[Current TNM system of the UICC/AJCC : the prognostic significance for differentiated thyroid carcinoma]

The Clinicopathological Features of Papillary Thyroid Carcinoma Patients with Positive Hepatitis B Surface Antigen

BACKGROUND

Hepatitis B virus infection has been reported to be associated with some kinds of cancer. The aim of this study was to investigate clinicopathological features of papillary thyroid carcinoma (PTC) patients with positive hepatitis B surface antigen (HBsAg).

MATERIALS AND METHODS

A total of 569 PTC patients were analyzed retrospectively in this study. The relationships of HBsAg with clinicopathologic features of PTC were analyzed by univariate analysis. The relationships of central lymph node metastasis (CLNM) with clinicopathological features of PTC were analyzed by univariate and multivariate logistic regression analysis.

RESULTS

The incidence of CLNM in PTC with positive HBsAg was higher than that in PTC with negative HBsAg (71.4 vs. 60.0%, p = 0.047). Univariate analysis showed that positive HBsAg was significantly associated with bilateral tumors (p = 0.043) and lymph node metastasis (LNM) (p = 0.047) in PTC patients. In addition, the incidence of CLNM in patients with PTC was 61.7% (351 of 569 cases). Univariate analysis showed that CLNM of patients with PTC was significantly associated with positive HBsAg (p = 0.047). Multivariate logistic regression analysis revealed that positive HBsAg (p = 0.038) was an independent predictor of CLNM in patients with PTC.

CONCLUSIONS

The incidence of CLNM in PTC patients with positive HBsAg was significantly higher than that of patients with negative HBsAg. Positive HBsAg was correlated with LNM and bilateral tumors. In addition to gender, age <45 years, tumor size >2 cm, and lateral LNM, positive HBsAg was also an independent predictor of CLNM in PTC patients.

Does every classical type of well-differentiated thyroid cancer have excellent prognosis? A case series and literature review

Introduction: The classical type of well-differentiated thyroid cancer (WDTC) is the most common endocrine tumor with generally excellent prognosis. WDTC of the WHO stage 1 classification metastasizing to the vertebral column is not often seen for this neoplasm. Here, I present a case series of 14 individuals with aggressive classical type of WDTC. Methods: To identify the most aggressive cases of classical type WDTC, I reviewed the medical records of 4,327 patients consecutively admitted and surgically treated in a single institution for thyroid pathology in the years 2008-2016. Demographic, pathological and outcome data were collected and reviewed. Results: During the study period, 14 (4.02%) patients with aggressive forms of the classical type of WDTC were reviewed: 10 (2.87%) cases with papillary thyroid cancer (PTC) and 4 (1.14%) with follicular thyroid cancer (FTC). The median age at diagnosis was 61 years (31-84 years). Aggressive features such as extrathyroid extension 11/14 (78.57%), positive surgical margins 11/14 (78,57%), lymph node metastases 7/14 (50%), multifocality 6/14 (42.85%), regional tissue infiltration 11/14 (78.57%) and distant metastases 4/14 (28.57%) were observed. Long-term follow-up (median 40 months) demonstrated a high rate of locoregional recurrence in 12/14 (85.71%) individuals. Pulmonary and other distant metastases were observed in 4/14 (28.57%) patients, with mortality in 3/14 (21.42%) individuals. Conclusion: In patients with classical type of WDTC characterized by excellent prognosis, extremely aggressive entities might be observed, making WDTC in some cases an unpredictable tumor.

Clinicopathological Features and Prognosis of Papillary Thyroid Microcarcinoma for Surgery and Relationships with the BRAFV600E Mutational Status and Expression of Angiogenic Factors

Objective

To investigate the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) for surgery by comparing the difference between PTMC and larger papillary thyroid carcinoma (LPTC).

Methods

We analyzed the differences in the clinicopathological characteristics, prognosis, B-type RAF kinase (BRAF)^V600E mutational status and expression of angiogenic factors, including pigment epithelium-derived factor (PEDF), Vascular Endothelial Growth Factor (VEGF), and hypoxia-inducible factor alpha subunit (HIF-1α), between PTMC and LPTC by retrospectively reviewing the records of 251 patients with papillary thyroid carcinoma, 169 with PTMC, and 82 with LPTC (diameter >1 cm).

