ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
Objective To investigate the role of preoperative serum thyroid stimulating hormone (TSH) in evaluating differentiated thyroid cancer (DTC). Methods A total of 551 patients with thyroid nodules met the study criteria, who got treatment in the First Affiliated Hospital of Jiamusi University between Aug. 2017 and Dec. 2017. And the patients were divided into DTC group (n=110) and benign group (n=441) according to the postoperative pathological results. The difference of serum TSH level between the 2 groups was compared and then explored the diagnostic significance of serum TSH level, thyroid imaging report and data system (TI-RADS), and serum TSH combined withTI-RADS. Results The serum TSH level was higher in the DTC group than that of the benign group (Z=5.198, P<0.05). The sensitivity of preoperative serum TSH level in the diagnosis of DTC was 80.9% (89/110), the specificity was 74.4% (328/441), and the area under receiver operating characteristic (ROC) curve was 0.660 ［95%CI was (0.602, 0.719), P<0.05］. The sensitivity of TI-RADS in the diagnosis of DTC was 82.7% (91/110), the specificity was 73.5% (324/441), and the area under the ROC curve was 0.772 ［95%CI was (0.711, 0.823), P<0.05］. The sensitivity of preoperative serum TSH combined with TI-RADS in the diagnosis of DTC was 91.8% (101/110), the specificity was 87.5% (386/441), and the area under the ROC curve was 0.831 ［95%CI was (0.786, 0.876), P<0.05］. Conclusions Preoperative serum TSH level may be a potential risk factor for the occurrence of DTC. Preoperative serum TSH level combined with TI-RADS classification can improve the accuracy of preoperative diagnosis of DTC, not only to reduce the misdiagnosis of thyroid cancer, but also can avoid excessive treatment.
【Abstract】ObjectiveTo discuss the value of thyroglobulin (TG) in diagnosis and treatment of differentiated thyroid cancer (DTC) patients. MethodsLiteratures on measurement and clinical application of serum TG were reviewed. ResultsImmunometric assay (IMA) was adopted by most clinical lab.TG antibody （TGAb） should be measured in the same sample of DTC patient.TG detection before operation is of less value in confirming diagnosis of DTC, but is helpful in differential diagnosis of histopathological type of DTC.TG detection after operation is very important in patients who had undergone total thyroidectomy.Monitoring TG after thyroid hormone withdrawal or recombinant human TSH stimulation is more sensitive to identify tumor recurrence. ConclusionMonitoring TG after total thyroidectomy has great value in followup of DTC patients.
Objective To observe the action and correlation of p16 and estrogen receptor (ER) in papillary thyroid cancer (PTC).Methods Using immunohistochemical method, the p16 and ER in 50 cases of PTC were detected. Results The expression of p16 and ER was associated with the cellular differentiation, the lymphatic metastasis and prognosis in PTC. Conclusion It is helpful to detect the p16 protein and ER for analyzing the cellular differentiation degree and prognosis in PTC.
ObjectiveTo analyze the expression and significance of NF-κBp65 and autophagy-related proteins Beclin1 and p62 in patients with papillary thyroid carcinoma (PTC).MethodsOne hundred and sixty cases of PTC patients' tumor tissue specimens and paracancerous tissue specimens in our hospital from March 2013 to February 2015 were collected, and 90 cases of cervical lymph node metastasis tissue specimens of the above patients were collected. The expressions of NF-κBp65, Beclin1 and p62 in PTC tissues, metastatic lymph node tissues and paracancerous tissues were detected by immunohistochemical method, and the relationship between the above indexes and the clinicopathological characteristics and prognosis of PTC patients was analyzed.ResultsThe positive rates of expression of NF-kappa Bp65 and p62 in PTC tissues and metastatic lymph node tissues were higher than those in paracancerous tissues (P<0.05). The expression rate of Beclin1 in PTC tissues and metastatic lymph node tissues was lower than that in paracancerous tissues (P<0.05). The positive rate of NF-κBp65 expression in PTC tissues was not related to the clinicopathological characteristics of patients (P>0.05). The expression of p62 decreased with the increase of tumor differentiation (P<0.05). The expression of Beclin1 in patients with stage Ⅲ+Ⅳ and lymph node metastasis were lower than those in patients with stage Ⅰ+Ⅱ and without lymph node metastasis (P<0.05), while the expression of p62 was opposite. Spearman correlation analysis showed that the expression of Beclin1 and p62 in PTC tissues was negatively correlated (r=–0.656, P<0.01). In metastatic lymph node tissues, the expression of Beclin1 and p62 was also negatively correlated (r=–0.562, P<0.01). The 3-year survival rates of patients with positive expression of p62 and NF-κBp65 in PTC tissues were lower than that of patients with negative expression (P<0.05). The 3-year survival rate of patients with positive expression of Becrin1 was higher than that of negative expression (P<0.05). TNM stage, lymph node metastasis, NF-κBp65 and p62 were independent risk factors for PTC prognosis, and Beclin1 was protective factor.ConclusionsNF-κBp65 and p62 are highly expressed in PTC tissues and lymph node metastasis tissues, while Beclin1 is poorly expressed, which could be used as independent prognostic factors for PTC patients. In addition, Beclin1 and p62 are related to PTC biological behavior and may become potential indicators for PTC diagnosis.
