Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review

A prediction model based on random survival forest analysis of the overall survival of elderly female papillary thyroid carcinoma patients: a SEER-based study

OBJECTIVE

Papillary thyroid carcinoma (PTC) is a common malignancy whose incidence is three times greater in females than in males. The prognosis of ageing patients is poor. This research was designed to construct models to predict the overall survival of elderly female patients with PTC.

METHODS

We developed prediction models based on the random survival forest (RSF) algorithm and traditional Cox regression. The data of 4539 patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Twelve variables were analysed to establish the models. The C-index and the Brier score were selected to evaluate the discriminatory ability of the models. Time-dependent receiver operating characteristic (ROC) curves were also drawn to evaluate the accuracy of the models. The clinical benefits of the two models were compared on the basis of the DCA curve. In addition, the Shapley Additive Explanations (SHAP) plot was used to visualize the contribution of the variables in the RSF model.

RESULTS

The C-index of the RSF model was 0.811, which was greater than that of the Cox model (0.781). According to the Brier score and the area under the ROC curve (AUC), the RSF model performed better than the Cox model. On the basis of the DCA curve, the RSF model demonstrated fair clinical benefit. The SHAP plot showed that age was the most important variable contributing to the outcome of PTC in elderly female patients.

CONCLUSIONS

The RSF model we developed performed better than the Cox model and might be valuable for clinical practice.

Isthmusectomy for papillarythyroid carcinoma in the isthmus: The less the better

BACKGROUND

Appropriate surgical treatments of papillary thyroid carcinoma (PTC) located in the isthmus (PTCI) remains controversial. This study evaluated the outcomes from isthmusectomy in single PTCI and compared it with those for patients who underwent total thyroidectomy.

MATERIAL AND METHODS

This study enrolled 89 PTCI patients who underwent total thyroidectomy or isthmusectomy plus bilateral central lymph node dissection (BCLND). Patients were divided into Group A (n = 48) with total thyroidectomy plus BCLND and Group B (n = 41) with isthmusectomy plus BCLND. We compared the effects of different surgical modalities and clinicopathological characteristics on the prognosis of PTCI, and conducted a multivariate analysis to assess risk factors for bilateral central node metastasis for PTCI.

RESULTS

There was no significant difference in postoperative recurrence-free survival (RFS) between Group A and Group B (P = 0.574). Temporary hypocalcemia occurred more in Group A than Group B (χ2 = 4.608, P = 0.032). There was no significant difference in metastatic lymph nodes between the 2 groups. However, there are 8 patients occurred bilateral central node metastasis in group A, and 6 in Group B (16.7% vs. 14.6%, respectively, P = 0.793). Multiple logistic analysis suggested that tumor size greater than 1.0 cm (OR = 9.72, 95% CI: 2.06-56.59, P < 0.001), and tumor located in the center of isthmus (OR = 5.19, 95% CI: 1.04-2.58,P < 0.001) were risk factors for bilateral central node metastasis.

CONCLUSIONS

Our results reveal that isthmusectomy plus BCLND may be a simple but feasible approach for selected PTCI patients, resulting in a better quality of life than total thyroidectomy plus BCLND.

Effects of group reminiscence interventions on depressive symptoms and life satisfaction in older adults with intact cognition and mild cognitive impairment: A systematic review

OBJECTIVE

Reminiscence interventions have been extensively used to improve the psychological health of people with dementia. However, there is uncertainty about the effectiveness of group reminiscence interventions for older adults with intact cognition and mild cognitive impairment. Based on the large number of older adults and strained health care resources in China, we conducted a systematic review of the evidence on the effectiveness of group reminiscence interventions for older adults with intact cognition or mild cognitive impairment.

MATERIALS AND METHODS

Five English databases were searched from inception to 21 August 2022. The quality of the included articles was assessed by using the Cochrane Risk of Bias Scale or Criteria (2020) and the Australian Evidence-Based Health Care Centre (2020). Data related to study and intervention characteristics were extracted.

RESULTS

Twenty-four articles were included, of which eight were quasiexperimental studies and sixteen were randomized controlled studies. The overall study quality was high, but most studies did not blind the participants. Group reminiscence interventions were beneficial in improving depressive symptoms and life satisfaction in older adults with intact cognition or mild cognitive impairment, but no valid conclusions could be drawn about the effect on quality of life.

