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Yoon JH, Park JY, Hong AR, Kim HK, Kang HC. Predictors of lateral lymph node metastasis and skip metastasis in patients with papillary thyroid microcarcinoma. Front Endocrinol (Lausanne) 2024; 15:1392247. [PMID: 39015180 PMCID: PMC11250241 DOI: 10.3389/fendo.2024.1392247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/03/2024] [Indexed: 07/18/2024] Open
Abstract
Background Papillary thyroid microcarcinoma (PTMC) is characterized by its favorable prognosis and potential for active surveillance (AS) as a management option. However, the presence of cervical lymph node (LN) metastasis, especially lateral LN metastasis, significantly impacts management and prognosis. Previous studies have focused on post-surgery risk factors for cervical LN metastasis. This study aims to identify predictors of lateral LN metastasis by analyzing pre-operative ultrasonographic findings alongside clinicopathological factors. Methods A retrospective review of medical records was conducted for patients with PTMC who underwent surgery at Chonnam National University Hwasun Hospital between 2004 and 2013. This is a case-control study that compares patients with lateral LN metastasis (N1b) to age- and sex-matched patients without LN metastasis (N0). Subgroup analysis was performed to evaluate risk factors of skip metastasis. Results The study included 90 patients with PTMC with lateral LN metastasis (N1b) and 268 age- and sex-matched patients without LN metastasis (N0). The mean age was 49.3 years, and female patients were dominant in both groups. Structural recurrences of 4.4% (4/90) were observed only in the N1b group. The N1b group exhibited a higher frequency of upper lobe tumor location compared to the N0 group (38.9% vs. 16.0%, p < 0.001). There was no significant difference in the locations with the presence of invasion to adjacent organs. A higher proportion of non-parallel shape was observed in the N1b group than the N0 group (80.0% vs. 66.0%, p = 0.013). There were no differences in echogenicity, sonographic feature, margin, and AP diameter of the thyroid gland between the two groups. In multivariate analysis, independent risk factors for lateral LN metastasis included extrathyroidal extension, multiplicity, upper lobe tumor location, and non-parallel shape. Skip metastasis in patients with PTMC was associated with upper lobe tumor location. Conclusion Detailed ultrasound examinations, evaluating tumor location, number, orientation, and the presence of ETE, are crucial in accurately predicting lateral LN metastasis especially when primary tumor was in the upper lobe to avoid missing skip metastasis. These evaluations can help guide the decision between AS and immediate surgery in patients with PTMC.
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Affiliation(s)
- Jee Hee Yoon
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Ji Yong Park
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - A Ram Hong
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam University Medical School, Gwangju, Republic of Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam University Hwasun Hospital, Gwangju, Republic of Korea
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Ginzberg SP, Sharpe J, Passman JE, Amjad W, Wirtalla CJ, Soegaard Ballester JM, Finn CB, Mandel S, Kelz RR, Wachtel H. Revisiting the Relationship between Tumor Size and Risk in Well-Differentiated Thyroid Cancer. Thyroid 2024. [PMID: 38877803 DOI: 10.1089/thy.2023.0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
INTRODUCTION Large tumor size is associated with poorer outcomes in well-differentiated thyroid cancer (WDTC), yet it remains unclear whether size >4 cm alone confers increased risk, independent of other markers of aggressive disease. The goal of this study was to assess the relationship between tumor size, other high-risk histopathologic features, and survival in WDTC, and to evaluate the significance of 4 cm as a cutoff for management decisions. METHODS Patients with WDTC were identified from the National Cancer Database (2010-2015) and categorized by tumor size [i.e., small (≤4 cm) or large (>4 cm)] and presence of high-risk histopathologic features (e.g., extrathyroidal extension). First, propensity score matching was used to identify patients who were similar across all other observed characteristics except for small vs. large tumor size, and a multivariable Cox proportional hazards model was used to estimate the relationship between tumor size and survival. Second, we assessed whether the presence of high-risk features demonstrate conditional effects on survival based on the presence of tumor size >4 cm using an interaction term. Finally, additional models assessed the relationship between incremental 1 cm increases in tumor size and survival. Analyses were repeated using a validation cohort from the Surveillance, Epidemiology, and End Results Program (2008-2013). RESULTS Of 193,133 patients in the primary cohort, 7.9% had tumors >4 cm, and 30% had at least one high-risk feature. After matching, tumor size >4 cm was independently associated with worse survival (HR 1.63, p<0.001). However, tumor size >4 cm and one or more other high-risk features together yielded worse survival than either size >4 cm alone (MMD: 0.70, p<0.001) or other high-risk features alone (MMD: 0.49, p<0.001). When assessed in 1 cm increments, the largest increases in hazard of death occurred at 2 cm and 5 cm, not 4 cm. Results from the validation cohort were largely consistent with our primary findings. CONCLUSIONS Concomitant high-risk features confer worse survival than large tumor size alone, and a 4 cm cutoff is not associated with the greatest increase in risk. These findings support a more nuanced approach to tumor size in the management of WDTC.
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Affiliation(s)
- Sara P Ginzberg
- University of Pennsylvania Health System, Department of Surgery, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Penn Center for Cancer Care Innovation, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, United States;
| | - James Sharpe
- University of Pennsylvania Health System, Department of Surgery, Philadelphia, Pennsylvania, United States;
| | - Jesse E Passman
- University of Pennsylvania Health System, Department of Surgery, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, United States;
| | - Wajid Amjad
- University of Pennsylvania Health System, Department of Surgery, Philadelphia, Pennsylvania, United States;
| | - Christopher J Wirtalla
- University of Pennsylvania Health System, Department of Surgery, Philadelphia, Pennsylvania, United States;
| | - Jacqueline M Soegaard Ballester
- University of Pennsylvania Health System, Department of Surgery, Philadelphia, Pennsylvania, United States
- University of Pennsylvania, Penn Center for Cancer Care Innovation, Philadelphia, Pennsylvania, United States;
| | - Caitlin B Finn
- Weill Cornell Medicine, Department of Surgery, New York, New York, United States
- University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, United States;
| | - Susan Mandel
- University of Pennsylvania Perelman School of Medicine, Endocrinology, Diabetes and Metabolism, 4 PCAM West, 3400 Civic Center Blvd, Philadephia, Pennsylvania, United States, 19104;
| | - Rachel R Kelz
- Hospital of the University of Pennsylvania, Center for Surgery and Health Economics , Philadelphia, Pennsylvania, United States;
| | - Heather Wachtel
- Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, Pennsylvania, United States;
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Wang H, Zhang C, Li Q, Tian T, Huang R, Qiu J, Tian R. Development and validation of prediction models for papillary thyroid cancer structural recurrence using machine learning approaches. BMC Cancer 2024; 24:427. [PMID: 38589799 PMCID: PMC11000372 DOI: 10.1186/s12885-024-12146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Although papillary thyroid cancer (PTC) patients are known to have an excellent prognosis, up to 30% of patients experience disease recurrence after initial treatment. Accurately predicting disease prognosis remains a challenge given that the predictive value of several predictors remains controversial. Thus, we investigated whether machine learning (ML) approaches based on comprehensive predictors can predict the risk of structural recurrence for PTC patients. METHODS A total of 2244 patients treated with thyroid surgery and radioiodine were included. Twenty-nine perioperative variables consisting of four dimensions (demographic characteristics and comorbidities, tumor-related variables, lymph node (LN)-related variables, and metabolic and inflammatory markers) were analyzed. We applied five ML algorithms-logistic regression (LR), support vector machine (SVM), extreme gradient boosting (XGBoost), random forest (RF), and neural network (NN)-to develop the models. The area under the receiver operating characteristic (AUC-ROC) curve, calibration curve, and variable importance were used to evaluate the models' performance. RESULTS During a median follow-up of 45.5 months, 179 patients (8.0%) experienced structural recurrence. The non-stimulated thyroglobulin, LN dissection, number of LNs dissected, lymph node metastasis ratio, N stage, comorbidity of hypertension, comorbidity of diabetes, body mass index, and low-density lipoprotein were used to develop the models. All models showed a greater AUC (AUC = 0.738 to 0.767) than did the ATA risk stratification (AUC = 0.620, DeLong test: P < 0.01). The SVM, XGBoost, and RF model showed greater sensitivity (0.568, 0.595, 0.676), specificity (0.903, 0.857, 0.784), accuracy (0.875, 0.835, 0.775), positive predictive value (PPV) (0.344, 0.272, 0.219), negative predictive value (NPV) (0.959, 0.959, 0.964), and F1 score (0.429, 0.373, 0.331) than did the ATA risk stratification (sensitivity = 0.432, specificity = 0.770, accuracy = 0.742, PPV = 0.144, NPV = 0.938, F1 score = 0.216). The RF model had generally consistent calibration compared with the other models. The Tg and the LNR were the top 2 important variables in all the models, the N stage was the top 5 important variables in all the models. CONCLUSIONS The RF model achieved the expected prediction performance with generally good discrimination, calibration and interpretability in this study. This study sheds light on the potential of ML approaches for improving the accuracy of risk stratification for PTC patients. TRIAL REGISTRATION Retrospectively registered at www.chictr.org.cn (trial registration number: ChiCTR2300075574, date of registration: 2023-09-08).
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Affiliation(s)
- Hongxi Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, 610041, Chengdu, China
| | - Chao Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Qianrui Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, 610041, Chengdu, China
| | - Tian Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, 610041, Chengdu, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, 610041, Chengdu, China
| | - Jiajun Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, 610041, Chengdu, China.
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, No 37. Guoxue Alley, 610041, Chengdu, China.
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Parvathareddy SK, Siraj AK, Annaiyappanaidu P, Ahmed SO, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Recurrent Middle Eastern Differentiated Thyroid Carcinoma Has Worse Outcomes Than Persistent Disease. J Clin Med 2024; 13:1877. [PMID: 38610642 PMCID: PMC11012810 DOI: 10.3390/jcm13071877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Despite the excellent prognosis of differentiated thyroid carcinoma (DTC), recurrent and persistent disease remain major challenges. Emerging studies to differentiate between recurrent and persistent disease are controversial, with studies from the Middle East lacking. Methods: We retrospectively analyzed 1691 patients who underwent surgery ± I131 treatment for DTC, with a median age of 38.7 years and median follow-up of 95.3 months. Results: We found a similar prevalence rate for persistent and recurrent disease (17.7% vs. 17.9%) in Middle Eastern DTC patients. Relative to patients with persistent disease, patients with recurrent disease were significantly older (median age: 36.1 vs. 45.8 years; p < 0.0001) and were more likely to have ATA high-risk tumors (61.5% vs. 75.2%; p = 0.0003). On multivariate logistic regression analysis, both T and N status were independent predictors for recurrent as well as structural persistent disease. However, older age, bilaterality and extrathyroidal extension were independent predictors of recurrent disease alone. In addition, patients with recurrent disease had significantly worse cancer-specific survival (p < 0.0001), which remained significant in multivariate analysis. Conclusions: Although persistent and recurrent disease in Middle Eastern DTC have similar frequencies, recurrent disease has worse outcomes compared to persistent disease. Hence, differentiating recurrence from persistence has great potential clinical relevance for therapeutic and follow-up approaches, contributing to improving the outcomes of DTC patients of Middle Eastern ethnicity.
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Affiliation(s)
- Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Abdul K. Siraj
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Padmanaban Annaiyappanaidu
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Saeeda O. Ahmed
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Fouad Al-Dayel
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Khawla S. Al-Kuraya
- Human Cancer Genomic Research, Research Centre King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (S.K.P.); (A.K.S.); (P.A.); (S.O.A.)
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Shang S, Yang H, Chen M, Wu J, Shi X, Li X, Feng N, Zheng Z, Liu H, Zhang Y. Correlation between genetic alterations and clinicopathological features of papillary thyroid carcinomas. J Int Med Res 2024; 52:3000605241233166. [PMID: 38456650 PMCID: PMC10924567 DOI: 10.1177/03000605241233166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE To investigate the correlations between multigene alterations and clinicopathological features in papillary thyroid carcinoma (PTC) samples. METHODS In this retrospective study, 111 cytological specimens of thyroid nodules, including 74 PTC samples and 37 benign samples, were analyzed using a 22-gene mutation assay employing next-generation sequencing. Clinicopathological information was retrospectively collected and analyzed. RESULTS Gene alterations were associated with a higher rate of lymph node metastasis (LNM) and thyroid capsular invasion, a lower rate of coexisting Hashimoto's thyroiditis, the classical PTC subtype, and younger age (<45 years). Among the 22 genes tested, the BRAF mutation rates showed a significant difference between the PTC and benign groups. In the subgroup analysis, younger age (odds ratio = 12.512, 95% confidence interval: 3.126-50.087) was an independent risk factor for LNM. In further analyses, BRAF mutation was significantly associated with LNM in the older subgroup (age ≥ 45 years), suggesting that the BRAF mutation test has greater value for determining PTC prognosis in the older age group. CONCLUSIONS Our findings will provide a more comprehensive understanding of the relationship between gene mutations and PTC and may contribute to improved PTC management.
