lesions were found in 48 patients (46.60%). A total of 31 patients (30.10%) were confirmed to have central lymph node metastasis after operation, central lymph node metastasis only located in the same side of multifocal papillary thyroid carcinoma in 16 patients (29.10%), but of 15 patients (31.25%) with 2-side of multifocal papillary thyroid carcinoma, 7 patients suffered from 2-side central lymph node metastasis and 8 patients suffered from 1-side central lymph node metastasis. Thirty patients (12.62%) suffered from transient postoperative hypocalcemia after operation, and returned to normal for longest of 2 weeks; 1 patient (0.97%) suffered from parathyroid permanent damage; 18 patients (17.48%) suffered from transient recurrent laryngeal nerve palsy, no one suffered from permanent recurrent laryngeal nerve injury; 3 patients (2.91%) suffered from postoperative transient drinking cough. All of 103 patients were followed up for 5 months to 4 years, and the postoperative follow-up rate was 100%. During the follow-up period, 3 patients (2.91%) suffered from cervical lymph node metastasis in side region of neck. ConclusionTotal thyroidectomy plus prophylactic central lymph node dissection plays an important role in the treatment of multifocal papillary thyroid carcinoma.
ObjectiveTo explore the best timing of thyroid stimulating hormone (TSH) inhibition therapy by analyzing the trend of TSH level changes after unilateral thyroid lobectomy in patients with low-risk papillary thyroid microcarcinoma (PTMC).MethodsThe clinical data of patients with low-risk PTMC who underwent unilateral thyroid lobectomy in the Dongfeng Hospital Affiliated to Hubei Medical College from September 2016 to December 2018 were retrospectively analyzed. The TSH of all patients were measured before operation and in month 1, 3, and 6 after operation, respectively, and the change trend was analyzed.ResultsAccording to the inclusion and exclusion criteria, a total of 271 patients with low-risk PTMC were included in this study. The TSH level in month 1 after operation was higher than that of before operation [(2.93±1.09) mU/L versus (2.05±0.76) mU/L, t=19.9, P<0.001]. Among the 129 patients with TSHlevel ≤2.0 mU/L before operation, 56.6% (73/129) of them still had the TSH level ≤2.0 mU/L in month 1 after operation, 45.0% (58/129) in month 3 after operation and 39.5% (51/129) in month 6 after operation.ConclusionsTSH level of patient with low-risk PTMC is increased after lobectomy, so individualized TSH inhibition treatment should be formulated. For patients with TSH level>2.0 mU/L before operation, oral levothyroxine sodium tablets should be taken immediately after operation. For patients with preoperative TSH level ≤2.0 mU/L, TSH level should be dynamically monitored, and whether and when to start oral TSH inhibition therapy should be decided according to results of TSH level.
ObjectiveTo explore the relationship between the -2548 G/A functional polymorphism in the 5′ promoter region of the leptin gene and gallstones. Methods The -2548 G/A polymorphisms of leptin gene were determined by polymerase chain reactionrestriction fragment length polymorphism technology (PCRRFLP) in 118 patients with cholesterol gallstones and 53 normal control subjects. Then the allele and genotype distribution were studied. Results The distribution of leptin2458 G/A in two groups was statistically significantly different: the genotype frequency of AA+GA of patients in gallstone group was higher than that in control group (χ2=4.251, P=0.039). AA+AG genotype had 2.813 times greater risk for gallstone disease compared with GG genotype (OR=2.813, 95% CI=1.020-7.757). Allele frequency distribution in the two groups was different: the allele frequency of A of patients in gallstone group was higher than that in control group (χ2=5.791, P=0.016). The risk of gallstone disease in the A alleles carriers was 1.777 times as higher as the carriers of G alleles (OR=1.777, 95% CI=1.110-2.844). ConclusionThe -2548 G/A polymorphism in the 5′ promoter region of leptin gene is significantly correlated with the gallstones. The A alleles of leptin may be a genetic factor which contributes to individual susceptibility for gallstone, while the G alleles of leptin may be a genetic factor that prevents people from gallstone.