ObjectiveTo evaluate the safty of recurrent laryngeal nerve (RLN) and parathyroid if Pseudomonas aeruginosa injection (PAI) is used after total thyroidectomy and central neck dissection (CND).MethodsFrom Mar. 2016 to Oct. 2017, we recruited 113 patients with papillary thyroid cancer (PTC) who accepted total thyroidectomy and CND. During operation, 1 mL of PAI was applied in 58 patients (local spray group) and 55 not (control group). The hoarseness, hypoparathyroidism, chylous fistula, drainage volume, hospital stay, and incidence of complications were compared between the two groups.ResultsThe two groups embraced few difference in age, gender, BMI, tumor site, the diameter of tumor and the number of metastatic and the harvested lymph nodes (P>0.05). There were nobody who has suffered in hoarseness and permanent hypoparathyroidism in both groups at any time after operation. There was no significant differences of complication between the two groups. The drainage volume at 24 h after operation in the local spraying group was more than that in the control group, and the difference was statistically significant (P=0.023). There were 2 patients had chylous fistula after surgery in the control group but none in the local spray group. The total volumes of drainage, incidence of fever and incision infection, the mean stay in the hospital, and the postoperative pain score had no statistic significance in the both groups.ConclusionAfter total thyroidectomy and CND, local spraying of PAI in the wound cavity is safe and will not damage the recurrent laryngeal nerve.
ObjectiveTo screen prognosis prediction targets related to progression free survival (PFS) for patients with papillary thyroid cancer (PTC) based on the RNA binding proteins (RBPs) gene set. MethodsThe clinicopathologic data of patients with PTC were obtained from UCSC Xena database and the cancer tissues and paired tissue adjacent to cancer (a distance >2.0 cm) of the patients with PTC underwent thyroid surgery were obtained from the First Affiliated Hospital of Zhengzhou University. The differentially expressed RBPs genes between the cancer and normal tissues were determined from the comprehensive analysis of multiple public data sets, and the RBPs genes related to PFS were determined by univariate and multivariate Cox analyses. Western blot method was used to verify the protein expression of RBPs gene in the clinical cases. The RBPs genes with prognostic value and in combination with clinicopathologic parameters were use to establish a nomogram associated with prognostic prediction. Results① A total of 424 patients with PTC were included from the UCSC Xena database and 30 patients with PTC were collected from the First Affiliated Hospital of Zhengzhou University. ② Seven down-regulated RBPs genes (ARHGEF28, IGF2BP2, KHDRBS2, MVP, PPARGC1A, SMAD9, TDRD9) and 3 up-regulated RBPs genes (ZFP36, ZFP36L2, ZMAT3) were identified in PTC. ③ The RBPs gene ZFP36 associated with PFS was screened by multivariate Cox analysis. ④ The Western blot result showed that the expression of ZFP36 protein was basically consistent with its gene expression. ⑤ The areas under the receiver operating characteristics curve of nomogram constructed in combination the clinicopathologic features related to PFS (M stage, T stage) with ZFP36 in predicting 1, 3, and 5-year PFS rates were 0.80 [95%CI (0.69, 0.91)], 0.72 [95%CI (0.62, 0.81)], and 0.64 [95%CI (0.50, 0.77)], respectively. The consistency index of nomogram was 0.724 [95%CI (0.685, 0.763)], and the calibration curve of the 3-year PFS probability was very close to the ideal diagonal. ConclusionAccording to the preliminary research results of database and clinical case data, RBPs ZFP36 might be a potential prognostic target for patients with PTC.
ObjectiveTo establish a predictive model for neck lateral lymph node metastasis (LLNM) in unilateral papillary thyroid cancer (uni-PTC) with central lymph node metastasis (CLNM). MethodsThe uni-PTC patients with CLNM were included in this study. The patients underwent thyroid surgery in the 960th Hospital of the PLA Joint Logistics Support Force from May 2018 to December 2021, who were randomly divided into the modeling group and the validation group according to the ratio of 7∶3. The risk factors of neck LLNM were analyzed by univariate and multivariate logistic regression and the nomogram of prediction model was constructed. The receiver operating characteristic (ROC) curve and calibration curve were used to validate the prediction model. ResultsA total of 237 patients were included in this study, including 158 patients in the modeling group and 79 patients in the validation group. The LLNM occurred in the 84 patients of the modeling group and 43 patients of the validation group. The multivariate logistic regression analysis was performed according to the statistical indicators in the univariate analysis results of the modeling group and the risk factors considered in the previous studies. The results showed that the patients with maximum diameter of the lesions >1 cm, multiple lesions, extraglandular invasion, the rate of CLNM ≥0.414, and lesions located at the upper portion had higher probability of LLNM (OR>1, P<0.05). The area under ROC curve of the nomogram in predicting LLNM in the modeling group was 0.834 [95%CI (0.771, 0.896)], which in the validation group was 0.761 [95%CI (0.651, 0.871)]. The calibration curve showed a good calibration degree in the prediction model. ConclusionThe clinical risk prediction model established based on the risk factors can better predict the probability of LLNM.