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Affiliation(s)
- Shixuan Shang
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Huimin Yang
- Shanghai Singlera Medical Laboratory, Shanghai, China
| | - Meixiang Chen
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Jin Wu
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Xianjun Shi
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Xiangqin Li
- Department of Pathology, The First People's Hospital of Jiangxia District (Union Jiangnan Hospital), Wuhan, China
| | - Ningning Feng
- Shanghai Singlera Medical Laboratory, Shanghai, China
| | | | - Hongmei Liu
- Shanghai Singlera Medical Laboratory, Shanghai, China
| | - Yunzhi Zhang
- Shanghai Singlera Medical Laboratory, Shanghai, China
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Maino F, Botte M, Dalmiglio C, Valerio L, Brilli L, Trimarchi A, Mattii E, Cartocci A, Castagna MG. Prognostic Factors Improving ATA Risk System and Dynamic Risk Stratification in Low- and Intermediate-Risk DTC Patients. J Clin Endocrinol Metab 2024; 109:722-729. [PMID: 37804529 DOI: 10.1210/clinem/dgad591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
CONTEXT American Thyroid Association (ATA) guidelines do not consider age at diagnosis as a prognostic factor on the estimation of the risk of persistent/recurrent disease in differentiated thyroid carcinoma (DTC) patients. While age at diagnosis has already been assessed in high-risk patients, it remains to be established in low- and intermediate-risk patients. OBJECTIVE The aim of our study was to investigate the role of age as a prognostic factor in the short- and long-term outcome of DTC patients classified at low and intermediate risk according to the ATA stratification risk system. METHODS We retrospectively evaluated 863 DTC patients (mean follow-up: 10 ± 6.2 years) 52% classified as low (449/863) and 48% as intermediate risk (414/863). For each ATA-risk class patients were divided into subgroups based on age at diagnosis (<55 or ≥55 years). RESULTS In the intermediate-risk group, patients aged 55 years or older had a higher rate of structural disease (11.6% vs 8.9%), recurrent disease (4.1% vs 0.7%), and death (4.1% vs 1%) when compared with younger patients (<55 years) (P = .007). Multivariate analysis confirmed that older age at diagnosis (odds ratio [OR] = 3.9; 95% CI, 1.9-8.6; P < .001) was an independent risk factor for worse long-term outcome together with response to initial therapy (OR = 13.0; 95% CI, 6.3-27.9; P < .001), and T (OR = 32; 95% CI, 1.4-7.1; P = .005) and N category (OR = 2.3; 95% CI, 1.1-5.0; P = .03). Nevertheless, a negative effect of older age was documented only in the subgroup of intermediate DTC patients with persistent structural disease after initial therapy. Indeed, the rate of worse long-term outcome rose from 13.3% in the whole population of intermediate DTC patients to 47.8% in patients with persistent structural disease after initial therapy (P < .001) and to 80% in patients older than 55 years and persistent structural disease after initial therapy (P = .02). CONCLUSION Our results suggest that age at diagnosis further predict individual outcomes in Intermediate-Risk DTC allowing ongoing management to be tailored accordingly.
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Affiliation(s)
- Fabio Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Monica Botte
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Cristina Dalmiglio
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Laura Valerio
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Lucia Brilli
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Andrea Trimarchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Elisa Mattii
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Alessandra Cartocci
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Maria Grazia Castagna
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
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Xu D, Lai Y, Liu H, Li H, Feng N, Liu Y, Gong C, Zhang Y, Zhou J, Shen Y. A diagnostic model based on DNA methylation haplotype block characteristics for identifying papillary thyroid carcinoma from thyroid adenoma. Transl Res 2024; 264:76-84. [PMID: 37863284 DOI: 10.1016/j.trsl.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/22/2023]
Abstract
Papillary thyroid carcinoma (PTC) is the most prevalent form of thyroid cancer. Methylation of some genes plays a crucial role in the tendency to malignancy as well as poor prognosis of thyroid cancer, suggesting that methylation features can serve as complementary markers for molecular diagnosis. In this study, we aimed to develop and validate a diagnostic model for PTC based on DNA methylation markers. A total of 142 thyroid nodule tissue samples containing 84 cases of PTC and 58 cases of thyroid adenoma (TA) were collected for reduced representation bisulfite sequencing (RRBS) and subsequent analysis. The diagnostic model was constructed by the logistic regression (LR) method followed by 5-cross validation and based on 94 tissue methylation haplotype block (MHB) markers. The model achieved an area under the receiver operating characteristic curve (AUROC) of 0.974 (95% CI, 0.964-0.981) on 108 training samples and 0.917 (95% CI, 0.864-0.973) on 27 independent testing samples. The diagnostic model scores showed significantly high in males (P = 0.0016), age ≤ 45 years (P = 0.026), high body mass index (BMI) (P = 0.040), lymph node metastasis (P = 0.00052) and larger nodules (P = 0.0017) in the PTC group, and the risk score of this diagnostic model showed significantly high in recurrent PTC group (P = 0.0005). These results suggest that the diagnostic model can be expected to be a powerful tool for PTC diagnosis and there are more potential clinical applications of methylation markers to be excavated.
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Affiliation(s)
- Dong Xu
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, China
| | - Yi Lai
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, China; Department of Traditional Chinese Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, China
| | - Hongmei Liu
- Singlera Genomics (Shanghai) Ltd., 8th Floor, Building 1, Lane 500, Furonghua Road, Pudong, Shanghai 201328, China
| | - He Li
- Department of Traditional Chinese Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, China
| | - Ningning Feng
- Singlera Genomics (Shanghai) Ltd., 8th Floor, Building 1, Lane 500, Furonghua Road, Pudong, Shanghai 201328, China
| | - Yiying Liu
- Singlera Genomics (Shanghai) Ltd., 8th Floor, Building 1, Lane 500, Furonghua Road, Pudong, Shanghai 201328, China
| | - Chengxiang Gong
- Singlera Genomics (Shanghai) Ltd., 8th Floor, Building 1, Lane 500, Furonghua Road, Pudong, Shanghai 201328, China
| | - Yunzhi Zhang
- Singlera Genomics (Shanghai) Ltd., 8th Floor, Building 1, Lane 500, Furonghua Road, Pudong, Shanghai 201328, China
| | - Jiaqing Zhou
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, China.
| | - Yuling Shen
- Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, China.
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Stojanović S, Šelemetjev S, Đorić I, Janković Miljuš J, Tatić S, Živaljević V, Išić Denčić T. BRAFV600E, BANCR, miR-203a-3p and miR-204-3p in Risk Stratification of PTC Patients. Biomedicines 2023; 11:3338. [PMID: 38137560 PMCID: PMC10742276 DOI: 10.3390/biomedicines11123338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/26/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
In order to enhance the risk stratification of papillary thyroid carcinoma (PTC) patients, we assessed the presence of the most common mutation in PTC (BRAFV600E) with the expression profiles of long non-coding RNA activated by BRAFV600E (BANCR) and microRNAs, which share complementarity with BANCR (miR-203a-3p and miR-204-3p), and thereafter correlated it with several clinicopathological features of PTC. BRAFV600E was detected by mutant allele-specific PCR amplification. BANCR and miRs levels were determined by quantitative RT-PCR. Bioinformatic analysis was applied to determine the miRs' targets. The expression profile of miR-203a-3p/204-3p in PTC was not affected by BRAFV600E. In the BRAFV600E-positive PTC, high expression of miR-203a-3p correlated with extrathyroidal invasion (Ei), but the patients with both high miR-203a-3p and upregulated BANCR were not at risk of Ei. In the BRAFV600E-negative PTC, low expression of miR-204-3p correlated with Ei, intraglandular dissemination and pT status (p < 0.05), and the mutual presence of low miR-204-3p and upregulated BANCR increased the occurrence of Ei. Bioinformatic analysis predicted complementary binding between miR-203a-3p/204-3p and BANCR. The co-occurrence of tested factors might influence the spreading of PTC. These findings partially describe the complicated network of interactions that may occur during the development of PTC aggressiveness, potentially providing a new approach for high-risk PTC patient selection.
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Affiliation(s)
- Stefana Stojanović
- Department of Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy—INEP, University of Belgrade, Banatska 31b, 11000 Belgrade, Serbia; (S.S.); (S.Š.); (I.Đ.); (J.J.M.)
| | - Sonja Šelemetjev
- Department of Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy—INEP, University of Belgrade, Banatska 31b, 11000 Belgrade, Serbia; (S.S.); (S.Š.); (I.Đ.); (J.J.M.)
| | - Ilona Đorić
- Department of Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy—INEP, University of Belgrade, Banatska 31b, 11000 Belgrade, Serbia; (S.S.); (S.Š.); (I.Đ.); (J.J.M.)
| | - Jelena Janković Miljuš
- Department of Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy—INEP, University of Belgrade, Banatska 31b, 11000 Belgrade, Serbia; (S.S.); (S.Š.); (I.Đ.); (J.J.M.)
| | - Svetislav Tatić
- Institute for Pathology, Faculty of Medicine, University of Belgrade, Doctor Subotic Street 1, 11000 Belgrade, Serbia;
| | - Vladan Živaljević
- Clinic for Endocrine Surgery, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia;
| | - Tijana Išić Denčić
- Department of Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy—INEP, University of Belgrade, Banatska 31b, 11000 Belgrade, Serbia; (S.S.); (S.Š.); (I.Đ.); (J.J.M.)
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Zhao B, Chen S, Dai X, Gao F, Xie P, Wang S, Sui X. Secondary hyperparathyroidism combined with thyroid disease. Medicine (Baltimore) 2023; 102:e36514. [PMID: 38115353 PMCID: PMC10727630 DOI: 10.1097/md.0000000000036514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
To retrospectively analyze the diagnosis and treatment of secondary hyperparathyroidism (SHPT) combined with thyroid disease, and to investigate the correlation between SHPT and papillary thyroid carcinoma (PTC), SHPT and thyroid disease, and the importance of preoperative localization diagnosis in patients with SHPT. Clinical data of 101 patients who underwent surgical treatment for SHPT at the Third Hospital of Hebei Medical University were collected from August 2014 to May 2023, and patients were divided into SHPT without PTC group (n = 94) and SHPT with PTC group (n = 7) according to their postoperative pathology. Patients were divided into SHPT without thyroid disease group (n = 32) and SHPT with thyroid disease group (n = 69) according to their preoperative ultrasound diagnosis and postoperative pathology. The differences between the 2 groups were compared to explore the association between SHPT and PTC and between SHPT and thyroid disease. Of the 101 patients with SHPT, 65 were male and 36 were female with a mean age of (44.26 ± 11.16) years. There were 69 patients (68.32%) with concomitant thyroid disease and 32 patients (31.68%) without concomitant thyroid disease, including 7 patients (6.93%) with PTC. The results of univariate analysis showed that the differences in age and preoperative PTH levels between the SHPT without PTC group and the SHPT with PTC group were statistically significant (P < 0. 05),There were no significant differences in age, gender, preoperative PTH, preoperative alkaline phosphatase, preoperative serum calcium, preoperative serum phosphorus, preoperative serum creatinine, duration of dialysis disease, and whether they were accompanied by hypertension or not between the SHPT without thyroid disease group and the SHPT with thyroid disease group (P > 0. 05), logistic regression analysis showed that there was a correlation between the age of patients with SHPT and the level of preoperative PTH with PTC. In patients with SHPT, concomitant thyroid disease is more common, so patients with SHPT should be screened for thyroid disease at the same time as routine preoperative ultrasonography combined with nuclear scan for localized diagnosis, and surgical resection is preferred if concomitant PTC is present.
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Affiliation(s)
- Bingxin Zhao
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Simei Chen
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Xinpeng Dai
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Feng Gao
- Department of Pathology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Peng Xie
- Department of Nuclear Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Shuchang Wang
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
| | - Xin Sui
- Department of Ultrasound Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, PR China
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Tang S, Cai L, Wang Z, Pan D, Wang Q, Shen Y, Zhou Y, Chen Q. Emerging roles of circular RNAs in the invasion and metastasis of head and neck cancer: Possible functions and mechanisms. CANCER INNOVATION 2023; 2:463-487. [PMID: 38125767 PMCID: PMC10730008 DOI: 10.1002/cai2.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2023]
Abstract
Head and neck cancer (HNC) is the seventh most prevalent malignancy worldwide in 2020. Cancer metastasis is the main cause of poor prognosis in HNC patients. Recently, circular RNAs (circRNAs), initially thought to have no biological function, are attracting increasing attention, and their crucial roles in mediating HNC metastasis are being extensively investigated. Existing studies have shown that circRNAs primarily function through miRNA sponges, transcriptional regulation, interacting with RNA-binding proteins (RBPs) and as translation templates. Among these functions, the function of miRNA sponge is the most prominent. In this review, we summarized the reported circRNAs involved in HNC metastasis, aiming to elucidate the regulatory relationship between circRNAs and HNC metastasis. Furthermore, we summarized the latest advances in the epidemiological information of HNC metastasis and the tumor metastasis theories, the biogenesis, characterization and functional mechanisms of circRNAs, and their potential clinical applications. Although the research on circRNAs is still in its infancy, circRNAs are expected to serve as prognostic markers and effective therapeutic targets to inhibit HNC metastasis and significantly improve the prognosis of HNC patients.
