ObjectiveThis article aims to summarize the historical evolution of thyroid cancer classification and explore the establishment of a precise classification system based on molecular characteristics and its impact on clinical applications.MethodsA literature review was conducted to analyze and organize the recent influences of molecular classification of thyroid cancer on clinical diagnosis and treatment. ResultsIn recent years, the classification of thyroid cancer has introduced molecular features such as BRAF and RAS mutations, highlighting the close association between these molecular characteristics and prognosis. For example, the BRAF V600E mutation is associated with high aggressiveness in papillary thyroid cancer, while RAS mutations suggest malignant potential in follicular tumors. With the advancement of multi-omics research, classification strategies based on multi-omics have shown significant value in the diagnosis, monitoring, treatment, and prognostic assessment of thyroid cancer. Although multi-omics integration has significantly improved the accuracy of prognostic assessments in thyroid cancer, there are still limitations, including imprecise detection of tumor heterogeneity and insufficient sensitivity and specificity of molecular biomarker detection. ConclusionsThe classification of thyroid cancer is developing towards the integration of molecular features to achieve more precise diagnosis and treatment. To accomplish this goal, it is necessary to overcome the challenges of tumor heterogeneity and the limitations of detection technologies in the future, and to promote the practical application of molecular classification in clinical settings.
In order to help Chinese guideline developers, clinicians, health policy makers and other relevant researchers fully understand and make appropriate use of World Health Organization (WHO) guidelines, Chinese GRADE Center and Guidelines Review Committee of World Health Organization (WHO-GRC) have written a series of papers about development methods, review principles and the structure and content of WHO guidelines. This is the second paper of this series introducing the composition, main work and functions of WHO-GRC.
ObjectiveTo assess the correlation of WHO pathological classification and Masaoka stage of thymomas with its prognosis.MethodsA total of 468 patients with thymomas who received surgeries during 2009-2019 in Huashan Hospital, Fudan University, were collected. There were 234 males and 234 females with an average age of 21-83 (49.6±18.7) years. A total of 132 patients underwent video-assisted thoracic surgery (VATS) and 336 patients underwent thymectomy with median sternal incision. The follow-up time was 5.7±2.8 years. The clinical data of the patients were analyzed.ResultsThe amount of intraoperative bleeding was 178.3±133.5 mL in the median sternal incision group, and 164.8±184.1 mL in the VATS group (P=0.537). The operative time was 3.3±0.7 h in the median sternal incision group and 3.4±1.2 h in the VATS group (P=0.376). Postoperative active bleeding, phrenic nerve injury and chylothorax complications occurred in 8 patients, 9 patients and 1 patient in the VATS group, respectively, and 37 patients, 31 patients and 7 patients in the median sternal incision group, respectively. There was no statistical difference between the two groups (P=0.102, 0.402, 0.320). The 5-year cumulative progression free survival (PFS) rates of patients with WHO type A, AB, B1, B2, B3 and C thymomas were 100.0%, 100.0%, 95.7%, 81.4%, 67.5% and 50.0%, respectively (P<0.001). The 5-year PFS rates of patients with Masaoka stageⅠ-Ⅳ thymomas were 96.1%, 89.2%, 68.6% and 19.3%, respectively (P<0.001). The 5-year PFS rate was 87.3% in patients with myasthenia gravis (MG) and 78.2% in patients without MG (P<0.001). The 5-year PFS rates of patients with different surgeries were 82.4% and 83.8%, respectively (P=0.904). ConclusionWHO pathological classification and Masaoka stage have significant clinical prognosis suggestive effect. Thymoma patients combined with MG have better prognosis, which suggests early diagnosis and treatment of thymoma are important.