Objective To summarize the progress of research about the relationship between papillary thyroid carcinoma (PTC) and Hashimoto’s thyroiditis (HT). Method The relevant literatures at home and abroad in recent years about this topic were collected and analyzed. Results Comprehensive literature reviewed, combined with the author's clinical research results, PTC and HT were indeed closely related, or there was a certain causal link. HT and PTC might both come from the same embryonic stem cells. HT was an autoimmune thyroid disease caused by abnormal immune response, and might be a triggering factor of PTC. Meanwhile, lymphocyte infiltration might play a certain protective role in anti-tumor effect. RET chromosome rearrangement, RAS point mutation and BRAF gene mutation might activate mitogen-activated protein kinase (MAPK) pathway, especially in PTC cases with HT in which RET chromosome rearrangement was more common. In the future, selective targeted therapy aiming at the activation of RET/RAS/BRAF/MAPK pathway was a promising treatment especially in advanced PTC cases. Conclusions The correlation between PTC and HT is not fully clarified. HT is a potential risk factor for PTC but the cases of PTC with HT have a better prognosis. More prospective studies will help to further clarify the correlation between two diseases.
ObjectiveTo summarize the clinical and pathological characteristics of papillary thyroid cancer (PTC) in adolescents and analyze the risk factors affecting lateral lymph node metastasis and prognosis. MethodsIn retrospectively, 150 adolescent PTC patients admitted to the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2022 and meeting the inclusion and exclusion criterias were collected as the study subjects (adolescent group), and 100 adult PTC patients (adult group) were randomly selected. Statistical analysis was performed with SPSS 25.0 software to compare the clinicopathological characteristics of the patients in the two groups, and to explore the risk factors for lymph node metastasis in the lateral cervical region and recurrence in adolescent PTC patients by using logistic regression and Cox proportional hazards regression models, respectively. ResultsAdolescents with PTC were more prone to extrandular invasion [30.0% (45/150) versus 17.0% (17/100), P=0.020], neck lymph node metastasis [79.3% (119/150) versus 48.0% (48/100), P<0.001], central lymph node metastasis [78.7% (118/150) versus 48.0% (48/100), P<0.001], lateral lymph node metastasis [44.0% (66/150) versus 12.0% (12/100), P<0.001]; and had a greater maximum tumor diameter (1.75 cm versus 0.75 cm) and higher ratio of greater maximum tumor diameter ＞2 cm [（45.3% (68/150) versus 8.0% (8/100), P＜0.001] in adolescent PTC patients. In adolescent PTC patients, extraglandular invasion (OR=2.654, P=0.022), multifoci (OR=4.860, P<0.001) and maximum tumor diameter>2 cm (OR=3.845, P=0.001) were risk factors for lateral lymph node metastasis; lateral lymph node metastasis (RR=10.105, P=0.040) and distant metastasis (RR=7.508, P=0.003) were predictors of postoperative recurrence in adolescent PTC patients. ConclusionsCompared with adult PTC patients, adolescent PTC patients have more aggressive tumors. Adolescent PTC with extraglandular invasion, multilesions, and maximum tumor diameter>2 cm should be considered for lymph node dissection in the cervical area; and adolescent PTC patients with lymph node metastasis and distant metastasis should pay close attention to their recurrence status.
ObjectiveTo understand the significance of common gene variations in the diagnosis, treatment, and prognosis of papillary thyroid carcinoma (PTC). MethodThe literature relevant research on PTC gene variations both domestically and internationally was reviewed. ResultsThe most common genetic variations in the PTC in clinical studies included mutations or rearrangements in BRAF, TERT, RAS, RET and other genes, which had certain diagnostic value for PTC, but the drugs available for their treatment were relatively limited; Moreover, it had been found that multiple gene co-mutations were also common in PTC, and their prognosis was often worse. ConclusionsBy sorting out the genetic variations in PTC, new ideas and methods are provided for the diagnosis, treatment, and prognosis of PTC. By detecting the types of genetic variations, the occurrence, development, and prognosis of PTC can be predicted, and personalized treatment plans can be developed for patients with PTC.