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Affiliation(s)
- Shouyi Tang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Luyao Cai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Zhen Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Dan Pan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Qing Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Yingqiang Shen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
| | - Yu Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
- State Institute of Drug/Medical Device Clinical TrialWest China Hospital of StomatologyChengduChina
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of StomatologySichuan UniversityChengduChina
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11
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Jeong SI, Kim W, Yu HW, Choi JY, Ahn CH, Moon JH, Choi SI, Cha W, Jeong WJ, Park SY, Na HY. Incidence and Clinicopathological Features of Differentiated High-Grade Thyroid Carcinomas: An Institutional Experience. Endocr Pathol 2023; 34:287-297. [PMID: 37515661 DOI: 10.1007/s12022-023-09778-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
Differentiated high-grade thyroid carcinoma (DHGTC) is a new entity in the 2022 WHO classification. We aimed to investigate the incidence and clinicopathological features of differentiated HG thyroid carcinoma (DHGTC) and compare the clinicopathological parameters of DHGTC, DTC without HG features, and poorly differentiated thyroid carcinoma (PDTC). A total of 1069 DTCs including papillary thyroid carcinomas (PTCs) and follicular thyroid carcinomas (FTCs) were included in this study. Consecutive 22 PDTCs were also included for comparative purposes. There were a total of 14 (1.3%) cases of DHGTCs, with 13 HGPTCs (1.2% of PTCs) and one HGFTC (6.7% of FTCs). Compared to DTCs without HG features, DHGTCs were associated with larger tumor size, presence of blood vessel invasion, gross extrathyroidal extension, distant metastasis at the time of diagnosis, higher American Joint Committee on Cancer stage, high American Thyroid Association risk, and TERT promoter mutations. DHGTC and PDTC showed a significantly shorter recurrence-free survival (RFS) than DTC without HG features. Multivariate Cox regression analysis revealed that blood vessel invasion, lateral node metastasis, TERT promoter mutations, and HG features were independent prognostic factors (all p < 0.05). When tumor necrosis and increased mitotic count were evaluated separately, tumor necrosis, but not increased mitotic counts, was found to be an independent prognostic factor (p = 0.006). This study confirmed that DHGTC is significantly associated with aggressive clinicopathological features and poor clinical outcomes, similar to PDTC. Although the incidence is low, careful microscopic examination of HG features in DTC is required.
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Affiliation(s)
- Se In Jeong
- Department of Pathology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Woochul Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, 13620, Republic of Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, 13620, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, 13620, Republic of Korea
- Department of Surgery, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Chang Ho Ahn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Sang Il Choi
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, 13620, Republic of Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
- Department of Pathology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
- Department of Pathology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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Yun HJ, Lee JS, Lee JS, Kim SM, Chang H, Lee YS, Chang HS, Park CS. Lateral neck dissection for the treatment of synchronous and metachronous lateral neck metastasis of N1b papillary thyroid cancer. Front Endocrinol (Lausanne) 2023; 14:1166640. [PMID: 37424860 PMCID: PMC10325561 DOI: 10.3389/fendo.2023.1166640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Metachronous lateral neck recurrence after thyroidectomy for N1b papillary thyroid cancer is accompanied by high morbidity and increased difficulty of reoperation. From the perspective of recurrence, the objective of this study was to compare patients who underwent metachronous lateral neck dissection (mLND) despite initial thyroidectomy and patients who underwent synchronous lateral neck dissection (sLND) for papillary thyroid cancer and analyze the risk factors for recurrence after mLND. Method This retrospective study involved 1,760 patients who underwent lateral neck dissection for papillary thyroid cancer at the Gangnam Severance Hospital, a tertiary medical center in Korea, from June 2005 to December 2016. The primary outcome was structural recurrence, and secondary outcome measures were risk factors of recurrence in the mLND group. Result A total of 1,613 patients underwent thyroidectomy and sLND at diagnosis. In 147 patients, thyroidectomy alone was performed at the time of diagnosis, and mLND was performed when recurrence to the lateral neck lymph node was confirmed. During a median follow-up of 102.1 months, 110 (6.3%) patients experienced a recurrence. There was no significant difference in the recurrence between the sLND and mLND groups (6.1% vs 8.2%, P=.32). The period from lateral neck dissection to recurrence was longer in the mLND group than in the sLND group (113.6 ± 39.4 months vs 87.0 ± 33.8 months, respectively, P<.001). Age ≥50 years (adjusted HR=5.209, 95% CI=1.359-19.964; P=.02), tumor size >1.45 cm (adjusted HR=4.022, 95% CI=1.036-15.611; P=.04), and lymph node ratio in the lateral compartment (adjusted HR=4.043, 95% CI=1.079-15.148; P=.04) were independent variables predictive of recurrence after mLND. Conclusion mLND is suitable for treating lateral neck recurrence in patients with N1b papillary thyroid cancer who previously underwent thyroidectomy. Lateral neck recurrence after treatment in patients who underwent mLND was predicted by age, tumor size, and lymph node ratio in the lateral compartment.
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Affiliation(s)
- Hyeok Jun Yun
- Department of Surgery, Institute of Refractory Thyroid Cancer, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Seok Lee
- Department of Surgery, Institute of Refractory Thyroid Cancer, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Sung Lee
- Department of Surgery, Institute of Refractory Thyroid Cancer, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok Mo Kim
- Department of Surgery, Institute of Refractory Thyroid Cancer, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hojin Chang
- Department of Surgery, Institute of Refractory Thyroid Cancer, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Sang Lee
- Department of Surgery, Institute of Refractory Thyroid Cancer, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hang-Seok Chang
- Department of Surgery, Institute of Refractory Thyroid Cancer, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheong Soo Park
- Department of Surgery, CHA Ilsan Medical Center, Goyang-si, Republic of Korea
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Liu Y, Lai F, Lin B, Gu Y, Chen L, Chen G, Xiao H, Luo S, Pang Y, Xiong D, Li B, Peng S, Lv W, Alexander EK, Xiao H. Deep learning to predict cervical lymph node metastasis from intraoperative frozen section of tumour in papillary thyroid carcinoma: a multicentre diagnostic study. EClinicalMedicine 2023; 60:102007. [PMID: 37251623 PMCID: PMC10209138 DOI: 10.1016/j.eclinm.2023.102007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Lymph node metastasis (LNM) assessment in patients with papillary thyroid carcinoma (PTC) is of great value. This study aimed to develop a deep learning model applied to intraoperative frozen section for prediction of LNM in PTC patients. Methods We established a deep-learning model (ThyNet-LNM) with the multiple-instance learning framework to predict LNM using whole slide images (WSIs) from intraoperative frozen sections of PTC. Data for the development and validation of ThyNet-LNM were retrospectively derived from four hospitals from January 2018 to December 2021. The ThyNet-LNM was trained using 1987 WSIs from 1120 patients obtained at the First Affiliated Hospital of Sun Yat-sen University. The ThyNet-LNM was then validated in the independent internal test set (479 WSIs from 280 patients) as well as three external test sets (1335 WSIs from 692 patients). The performance of ThyNet-LNM was further compared with preoperative ultrasound and computed tomography (CT). Findings The area under the receiver operating characteristic curves (AUCs) of ThyNet-LNM were 0.80 (95% CI 0.74-0.84), 0.81 (95% CI 0.77-0.86), 0.76 (95% CI 0.68-0.83), and 0.81 (95% CI 0.75-0.85) in internal test set and three external test sets, respectively. The AUCs of ThyNet-LNM were significantly higher than those of ultrasound and CT or their combination in all four test sets (all P < 0.01). Of 397 clinically node-negative (cN0) patients, the rate of unnecessary lymph node dissection decreased from 56.4% to 14.9% by ThyNet-LNM. Interpretation The ThyNet-LNM showed promising efficacy as a potential novel method in evaluating intraoperative LNM status, providing real-time guidance for decision. Furthermore, this led to a reduction of unnecessary lymph node dissection in cN0 patients. Funding National Natural Science Foundation of China, Guangzhou Science and Technology Project, and Guangxi Medical High-level Key Talents Training "139" Program.
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Affiliation(s)
- Yihao Liu
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fenghua Lai
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo Lin
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunquan Gu
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumour Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Han Xiao
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuli Luo
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuyan Pang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumour Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dandan Xiong
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Guangxi Zhuang Autonomous Region Engineering Research Center for Artificial Intelligence Analysis of Multimodal Tumour Images, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bin Li
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sui Peng
- Clinical Trials Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weiming Lv
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Erik K. Alexander
- Thyroid Section, Brigham & Women's Hospital, Harvard Medical School, Boston, USA
| | - Haipeng Xiao
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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14
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Bayadsi H, Nylén C, Sandström M, Angelsten J, Sund M, Hennings J. Risk factors for recurrent disease in small papillary thyroid cancers - a Swedish register-based study. Langenbecks Arch Surg 2023; 408:162. [PMID: 37099203 PMCID: PMC10133060 DOI: 10.1007/s00423-023-02905-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/19/2023] [Indexed: 04/27/2023]
Abstract
AIMS To study the correlation between clinicopathological risk factors and the risk for intervention-requiring cancer recurrence in patients with small papillary thyroid cancers (sPTCs). MATERIALS AND METHODS Records for 397 patients with sPTC (T1 ≤ 20mm) were obtained from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery (SQRTPA) between 2010 and 2016. Follow-up time was at least 5 years. Data regarding intervention-requiring cancer recurrence were obtained from patient medical records and analysed regarding lymph node (LN) status (N0, N1a and N1b) and recurrence. RESULTS Age was significantly lower in the N1a and N1b groups compared to N0 (45 vs. 40.5 vs. 49 years, respectively; p = 0.002). Tumour size was smaller in the N1a group compared to N1b group (9 vs. 11.8 mm; p <0.01). The mean number of metastatic LNs at initial surgery was higher in the N1b compared to N1a group (6.6 vs. 3; p = 0.001), and in the recurrent compared to the non-recurrent group (7 versus 3.9; p <0.01). The recurrence rate was higher in the N1b group than the N1a and N0 groups (25% vs. 2.4% vs. 1.4%, respectively; p = 0.001). CONCLUSIONS Lymph node stage N1b at diagnosis, and having five or more metastatic nodes, are strong risk factors for cancer recurrence and decreased disease-free survival in sPTC. The management of patients with sPTC should include thorough lymph node mapping for optimal treatment and individual risk stratification.
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Affiliation(s)
- Haytham Bayadsi
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden.
| | - Carolina Nylén
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Maria Sandström
- Department of Radiation Sciences/Oncology, Umeå University, Umeå, Sweden
| | - Jakob Angelsten
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joakim Hennings
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden
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Liang T, Wu X, Wang L, Ni Z, Fan Y, Wu P, Wang H, Niu Y, Huang H. Clinical significance and diagnostic value of QPCT, SCEL and TNFRSF12A in papillary thyroid cancer. Pathol Res Pract 2023; 245:154431. [PMID: 37060824 DOI: 10.1016/j.prp.2023.154431] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023]
Abstract
PURPOSE To identify specific novel genes that could be used as diagnostic and prognostic factors in papillary thyroid carcinoma (PTC). METHODS Screening of differential genes by RNA sequencing (RNA-Seq) in normal thyroid, Hashimoto's thyroiditis, PTC combined with Hashimoto's thyroiditis and PTC tissues. The genes QPCT, SCEL and TNFRSF12A were selected by qRT-PCR and immunohistochemical pre-experiments. The GEPIA2 database, qRT-PCR, and immunohistochemical studies were used to confirm the target genes QPCT, SCEL, and TNFRSF12A. ROC curves were used to assess the diagnostic usefulness of these 3 genes for PTC in more detail. RESULTS Functional enrichment analysis showed that QPCT, SCEL and TNFRSF12A were enriched in the pathways for peptidyl-pyroglutamic acid biosynthesis, keratinocyte differentiation, WNT signaling, apoptosis. GEPIA2 database analysis revealed that QPCT, SCEL and TNFRSF12A were high in thyroid cancer, and TC patients with lower TNFRSF12A levels had short survival. QPCT, SCEL and TNFRSF12A were elevated in PTC and thyroid adenoma. The mRNA diagnostic values were as follows: for QPCT, AUROC = 0.891, 95% CI, 0.835-0.947; for SCEL, AUROC = 0.921, 95% CI, 0.869-0.974; for TNFRSF12A, AUROC = 0.884, 95% CI, 0.809-0.958. Immunohistochemical results showed that QPCT, SCEL, and TNFRSF12A differed to varying degrees between subgroups of thyroid tissue. SCEL was associated with BRAF V600E mutation status and stratification of recurrence risk, while TNFRSF12A was associated with Cyclin D1. The protein diagnostic values were as follows: for QPCT, AUROC = 0.752, 95% CI, 0.685-0.819; for SCEL, AUROC = 0.715, 95% CI, 0.645-0.784; for TNFRSF12A, AUROC = 0.660, 95% CI, 0.587-0.734. CONCLUSION QPCT, SCEL and TNFRSF12A are expected to be diagnostic markers for PTC.
