ObjectiveTo investigate the relationship between clinicopathologic characteristics of patients with papillary thyroid carcinoma (PTC) and diabetes mellitus (DM), and to provide basis for individualized diagnosis and treatment.MethodsThe patients who underwent the first thyroid surgery in the Renmin Hospital of Wuhan University from January 1, 2017 to September 15, 2020 and were pathologically diagnosed as PTC were collected. According to the presence or absence of DM, the clinical features were compared.ResultsThere were 2859 patients without DM and 133 patients with DM in 2992 patients. In patients with or without DM, there were no differences in lymph node metastasis, multiple, bilateral tumors, and extrathyroid invasion between the two groups (P>0.05). However, compared with the PTC patients without DM, the proportion of women with DM was lower (58.65% versus 76.71%, P<0.01), the proportions of age >55 years old (92.48% versus 66.32%, P<0.01) and capsule invasion (67.21% versus 63.11%, P=0.04) with DM were higer. After adjusting for age and gender, the multivariate analysis showed that the risks of larger tumor and capsular invasion in the patients with DM was 1.51 times [95%CI (1.06, 2.16), P=0.02] and 1.75 times [95%CI (1.16, 2.64), P<0.01] respectively as compared with in the patients without DM.ConclusionsIn PTC patients with DM, proportion of women is lower, proportions of elderly population (age >55 years old) and patients with capsular invasion are higer, tumor is larger. Therefore, patients with DM must not neglect regular examination of thyroid morphology and function, and PTC patients should also pay attention to control of blood glucose.
ObjectiveTo explore the safety, effectiveness and minimally invasive cosmetic evaluation results of treatment for papillary thyroid carcinoma (PTC) by video-assisted lateral neck dissection (VALND) or open lateral neck dissection (OLND).MethodsThe clinical data of patients with PTC who received surgical treatment in the Affiliated Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed. The data of 94 cases in the VALND group (n=47) and the OLND group (n=47) were finally included in this study, and perioperative conditions and minimally invasive cosmetic evaluation results between the two groups were studied.ResultsThere were no statistical differences of lateral metastatic lymph node numbers, operative time, postoperative drainage volume, drainage tube removal time and postoperative hospitalization days between the two groups (P>0.05). The lateral retrieved lymph node numbers, intraoperative blood loss, the degree of cervical paresthesia and the degree of cosmetic satisfaction in the VALND group were significantly better than those in the OLND group (P<0.05). There was no significant difference of surgical complications between the two groups (P>0.05).ConclusionWithout sacrificing surgical safety and effectiveness, VALND has better cosmetic effect and less neck trauma than OLND, which is worthy of clinical application and promotion.
ObjectiveTo establish a prediction model for ipsilateral cervical lateral lymph node metastasis (LLNM) in stages T1–T2 unilateral papillary thyroid carcinoma (PTC) and to verify its efficacy. MethodsA retrospective case-control study was conducted to analyze the clinical information of 280 patients with unilateral PTC at stages T1–T2 who underwent ipsilateral cervical lateral lymph node dissection and were diagnosed postoperatively via pathological examination in the Department of Thyroid Surgery (General Surgery) at the First Hospital of Shanxi Medical University from February 2019 to February 2024. The patients were randomly allocated into a training set and a test set in a 7∶3 ratio. The general, clinical, laboratory, and imaging data were collected for all patients. The univariate and multivariate logistic regression analyses were used to compare the differences in data of the patients between with and without LLNM in the training set. Then the risk factors affecting on the LLNM were used to construct a nomogram prediction model. The receiver operating characteristic (ROC) curve was generated for both the training and test sets, and the area under the ROC curve (AUC) was calculated to evaluate model discrimination. The calibration curve was used to assess model calibration, and decision curve analysis (DCA) was conducted to evaluate the clinical utility of the nomogram prediction model. ResultsA total of 280 patients were included, including 196 in the training set and 84 in the testing set. There were no statistically significant differences in the clinical and pathological data between the training set and the testing set (P>0.05). There were 147 cases of LLNM in the training set and 63 cases of LLNM in the testing set. The results of multivariate logistic regression analysis showed that the patients with T1–T2 stage unilateral PTC who were male in gender, had cancer lesions located in the upper pole, had central lymph node metastasis, had larger cancer lesions, and higher serum thyroid stimulating hormone level had a higher probability of developing ipsilateral cervical LLNM (P<0.05). The AUC (95%CI) of the nomogram prediction model constructed based on these risk factors in the training and testing sets were 0.822 (0.747, 0.897) and 0.838 (0.743, 0.933), respectively. The calibration curves of the training and testing sets roughly overlapped with the reference curve. The DCA results indicated that the net benefit for patients was positive when the threshold probabilities were within the ranges of 15% to 92% for the training set and 10% to 100% for the test set. ConclusionsThe results of this study suggest that gender, maximum cancer lesion diameter, cancer lesion location, central lymph node metastasis, and serum thyroid stimulating hormone are risk factors affecting the occurrence of ipsilateral cervical LLNM in T1–T2 stages unilateral PTC. The nomogram prediction model developed based on these risk factors demonstrates good discrimination, accuracy, and clinical applicability for its prediction.