CONCLUSIONS

Group reminiscence interventions are an effective type of psychological intervention to improve the psychological health of older people. In addition, group reminiscence interventions are simple and easy to implement and can be considered a routine care activity to meet the spiritual needs of cognitively intact and mildly cognitively impaired older people.

Effectiveness and Safety of Percutaneous Treatment in Lesions Suggestive of Thyroid Cancer (Bethesda V and VI-T1aN0M0) Compared to Surgical Treatment: Systematic Review and Meta-Analysis

INTRODUCTION

Thyroid nodules are common entities, with 5% malignancy. Differentiated thyroid cancer represents 90% of thyroid malignancies, with papillary carcinoma being the most common. Management is generally surgical; among its complications are injury to the recurrent laryngeal and superior laryngeal nerve, causing hoarseness, postsurgical hypoparathyroidism, hypothyroidism, and pain. Other noninvasive percutaneous interventions of thermal ablation such as microwave, radiofrequency, or laser incur lower costs and could be an option for treatment.

OBJECTIVE

To determine the effectiveness and safety of thermal ablation in lesions suspected of thyroid cancer (Bethesda V and VI/T1aN0M0) compared to surgical treatment.

METHODS

Systematic review/meta-analysis of observational studies and clinical trials. Database search includes MEDLINE/PUBMED, Embase, Scopus, Scielo, and BVS/LILACS. Studies on patients over 18 years of age with lesions suspicious of thyroid cancer were included.

RESULTS

A total of 10 studies were obtained, with 2939 patients: 1468 subjected to thermal ablation and 1471 to surgery. Regarding effectiveness, no differences were found in local recurrence [relative risk (RR) 1.17 (95% CI 0.69-1.99)] and cervical lymph node metastasis [RR 0.76 (95% CI 0.43-1.36)]. Regarding safety, infection [RR 0.29 (95% CI 0.05-1.74)], hematoma [RR 0.57 (95% CI 0.17-1.94)], and transient hoarseness [RR 0.77 (95% CI 0.39-1.51)] were evaluated, without difference. However, permanent hoarseness had significant differences in favor of thermal ablation [RR 0.29 (95% CI 0.11-0.75)].

CONCLUSIONS

Thermal ablation for the treatment of T1aN0M0 papillary thyroid carcinoma is equally effective when compared to surgical techniques and offers a better safety profile, particularly in permanent hoarseness.

Reminiscence therapy care program as a potential nursing intervention to relieve anxiety, depression, and quality of life in older papillary thyroid carcinoma patients: A randomized, controlled study

Objective

Reminiscence therapy (RT) ameliorates psychological problems and quality of life in cancer patients. However, no study reports its effect on older papillary thyroid carcinoma (PTC) patients. This study intended to investigate the effect of the RT-care program (CP) on anxiety, depression, quality of life, and survival in older PTC patients.

Methods

Eighty-six postoperative older PTC patients were enrolled and randomly assigned to RT-CP group (N = 44) and usual (U)-CP group (N = 42) as a 1:1 ratio for a 6-month intervention. Hospital Anxiety and Depression Scale (HADS) and Quality of Life Questionnaire-Core 30 (QLQ-C30) scores were assessed at baseline, month (M)1, M2, M4, and M6.

Results

HADS and QLQ-C30 scores at baseline were not different between two groups. Additionally, HADS-anxiety score at M6 (p = 0.029), and HADS-depression score at M2 (p = 0.030), M4 (p = 0.029), M6 (p = 0.012) were reduced in RT-CP group versus U-CP group. Meanwhile, anxiety and depression rates from M1 to M6 were slightly decreased in RT-CP group versus U-CP group but did not reach statistical significance. Furthermore, depression severity at M6 was reduced in RT-CP group versus U-CP group (p = 0.049). Besides, QLQ-C30 global health status was increased at M2 (p = 0.023) and M6 (p = 0.033), QLQ-C30 function score was elevated at M2 (p = 0.040) and M4 (p = 0.035), while QLQ-C30 symptom score was decreased at M2 (p = 0.046) in RT-CP group versus U-CP group. Moreover, disease-free survival and overall survival were not different between two groups.

Conclusion

RT-CP may be a potential intervention for ameliorating anxiety, depression, and quality of life in older PTC patients.

Establishing a predictive model of hypoparathyroidism after total thyroidectomy and central lymph node dissection for postoperative calcium supplementation selectively

Background

The core goal of this article is to find some meaningful risk factors that can affect the postoperative hypoparathyroidism of thyroid cancer, create an effective prediction model on this basis, and use it to selectively implement routine prophylactic calcium supplementation for patients after thyroid carcinoma surgery.