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16
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Huang S, Cui M, Wang R, Yang G, Wang N, Cui L, Ma G. Combined treatment with Prunella vulgaris and Radix bupleuri activated the Bax/Bcl-2 and Caspase-3 signal pathways in papillary thyroid carcinoma cells. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2023:1-12. [PMID: 36924446 DOI: 10.1080/15257770.2023.2189464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
To explore the effect of Prunella vulgaris (PV) combined with Radix bupleuri (RB) on apoptosis of papillary thyroid carcinoma cells. Our study was divided into four groups: the control group, the PV group, the RB group, and the PV combined with the RB group. The viability of cells from different treatment groups was assessed by the CCK-8 assay. Cell migration and invasion were assessed by healing wounding and the transwell assay, respectively. Cell apoptosis rate and cell cycle arrest were detected by a flow cytometry assay. The protein expression of Bcl-2, Bax, Caspase-3, CyclinA1, CyclinB1, and CDK1 was detected using a western blot assay. Our results indicated that, compared with the control group, PV combined with RB group could significantly alter the cell morphology, inhibit cell migration and invasion, decrease the number of cells in the G0/G1 phase and increase the number of cells in the G2/M phase, and promote the cell apoptosis. Moreover, PV combined with RB treatment also obviously increased the expression of Bax/Bcl2 and caspase-3 proteins and decreased the expression of Cyclin A1, Cyclin B1, and CDK1 proteins. Overall, our results indicated that PV combined with RB could activate the Bax/Bcl-2 and Caspase-3 signal pathways to induce cell apoptosis in papillary thyroid carcinoma cells; this also provides a new way to treat thyroid cancer.
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Affiliation(s)
- Shujuan Huang
- Pathology Teaching and Research Department, Cangzhou Medical College, Cangzhou, Hebei, P. R. China
| | - Maoxiang Cui
- Pathology Teaching and Research Department, Cangzhou Medical College, Cangzhou, Hebei, P. R. China
| | - Rufeng Wang
- School of Basic Medical Sciences, Cangzhou Medical College, Cangzhou, Hebei, P.R. China
| | - Guiran Yang
- Department of Medical Technology, Cangzhou Medical College, Cangzhou, Hebei, P.R. China
| | - Ning Wang
- Pathology Teaching and Research Department, Cangzhou Medical College, Cangzhou, Hebei, P. R. China
| | - Lijun Cui
- Pathology Teaching and Research Department, Cangzhou Medical College, Cangzhou, Hebei, P. R. China
| | - Guang Ma
- Pathology Teaching and Research Department, Cangzhou Medical College, Cangzhou, Hebei, P. R. China
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17
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Jiang Q, Zhai M, Lin X, Ren C, Li Y, Ye F, Gong Y, Liu S. Case Report: A papillary thyroid microcarcinoma patient with skip lymph node metastasis and multiple distant metastasis. Front Surg 2023; 9:1019846. [PMID: 36743898 PMCID: PMC9889854 DOI: 10.3389/fsurg.2022.1019846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Papillary thyroid microcarcinoma (PTMC) is defined as PTC with a diameter less than 1 centimeter. Most lymph nodes of PTC patients have metastasized to the central neck, and a few lymph nodes have metastasized to the lateral neck. Skip lymph node metastasis, that is, lateral cervical lymph node metastasis without central lymph node metastasis, is even less common. Additionally, distant metastasis of PTMC is also rare, mainly occurring in the lung and bone. Here, we reported a case of PTMC patient with skip lymph node metastasis and multiple distant metastasis. The patient presented with a huge shoulder mass and the primary tumor was found to originate from the thyroid. However, the patient only suffered with PTMC via postoperative pathological results, and interestingly, the patient only had skip lymph node metastasis. Thus, we should focus on PTMC patients with lateral cervical lymph nodes metastasis, especially those with skip metastasis. In addition, this case provides a new perspective for us to understand of skip lymph metastasis and distant metastasis of PTMC.
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Affiliation(s)
- Qin Jiang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mimi Zhai
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xiang Lin
- Department of General Surgery, Huaihua Second People’s Hospital, Huaihua, China
| | - Chutong Ren
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunxia Li
- Xiangya Nursing School, Central South University, Changsha, China
| | - Fei Ye
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Gong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sushun Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China,Correspondence: Sushun Liu ;
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Zheng T, Hu W, Wang H, Xie X, Tang L, Liu W, Wu PY, Xu J, Song B. MRI-Based Texture Analysis for Preoperative Prediction of BRAF V600E Mutation in Papillary Thyroid Carcinoma. J Multidiscip Healthc 2023; 16:1-10. [PMID: 36636144 PMCID: PMC9831001 DOI: 10.2147/jmdh.s393993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose BRAF V600E mutation can compensate for the low detection rate by fine-needle aspiration (FNA) and is related to aggressiveness and lymph node metastasis. This study aimed to investigate the relationship between texture analysis features based on magnetic resonance imaging (MRI) and mutations. Methods Retrospective analysis was performed on patients with postoperative pathology confirmed papillary thyroid carcinoma (PTC) from 2017 to 2021. One thousand one hundred and thirty-two texture features were extracted from T2-weighted imaging (T2WI) and contrast-enhanced T1-weighted imaging (CE-T1WI) separately by outlining the tumor volume of interest (VOI). Univariate, minimum redundancy maximum relevance (mRMR), and multivariate analyses were used for feature selection to construct 3 models (T2WI, CE-T1WI, and combined model) to predict mutation. The reproducibility between observers was evaluated by intraclass correlation coefficient (ICC). Receiver operating characteristic (ROC) analysis was used to assess the performance of models. The diagnostic performance of the optimal cut-off value of models were calculated and validated by 10-fold cross-validation. Results A total of 80 PTCs (22 BRAF V600E wild-type and 58 BRAF V600E mutant) were included in our study. Good interobserver agreement was found on texture features we selected (all ICCs >0.75). The area under the ROC curves (AUCs) for the T2WI model, CE-T1WI model, and combined model were 0.83 (95% CI: 0.75-0.91), 0.83 (95% CI: 0.73-0.90), and 0.88 (95% CI: 0.81-0.94), respectively. The accuracy, sensitivity, specificity, PPV, and NPV were 0.776, 0.679, 0.905, 0.905, and 0.679 for the T2WI model at a cut-off value of 0.674; 0.755, 0.750, 0.762, 0.808, and 0.696 for the CE-T1WI model at a cut-off value of 0.573; 0.816, 0.893, 0.714, 0.806, and 0.833 for the combined model at a cut-off value of 0.420. Conclusion MRI-based texture analysis could be a potential method for predicting BRAF V600E mutation in PTC preoperatively.
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Affiliation(s)
- Tingting Zheng
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Wenjuan Hu
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Hao Wang
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Xiaoli Xie
- Department of Pathology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Lang Tang
- Department of Ultrasound, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Weiyan Liu
- Department of General Surgery, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Pu-Yeh Wu
- GE Healthcare, MR Research China, Beijing, People’s Republic of China
| | - Jingjing Xu
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Bin Song
- Department of Radiology, Minhang Hospital, Fudan University, Shanghai, People’s Republic of China,Correspondence: Bin Song; Jingjing Xu, Department of Radiology, Minhang Hospital, Fudan University, No. 170, Xinsong Road, Minhang District, Shanghai, 201199, People’s Republic of China, Email ;
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Stojanović S, Dobrijević Z, Šelemetjev S, Đorić I, Janković Miljuš J, Živaljević V, Išić Denčić T. MiR-203a-3p, miR-204-3p, miR-222-3p as useful diagnostic and prognostic tool for thyroid neoplasia spectrum. Endocrine 2023; 79:98-112. [PMID: 36103016 DOI: 10.1007/s12020-022-03185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE The challenge in the diagnosis and treatment of thyroid carcinoma is to correctly classify neoplasias with overlapping features and to identify the high-risk patients among those with a less aggressive form, in order to personalize the treatment of thyroid carcinoma patients accordingly. METHODS MiR-203a-3p, miR-204-3p, and miR-222-3p levels were determined in 99 cases of thyroid neoplasias (77 papillary thyroid carcinomas (PTC) of diverse variants, 12 follicular thyroid adenomas (FTA) and 10 nodular goiters (NG)) along with 99 adjacent non-malignant thyroid tissues using quantitative RT-PCR. The results were evaluated in comparison with the clinicopathological features of the patients and available TCGA data. RESULTS Down-regulated miR-203a-3p indicates the presence of thyroid tumor (PTC or FTA) with high sensitivity (75%) and specificity (73%), while its up-regulation indicates NG. If miR-203a-3p is down-regulated, up-regulated miR-204-3p with high sensitivity (83.3%) and specificity (74.4%) indicates FTA presence, while up-regulated miR-222-3p, with high sensitivity (76.6%) and specificity (75.0%), points to PTC. The expression of miR-204-3p and miR-222-3p depends on the PTC subtype (P < 0.05). While the deregulated expression of tested miRs is associated with a long-range of unfavorable clinicopathological parameters of PTC, only abundant expression of miR-222-3p may be used as an independent predictive factor for the presence of extrathyroid invasion and advanced pTNM stage of PTC (P < 0.05). CONCLUSION Successive evaluation of miR-203a-3p, miR-204-3p, and miR-222-3p expression can help in the differential diagnosis of thyroid neoplasias. A high relative value of miR-222-3p expression is an independent predictive factor for the presence of extrathyroid invasion and advanced pTNM stage of PTC. The panel consisting of miR-203a-3p, miR-204-3p, and miR-222-3p could be used as a diagnostic and prognostic tool for personalizing the treatment of thyroid cancer patients.
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Affiliation(s)
- Stefana Stojanović
- Department for Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Banatska 31b, 11080, Belgrade, Serbia
| | - Zorana Dobrijević
- Department for Metabolism, Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Banatska 31b, 11080, Belgrade, Serbia
| | - Sonja Šelemetjev
- Department for Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Banatska 31b, 11080, Belgrade, Serbia
| | - Ilona Đorić
- Department for Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Banatska 31b, 11080, Belgrade, Serbia
| | - Jelena Janković Miljuš
- Department for Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Banatska 31b, 11080, Belgrade, Serbia
| | - Vladan Živaljević
- Clinic for Endocrine Surgery, Clinical Center of Serbia, Koste Todorovića 8, 11000, Belgrade, Serbia
| | - Tijana Išić Denčić
- Department for Endocrinology and Radioimmunology, Institute for the Application of Nuclear Energy (INEP), University of Belgrade, Banatska 31b, 11080, Belgrade, Serbia.
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Xu B, Gao W, Xu T, Liu C, Wu D, Tang W. A UPLC Q-Exactive Orbitrap Mass Spectrometry-Based Metabolomic Study of Serum and Tumor Tissue in Patients with Papillary Thyroid Cancer. TOXICS 2022; 11:44. [PMID: 36668770 PMCID: PMC9863332 DOI: 10.3390/toxics11010044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To find the metabolomic characteristics of tumor or para-tumor tissues, and the differences in serums from papillary thyroid cancer (PTC) patients with or without lymph node metastasis. METHODS We collected serums of PTC patients with/without lymph node metastasis (SN1/SN0), tumor and adjacent tumor tissues of PTC patients with lymph node metastasis (TN1 and PN1), and without lymph node metastasis (TN0 and PN0). Metabolite detection was performed by ultra-high performance liquid chromatography combined with Q-Exactive orbitrap mass spectrometry (UPLC Q-Exactive). RESULTS There were 31, 15, differential metabolites in the comparisons of TN1 and PN1, TN0 and PN0, respectively. Seven uniquely increased metabolites and fourteen uniquely decreased metabolites appeared in the lymph node metastasis (TN1 and PN1) group. Meanwhile, the results indicated that four pathways were co-owned pathways in two comparisons (TN1 and PN1, TN0 and PN0), and four unique pathways presented in the lymph node metastasis (TN1 and PN1) group. CONCLUSIONS Common or differential metabolites and metabolic pathways were detected in the lymph node metastasis and non-metastatic group, which might provide novel ways for the diagnosis and treatment of PTC.