ObjectiveTo investigate the influencing factors of cervical lymph node metastasis of papillary thyroid carcinoma (PTC) and provide more accurate guidance for the cleaning strategy of PTC cervical lymph node.MethodsRetrospectively analyzed the case data of pathological diagnosis of PTC patients from June 2013 to June 2019 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, and explored the influencing factors of lymph node metastasis in central region and lymph node metastasis in lateral cervical region.ResultsThe results of multivariate analysis showed that patients aged ≤55 years old, tumor diameter >1 cm, peripheral invasion, bilateral cancer, and multifocal cancer had a higher lymph node metastasis rate in the central region (P<0.05). When the number of risk factors mentioned above was 0, 1, 2, 3, 4, 5 and 6, the lymph node metastasis rate in the central region was respectively: 3.5% (4/113), 25.2% (72/286), 30.0% (70/233), 38.6% (76/197), 52.5% (53/101), 76.9% (20/26), and 100% (13/13). With the increase of the number of risk factors, the lymph node metastasis rate in central region increased (χ2=236.894, P<0.001). In the lymph node metastasis in lateral cervical region, multivariate analysis showed that patients with tumor diameter >1 cm, membranous invasion, and lymph node metastasis in the central region ≥2 had a higher lymph node metastasis rate (P<0.05), while lymph node metastasis in the lateral cervical region was not related to age, gender, peripheral invasion, and multifocal carcinoma (P>0.05). When the cumulative number of risk factors in patients was 0, 1, 2, 3, 4, 5, and 6, the lymph node metastasis rate in the lateral cervical region was respectively: 11.1% (1/9), 29.4% (5/17), 79.2% (19/24), 89.6% (43/48), 96.4% (27/28), 100% (21/21), and 100% (3/3). With the increase in the number of risk factors, lymph node metastasis in the lateral cervical region increased (χ2=101.094, P<0.001).ConclusionsThe cervical lymph node metastasis is positively correlated with the number of corresponding risk factors. With the increase of risk factors, cervical lymph node metastasis rate also increases. The number of risk factors provides a simple and intuitive indicator for cervical lymph node metastasis, which is more conducive to the formulation of individualized and accurate surgical program.
Objective To investigate the efficacy of fine needle aspiration-thyroglobulin (FNA-Tg) with colloidal gold immunochromatographic assay (CGICA) on the assessment of lymph node metastasis during surgery in papillary thyroid carcinoma (PTC) patients. Methods Seventy-eight patients with PTC who underwent surgery in the Department of Thyroid Surgery of West China Hospital of Sichuan University from August to December 2019 were selected as the research objects, 289 neck lymph node specimens cleaned during the operation were prepared into eluent after lymph node FNA within 10 minutes in vitro, and then the FNA-Tg level was detected rapidly and quantitatively by CGICA. The specimen of washout fluid was labeled and sent to the laboratory for FNA-Tg detection by Roche electrochemiluminescence immunoassay. The lymph nodes in the whole group were divided into central region group and lateral cervical region group according to their location. According to the long diameter of lymph nodes, they were divided into <5 mm group, 5–10 mm group and >10 mm group. With postoperative pathological report as the gold standard, the receiver operating characteristic (ROC) curve of the whole group of data subjects was drawn, and the area under curve (AUC) was compared to calculate the best cut-off value of FNA-Tg in diagnosing PTC lymph node metastasis. The sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNA-Tg CGICA method and Roche method in the whole group and different subgroups were compared. The data of 55 lymph nodes detected by FNA-Tg CGICA method and rapid frozen pathology were collected, and the diagnostic efficacy indexes of CGICA method and rapid frozen pathology in the diagnosis of lymph node metastasis were compared. Results The ROC curves AUC of FNA-Tg detected by CGICA method and Roche method was 0.850 and 0.883, respectively, the difference was not statistically significant (Z=1.011, P>0.05). The sensitivity was 77.7% and 79.6% respectively (χ2=0.05, P>0.05), specificity was 84.9% and 93.5% respectively (χ2=7.50, P<0.05). Using McNemar test, there was no significant difference in the diagnostic results between the CGICA method and Roche method of FNA-Tg in the whole group (P>0.05). The diagnostic efficacy of FNA-Tg CGICA method was better in the lateral cervical region group than that in the central region group, and the diagnostic efficacy of the group with the long diameter of lymph nodes >10 mm was better than those of the groups with the long diameter of lymph nodes <5 mm and 5–10 mm. There was no significant difference in diagnostic results between FNA-Tg CGICA method and rapid frozen pathology (P>0.05). Conclusions The FNA-Tg CGICA method has high value in diagnosing PTC cervical lymph node metastasis, and has the characteristics of rapidity and convenience. The diagnostic efficiency is similar to that of Roche method.