ObjectiveTo explore the safety, effectiveness, and cosmetic advantage of endoscopic thyroidectomy for differentiated thyroid cancer in the cT1N0 stage. MethodsThe clinical data of 148 patients underwent thyroidectomy for the cT1N0 differentiated thyroid cancer in the First Affiliated Hospital of PLA General Hospital and the PLA General Hospital from September 2010 to September 2013 were analyzed retrospectively, including 36 patients by total endoscopic thyroidectomy (TET group), 41 patients by endoscopic-assisted thyroidectomy (EAT group), and 71 patients by open thyroidectomy (OT group). The intraoperative status, early complications, late complications, and cosmetic result were compared among these three groups. ResultsAll the procedures were accomplished successfully.①In the intraoperative status: The operation time of the TET group was significantly longer than that of the EAT group(P < 0.05)or OT group (P < 0.05), drainage on the first day after operation in the TET group was significantly more than that in the EAT(P < 0.05)or OT group (P < 0.05), the intraoperative bleeding of the TET group or EAT group was significantly less than that of the OT group (P < 0.05), there were no statistical significances in the total number of lymph nodes dissection and number of positive lymph nodes among three groups (P > 0.05).②In the early complications: The postoperative pain score of the TET group was significantly lower than that of the EAT group (P < 0.05)or OT group (P < 0.05), there were no statistical significances in the postoperative bleeding, seroma, infection, transient recurrent laryngeal nerve paralysis, or transient hypoparathyroidism among three groups (P > 0.05).③In the late complications: there was no statistical significance in the perpetual recurrent laryngeal nerve paralysis, perpetual hypoparathyroidism, or thyroid cancer relapse among three groups (P > 0.05).④The best cosmetic result was obtained by the patients underwent TET as compared with the patients underwent EAT(P < 0.05)or OT (P < 0.05). ConclusionsEndoscopic procedure has the same effectiveness and safety with open procedure for differentiated thyroid cancer in the cT1N0 stage, but endoscopic procedure has a better cosmetic result than that open procedure. Compared with EAT, TET has more advantages in the cosmetic result.
ObjectiveTo summarize the efficacy and safety of Jindan Fuyan Granule in the treatment of refractory chylous leakage after neck lymph node dissection for thyroid cancer. MethodThe clinical data of thyroid cancer patients with refractory chylous leakage after neck lymph node dissection treated with Jindan Fuyan Granules in the Department of Head and Neck Surgery of Jiangsu Cancer Hospital from January to December 2023, were retrospectively collected. ResultsAfter treatment with Jindan Fuyan Granules on the basis of conventional treatment, the drainage volume of 3 patients with thyroid cancer after radical neck lymph node dissection was significantly reduced, from 100 mL to 2 mL, 1 285 mL to 5 mL, and 960 mL to 5 mL, respectively. After 3 days of treatment, the tubes were removed successfully. After discharge from the hospital, 3 patients were followed up for 3, 3, 4 months, respectively, showing satisfactory wound healing without chylous leakage or other discomfort. ConclusionsCombined with low-fat diet, drainage and other non-surgical treatment methods, Jindan Fuyan Granule has obvious effect on treating refractory chylous fistula after neck lymph node dissection, which can be used as a non-surgical treatment option. However, the efficacy needs to be further verified.
Initial surgical treatment plays an important role in the treatment of differentiated thyroid cancer, and standardized surgical treatment can help to reduce underdiagnosis and overtreatment. Accurate preoperative diagnosis is the premise of standardized surgical treatment, which helps to reduce the overtreatment of thyroid nodules. Preoperative clinical TN staging assessment for differentiated thyroid cancer should be highly valued, the extent of thyroidectomy should be individualized, and the cervical lymph nodes should be performed in a standardized manner. In addition, the indications for endoscopic thyroid surgery should be strictly selected to maximize the benefit of the patient.