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Affiliation(s)
- Bo Xu
- State Key Laboratory of Reproductive Medicine, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Wei Gao
- Department of Endocrinology, Nanjing Medical University Affiliated Geriatric Hospital, Nanjing 210024, China
| | - Ting Xu
- Department of Endocrinology, Nanjing Medical University Affiliated Geriatric Hospital, Nanjing 210024, China
| | - Cuiping Liu
- Bank of Biological Samples, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Dan Wu
- Department of Endocrinology, Nanjing Medical University Affiliated Geriatric Hospital, Nanjing 210024, China
| | - Wei Tang
- Department of Endocrinology, Nanjing Medical University Affiliated Geriatric Hospital, Nanjing 210024, China
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21
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Huang C, Hu D, Zhuang Y, Su X. Risk factors and prediction model of level II lymph node metastasis in papillary thyroid carcinoma. Front Oncol 2022; 12:984038. [PMID: 36605444 PMCID: PMC9807902 DOI: 10.3389/fonc.2022.984038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Surgical management of lateral lymph nodes in papillary thyroid carcinoma, especially at level II, remains controversial. This study aimed to investigate the risk factors for level II lymph node metastasis in patients with papillary thyroid carcinoma and establish a prediction model to estimate the metastatic risk. Materials and methods A total of 768 patients with papillary thyroid carcinoma underwent thyroidectomy and central plus lateral lymph node dissection, including levels VI, II, III, and IV, at the First Affiliated Hospital of Chongqing Medical University from January 2016 to December 2018. Data on the clinicopathological characteristics were collected and analyzed. Univariate and multivariate analyses were performed to identify risk factors for level II lymph node metastasis. Subsequently, a predictive model was established based on the results of the multivariate analyses. Results The level II lymph node metastatic rate was 34.11% with the following features: largest tumor diameter >20 mm (Odds ratio=1.629, P=0.026), located in the upper pole (Odds ratio=4.970, P<0.001), clinical lymph node-positive (clinical central lymph node-positive: Odds ratio=1.797; clinical lateral lymph node-positive: Odds ratio=1.805, P=0.008), vascular invasion (Odds ratio=6.759, P=0.012), and rate of central lymph node metastasis (Odds ratio=2.498, P<0.001). Level III lymph node metastasis (Odds ratio=2.749, P<0.001) and level IV lymph node metastasis (Odds ratio=1.732, P=0.007) were independent of level II lymph node metastasis predictors. The prediction model's areas under the receiver operating characteristic curve were 0.815 and 0.804, based on bootstrapping validation. Level II lymph node metastasis was associated with the tumor-free survival rate of patients with papillary thyroid carcinoma (P<0.001). Conclusions Largest tumor diameter >20 mm, located in the upper pole, clinical lymph node-positive, vascular invasion, rate of central lymph node metastasis, and levels III and IV lymph node metastases were independent level II lymph node metastasis predictors. We developed a prediction model for level II lymph node metastasis. Overall, level II lymph node metastasis dissection should be individualized according to clinicopathological data both preoperatively and intraoperatively.
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Affiliation(s)
- Chun Huang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuchen Zhuang
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinliang Su
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Xinliang Su,
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22
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Chung SR, Baek JH, Rho YH, Choi YJ, Sung TY, Song DE, Kim TY, Lee JH. Sonographic Diagnosis of Cervical Lymph Node Metastasis in Patients with Thyroid Cancer and Comparison of European and Korean Guidelines for Stratifying the Risk of Malignant Lymph Node. Korean J Radiol 2022; 23:1102-1111. [PMID: 36126955 PMCID: PMC9614289 DOI: 10.3348/kjr.2022.0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the ultrasonography (US) features for diagnosing metastasis in cervical lymph nodes (LNs) in patients with thyroid cancer and compare the US classification of risk of LN metastasis between European and Korean guidelines. MATERIALS AND METHODS From January 2014 to December 2018, US-guided fine-needle aspiration was performed on 836 LNs from 714 patients for the preoperative nodal staging of thyroid cancer. The US features of LNs were retrospectively reviewed for the following features: size, presence of hilum, margin, orientation, cystic change, punctate echogenic foci (PEF), large echogenic foci, eccentric cortical thickening, abnormal vascularity, and cortical hyperechogenicity. A multiple logistic regression analysis was performed to identify the independent US features for the diagnosis of metastatic LNs. The diagnostic performance of independent US features was subsequently evaluated. LNs were categorized according to the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and European Thyroid Association (ETA) guidelines, and the correlation between the two sets of classifications was assessed. RESULTS Absence of the hilum, presence of cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features of metastatic LNs. Cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity showed high specificity (86.8%-99.6%). The absence of the hilum had the highest sensitivity yet low specificity (66.4%). When LNs were classified according to the ETA guidelines and K-TIRADS, they yielded similar categorizations of malignancy risks and were strongly correlated (Spearman coefficient, 0.9766 [95% confidence interval, 0.973-0.979]). According to the ETA guidelines, 9.8% (82/836) of LNs were classified as "not specified." CONCLUSION Absence of hilum, cystic changes, PEF, abnormal vascularity, and cortical hyperechogenicity were independent US features suggestive of metastatic LNs in thyroid cancer. Both K-TIRADS and the ETA guidelines provided similar risk stratification for metastatic LNs with a high correlation; however, the ETA guidelines failed to classify 9.8% of LNs into a specific risk stratum. These results may provide a basis for revising LN classification in future guidelines.
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Affiliation(s)
- Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yun Hwa Rho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Eun Song
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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23
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Feng JW, Wu WX, Qi GF, Hong LZ, Hu J, Liu SY, Jiang Y, Ye J. Nomograms based on sonographic and clinicopathological characteristics to predict lateral lymph node metastasis in classic papillary thyroid carcinoma. J Endocrinol Invest 2022; 45:2043-2057. [PMID: 35809195 DOI: 10.1007/s40618-022-01825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lateral lymph node metastasis (LLNM) has been considered a risk factor of recurrence in papillary thyroid cancer (PTC). Preoperative detecting LLNM accurately is difficult. Solitary lateral lymph node metastasis is a special type of LLNM. We aimed to develop nomograms for predicting LLNM and multiple lateral lymph node metastasis (MLLNM). METHODS We retrospectively retrieved 528 classic PTC patients that underwent surgery between March 2019 and May 2020. Sonographic and clinicopathological features were collected. Risk factors of LLNM and MLLNM were determined by univariate and multivariate analysis. Nomograms for predicting LLNM and MLLNM were developed. RESULTS LLNM was independently associated with tumor size, the number of foci, location, margin, central lymph node metastasis, and lymph node ratio. Independent predictors of MLLNM were age, margin, and the number of metastatic lymph nodes in central compartment. By using above variables, we constructed nomograms for predicting LLNM and MLLNM, with area under curves of 0.864 and 0.748, respectively. CONCLUSION Through these accurate and easy-to-use nomograms, we can detect the risk of residual LLNM postoperatively for classic PTC patients who did not receive lateral neck dissection and provide an individualized plan for postoperative management of classic PTC patients.
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Affiliation(s)
- J-W Feng
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - W-X Wu
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - G-F Qi
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - L-Z Hong
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - J Hu
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - S-Y Liu
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Y Jiang
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
| | - J Ye
- Department of Thyroid Surgery, The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
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Ito Y, Miyauchi A, Fujishima M, Masuoka H, Higashiyama T, Kihara M, Onoda N, Miya A. Prognostic significance of patient age in papillary thyroid carcinoma with no high-risk features. Endocr J 2022; 69:1131-1136. [PMID: 35431281 DOI: 10.1507/endocrj.ej22-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Older age is recognized as a predictor of poor prognosis in papillary thyroid carcinoma (PTC) patients. However, young age is associated with disease progression of PTC measuring 1 cm or smaller in patients on active surveillance. In this study, we investigated the relationship between patient age and prognosis of PTC belonging to very low-, low-, and intermediate-risk groups based on the guidelines published by the Japan Association of Endocrine Surgery in 2018. We enrolled 4,870 PTC patients with no high-risk features and assigned each to one of three categories: very low risk (N = 1,161), low risk (N = 1,746), and intermediate risk (N = 1,963). In very low-risk patients, the local recurrence-free survival (RFS) rate of young patients (<55 years) was significantly worse (p = 0.0437) than that of older patients (≥55 years). In low-risk patients, although age did not affect local recurrence, older patients were more likely to show distant recurrence on univariate (p = 0.0005) and multivariate analyses (p = 0.0017). In the intermediate-risk series, the local RFS rate of older patients tended to be poor (p = 0.0538), and older age was significantly associated with distant RFS (univariate, p = 0.0356; multivariate, p = 0.0439) and carcinoma death (univariate, p < 0.0001; multivariate, not done because of no other suitable factors). The prognostic significance of patient age depends on risk classification: younger age significantly predicts local recurrence in very low-risk PTC, while older age predicts worse prognosis in low- and intermediate-risk patients. These findings indicate that young age is related to rapid growth in early-phase PTC.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | | | - Hiroo Masuoka
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | | | - Minoru Kihara
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
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Yang J, Zhao C, Niu X, Wu S, Li X, Li P, Ning C. Predictive value of Ultrasonic features and microscopic extrathyroidal extension in the recurrence of PTC. Eur J Radiol 2022; 157:110518. [DOI: 10.1016/j.ejrad.2022.110518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
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Lateral Involvement in Different Sized Papillary Thyroid Carcinomas Patients with Central Lymph Node Metastasis: A Multi-Center Analysis. J Clin Med 2022; 11:jcm11174975. [PMID: 36078905 PMCID: PMC9456507 DOI: 10.3390/jcm11174975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/13/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To quantitatively predict the probability of lateral lymph node metastasis (LLNM) for papillary thyroid carcinomas (PTC) patients with central lymph node metastasis (CLNM) in order to guide postoperative adjuvant treatment. Methods: Five hundred and three PTC patients with CLNM from three medical centers were retrospectively analyzed. Results: The LLNM rate for all patients was 23.9% (120 in 503), with 15.5% (45 in 291) and 35.4% (75 in 212) for patients with papillary thyroid microcarcinoma (PTMC) and large papillary thyroid carcinoma (LPTC), respectively. Patients with no fewer than five positive central lymph nodes (CLN) exhibited a higher risk of LLNM. For patients with fewer than five positive CLN, a maximum diameter of positive CLN > 0.5 cm and the presence of ipsilateral nodular goiter were identified as independent risk factors of LLNM for papillary thyroid microcarcinoma (PTMC) patients. The independent risk factors of LLNM for large papillary thyroid carcinoma (LPTC) patients included a tumor located in the upper portion of thyroid, maximum tumor diameter ≥ 2.0 cm, maximum diameter of positive CLN > 0.5 cm, and the presence of thyroid capsular invasion. Predictive nomograms were established based on these risk factors for PTMC and LPTC patients, respectively. The accuracy and validity of our newly built models were verified by C-index and calibration curves. PTMC and LPTC patients with fewer than five positive CLN were each stratified into three subgroups based on their nomogram risk scores, and a detailed risk stratification flow chart was established for a more accurate evaluation of LLNM risk in PTC patients. Conclusions: A detailed stratification flow chart for PTC patients with CLNM to quantitatively assess LLNM risk was established, which may aid in clinical decision-making for those patients.
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Zhang JW, Fei MJ, Hou YQ, Tang ZY, Zhan WW, Zhou JQ. Long-term follow-up ultrasonography surveillance in a large cohort of patients with papillary thyroid carcinoma. Endocrine 2022; 77:297-304. [PMID: 35588346 DOI: 10.1007/s12020-022-03071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to investigate the predictive factors as well as the time and age course of recurrence/persistence in a large cohort of postoperative patients with papillary thyroid carcinoma (PTC) based on the long-term ultrasonography (US) follow-up data. METHODS Between January 2007 and December 2016, 3106 patients underwent surgery for PTC and at least two postoperative US follow-up examination over more than three years. Tumor recurrence/persistence was confirmed based on the follow-up US data and histopathological results. Univariate and multivariate analyses were performed to evaluate the predictive factors of tumor recurrence/persistence. Kaplan-Meier survival analysis was used to evaluate the recurrence-/persistence-free survival curve based on the US results. RESULTS A total of 321(10.3%) patients developed tumor recurrence/persistence during 54.3 months of mean follow-up (range 36-135 months), including 268(83.5%) cases of lymph node recurrence/persistence, 37 (11.5%) cases of non-lymph node recurrence/persistence, and 16(5%) cases of both types. Recurrence/persistence was observed using US examination at a mean interval of 23.6 ± 21.6 months (range 1-135 months) after surgery and peak incidence was observed 1-2 years after initial treatment. Younger (20-30 years old) and older (70-80 years old) patients had a higher proportion of tumor recurrence/persistence. Multifocality, advanced T and advanced N stages were independent risk factors of tumor recurrence/persistence. CONCLUSION Tumor recurrence/persistence of PTC usually occurs during the early postoperative period. For patients with multifocal cancer, advanced T and N stage, the US surveillance examination should be cautiously performed, especially in younger and older patients.
