Objective To summarize the progress in the diagnosis and treatment of thyroid cancer related genes. Methods By using the method of literature review, The literatures of thyroid cancer related gene were reviewed on the study of emerging diagnosis and treatment strategy. Results Combined detection of BRAF oncogene, RAS oncogene, RET/PTC rearrangement, PAX8-PPARγ fusion gene and its related genes, can effectively improve the prediction accuracy of the malignant thyroid nodule form benign, and has become a basis of targeted drug therapy. Conclusion In preoperative thyroid cancer, Joint detection of related gene can provide a molecular basis for the patients to guide the operation and drug treatment.
ObjectiveTo investigate the value of carbon nanoparticle adopted in reoperation for thyroid cancer recurrence. MethodsFrom July to November of 2015, patients diagnosed with thyroid cancer recurrence in department of Thyroid & Parathyroid surgery, West China Hospital, Sichuan University were enrolled in the research. All enrollment patients underwent carbon nanoparticles location guided by ultrasonography before reoperation. Relative data about surgery and location were analyzed retrospectively. ResultsTwenty-two patients were enrolled in the research. Mean operation time was (60.45±12.91) minutes. During surgery, a total of 405 (average 18.4) lymph nodes were harvested, and the staining rate was 71.9% (291/405). The pathological examination showed that there was a significant difference in the positive rate between carbon nanoparticles stained lymph nodes (45.0%, 131/291) and non-stained lymph nodes (5.3%, 6/114), P < 0.001. In addition, the positive rate in non-targeted stained lymph nodes was 30.2% (62/205). By contrast, it was 5.3% (6/114) in non-targeted non-stained lymph nodes. The difference showed significant significance (P < 0.001). ConclusionsAdoption of carbon nanoparticles in reoperation for thyroid cancer, which improves efficiency of dissection for the non-palpable lymph nodes metastasis, is worth generalizing in clinical practice.
ObjectiveTo investigate the expressions of chemokine receptor CXCR4 and CCR7 in thyroid cancer and its clinicopathologic significance. MethodsFifty-five patients with thyroid cancer were selected in the Affiliated Hospital of North Sichuan Medical College from 2006 to 2009, and 30 patients with thyroid adenoma were selected in the same hospital during 2009. The expressions of CXCR4 and CCR7 were detected in all the selected cases samples (including thyroid cancer and thyroid adenoma) by immunohistochemical SP technique. ResultsThe positive expression rates of CXCR4 and CCR7 in the thyroid cancer were higher than those in the thyroid adenoma (Plt;0.01), which in the thyroid cancer with clinical stage Ⅲ+Ⅳ were higher than those of the clinical stage Ⅰ+Ⅱ (Plt;0.05). The positive expression rate of CCR7 in the thyroid cancer with lymph node metastasis was higher than that of the thyroid cancer without lymph node metastasis (Plt;0.05), which of CXCR4 in the patients with thyroid cancer was independent of lymph node metastasis (Pgt;0.05), and which of CXCR4 and CCR7 were also independent of the age and gender of the patients with thyroid cancer (Pgt;0.05). The positive expressions of CCR7 and CXCR4 in all the patients with thyroid cancer was positively correlated (rs=0.491, P=0.000). ConclusionsCXCR4 and CCR7 are involved in the coordination of thyroid cancer progression. They can be used as prognostic indicators of thyroid cancer. High expression of CCR7 is prone to lymph node metastasis of thyroid cancer.
ObjectiveTo discuss whether central lymph node dissection (CLND) should be performed for papillary thyroid cancer (PTC) patients. MethodsThe related domestic and foreign literatures were retrieved, the necessity of CLND and the risk of recurrent laryngeal nerve (RLN) injury in CLND were reviewed, and the application value of intraoperative nerve monitoring (IONM) in CLND were analyzed. Results① CLND can reduce the recurrence rate of PTC, improve postoperative survival rate, ease the difficulty of reoperation, and help to clarify tumor stage. ② CLND can increase the risk of RLN injury. ③ Application of INOM can decrease the risk of RLN injury. ConclusionsThe application of IONM during CLND effectively decrease the risk of RLN injury for surgeons, especially low seniority surgeons, and improve the survival quality and the prognosis. This combination will promote the implementation of routine CLND therapeutic strategy in thyroid cancer patients.