Methods

The clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) who underwent conventional bilateral total thyroidectomy (TT) + bilateral central lymph node dissection from January 2020 to August 2021 in the Affiliated Hospital of Nantong University were retrospectively analyzed. Firstly, this study analyzed the relationship between postoperative hypocalcemia and hypoparathyroidism. Then, we included many potential risk factors such as gender, age, body mass index (BMI), lateral lymph node dissection (LLND) and so on and also performed univariate and multivariate analysis of the independent risk factors for postoperative hypoparathyroidism in patients, and established a predictive scoring model.

Results

Among the 401 patients with PTC, 50.1% developed postoperative hypoparathyroidism. There was significant difference in serum calcium concentration between normal parathyroid group and hypoparathyroidism group after thyroid carcinoma surgery. BMI <24 kg/m², lateral lymph node dissection, multifocality, and extrathyroidal extension (ETE) were all identified as independent risk factors for postoperative hypoparathyroidism. Based on these independent risk factors, a nine-point risk scoring model was created to firstly assess the postoperative parathyroid function status of patients and then to determine whether routine prophylactic calcium supplementation is needed. Importantly, the area under the curve (AUC) of the risk scoring model is equal to 0.979.

Conclusions

At present, prophylactic calcium supplementation after thyroid carcinoma surgery is a controversial postoperative treatment. It should be selectively implemented for high-risk patients with hypoparathyroidism after surgery. Routine prophylactic calcium supplementation is recommended for PTC patients with a score greater than or equal to 5, although there are no clinical symptoms of postoperative hypocalcemia caused by hypoparathyroidism. However, prophylactic calcium supplementation is not recommended for patients with PTC with a score of less than 5; if the patient develops hypocalcemia at the later stage, therapeutic calcium supplementation can then be implemented.

Hypercalcemia in IgG4-related disease: coincidental or associated? Case based review

Immunoglobulin (Ig) G4-related disease (IgG4RD) is a chronic autoimmune disorder characterized by dense lymphoplasmacytic infiltrations and fibrosis of storiform pattern. The most typical manifestations include major salivary or lacrimal gland involvement, autoimmune pancreatitis, and retroperitoneal fibrosis. While the increase in IgG4 is the typical feature of the disease, hypercalcemia has been rarely reported in IgG4RD so far, only one of these cases has been shown parathyroid gland involvement (isolated involvement). In this study, we present a 43-year-old female patient with weight loss, pancreatic mass, lymphadenopathy, nodular lesion in the lung, hypercalcemia, and also increased level of serum IgG4. Histopathological investigation following parathyroidectomy revealed a dense lymphoplasmacytic infiltrate with an IgG4 to IgG ratio of > 50% in the fat tissue surrounding the parathyroid gland, particularly at the perivascular areas. This is the first systemic IgG4RD case in combination with hypercalcemia in the literature who was detected to have parathyroid adenoma. Our aim in this review is to emphasize that, although rarely, IgG4RD may be accompanied by hypercalcemia and parathyroid gland may be one of its target sites.

The Necessity of Lymph Node Dissection Between Sternocleidomastoid and Sternohyoid Muscles in pN1b Papillary Thyroid Carcinoma

BACKGROUND

This study aimed to evaluate the association between clinicopathologic variables and metastasis of the lymph node (LN) between the sternocleidomastoid and sternohyoid muscles (LNSS) to clarify the necessity of LNSS dissection in papillary thyroid carcinomas (PTCs).

METHODS

A total of 219 patients undergoing unilateral or bilateral neck dissection for PTCs were prospectively enrolled. The associations between clinicopathologic variables and LNSS metastasis were evaluated by univariate and multivariate analyses.

RESULTS

LNSS was present in 108 (40.1%) neck dissection samples and in 76 (34.7%) patients. Positive LNSS occurred in 40/269 (14.9%) neck dissection samples and in 20/219 (9.1%) patients. Univariate analysis showed that tumor stage, number of positive nodes in level III, and number of positive nodes in level IV were related to LNSS metastasis. Multivariate analysis confirmed that T3/4 stage tumors and >2 positive LNs in level IV independently increased the risk of LNSS metastasis.

CONCLUSIONS

The low rate of LNSS metastasis would deem routine dissection unnecessary; however, LNSS would require excision if advanced stage tumors or level IV LN metastasis were present.