Objective To investigate the expression and clinical significance of Notch-1 protein in papillary thyroid carcinoma (PTC) tissues and cervical lymph node metastases. Methods Immunohistochemical method was used to detect the expression of Notch-1 protein in 69 cases of PTC tissues, along with tumor adjacent tissues and 34 cases of metastatic lymph node tissues, and to analyze its role in PTC and metastatic lymph node tissue. Results Compared with PTC tissues or cervical lymph node metastases and tumor adjacent tissues, the positive rates of expression of Notch-1 protein in PTC tissues or cervical lymph node metastases were significantly lower than that in cancer adjacent tissues (P＜0.05). The expression of Notch-1 protein was correlated with the tumor size and capsule invasion of patients with PTC. Conclusions Notch-1 protein expression is decreased in PTC tissues and metastatic lymph node tissues, suggesting that the Notch-1 protein may play an important role in the development, invasion and metastasis of PTC. There is no significant difference in the positive rates of Notch-1 protein expression in PTC tissues and metastatic lymph node tissues, it's suggested that the malignant degree of cancer cells in lymph node metastasis is not significantly increased, and the biological behavior remained relatively stable.
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.
ObjectiveTo investigate relationship of long non-coding RNA FoxP4-AS1 expression with lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC).MethodsReal time fluorescent quantitative polymerase chain reaction was used to detect the expression level of FoxP4-AS1 in 52 cases of PTC tissues and corresponding adjacent tissues, PTC cells (TPC-1, B-CPAP, K1), and normal thyroid follicular epithelial cells (Nthy-ori3-1). Univariate and multivariate analysis were used to identify the influencing factors of LNM in PTC. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of influencing factors of LNM in PTC.ResultsThe expression level of FoxP4-AS1 in the PTC tissues was significantly decreased as compared with the corresponding adjacent tissues (t=7.898, P<0.001), which in the different cells had statistical difference (F=29.866, P<0.001): expression levels in the TPC-1 and K1 cells were lower than Nthy-ori3-1 cells (P<0.05) and in the B-CPAP cells and Nthy-ori3-1 cells had no statistical difference (P>0.05) by multiple comparisons. Univariate analysis showed that the extraglandular invasion (χ2=4.205, P=0.040)and low expression of FoxP4-AS1 (χ2=7.144, P=0.008) were the influencing factors of LNM in PTC. Binary logistic regression analysis showed that extraglandular invasion [OR=9.455, 95%CI (1.120, 79.835), P=0.039] and low expression ofFoxP4-AS1[OR=5.437, 95%CI (1.488, 19.873), P=0.010] were risk factors for LNM of PTC. The area under the ROC curve ofFoxP4-AS1,extraglandular invasion alone, and combination of the two were 0.679, 0.656, and 0.785, respectively.ConclusionsFoxP4-AS1 is down-regulated in PTC. Low level of FoxP4-AS1 is a risk factor for LNM of PTC. Combined detection of expression level of FoxP4-AS1 and extraglandular invasion has a high predictive value for LNM of PTC.
ObjectiveTo systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN0 papillary thyroid carcinoma. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), WanFang Data, CBM and CNKI were searched to collect the studies about total thyroidectomy (TT)+PCND versus TT alone for stage cN0 papillary thyroid carcinoma from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. ResultsA total of 10 studies involving 3 661 patients were included. The results of meta-analysis showed that, compared with TT alone, TT+PCND had higher transient hypocalcemia (OR=2.50, 95%CI 2.05 to 3.03, P<0.000 01), higher permanent hypocalcemia (OR=3.11, 95%CI 1.82 to 5.30, P<0.000 1), and lower recurrence (OR=0.66, 95%CI 0.47 to 0.93, P=0.02). But there were no significant differences between two groups in transient laryngeal nerve palsy or permanent laryngeal nerve palsy. ConclusionTT+PCND is safe and feasible for treating stage cN0 papillary thyroid carcinoma when its indications are strictly controlled. However, due to limited quantity and quality of the included studies, more high-quality randomized controlled trials are needed to verify the abovementioned conclusion.
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.