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Affiliation(s)
- Jing-Wen Zhang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Meng-Jia Fei
- Department of Head and Neck Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200001, China
| | - Yi-Qing Hou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhen-Yun Tang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wei-Wei Zhan
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Jian-Qiao Zhou
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Huang D, Zhi J, Zhang J, Qin X, Zhao J, Zheng X, Gao M. Relationship Between Thyroid Autoantibodies and Recurrence of Papillary Thyroid Carcinoma in Children and Adolescents. Front Oncol 2022; 12:883591. [PMID: 35756669 PMCID: PMC9213685 DOI: 10.3389/fonc.2022.883591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Numerous studies reported connection between papillary thyroid carcinoma (PTC) and thyroid autoantibody in adults, but few of them have investigated whether there is a similar link in children and adolescents. The purpose of this research was to explore the relationship between clinicopathological features, prognosis and preoperative thyroid peroxidase antibody (TPOAb) as well as thyroglobulin antibody (TgAb) status in children and adolescents with PTC. Methods This study retrospectively reviewed 179 patients of PTC who underwent a thyroidectomy from January 2000 to June 2021 at Tianjin Medical University Cancer Hospital. We compared preoperative TgAb and TPOAb status with the clinicopathological features and prognosis of children and adolescents with PTC in different age groups. Results Patients with positive preoperative TPOAb and TgAb had lower recurrence rate in the younger group (P = 0.006, 0.047, respectively). Patients with positive TPOAb preoperatively had normal level of preoperative Tg and less cervical LNM than patients with negative TPOAb in children and adolescents (P < 0.05). Positive TPOAb preoperatively of PTC patients had a longer median DFS (113.4 months) than negative TPOAb (64.9 months) (P = 0.009, log-rank). Univariate analyses showed age, maximal tumor size, T stage, multifocality, lateral LNM and N staging were predictors for cancer recurrence in children and adolescents (P<0.05). Cox regression analysis found younger age (HR 0.224, P < 0.001), lateral LNM (HR 0.137, P = 0.010), N stage (HR 30.356, P < 0.001) were independent risk factors for recurrence. Conclusions Our study found that presence of preoperative TPOAb and TgAb could serve as novel prognostic factors for predicting recurrence of PTC in children.
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Affiliation(s)
- Dongmei Huang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jingtai Zhi
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jinming Zhang
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xuan Qin
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jingzhu Zhao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xiangqian Zheng
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Ming Gao
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.,Department of Thyroid and Breast Surgery, Tianjin Union Medical Center, Tianjin, China.,Tianjin Key Laboratory of General Surgery Inconstruction, Tianjin Union Medical Center, Tianjin, China
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Zhong M, Khan FZ, He X, Cui L, Lei K, Ge M. Impact of Lung Metastasis versus Metastasis of Bone, Brain, or Liver on Overall Survival and Thyroid Cancer-Specific Survival of Thyroid Cancer Patients: A Population-Based Study. Cancers (Basel) 2022; 14:cancers14133133. [PMID: 35804903 PMCID: PMC9265095 DOI: 10.3390/cancers14133133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 12/24/2022] Open
Abstract
We investigate the impact of lung metastasis versus metastasis of bone, brain, or liver on overall survival (OS) and thyroid cancer-specific survival (TCSS) in patients with thyroid cancer (TC). Therefore, de-identified SEER 18 registry data of primary TC patients diagnosed between 2010 and 2016 were analyzed. The primary outcome was the prognosis of TC patients with lung metastasis compared with other sites. The secondary outcomes included the prognosis comparison between patients with and without surgery and between single and multiple metastasis sites. Isolated lung metastasis was associated with worse OS and TCSS than bone metastasis (both p < 0.05) and was associated with worse OS than liver metastasis (p = 0.0467). Surgery performed either for the primary or distant site was associated with better OS and TCSS in patients with metastasis of lung or bone (p < 0.05). Isolated lung metastasis was related to better OS and TCSS than lung−liver, lung−brain, and lung−other multiple metastases. The multivariable analysis revealed that age < 55 years, surgery to the primary site, and to the distant site(s) were associated with better outcomes, while T4 and Tx were associated with worse outcomes. Nevertheless, it revealed that the other race (i.e., any race other than white, black, or unknown) and male gender were associated with better TCSS only (p < 0.05). Isolated lung metastasis is associated with a worse prognosis in TC patients compared with bone or liver metastasis. Surgery performed either for the primary or distant site(s) is associated with better survival outcomes in TC patients with metastasis of lung or bone.
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Affiliation(s)
- Miaochun Zhong
- Department of Clinical Medicine, Medical College of Soochow University, Suzhou 215006, China;
- Department of General Surgery, Cancer Center, Division of Breast Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
| | - Farhana Zerin Khan
- Department of Pediatric Surgery, Square Hospital Pvt. Ltd., Dhaka 1205, Bangladesh;
| | - Xianghong He
- Public Basic Courses Department, Guangdong University of Science and Technology, Dongguan 523083, China;
| | - Lingfei Cui
- Department of General Surgery, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China;
| | - Kefeng Lei
- Department of General Surgery, The 7th Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China;
- Correspondence: (K.L.); (M.G.); Tel.: +86-185-2959-8502 (K.L.); +86-137-7783-1634 (M.G.)
| | - Minghua Ge
- Department of Clinical Medicine, Medical College of Soochow University, Suzhou 215006, China;
- Department of Head and Neck & Thyroid Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou 310014, China
- Correspondence: (K.L.); (M.G.); Tel.: +86-185-2959-8502 (K.L.); +86-137-7783-1634 (M.G.)
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Hei H, Gong W, Zheng C, Zhou B, Qin J. Macroscopic extranodal extension is an independent predictor of lung metastasis in papillary thyroid cancer. Endocrine 2022; 77:73-79. [PMID: 35389141 DOI: 10.1007/s12020-022-03045-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Lymph node metastasis is common in patients with papillary thyroid cancer (PTC). Some metastatic lymph nodes may present extranodal extension (ENE). The clinical role of ENE in PTC has yet to be clearly identified. We evaluated macroscopic ENE as a potential prognostic indicator of lung metastasis in PTC. PATIENTS AND METHODS We identified 1140 consecutive patients who had PTC initially resected at our cancer center. Clinical data and pathological results were reviewed. Univariate and multivariate logistic regression analyses were used to figure out the association between clinicopathological variables and lung metastasis. RESULTS In this cohort, 51.7% of PTC patients had lymph node metastasis; 10.4% had macroscopic ENE positive nodes; 2.3% had lung metastasis. In patients with lymph node metastasis, the average number of positive nodes was 5.10 ± 4.91. Multivariable analysis of clinicopathological factors revealed that extrathyroidal extension (odds ratio [OR], 3.57; 95% CI, 1.41-9.04), macroscopic ENE (OR, 7.08; 95% CI, 2.54-19.74), and number of positive nodes were significantly associated with lung metastasis. Compared with 0-3 positive nodes, 7-9 positive nodes denoted a moderate risk of lung metastasis (OR, 4.53; 95% CI, 1.03-19.85). And 10 positive nodes or more indicated a high risk of lung metastasis (OR, 9.63; 95% CI, 2.65-35.02). CONCLUSION Macroscopic ENE could serve as a strong independent prognostic factor of lungmetastasis in PTC. More attention should be paid to patients with ENE positive nodes duringfollow-up.
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Affiliation(s)
- Hu Hei
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Wenbo Gong
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Chen Zheng
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Bin Zhou
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China
| | - Jianwu Qin
- Department of Thyroid and Neck, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China.
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Risk and Prognostic Factors for BRAFV600E Mutations in Papillary Thyroid Carcinoma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9959649. [PMID: 35647194 PMCID: PMC9132653 DOI: 10.1155/2022/9959649] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/20/2022] [Indexed: 12/29/2022]
Abstract
Background Over the past ten years, the incidence rate of papillary thyroid carcinoma (PTC) worldwide has been increasing rapidly year by year, with the incidence rate increasing 6% annually. PTC has become the malignant tumor with the highest growth rate in the world that fourteen PTC-related mutant genes have been identified. Whether the BRAFV600E mutation related to more aggressive clinicopathologic features and worse outcome in PTC remains variable and controversial. We aim to investigate the risk factors that may predict the BRAFV600E mutation potential of these lesions and new prevention strategies in PTC patients. Methods A total of 9,908 papillary thyroid carcinoma patients with average 74.6% BRAFV600E mutations were analyzed (RevMan 5.3 software) in this study. The PubMed, Embase, and ISI Web of Science databases were systematically searched for works published through December 15, 2021. Results The following variables were associated with an increased risk of BRAFV600E mutation in PTC patients: age ≥ 45 years (OR = 1.39, 95%CI = 1.21–1.60, p < 0.00001), male gender (OR = 1.13, 95%CI = 0.99–1.28, p = 0.06), multifocality (OR = 1.22, 95%CI = 1.07–1.40, p = 0.004), lymph node metastasis (OR = 1.33, 95%CI = 0.79–2.23, p = 0.28), extrathyroidal extension + (OR = 1.61, 95%CI = 1.06–2.44, p = 0.03), vascular invasion + (OR = 2.04, 95%CI = 1.32–3.15, p = 0.001), and tumor node metastasis stage (OR = 1.61, 95%CI = 1.38–1.88, p < 0.00001). In addition, tumor size (>1 cm) (OR = 0.51, 95%CI = 0.32–0.81, p = 0.005) and distant metastasis (OR = 0.69, 95%CI = 0.22–2.21, p = 0.54) had no association or risk with BRAFV600E mutation in PTC patients. Conclusion Our systematic review identified the following significant risk factors of BRAFV600E mutation in PTC patients: age (≥45 years), gender (male), multifocality, lymph node metastasis, vascular invasion, extrathyroidal extension, and advanced tumor node metastasis stage (stages III and IV). Tumor size (>1 cm) and distant metastasis do not appear to be correlated with BRAFV600E mutation in PTC patients.
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Huang X, Xia Q, Huang Y, Peng A, Yang J. Age increased the cancer-specific mortality risk of thyroid cancer with lung metastasis. Clin Endocrinol (Oxf) 2022; 96:719-727. [PMID: 34990026 DOI: 10.1111/cen.14675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the relationship between age and cancer-specific mortality in thyroid cancer (TC) with lung-metastasis. PATIENTS AND METHODS A total of 1418 patients with initial distant metastases from Surveillance, Epidemiology, and End Results databases were investigated. Patients with a median follow-up time of 8 months (interquartile range [IQR]: 2-27] and a median age of 66 years (IQR: 55-76) were divided into five groups by age and the association between age and TC-specific mortality was analysed. RESULTS The TC-specific mortality rates were 32.78% (118/360), 46.71% (156/334), 53.93% (199/369), 58.96% (158/268) and 82.76% (72/87) in patients aged ≤55 years, >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years. Kaplan-Meier curves showed that TC-specific mortality rate was associated with increased age (p < .001). Compared with patients ≤55 years, patients aged >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years had significantly higher hazard ratios (HRs) of 1.69 (1.26-2.26), 1.97 (1.47-2.64), 2.18 (1.59-2.99) and 3.24 (2.08-5.06) after adjustments for sex, tumour size and radiation therapy (all p < .001). In TC with initial lung-metastasis, compared with patients ≤55 years, patients aged >55 but ≤65 years, >65 but ≤75 years, >75 but ≤85 years and >85 years had significantly higher adjusted HRs of 1.68 (1.20-2.36; p = .003), 2.18 (1.57-3.02), 2.16 (1.51-3.08) and 2.91 (1.79-4.75; p < .001). Similar results were obtained in papillary TC. CONCLUSIONS The TC-specific mortality was increased with age in TC patients with initial lung-metastasis, indicating that further risk stratification based on age was necessary for TC over 55 years with lung-metastasis. Individual treatment strategies maybe recommended for such patients.
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Affiliation(s)
- Xiu Huang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Qing Xia
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Yueye Huang
- Shanghai Center of Thyroid Diseases, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Aimei Peng
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | - Jie Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, P.R. China
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Zhang C, Li B, Zhang L, Chen F, Zhang Y, Cheng W. Clinicopathological and ultrasound features as risk stratification predictors of clinical and pathological nodal status in papillary thyroid carcinoma: a study of 748 patients. BMC Cancer 2022; 22:354. [PMID: 35365120 PMCID: PMC8976313 DOI: 10.1186/s12885-022-09474-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Papillary thyroid carcinoma (PTC) is the most common histological type of thyroid malignancy that tends to metastasize to cervical lymph nodes. In the present study, we aimed to investigate which clinicopathologic and ultrasound features of PTC are associated with clinical lymph node metastasis (LNM) and numbers of pathological LNM. Methods From January 2016 to December 2018, we identified a cohort of patients with PTC who underwent cervical ultrasonography and were diagnosed through operation and pathology. Clinical N1(cN1) and > 5 pathologic N1(pN1) were considered in the postoperative stratification to have an intermediate risk according to the 2015 ATA guidelines. Clinicopathological and ultrasound features in PTC patients were performed in accordance with the independent risk factors of cN1 and > 5pN1 respectively by using the univariate and multivariate analyses. Results We collected 748 PTC patients in the final inclusion criteria. There were 688 cN0 cases and 60 cN1 cases. From the analyses, primary tumor size > 2 cm, capsule contact, extrathyroidal extensions (ETE) and central LNM remained independent risk factors for cN1 in PTC patients. In the 748 PTC patients, 707 cases had ≤ 5 pN1, and 41 cases had > 5 pN1. Multifocality, primary tumor size > 2 cm, capsule contact and ETE are significant independent risk factors for > 5 pN1. Conclusions We concluded that multifocality, primary tumor size > 2 cm, capsule contact, ETE and central LNM were independent risk factors for the intermediate risk stratification in patients with PTC. Ultrasonography is a good technique for the preoperative lymph node staging of PTC and is helpful for detecting LNM.
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Affiliation(s)
- Cui Zhang
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China
| | - Baojun Li
- Department of Head and Neck Surgery, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China
| | - Lei Zhang
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China.,Department of Interventional Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China
| | - Fengjiao Chen
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China
| | - Yanhua Zhang
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China.
| | - Wen Cheng
- Department of Medical Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China. .,Department of Interventional Ultrasound, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, China.