Results

There were no significant differences in the gender, age, multifocality, Hashimoto’s thyroiditis, TNM stage, PEDF protein expression, rate of recurrence, or mean follow-up duration between patients with PTMC or LPTC. The prevalence of extrathyroidal invasion (EI), lymph node metastasis (LNM), and BRAF mutation in patients with PTMC was significantly lower than in patients with LPTC. In addition, in PTMC patients with EI and/or LNM and/or positive BRAF (high-risk PTMC patients), the prevalence of extrathyroidal invasion, Hashimoto's disease, lymph node metastasis, tumor TNM stage, PEDF positive protein expression, the rate of recurrent disease, and the mRNA expression of anti-angiogenic factors was almost as high as in patients with larger PTC, but with no significant difference.

Conclusions

Extrathyroid invasion, lymph node metastases, and BRAF^V600E mutation were the high risk factors of PTMC. PTMC should be considered for the same treatment strategy as LPTC when any of these factors is found. Particularly, PTMC with BRAF^V600E gene mutations needed earlier surgical treatment. In addition, the high cell subtype of PTMC with BRAF^V600E gene mutation is recommended for total thyroidectomy in primary surgery to reduce the risk of recurrence.

Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study

The aim of this study was to determine the effects of nanocarbon particles in combination with meticulous capsular dissection on enhancing the identification and protecting the function of parathyroid glands in thyroid cancer surgery.The data of 97 patients with papillary thyroid tumors diagnosed and treated at the Second Affiliated Hospital, Harbin Medical University between January 2014 and February 2015 were reviewed. Data regarding the sex, age, calcium and parathyroid hormone (PTH) levels, tumor size, multifocality, T stage, and extrathyroid invasion were collected. The incidence of surgeries in which the parathyroid glands were cut mistakenly, the concentration of serum calcium and parathyroid hormone before surgery (baseline) and after surgery on days 1, 3, and 7, and 1 and 6 months in the patients of the two groups (the nanocarbon and control groups) were analyzed.Fifty-two patients underwent meticulous capsular dissection combined with nanocarbon treatment (nanocarbon group), and 45 underwent meticulous capsular dissection alone (control group). The nanocarbon group showed a significantly higher total and average number of revealed parathyroid glands (average number is the mean for different individuals have different number) and a lower incidence of the parathyroid glands being mistakenly cut, in addition to a lower level of hypoparathyroidism than control group following surgery (P < 0.05). Serum calcium and PTH levels were significantly lower in patients from both groups after surgery on days 1, 3, and 7 and after 1 month, compared with the preoperative levels (P < 0.05). Compared with the control group, the serum calcium and PTH levels were significantly higher in the nanocarbon group after surgery on days 1, 3, 7, than in the control group.Treatment with nanocarbon in combination with meticulous capsular dissection can significantly facilitate the identification of the parathyroid in thyroid cancer surgery, reduce the risk of mistakenly cutting the parathyroid, and reduce the incidence of postoperative hypoparathyroidism.

Pigment epithelium-derived factor has a role in the progression of papillary thyroid carcinoma by affecting the HIF1α-VEGF signaling pathway

The progression mechanism of papillary thyroid carcinoma (PTC) remains largely unknown. Accumulating evidence has suggested that various targets of pigment epithelium-derived factor (PEDF) are able to inhibit cancer progression. The aim of the present study was to examine PEDF expression in PTC patients and to investigate its relationship with aggressive clinicopathological features, as well as to explore whether PEDF affects the progression of PTC via the hypoxia-inducible factor 1α (HIF1α)-vascular endothelial growth factor (VEGF) pathway. A total of 271 patients with PTC, including 24 men and 247 women, were enrolled in the present study. Relevant patient data, including demographic features, preoperative clinical features and pathological features, were collected for analysis. The protein expression levels of PEDF in PTC tissues were detected using immunohistochemical staining, and the mRNA expression levels of PEDF, VEGF and HIF1α in 15 PTC tissues with lymph node metastasis (LNM) and 10 tissues without LNM were detected using reverse transcription-quantitative polymerase chain reaction. Immunohistochemical staining with an anti-PEDF antibody detected PEDF expression in 74.5% of the PTC tissues. PEDF expression levels were significantly correlated with LNM, extrathyroid invasion, a high TNM stage, the presence of the BRAF^V600E mutation and tumor size. PEDF mRNA expression levels were significantly decreased in PTC tissues with LNM, as compared with PTC tissues without LNM, while the mRNA expression levels of HIF1α and VEGF were markedly increased in PTC tissues with LNM. Taken together, the results of the present study suggested that PEDF plays a role in the progression of PTC, and that PEDF may exert an anti-angiogenesis role by affecting the HIF1α-VEGF pathway, eventually inhibiting the metastasis of PTC.