Objective To evaluate the quality of the registration information for trials sponsored by China registered in the WHO International Clinical Trial Registration Platform (ICTRP) primary registries or other registries that meet the requirements of the International Committee Medical Journal Editor (ICMJE). Methods We assessed the registration information for trials registered in the 9 WHO primary registries and one other registry that met the requirements of ICJME as of 15 October 2008. We analyzed the trial registration data set in each registry and assessed the registration quality against the WHO Trial Registration Data Set (TRDS). We also evaluated the quality of the information in the Source(s) of Monetary or Material Support section, using a specially prepared scale. Results The entries in four registries met the 20 items of the WHO TRDS. These were the Chinese Clinical Trial Registration Center (ChiCR), Australian New Zealand Clinical Trials Registry (NZCTR), Clinical Trials Registry – India (CTRI), and Sri Lanka Clinical Trials Registry (SLCTR). Registration quality varied among the different registries. For example, using the Scale of TRDS, the NZCTR scoreda median of 19 points, ChiCTR (median = 18 points), ISRCTN.org (median = 17 points), and Clinical trials.org (median = 12 points). The data on monetary or material support for ChiCTR and ISRCTN.org were relatively complete and the score on our Scale for the Completeness of Funding Registration Quality ranged from ChiCTR (median = 7 points), ISRCTN.org (median = 6 points), NZCTR (median = 3 points) to clinicaltrials.gov (median = 2 points). Conclusion Further improvements are needed in both the quantity and quality of trial registration. This could be achieved by full completion of the 20 items of the WHO TRDS. Future research should assess ways to ensure the quality and scope of research registration and the role of mandatory registration of funded research.
ObjectivesTo summarize the latest advances about definition, classification, and TNM stage of adenocarcinoma of esophagogastric junction (AEG).MethodThe available guidelines, consensuses, international conference proceedings, and clinical studies were reviewed and summarized.ResultsThe AEG trended to be an independent entity of malignant tumor at the special location. The previous misunderstanding of AEG definitions from the WHO needed to be corrected and unified in China. The Siewert classification was still a practical clinical approach to guiding treatment strategy, while the new draft of JGCA classification needed to be evaluated and verified in the clinical practice. By contrast, the 8th edition AJCC/UICC classification was relatively controversial in the guiding treatment strategies, mainly due to the staging system, surgical approach, and extent of lymphadenectomy of Siewert Ⅱ type AEG. Based on the available research results, the TNM staging system of the 8th edition of gastric cancer tended to be more reasonable for the Siewert Ⅱ and Ⅲ types AEG.ConclusionWith increasing incidence of AEG, more experimental and clinical studies on AEG are ongoing, and it is expected to have more optimized classification and exclusive staging system for AEG in future.
Pulmonary adenocarcinoma in situ is reclassified as precursor glandular lesions in the fifth edition of WHO classification of thoracic tumours, causing widespread attention and heated debate among domestic thoracic oncologists, radiologists, pathologists and surgeons. We would like to comment on the topic and make a few suggestions on the management of pulmonary nodule during lung cancer screening. We are open to all suggestion and welcome debates.
Advancing patient safety is one of the most important strategies developed by WHO. The following paper outlined the main content, aims and goals of WHO the second global patient safety challenges “ Safe surgery saves lives” as well as discussed the importance of communication between surgeons and patients.
ObjectiveTo assess the accuracy of CT features of lung nodules (≤3 cm) in predicting the accuracy of the pathological subtype and degree of infiltration of adenocarcinoma. Methods We retrospectively analyzed the clinical data of 333 patients with non-cavitary pulmonary nodules diagnosed as adenocarcinoma by surgery and pathology in the China-Japan Friendship Hospital from 2011 to 2018, including 108 males and 225 females, aged 16-82 (59.57±10.16) years. The basic clinical data and CT characteristics of the patients were recorded. ResultsWhen the average CT value was ≥−507 Hu, the maximum diameter of the lung window was ≥14.5 mm, and the solid component ratio was ≥5.0%, it indicated more likely the invasive adenocarcinoma (IAC). The higher the average CT value of the nodule, the larger the maximum diameter of the lung window, and the more solid components, the higher the degree of infiltration. CT morphological features (including burrs, lobes, vascular signs, bronchial signs, pleural stretch or depression signs) were more common in IAC. Among them, burrs were more common in acinar adenocarcinoma and papillary adenocarcinoma. In invasive adenocarcinoma, the higher the risk of recurrence of the pathological subtype, the greater the average CT value. When the average CT value of IAC was >−106 Hu, and the proportion of solid components was ≥70.5%, the histological subtypes were more inclined to micropapillary/solid predominant adenocarcinoma. Conclusion The evaluation of CT features of lung nodules can improve the predictive value of histopathological types of lung adeno- carcinoma, thereby optimizing clinical treatment decisions and obtaining more ideal therapeutic effects.
Participating in patients for patient safety program will help place patients at the center of efforts to improve patient safety. This paper presented a brief introduction to patients for patient safety program and its significance and functions.