ObjectiveTo detect expressions of transient receptor potential channel C5 (TRPC5) and microRNA-320a (miR-320a) in thyroid cancer and explore clinical significances of them in thyroid cancer.MethodsThe expressions of TRPC5 and miR-320a mRNA in the thyroid cancer were investigated by searching the Ualcan database. While the expressions of TRPC5 and miR-320a mRNA in 80 cases of thyroid cancer, 35 cases of thyroid adenoma and 32 cases of normal thyroid tissues adjacent to thyroid adenoma tissues in the Zhengzhou Seventh People’s Hospital from March 2014 to March 2015 were tested. Real time PCR was used to detect the expressions of TRPC5 mRNA and miR-320a mRNA in the various tissues and Western blot was used to detect the TRPC5 protein in the thyroid cancer tissues. Therelationships between the expressions of TRPC5 and miR-320a mRNAs and clinicopathologic features of thyroid cancer were analyzed. The correlation between expressions of TRPC5 and miR-320a mRNA was analyzed by Pearson method. The risk factors influencing the prognosis were analyzed by univariate and multivariate Cox proportional hazards regression model.ResultsThe results of Ualcan database showed that the expression level of TRPC5 mRNA in the thyroid cancer was higher than that in the normal thyroid tissue (P<0.001), while the expression level of miR-320a mRNA was lower than that in the normal thyroid tissue (P<0.001). The results of clinical cases showed that the expression level of TRPC5 mRNA was significantly higher, while the expression of miR-320a mRNA was significantly lower in the thyroid cancer tissues as compared with the normal thyroid tissues (P<0.05). There was a negative correlation between the expression level of TRPC5 and miR-320a mRNA in the thyroid cancer (r=−0.653, P<0.001). The expressions of TRPC5 and miR-320a mRNA were correlated with the degree of differentiation, lymph node metastasis, and TNM stage (P<0.05). Kaplan-Meier survival curve analysis found that the patients with higher expression level of TRPC5 and lower expression level of miR-320a showed the poor prognosis, and multivariate analysis found that the lower tumor differentiation, later TNM stage, with lymph node metastasis, higher expression level of TRPC5 mRNA, and lower expression level of miR-320a mRNA were the risk factors affecting prognostic survival (P<0.05).ConclusionsFrom the database and clinical case data, it is concluded that TRPC5 mRNA is highly expressed, while miR-320a mRNA is lowly expressed in thyroid cancer tissues, and expressions of TRPC5 and miR-320a mRNA are related to degree of tumor differentiation, lymph node metastasis, TNM staging, and prognosis in patients with thyroid cancer. TRPC5 and miR-320a mRNA might be used as potential indicators for clinical and prognostic monitoring.
Objective To explore value of multidisciplinary team (MDT) model in diagnosis and treatment of patients with advanced special thyroid cancer who lost chance of operation. Method Two patients with the advanced special thyroid cancer who lost chance of operation were treated by low dose apatinib (250 mg/d) after the MDT discussion. Results One medullary thyroid cancer patient with the compressing of the trachea for mediastinal metastatic lymphadenopathy and inability to lie down underwent the multiple surgical treatment, the therapeutic effect was poor. Then low dose apatinib (250 mg/d) was performed, the patient could supine, breathe smoothly, and move freely, whose life quality was obviously improved, the mediastinal lymph nodes reduced and no serious drug toxicity occurred on month 1 after the treatment. One undifferentiated thyroid cancer patient with the lung metastasis, hemoptysis, and tumor invasion resulted in the inability to lie down and having difficulty in breathing, these symptoms still existed and more pleural effusion occurred after the resection of the invaded trachea. Then low dose apatinib (250 mg/d) was performed, the patient could supine, the pleural effusion disappeared, the hemoptysis stopped, the breathing was smooth, and could do some minor housework, no drug toxicity occurred on month 1 after the treatment. Conclusion After MDT discussion, low dose apatinib in treatment of advanced special thyroid cancer is reliable and safe and has a good short-term effect, which could be used as a new remedy, but long-term effect should be further researched by increasing case samples and a long-term following-up.
