ObjectiveTo investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.ResultsCLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.ConclusionsCLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.
Objective To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma. Method Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized. Results Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis. Conclusions The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.
ObjectiveTo summarize potential related proteins in thyroid papillary carcinoma metastasis and explore its mechanism.MethodThe relevant literatures on the potential related proteins of papillary thyroid carcinoma metastasis at home and abroad were reviewed.ResultsThe previous studies had shown that many biological indicators might be associated with the metastasis of papillary thyroid carcinoma, such as the interleukin-13 receptor alpha 2, chemokine receptor 7, low-density lipoprotein receptor-related protein 4, cytokine receptor-like factor 1, Rho-related protein kinase 1, and astrocyte up-regulated gene-1 were involved in the proliferation, migration, and metastasis of papillary thyroid carcinoma, which might be the potential therapeutic target for the papillary thyroid carcinoma.ConclusionsThyroid papillary carcinoma metastasis-associated proteins play an important role in tumor metastasis. Some progress has been made in study of metastasis mechanisms, its role and mechanism in lymphatic metastasis should be further studied.
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 analyze the clinical and pathological features of multifocal papillary thyroid carcinoma, and to assess the value and safety of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma. MethodsClinical data of 103 patients with multifocal papillary thyroid carcinoma, who underwent total thyroidectomy plus prophylactic central lymph node dissection in Affliated Dongfeng Hospital from June 2011 to February 2015 were collected retrospectively. Preoperative ultrasound showed that all patients didn't suffered from cervical lymph node metastasis. ResultsAmong 103 patients who underwent total thyroidectomy plus central lymph node dissection, the unilateral multiple lesions were found in 55 patients (53.40%), and the bilateral multiple lesions were found in 48 patients (46.60%). A total of 31 patients (30.10%) were confirmed to have central lymph node metastasis after operation, central lymph node metastasis only located in the same side of multifocal papillary thyroid carcinoma in 16 patients (29.10%), but of 15 patients (31.25%) with 2-side of multifocal papillary thyroid carcinoma, 7 patients suffered from 2-side central lymph node metastasis and 8 patients suffered from 1-side central lymph node metastasis. Thirty patients (12.62%) suffered from transient postoperative hypocalcemia after operation, and returned to normal for longest of 2 weeks; 1 patient (0.97%) suffered from parathyroid permanent damage; 18 patients (17.48%) suffered from transient recurrent laryngeal nerve palsy, no one suffered from permanent recurrent laryngeal nerve injury; 3 patients (2.91%) suffered from postoperative transient drinking cough. All of 103 patients were followed up for 5 months to 4 years, and the postoperative follow-up rate was 100%. During the follow-up period, 3 patients (2.91%) suffered from cervical lymph node metastasis in side region of neck. ConclusionTotal thyroidectomy plus prophylactic central lymph node dissection plays an important role in the treatment of multifocal papillary thyroid carcinoma.
Objective The aim of this study is to review the association between long non-coding RNA (lncRNA) and papillary thyroid carcinoma (PTC). Method The relevant literatures about lncRNA associated with PTC were retrospectively analyzed and summarized. Results The expression levels of noncoding RNA associated with MAP kinase pathway and growth arrest (NAMA), PTC susceptibility candidate 3 (PTCSC3), BRAF activated non-coding RNA (BANCR), maternally expressed gene 3 (MEG3), NONHSAT037832, and GAS8-AS1 in PTC tissues were significantly lower than those in non-thyroid carcinoma tissues. The expression levels of ENST00000537266, ENST00000426615, XLOC051122, XLOC006074, HOX transcript antisense RNA (HOTAIR), antisense noncoding RNA in the INK4 locus (ANRIL), and metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in PTC tissues were upregulated in PTC tissues, comparing with the non-thyroid carcinoma tissues. These lncRNAs were possibly involved in cell proliferation, migration, and apoptosis of PTC. Conclusion LncRNAs may provide new insights into the molecular mechanism and gene-targeted therapy of PTC and become new molecular marker for the diagnosis of PTC.
In recent years, with the improvement of the sensitivity of examination equipment and the change of people's living environment and diet, the rate of thyroid cancer has risen rapidly, which has increased nearly five folds in 10 years. The pathogenesis, clinical manifestation, biological behavior, treatment and prognosis of thyroid carcinoma of different pathological types are obviously different. Papillary thyroid carcinoma (PTC) can develop at any age, which accounts for about 90% of thyroid cancer. It progresses slowly and has favourable prognosis, but lymph node metastasis appears easily. Whether PTC is accompanied by lymph node metastasis has an important impact on its prognosis and outcome. The Raf murine sarcoma viral oncogene homolog B(BRAF)gene mutation plays a crucial role in PTC lymph node metastasis. Having an in-depth understanding of the specific role and mechanism of BRAF gene mutation in PTC is expected to provide new ideas for diagnosis and treatment of PTC.
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 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 investigate association between BRAFV600E gene mutation and extrathyroidal extension (ETE) among patients with papillary thyroid carcinoma (PTC).MethodsA retrospective study was conducted to collect all PTC surgical patients in the Renmin Hospital of Wuhan University from 2017 to 2019. The patients tested for BRAFV600E gene mutation were selected, and the association between BRAFV600E gene mutation and ETE were analyzed.ResultsThe BRAFV600E gene mutation test was performed only in 273 cases, 223 and 50 of whom were BRAFV600E gene with and without mutation, respectively; 194 and 79 of whom had ETE and no ETE, respectively. Univariate analysis showed that the incidence rate with BRAFV600E gene mutation was higher in the patients with ETE as compared with the patients without ETE (86.1% vs 70.9%, P=0.003) and the incidence rate of ETE was higher in the patients with BRAFV600E gene mutaton than in the patients without BRAFV600E gene mutaton (74.9% vs 54.0%, P=0.003). In addition, the incidence rates of ETE in the patients with tumor diameter >1 cm, bilaterality, and multifocality were higher than those in the patients with tumor diameter ≤1 cm (86.7% vs 61.3%, P<0.001), unilaterality (89.6% vs 63.8%, P<0.001), and single lesion (85.7% vs 60.9%, P<0.001), respectively. The incidence rate of ETE was increased with the increase of lymph node stage (P=0.003). Multivariate logistic regression analysis showed tumor size >1 cm [OR=3.606, 95%CI (1.758, 7.396), P<0.001], multifocality [OR=2.524, 95%CI (1.154, 5.519), P=0.020], with BRAFV600E gene mutaton [OR=3.022, 95%CI (1.443, 6.326), P=0.003] were the risk factors for ETE.ConclusionThe preliminary results of this study suggest that PTC patients with BRAFV600E gene mutaton are more likely to gross ETE.