ObjectiveTo explore the association between single nucleotide polymorphism (SNP) in the X-ray cross complementary repair gene-1 (XRCC1) rs1799782 locus and thyroid cancer.MethodsStudies investigating the association between SNP in the XRCC1 gene and thyroid cancer susceptibility were retrieved from the PubMed, Embase, Web of Science, CNKI (Chinese National Knowledge Infrastructure), Wanfang, and CBM (China Biology Medicine) databases (published date up to February 15, 2021). Eligible studies were screened according to inclusion/exclusion criteria and principles of quality evaluation. Meta-analysis was performed using Stata 14.0 software. Odds ratios with their corresponding 95% confidence intervals (95%CI) were pooled to assess the association between SNP in the XRCC1 gene rs1799782 locus and thyroid cancer susceptibility.ResultsTwelve articles were eligible for this meta-analysis. Meta-analysis results were shown as follows: No significant association was found between XRCC1 rs1799782 polymorphism and thyroid cancer in overall population [Dominant model: CT+TT vs CC, OR=1.07, 95%CI (0.84, 1.36). Recessive model: TT vs CT+CC, OR=1.48, 95%CI (0.95, 2.31). Allelic model: T vs C, OR=1.15, 95%CI (0.93, 1.43). Codominant model: TT vs CC: OR=1.44, 95%CI (0.83, 2.53); CT vs CC, OR=1.02, 95%CI (0.82, 1.28); TT vs CT, OR=1.40, 95%CI (0.98, 1.99)]. rs1799782 polymorphism was significantly associated with the risk of thyroid cancer in Chinese population [Dominant model: CT+TT vs CC, OR=1.38, 95%CI (1.11, 1.71). Recessive model : TT vs CT+CC, OR=1.97, 95%CI (1.55, 2.50); Allelic model: T vs C, OR=1.40, 95%CI (1.16, 1.68). Codominant model: TT vs CC, OR=2.12, 95%CI (1.66, 2.71); CT vs CC, OR=1.26, 95%CI (1.09, 1.47); TT vs CT, OR=1.70, 95%CI (1.31, 2.21)]. rs1799782 polymorphism was significantly associated with the risk of thyroid cancer in Asian population [Dominant model: CT+TT vs CC, OR=0.64, 95%CI (0.49, 0.83). Codominant model: TT vs CC: OR=0.50, 95%CI (0.33, 0.74); CT vs CC, OR=0.65, 95%CI (0.49, 0.86)].ConclusionsThere is no significant correlation between XRCC1 rs1799782 polymorphism and the risk of thyroid cancer in general population. The XRCC1 rs1799782 polymorphism may be associated with an increased thyroid cancer risk among Chinese, and a tendency for decreased thyroid cancer risk among Asians (Chinese excluded). The XRCC1 rs1799782 polymorphism is not associated with thyroid cancer susceptibility among Caucasians under all genetic models.
ObjectiveTo explore the research hotspots of thyroid cancer nursing, and provide reference and guidance for future research on thyroid cancer nursing. MethodRelevant literature on thyroid cancer care was retrieved through the China National Knowledge Infrastructure (CNKI) and Web of Science (WOS) Core Database, and then analyzed the data using CiteSpace 6.2R4 software. ResultsThis study included a total of 1 096 Chinese literature and 263 English literature. The total number of publications was on the rise. The top 10 keywords in CNKI were: surgery, anxiety and depression, perioperative care, quality of life, complications, postoperative care, clinical pathway, rapid recovery surgery, differentiated thyroid cancer, and psychological care. Except for rapid recovery surgery, the centrality of other key words was greater than 0.1. The top 10 keywords in WOS were: quality of life, management, 131I, papillary thyroid cancer, surgery, impact, anxiety, prevalence, risk factor, and differentiated thyroid cancer. Among them, quality of life played an important intermediary role in co-occurrence networks, with the highest centrality of 0.34. ConclusionsQuality of life, mental health, perioperative period, and papillary thyroid cancer are research hotspots in thyroid cancer care both domestically and internationally. The management of quality of life and symptom management are the development trend of future research. Further research on thyroid cancer care needs to be strengthened, and important measures should be taken to address clinical issues and promote the recovery of thyroid cancer patients. We should strengthen domestic multi center cooperation, expand the breadth and depth of research, and promote the prosperous development of thyroid cancer nursing.