ObjectiveTo detect expressions of PTEN and Ki-67 in primary thyroid cancer tissues and explore its clinical significances. MethodsThe expressions of PTEN protein and Ki-67 protein in 40 cases of paraffin-embedded tissues of primary thyroid cancer and the corresponding paracancerous tissues were detected by immunohistochemical method. The expressions of PTEN mRNA and Ki-67 mRNA in 14 cases of resected fresh tissues of primary thyroid cancer and the corresponding paracancerous tissues were detected by RT-PCR method. The relations between clinicopathologic characteristics and expression of PTEN protein or Ki-67 protein in the primary thyroid cancer tissues were analyzed. Results① The PTEN protein positive expression rate and the PTEN mRNA in the primary thyroid cancer tissues were significantly lower than those in the corresponding paracancerous tissues[35.0% (14/40) versus 60.0% (24/40), P<0.05; 0.225 7±0.036 3 versus 0.503 6±0.037 5, P<0.05], the Ki-67 protein positive expression rate and Ki-67 mRNA in the primary thyroid cancer tissues were significantly higher than those in the corresponding paracancerous tissues [72.5% (29/40) versus 42.5% (17/40), P<0.05; 1.212 1±0.042 1 versus 0.293 6±0.027 4, P<0.05]. ② The expressions of PTEN protein and Ki-67 protein were associated with the histological grading, pathological type, tumor stage, and presence of regional lymph node metastasis (P<0.05), which not associated with the patient's gender, age and integrity of tumor capsule or not (P>0.05). ③ The PTEN and Ki-67 protein expressions in the primary thyroid cancer tissues had a significantly negative correlation (rs=-0.605, P=0.000), which in the corresponding paracancerous tissues had no correlation (rs=-0.021, P=0.899). ConclusionPTEN and Ki-67 genes abnormally express in thyroid cancer tissue, which might be related with occurrence and development and its mechanism of primary thyroid cancer. Combination of two genes might contribute to identification of pathologic type, judge of biological behavior, and tumor stage of primary thyroid cancer, which might serve as a new target for diagnosis and treatment of it.
Objective The expression of CD15 antigen and oncoprotein bcl-2 in thyroid cancer were examined in order to study the correlation between them. Methods The expression of CD15 and bcl-2 in 50 thyroid cancers, 20 adjacent noncancerous portion, 45 adenoma and 10 normal thyroid tissue were respectively investigated by microwave-LSAB immunohistochemical technique. Results The positive rate of CD15 and bcl-2 in thyroid cancer was 68.0% and 46.0% respectively, which was significantly higher than that in adenoma or adjacent noncancerous (Ｐ＜0.05). The percentage of CD15 and bcl2 positive expression were found to be significantly correlated with the tumor metastasis (Ｐ＜0.05), but not correlated with histological feature. Expression of CD15 was significantly correlated with bcl-2.Conclusion Expression of CD15 and bcl-2 can be regarded as a parameter to evaluate tumor metastasis and prognosis of thyroid cancer.
To search for the relationship between immune state and tumor metastases, CD3,CD4,CD8 and CD44 contents in 13 speciments of fine needle aspiration (FNA) from thyroid cancer patients were detected by the flowcytometry (FCM) and comparison between thyroid cancer and benign tumor was made. The result showed :in thyroid cancer group, CD＋3，CD＋4 cells and the ratio of CD＋4/CD＋8 reduced significantly (Ｐ＜0.01),and CD＋8 cell increased significantly (Ｐ＜0.01), in metastases group,this change was much significantly. CD44 expressed significantly higher in cancer group than that of the benign thyroid neoplasms, and the change was related to the tumor metastases. The results indicate that CD44 can be as a marker of tumor and indicator of metastases. The disturbance of immune system results in active expression of CD44 by tumor cells, so, lead to metastases. It is helpful to the diagnosis of thyroid cancer, assessment of metastases and management in surgery.