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Ma B, Chen X, Zhao Z, Yin X, Ji Q, Zhou Y, Ma C, Wang J. Coexisting CLT in PTC is an independent predictor of tumor aggressiveness for patients aged under 55: a retrospective analysis of 635 patients. BMC Endocr Disord 2022; 22:55. [PMID: 35255870 PMCID: PMC8900407 DOI: 10.1186/s12902-022-00945-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 01/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study was aimed at investigating the potential role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid cancer (PTC) aggressiveness for patients aged below 55, as well as to figure out factors influencing potential recurrence risk in different age groups. METHODS A total of 635 adult patients were retrospectively analyzed. 188 patients were diagnosed with coexistent CLT and the remaining 447 were classified as non-CLT. Then the characteristics of CLT-coexisted patients and non-CLT ones were compared respectively when patients were aged ≥ 55 years or below. The association among postoperative clinicopathological features were also analyzed using multivariate regression. In addition, the prognostic value of several variables relating to high-risk recurrence were estimated within different age groups. RESULTS When divided in two age groups (55 years as the borderline), non-CLT group (aged below 55 years) had a remarkable frequency of small size lesion (Dmax ≤ 1 cm) compared with CLT-coexisted patients (54.6% to 43.0%, p = 0.02). In addition, non-CLT patients tended to have intrathyroidal extension as opposed to those with coexistent CLT (20.2% to 28.2%, p = 0.05). In multivariate analysis, CLT still significantly acted as an independent risk factor of greater lesion size (Dmin > 1 cm) (OR = 1.7, p = 0.02) and mildly promoted gross extrathyroidal extension (ETE) (OR = 1.4, p = 0.06). However, associations didn't emerge in the characteristics mentioned above with CLT when patients were ≥ 55 years old. The prognostic value of CLT in high-risk recurrence was evident only in patients aged 35-44 years. (OR = 2.4, 95%CI:1.2-5.4, p = 0.02). Greater lesion size independently promoted gross ETE, no matter patients were aged above 55 years or not. Its prognostic value of high-risk recurrence was significant throughout all age groups. CONCLUSION These findings revealed that CLT coexistence might be the unfavorable factor of PTC aggressiveness in patients aged below 55 years. Its role as well as greater tumor size may potentially predict higher recurrence risk according to results figured out in the prediction model.
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Affiliation(s)
- Bing'e Ma
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiyi Chen
- The Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing, 210029, China
| | - Zhengping Zhao
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China
| | - Xiaoyang Yin
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Qin Ji
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yifan Zhou
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Chaoqun Ma
- Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Jianhua Wang
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210028, China.
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, 210028, China.
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Wu WX, Feng JW, Ye J, Qi GF, Hong LZ, Hu J, Liu SY, Jiang Y, Qu Z. Influence of Obesity Parameters on Different Regional Patterns of Lymph Node Metastasis in Papillary Thyroid Cancer. Int J Endocrinol 2022; 2022:3797955. [PMID: 36389127 PMCID: PMC9663220 DOI: 10.1155/2022/3797955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/27/2022] [Accepted: 10/29/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Obesity increases risk of thyroid cancer. However, the association between obesity and the progression of papillary thyroid cancer (PTC) remains controversial. This retrospective study aimed to explore the relationship between obesity and regional patterns of lymph node metastasis (LNM) in PTC. METHODS We retrospectively reviewed data from 1015 patients with PTC. We calculated obese parameters, such as body mass index (BMI), body fat percentage (BFP), and body surface area (BSA). Logistic regression models were used to assess associations between obese parameters and the rate of lymph node metastasis (LNM), number of LNM, pattern of LNM, and lymph node ratio (LNR). RESULTS Higher BMI was not associated with different regional patterns of LNM in PTC. In men with PTC, high BFP was an independent predictor of total LNM, central lymph node metastasis (CLNM), total lateral lymph node metastasis (LLNM), multiple lateral lymph node metastasis, and simultaneous metastasis in lateral compartment. In addition, male patients with high BFP had higher central LNR and higher number of CLNM. For women, high BSA was an independent predictor of LLNM and level IV metastasis. Female patients with high BSA had higher number of CLNM. CONCLUSION BFP and BSA, possibly influenced by gender, were positively associated with the number and risk of LNM in different regions of PTC patients. However, BMI was not the predictor for aggressiveness of PTC in terms of LNM. Clinical decision-making for regional LNM in PTC patients should consider the factor of obesity.
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Affiliation(s)
- Wan-Xiao Wu
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Jia-Wei Feng
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Jing Ye
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Gao-Feng Qi
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Li-Zhao Hong
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Jun Hu
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Sheng-Yong Liu
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Yong Jiang
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Zhen Qu
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
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Lan H. Regulatory effects of LncRNA SNHG4 on miR-25/FBXW7 axis in papillary thyroid cancer cells. Crit Rev Eukaryot Gene Expr 2022; 32:1-9. [DOI: 10.1615/critreveukaryotgeneexpr.2022041421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Sutherland R, Tsang V, Clifton-Bligh RJ, Gild ML. Papillary thyroid microcarcinoma: Is active surveillance always enough? Clin Endocrinol (Oxf) 2021; 95:811-817. [PMID: 34021503 DOI: 10.1111/cen.14529] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
The incidence of papillary thyroid carcinoma (PTC) has increased over recent decades. This apparent epidemic has been attributed to the overdiagnosis of small PTC ≤10 mm in diameter (papillary thyroid microcarcinoma [PTMC]) incidentally detected on imaging for unrelated presentations. Although most PTMCs follow an indolent disease course, there is a small but significant proportion of cases that display more biologically aggressive features such as early metastasis and lymph node involvement. Management of PTMC diagnosed preoperatively should be distinguished from managing those PTMCs incidentally discovered after thyroidectomy. Here, we will focus on the challenge of managing the preoperative patient. Current guidelines recommend against routine biopsy of nodules ≤10 mm, even if they display highly suspicious features on ultrasound; however, it is not known how to identify those PTMCs at higher risk of disease progression. In view of their good prognosis even without surgical resection, active surveillance has emerged as an alternative to operative management for low-risk PTMC without lymph node involvement or distant metastasis. This review aims to summarise active surveillance data for PTMC and identify clinical features that may differentiate the indolent majority from those PTMCs that exhibit early disease progression and metastasis.
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Affiliation(s)
- Rosie Sutherland
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
| | - Venessa Tsang
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Roderick J Clifton-Bligh
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
| | - Matti L Gild
- Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Cancer Genetics Unit, Kolling Institute of Medical Research, Sydney, Australia
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Shu X, Tang L, Hu D, Wang Y, Yu P, Yang Z, Deng C, Wang D, Su X. Prediction Model of Pathologic Central Lymph Node Negativity in cN0 Papillary Thyroid Carcinoma. Front Oncol 2021; 11:727984. [PMID: 34646771 PMCID: PMC8503674 DOI: 10.3389/fonc.2021.727984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Most patients with papillary thyroid carcinoma (PTC) have an excellent prognosis. Although central lymph node invasion is frequent, management via central lymph node dissection (CLND) remains controversial. The present study retrospectively investigated independent predictors of pathologic central lymph node negativity (pCLN-) and established a prediction model for pCLN- in clinical lymph node negativity (cN0) PTC. Methods A total of 2,687 patients underwent thyroid surgery for cN0 PTC from 2013 to 2018 at the First Affiliated Hospital of Chongqing Medical University, and lobectomy plus ipsilateral CLND was the basic surgical extent. Clinicopathological characteristics were reviewed and analyzed. Univariate and multivariate analyses were performed to identify factors related to pCLN-. A prediction model was established based on the results of multivariate analyses. Results The pCLN- rate was 51.5% (1,383/2,687). Multivariate analysis revealed that sex, age, thyroid stimulating hormone (TSH), size, location, laterality, unifocality and extrathyroidal extension negativity (ETE-) were independent predictors of pCLN-. The nomogram showed good discriminative ability (C-index: 0.784 and 0.787 in derivation and validation groups, respectively) and was well calibrated. We quantified the clinical usefulness of the nomogram by decision curve analysis. The median length of follow-up was 30 (range 12– 83) months, and 190 cases were lost, with a follow-up rate of 92.9% (2,497/2,687). Of the 2,687 patients included, 21 (0.8%) experienced recurrence. Conclusion This nomogram, which integrates available preoperative clinicopathological features and intraoperative frozen biopsy outcomes, is a reliable tool with high accuracy to predict pCLN- in cN0 PTC.
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Affiliation(s)
- Xiujie Shu
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lingfeng Tang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanyuan Wang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ping Yu
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhixin Yang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Deng
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Denghui Wang
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinliang Su
- Department of Endocrinology and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ywata de Carvalho A, Kohler HF, Gomes CC, Vartanian JG, Kowalski LP. Predictive factors for recurrence of papillary thyroid carcinoma: analysis of 4,085 patients. ACTA ACUST UNITED AC 2021; 41:236-242. [PMID: 34264917 PMCID: PMC8283398 DOI: 10.14639/0392-100x-n1412] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/16/2021] [Indexed: 11/24/2022]
Abstract
Objective The incidence of papillary thyroid carcinoma (PTC) has increased in recent years and its treatment remains controversial. The objective of this study is to identify clinicopathological predictive factors of tumour recurrence. Methods We retrospectively analysed 4,085 patients who underwent thyroidectomy for PTC from 1996 to 2015. Patients were stratified according to American Thyroid Association (ATA) risk categories and clinicopathological features were evaluated to identify independent factors for recurrence. Results After a mean follow-up of 58.7 (range 3-256.5) months, tumour recurrence was diagnosed in 176 (4.3%) patients, mostly in lymph nodes. Distant metastasis occurred in 18 patients (0.4%). There were 3 (0.1%) cancer-related deaths. Multivariate analysis showed that tumour size >10 mm, multifocality, extrathyroidal extension and lymph node metastasis (all, P < 0.001) were independent risk factors for recurrence. Further, recurrence was identified in 1.6% of the ATA low-risk, 7.4% of the intermediate-risk and 22.7% of the high-risk patients (P < 0.001). Conclusions In PTC patients, tumour size >10 mm, multifocality, extrathyroidal extension and presence of lymph node metastasis as well as the ATA recurrence staging system effectively predict recurrence.
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Affiliation(s)
- Andre Ywata de Carvalho
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Hugo Fontan Kohler
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Camila Couto Gomes
- Surgical Oncology Division, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Jose Guilherme Vartanian
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil.,Head and Neck Surgery Department, University of Sao Paulo, Sao Paulo, Brazil
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Park HM, Lee J, Kwak JY, Park VY, Rho M, Lee M, Yoon JH. Using ultrasonographic features to predict the outcomes of patients with small papillary thyroid carcinomas: a retrospective study implementing the 2015 ATA patterns and ACR TI-RADS categories. Ultrasonography 2021; 41:298-306. [PMID: 34674455 PMCID: PMC8942744 DOI: 10.14366/usg.21097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate whether risk stratification systems using ultrasonographic (US) features show associations with the outcomes of patients with small papillary thyroid carcinomas (PTCs). METHODS This retrospective study received institutional review board approval. From March 2007 to February 2010, 775 patients who underwent surgery for small PTCs (10-20 mm) were included. Based on preoperative US features, PTCs were categorized according to the 2015 American Thyroid Association (ATA) guideline and the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). The associations of clinicopathological and US features with postoperative patient outcomes were evaluated. RESULTS In total, 61 patients had high-volume central lymph node metastasis (CLNM, 7.9%) and 100 patients had lateral lymph node metastasis (LLNM, 12.9%). In univariable analyses, a high number of suspicious US features and higher ACR TI-RADS point totals were significantly associated with both high-volume CLNM (P=0.001, each) and LLNM (P<0.001, each). In multivariable analyses of preoperative features, a higher number of suspicious US features and higher ACR TI-RADS point totals were independently associated with high-volume CLNM (odds ratio [OR], 1.516 and 1.201; P=0.002 and P=0.001, respectively) and LLNM (OR, 1.763 and 1.293; all P<0.001). Individual US features, ATA categories, and ACR TI-RADS point totals were not significantly associated with recurrence or distant metastasis. CONCLUSION The number of suspicious US features and the ACR TI-RADS point total are potential risk factors for cervical lymph node metastasis in patients with small PTCs.