Objective To investigate the diagnostic significance of fine needle aspiration cytology (FNAC) combined with BRAFV600E gene detection in the diagnosis of cervical lymph node metastasis of thyroid cancer. Methods Atotal of 140 patients with suspected cervical lymph node metastasis of thyroid cancer were collected as the research objects, and all patients were given ultrasound-guided FNAC and detection of BRAFV600E gene. The significance of the diagnosis was analyzed according to the gold standard after pathological examination. Results All the 140 patients underwent surgical treatment. For FNAC, the sensitivity was 63.6% (84/132), the specificity was 100% (8/8), the accuracy was 65.7% (92/140), the positive predictive value was 100% (84/84), and the negative predictive value was 14.3% (8/56). For detection of BRAFV600E gene, the sensitivity was 84.8% (112/132), the specificity was 100% (8/8), the accuracy was 85.7% (120/140), the positive predictive value was 100% (112/112), and the negative predictive value was 28.5% (8/28). For FNAC combined with BRAFV600E gene detection, the sensitivity was 90.9% (120/132), the specificity was 100% (8/8), the accuracy was 91.4% (128/140), the positive predictive value was 100% (120/120), and the negative predictive value was 40.0% (8/20). The area under curve of receiver operating characteristic for FNAC, detection of BRAFV600E gene, and FNAC combined with BRAFV600E gene detection were 0.818, 0.924, and 0.955, respectively. Conclusion FNAC combine with BRAFV600E gene detection improves the accuracy of neck lymph node metastasis in patients with thyroid cancer, which is worthyof performed.
ObjectiveTo screen prognosis prediction targets related to progression free survival (PFS) for patients with papillary thyroid cancer (PTC) based on the RNA binding proteins (RBPs) gene set. MethodsThe clinicopathologic data of patients with PTC were obtained from UCSC Xena database and the cancer tissues and paired tissue adjacent to cancer (a distance >2.0 cm) of the patients with PTC underwent thyroid surgery were obtained from the First Affiliated Hospital of Zhengzhou University. The differentially expressed RBPs genes between the cancer and normal tissues were determined from the comprehensive analysis of multiple public data sets, and the RBPs genes related to PFS were determined by univariate and multivariate Cox analyses. Western blot method was used to verify the protein expression of RBPs gene in the clinical cases. The RBPs genes with prognostic value and in combination with clinicopathologic parameters were use to establish a nomogram associated with prognostic prediction. Results① A total of 424 patients with PTC were included from the UCSC Xena database and 30 patients with PTC were collected from the First Affiliated Hospital of Zhengzhou University. ② Seven down-regulated RBPs genes (ARHGEF28, IGF2BP2, KHDRBS2, MVP, PPARGC1A, SMAD9, TDRD9) and 3 up-regulated RBPs genes (ZFP36, ZFP36L2, ZMAT3) were identified in PTC. ③ The RBPs gene ZFP36 associated with PFS was screened by multivariate Cox analysis. ④ The Western blot result showed that the expression of ZFP36 protein was basically consistent with its gene expression. ⑤ The areas under the receiver operating characteristics curve of nomogram constructed in combination the clinicopathologic features related to PFS (M stage, T stage) with ZFP36 in predicting 1, 3, and 5-year PFS rates were 0.80 [95%CI (0.69, 0.91)], 0.72 [95%CI (0.62, 0.81)], and 0.64 [95%CI (0.50, 0.77)], respectively. The consistency index of nomogram was 0.724 [95%CI (0.685, 0.763)], and the calibration curve of the 3-year PFS probability was very close to the ideal diagonal. ConclusionAccording to the preliminary research results of database and clinical case data, RBPs ZFP36 might be a potential prognostic target for patients with PTC.