ObjectiveTo assess the efficiency, safety and long-term prognosis for interventional bronchoscopy in the treatment of trachea invasion by thyroid cancer. MethodsThe clinical data of forty-three patients with trachea invasion by thyroid cancer in Changhai Hospital from January 2006 to September 2015 were retrospectively analyzed. The trachea diameter and dyspnea score were compared before and after interventional treatment to explore the efficiency. The complications during and after therapy were observed. All patients were treated with interventional modalities including electrocautery, argon plasma coagulation, laser, cryotherapy, stent insertion or radioactive seeds implantation according to different invasion types, degree of stenosis and base situation. ResultsThe trachea diameter increased from (3.9±1.5)mm to (10.6±0.6)mm after bronchoscopy therapy (t=-17.314, P < 0.000 1). The dyspnea score decreased from 3.3±0.7 to 2.3±0.7 after bronchoscopy therapy (t=9.274, P < 0.000 1). The complications during therapy included haemorrhage (46.5%), vocal cord paralysis (4.7%) and glottis edema (7.0%). The restenosis rate in the patients with stent insertion was 26.7%. Thirty-seven patients were followed up successfully, and the medium survival time for follow-up patients was 27 months. The univariate and multivariate analysis indicated that the kind of interventional modalities used for therapy was an independent prognostic factor of survival (HR=0.261, P=0.036). The medium survival time for the patients treated with≥3 methods, 2 methods and 1 method was 47 months, 36 months and 13 months, respectively. ConclusionsFor trachea invasion by thyroid cancer, bronchoscopic therapy can effectively relieve airway obstruction and dyspnea symptom. Combination of multiple interventional modalities could have a favorable prognosis after treatment.
ObjectiveTo review the recent progress of the molecular targeted therapy for thyroid cancer. MethodsThe literatures of molecular etiology for thyroid cancer, mechanism and evaluation of targeted therapy via Medline and CHKD database were reviewed. ResultsSo far, four molecular targeted drugs (Sorafenib, Lenvatinib, Vandetanib, and Cabozantinib) have been approved for treatment of advanced thyroid cancer by FDA. They can mainly improve the patient's progression-free survival. Besides, several new molecular targeted drugs have accomplishedⅠphase or Ⅱ phase clinical trials. These drugs may be new options for treatment of advanced thyroid cancer in the future. ConclusionsMolecular targeted drugs have been the main therapeutic method for advanced thyroid cancer. However, we should invent more effective new drugs and investigate the drug combination to improve the therapeutic effect.
ObjectiveTo evaluate whether thyroglobin (Tg) value by radioimmunoassay (Tg-RIA) can be used as a complementary marker in differentiated thyroid cancer (DTC) patients, as serum Tg value is the key marker for the follow-up of patients with DTC, and endogenous antithyroglobulin (TgAb) interferes with serum Tg value by immunometric assay (Tg-IMA). MethodsFifty-five in-hospital patients with DTC after total thyroidectomy and 131I ablation during September and December 2012 were enrolled. Tg-IMA tests and Tg-RIA tests were performed separately. Diagnostic criteria about relapse, metastasis or disease-free status of thyroid carcinoma were established by serum Tg, diagnostic whole body scan (D-WBS), neck ultrasonography, chest CT and patients' history. ResultsTwo DTC patients showed false negative Tg-IMA and true positive Tg-RIA. Five patients had false negative Tg-RIA because of low sensitivity of RIA. Four patients with weak positive Tg-IMA (1.07-4.09 μg/L) required follow-up. Among the 11 DTC patients with strong TgAb positivity (>115 kU/L), two patients with positive Tg-IMA and positive Tg-RIA received second operation or radioiodine therapy, seven patients had positive Tg-RIA and negative Tg-IMA. Five of the seven patients with strong positive TgAb needed further follow-up, and two of them received radioiodine therapy. ConclusionTg value with radioimmunoassay is a complementary marker to find false negative Tg-IMA in follow-up patients with DTC.