ObjectiveTo explore the causes and surgical strategies of completion thyroidectomy for thyroid cancer. Method The clinical data of 35 patients with thyroid cancer who underwent completion thyroidectomy in Guizhou Provincial People’s Hospital from January 2020 to July 2022 were analyzed retrospectively. Results There were 23 females and 12 males, aged from 17 to 68 years (median 42 years). The nature of thyroid nodules in 22 patients was not determined at preoperative fine needle aspiration cytology or intraoperative frozen pathological examination, but the paraffin section examination after operation indicated thyroid cancer. Pathological examination after the first operation showed that 11 patients had a large number of lymph node metastasis in the central area (more than 5), and 2 patients were confirmed as medullary thyroid carcinoma. All the 35 patients underwent completion thyroidectomy at 5–93 days after the initial operation, among which 3 patients underwent resection of the affected side residual glandular lobe and isthmus ± ipsilateral CLN dissection, 18 patients underwent contralateral lobectomy and CLN cleaning, and 14 patients underwent contralateral lobectomy and lymph node dissection of the affected side cervical region (Ⅲ–Ⅳ region). The operative time was 45–135 min (median 105 min). Intraoperative blood loss was 10–50 mL (median 20 mL). One patient suffered from temporary recurrent laryngeal nerve injury after operation, and voice had returned to normal at 5 months after operation. Six patients showed temporary hypoparathyroidism, and serum parathyroid hormone returned to normal level in 1–3 months after symptomatic treatment. Nineteen patients were treated with iodine-131 after operation, and were followed-up for 1–16 months (median 12 months). No signs of tumor recurrence or metastasis were found. Conclusions Accurate preoperative and intraoperative evaluation of thyroid nodules and standardized surgery can reduce the incidence of completion thyroidectomy. For patients who really need completion thyroidectomy, adequate doctor-patient communication during the perioperative period, early response measures and appropriate completion thyroidectomy can reduce the probability of postoperative tumor recurrence and improve the survival of patients.
ObjectiveTo evaluate the safety and efficacy of lenvatinib as targeted therapy for locally advanced thyroid cancer. MethodsThe data of 17 patients with locally advanced thyroid cancer who received targeted therapy in the Department of Head and Neck Surgery, Clinical Oncology School of Fujian Cancer Hospital from September 2021 to June 2023 were prospectively collected and analyzed. ResultsSeventeen patients received lenvatinib for a median of 8 weeks (4–32 weeks), 5 patients achieved partial response, 11 patients achieved stable disease, and 1 patient experienced progressive disease. The objective response and disease control rates were 29.4% (5/17) and 94.1% (16/17) respectively, the median tumor diameter of the target lesion decreased from 43 mm before treatment to 12 mm after treatment. Five patients did not undergo surgery because of tumor progression and their refusal; R0/1 resection was achieved in 11 of the 12 remaining patients (91.7%). All patients suffered from drug-related adverse events, and the commonest drug-related adverse events were hypertension (7/17, 41.2%), diarrhea (6/17, 35.3%), and proteinuria (5/17, 29.4%). There were no major drug-related adverse events. ConclusionPreliminary analysis indicates that lenvatinib is effective and safe for targeted therapy of locally advanced thyroid cancer, with a relatively high rate of R0/1 resection.
ObjectiveTo explore the application value of carbon nanoparticles during radical operation of differentiated thyroid cancer (DTC).MethodsThe DTC patients underwent total thyroidectomy plus neck lymph node (area Ⅳ) dissection from September 2017 to September 2019 in this hospital were retrospectively collected, who were divided into observation group and control group according to using carbon nanoparticles or not during the operation. The operation related informations [operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, number of lymph nodes dissection (area Ⅳ), lymph node metastasis rate, and rate of parathyroid glands resected by mistake during operation] and blood calcium (Ca2+) level and parathyroid hormone (PTH) level before and after (24 h and 1 month) operation were compared between the two groups.ResultsA total of 134 patients with DTC were collected, including 76 patients in the observation group and 58 patients in the control group. There were no significant differences in baseline data such as gender, age, etc. between the two groups (P>0.05). Although there were no significant differences in terms of operation time, intraoperative blood loss, total drainage volume on day 3 after operation, postoperative hospitalization time, lymph node metastasis rate between the two groups (P>0.05), the numbers of lymph node dissection and metastasis (area Ⅳ) were more and rate of parathyroid glands resected by mistake during operation was lower in the observation group as compared with the control group (P<0.05). On hour 24 after operation, the levels of Ca2+ and PTH in the observation group were higher than those in the control group (P<0.05). On month 1 after operation, the PTH level in the observation group was still higher than that in the control group (P<0.05), but there was no significant difference in Ca2+ level between the two groups (P>0.05). ConclusionCarbon nanoparticles can better protect the function of parathyroid gland during radical operation of DTC and clean neck lymph nodes more thoroughly.
ObjectiveTo explore the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma.MethodsWe retrospectively analyzed the clinical data of 51 patients diagnosed with papillary thyroid microcarcinoma who underwent an endoscopic thyroidectomy using a gasless unilateral axillary approach by the same surgeon from November 2019 to September 2020 in the Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University. The cumulative sum (CUSUM) analysis was used to determine the learning curve of the technology, and the CUSUM learning curve was modeled by the best fit. The operative time, intraoperative blood loss, number of lymph nodes dissected, incidence of complications and postoperative hospital stay in different phases of the learning curve were compared.ResultsThe CUSUM fitting curve reached the top at the 18th case. As a cut-off point, the learning curve was divided into two stages: the learning improvement period and the proficiency period. The operative time of patients in the proficiency stage was significantly shorter than that in the learning improvement stage (P<0.05), and there were no statistically significant differences in other data of patients in the two stages (P>0.05).ConclusionThe CUSUM analysis method is used to accurately analyze the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma, indicating that the cumulative number of operations required to master this technique is 18 cases.
Patients with locally advanced thyroid cancer often face challenges in achieving radical surgery during initial diagnosis. This has become a significant hurdle in the treatment of thyroid cancer. With the continuous development of systemic therapy for thyroid cancer, several studies have demonstrated that neoadjuvant therapy can shrink tumors in some patients, thereby increasing the chances of complete resection and improving prognosis. Targeted therapy plays a crucial role as a core component of neoadjuvant treatment. Simultaneously, the potential efficacy of immunotherapy has gained attention, showing promising prospects. We aim to summarize the research progress and existing issues regarding neoadjuvant therapy for locally advanced thyroid cancer. We look forward to more high-quality clinical studies providing robust evidence for neoadjuvant therapy in locally advanced thyroid cancer, expanding the breadth of treatment options.
ObjectiveTo summarize and analyze the possible association between thyroid diseases and alopecia areata. MethodThe literatures on the relationship between thyroid disease and alopecia areata in recent years were searched and reviewed. ResultsAmong individuals with alopecia areata, the risk of thyroid disease was heightened. They were more susceptible to autoimmune thyroid conditions, often accompanied by thyroid function abnormalities. Moreover, alopecia areata patients face an increased risk of thyroid cancer. However, in patients with thyroid disease, the change of the incidence of alopecia areata was not completely clear. The risk of alopecia areata was increased in patients with autoimmune thyroid disease, and abnormal thyroid function may be one of the potential reasons for the persistence of alopecia areata. ConclusionsAutoimmune thyroid disease and alopecia areata may have a common disease basis. Patients with alopecia areata are at greater risk of autoimmune thyroid disease and thyroid dysfunction. The increased risk of alopecia areata in patients with autoimmune thyroid disease may be related to abnormal thyroid function.