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Affiliation(s)
- Hee Min Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jihye Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Vivian Youngjean Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Miribi Rho
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Minah Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Hyun Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
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Kou Y, Shen G, Cheng Z, Kuang A. Predictive Value of Gross Extranodal Extension for Differentiated Thyroid Carcinoma Persistence/Recurrence. Otolaryngol Head Neck Surg 2021; 166:643-651. [PMID: 34182831 DOI: 10.1177/01945998211023177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We systematically investigated the predictive value of gross extranodal extension (gENE) for differentiated thyroid carcinoma persistence/recurrence. STUDY DESIGN Retrospective study. SETTING A tertiary care hospital. METHODS This study was divided into 2 groups according to gENE status: the gENE group and non-gENE group. We compared the disease persistence/recurrence rates of these 2 groups in the entire cohort and by individual risk group (intermediate/high risk), analyzed whether gENE was an independent risk factor for disease persistence/recurrence, and explored the impact of gENE-specific features on disease persistence/recurrence. RESULTS There were 989 patients who satisfied the inclusion criteria: 57 patients in the gENE group and 932 in the non-gENE group. The disease persistence/recurrence rate of the gENE group was higher than that of the non-gENE group in the entire cohort and by individual risk group (P < .05 for each). Unexpectedly, the outcomes of the gENE group with intermediate risk were similar to those of the non-gENE group with high risk (P = .72). For the entire cohort, gENE was an independent predictor for disease persistence/recurrence (odds ratio, 2.89; 95% CI, 1.39-6.00; P = .005). Specific features of gENE (P > .05 for each) were not related to disease persistence/recurrence. CONCLUSION Patients with gENE and intermediate risk might be regraded as high risk. Specific features of gENE have no impact on disease persistence/recurrence.
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Affiliation(s)
- Ying Kou
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China.,PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Guohua Shen
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China
| | - Zhuzhong Cheng
- PET/CT Center, Department of Nuclear Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Anren Kuang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China
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Zhu J, Zheng J, Li L, Huang R, Ren H, Wang D, Dai Z, Su X. Application of Machine Learning Algorithms to Predict Central Lymph Node Metastasis in T1-T2, Non-invasive, and Clinically Node Negative Papillary Thyroid Carcinoma. Front Med (Lausanne) 2021; 8:635771. [PMID: 33768105 PMCID: PMC7986413 DOI: 10.3389/fmed.2021.635771] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose: While there are no clear indications of whether central lymph node dissection is necessary in patients with T1-T2, non-invasive, clinically uninvolved central neck lymph nodes papillary thyroid carcinoma (PTC), this study seeks to develop and validate models for predicting the risk of central lymph node metastasis (CLNM) in these patients based on machine learning algorithms. Methods: This is a retrospective study comprising 1,271 patients with T1-T2 stage, non-invasive, and clinically node negative (cN0) PTC who underwent surgery at the Department of Endocrine and Breast Surgery of The First Affiliated Hospital of Chongqing Medical University from February 1, 2016, to December 31, 2018. We applied six machine learning (ML) algorithms, including Logistic Regression (LR), Gradient Boosting Machine (GBM), Extreme Gradient Boosting (XGBoost), Random Forest (RF), Decision Tree (DT), and Neural Network (NNET), coupled with preoperative clinical characteristics and intraoperative information to develop prediction models for CLNM. Among all the samples, 70% were randomly selected to train the models while the remaining 30% were used for validation. Indices like the area under the receiver operating characteristic (AUROC), sensitivity, specificity, and accuracy were calculated to test the models' performance. Results: The results showed that ~51.3% (652 out of 1,271) of the patients had pN1 disease. In multivariate logistic regression analyses, gender, tumor size and location, multifocality, age, and Delphian lymph node status were all independent predictors of CLNM. In predicting CLNM, six ML algorithms posted AUROC of 0.70–0.75, with the extreme gradient boosting (XGBoost) model standing out, registering 0.75. Thus, we employed the best-performing ML algorithm model and uploaded the results to a self-made online risk calculator to estimate an individual's probability of CLNM (https://jin63.shinyapps.io/ML_CLNM/). Conclusions: With the incorporation of preoperative and intraoperative risk factors, ML algorithms can achieve acceptable prediction of CLNM with Xgboost model performing the best. Our online risk calculator based on ML algorithm may help determine the optimal extent of initial surgical treatment for patients with T1-T2 stage, non-invasive, and clinically node negative PTC.
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Affiliation(s)
- Jiang Zhu
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinxin Zheng
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Longfei Li
- Department of Health Statistics, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Rui Huang
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haoyu Ren
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University, Munich, Germany
| | - Denghui Wang
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhijun Dai
- Department of Breast Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xinliang Su
- Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ena J, Gómez-Tierno A. Papillary thyroid microcarcinoma: not always indolent. Rev Clin Esp 2021; 221:157-159. [PMID: 32416927 DOI: 10.1016/j.rce.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/21/2022]
Affiliation(s)
- J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Alicante, España.
| | - A Gómez-Tierno
- Servicio de Anatomía Patológica, Hospital Marina Baixa , Alicante, España
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Ruiz Pardo J, Ríos Zambudio A, Rodríguez González JM, Paredes Quiles M, Soriano Giménez V, Oviedo Ramírez MI, Hernández Martínez AM, Parrilla Paricio P. Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment? Rev Clin Esp 2021; 221:131-138. [PMID: 32216965 DOI: 10.1016/j.rce.2019.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/20/2019] [Accepted: 12/08/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within 2years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS We observed PTMC with mETE in 11.2% (n=18) of patients. On the multivariate analysis, mETE was associated with age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8mm (OR: 5.913; 95% CL: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). During a mean follow-up of 119.8±65 months, one recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9±5.6 vs. 97.4±10.3 months; p = .034). CONCLUSIONS The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.
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Affiliation(s)
- J Ruiz Pardo
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - A Ríos Zambudio
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España
| | - J M Rodríguez González
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España
| | - M Paredes Quiles
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - V Soriano Giménez
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - M I Oviedo Ramírez
- Servicio de Anatomía Patológica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - A M Hernández Martínez
- Servicio de Endocrinología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - P Parrilla Paricio
- Servicio de Cirugía General y de Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; Instituto Murciano de Investigación Bio-Sanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, España; Departamento de Cirugía, Pediatría y Obstetricia y Ginecología, Universidad de Murcia, Murcia, España
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Papillary thyroid microcarcinoma with minimal extrathyroidal extension. Is its course so indolent that it requires a less aggressive treatment? Rev Clin Esp 2021; 221:131-138. [PMID: 33998460 DOI: 10.1016/j.rceng.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/08/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although the incidence of papillary thyroid microcarcinoma (PTMC) has increased in recent decades, the role played by minimal extrathyroidal extension (mETE) in the prognosis of PTMC is still unclear. The aim of this study is to analyze the factors associated with PTMC with mETE and its long-term prognosis. MATERIAL AND METHODS We conducted a retrospective study on patients with a histological diagnosis of PTMC. We excluded patients who had previously undergone thyroid surgery, those who had other synchronous malignancies, those with an ectopic location of the PTMC, and those lost to follow-up within two years. We compared group 1 (PTMC without extrathyroidal extension) to group 2 (PTMC with mETE) and performed a multivariate analysis. RESULTS We observed PTMC with mETE in 11.2% (n = 18) of patients. On the multivariate analysis, mETE was associated with an age ≥45 years (OR: 4.383; 95% CI: 1.051-18.283, p = .043), tumor size ≥8 mm (OR: 5.913; 95% CI: 1.795-19.481; p = .003), bilaterality (OR: 4.430; 95% CI: 1.294-15.173; p = .018) and metastatic lymph nodes (OR: 12.588; 95% CI: 2.919-54.280; p = .001). Over the mean follow-up period of 119.8 ± 65 months, one case of recurrence was detected in group 2 (0% vs. 5.6%; p = .112). No patients died of the disease. Disease-free survival was lower in group 2 (124.9 ± 5.6 vs. 97.4 ± 10.3 months; p = .034). CONCLUSIONS The mETE of PTMC is a factor of worse prognosis associated with the presence of metastatic lymph nodes and a lower rate of disease-free survival.
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Ena J, Gómez-Tierno A. Papillary thyroid microcarcinoma: Not always indolent. Rev Clin Esp 2021; 221:157-159. [PMID: 33998464 DOI: 10.1016/j.rceng.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- J Ena
- Servicio de Medicina Interna, Hospital Marina Baixa, Alicante, España.
| | - A Gómez-Tierno
- Servicio de Anatomía Patológica, Hospital Marina Baixa, Alicante, España
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Kwon HK, Cheon YI, Shin SC, Sung ES, Lee JC, Kim IJ, Lee BJ. Risk factors of suprasternal lymph node metastasis in papillary thyroid carcinoma with clinical lateral cervical lymph node metastasis. Gland Surg 2021; 10:512-520. [PMID: 33708534 DOI: 10.21037/gs-20-368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Metastatic lymph nodes are occasionally found in suprasternal lymph nodes in patients with papillary thyroid cancer (PTC). However, limited studies have examined these lymph nodes thus far. Therefore, we investigated the frequency and risk factors of suprasternal lymph node metastasis in patients with PTC and lateral cervical lymph node metastasis. Methods A total of 85 patients with cN1b PTC underwent total thyroidectomy, central neck dissection, and ipsilateral selective neck dissection including suprasternal lymph node dissection. We analyzed the correlation between suprasternal lymph node metastasis and sex, age, tumor characteristics, and cervical lymph node metastasis status. Results Eleven (12.9%) patients had pathological suprasternal lymph node metastasis. Suprasternal lymph node metastasis was associated with tumors located in the inferior pole of the thyroid gland and level IV lymph node metastasis (P=0.005 and 0.014, respectively). Receiver operating characteristic curve analysis indicated that two or more level IV metastatic lymph nodes had the best predictive value for suprasternal lymph node metastasis (P<0.001). Conclusions In patients with cN1b PTC, especially those with tumors in the inferior pole of the thyroid gland or level IV lymph node metastasis, greater attention should be paid to the suprasternal lymph nodes and suprasternal lymph node dissection should be routinely included as part of selective neck dissection.
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Affiliation(s)
- Hyun-Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong-Il Cheon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eui-Suk Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin-Choon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In Ju Kim
- Department of Internal medicine, College of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Deng C, Li S, Yang Z, Dou Y, Hu D, Zhu J, Wang D, Su X. Multi-gene assay and clinical characteristics research in papillary thyroid carcinoma. Gland Surg 2021; 10:242-251. [PMID: 33633980 DOI: 10.21037/gs-20-589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the significance of multi-gene assay in papillary thyroid carcinoma (PTC) patients in clinical practice. Methods From April to December 2019, medical records of 68 patients with PTC after the initial surgery were retrospectively collected and analyzed in terms of the relations between gene mutations and clinicopathological characteristics. Results RET/PTC rearrangement was not detected in BRAF V600E mutation patients (P<0.001). Besides, compared with wild-type patients, BRAF V600E mutation was associated with significantly older age (P=0.001) and a higher rate of extrathyroid invasion (P=0.023). Significantly higher BRAF V600E mutation rates were found in clinical lymph node-negative (P=0.041) and non-metastatic lateral lymph nodes (P=0.027) patients as RET/PTC rearrangement was associated with younger age (P=0.001) and the increasing metastatic number of lymph nodes (P=0.020). Compared to other gene mutations, the multivariate analysis showed that larger tumor size [odds ratio (OR), 8.831; 95% CI: 1.971-35.578; P=0.004], the BRAF V600E mutation alone(OR, 10.567; 95% CI: 1.748-63.873; P=0.010) or in combination with one additional gene mutation (OR, 8.654; 95% CI: 1.453-68.603; P=0.041), and Hashimoto's thyroiditis (OR, 0.112; 95% CI: 0.025-0.499; P=0.004) were all independent predictors for the prevalence of ETE. Conclusions BRAF V600E mutation was associated with older age and the aggressiveness of PTC but was independent of lymph node metastasis (LNM). RET/PTC rearrangement suggested more LNM in young patients with PTC. BRAF V600E mutation combined with other gene mutations, namely, multi-gene mutations, could indicate a higher aggressiveness in PTC.
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Affiliation(s)
- Chang Deng
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shan Li
- Department of Gastroenterology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhixin Yang
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Dou
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiang Zhu
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Denghui Wang
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinliang Su
- Department of Endocrine and Breast Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Bayadsi H, Bergman M, Sund M, Hennings J. Invasiveness and Metastatic Aggressiveness in Small Differentiated Thyroid Cancers: Demography of Small Papillary Thyroid Carcinomas in the Swedish Population. World J Surg 2020; 44:461-468. [PMID: 31834455 DOI: 10.1007/s00268-019-05312-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The western world is seeing a rising incidence of thyroid cancer. Improved diagnostic methods do not entirely explain this increase. Papillary thyroid carcinoma (PTC) is the most common subtype of thyroid cancer. Small PTC (≤20 mm) and especially papillary thyroid microcarcinomas (PTMC ≤10 mm) are considered to be low-risk tumors but some cases are considerably more aggressive. Sufficient understanding of these mechanisms is a long-term goal for more efficient and safer treatment of these tumors. METHODS We identified 959 cases of small PTCs in the validated Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery, grouped according to lymph node metastasis. These were analyzed according to age, gender, tumor size and geographic region. RESULTS Patients with N1b disease (lateral lymph nodes metastases) had a smaller tumor size compared to patients with N1a disease (8.6 mm vs 10.1 mm respectively, p < 0.05). Patients and specifically females with N1b disease were younger than those with N0 or N1a disease. Patients with N1b disease had a lower proportion of females (60%) compared to N0 and N1a groups (81% and 78%, respectively). The incidence of operated small PTCs and of lymph node engagement differs between geographic regions in Sweden. CONCLUSIONS Small PTC and especially PTMC seem to show different patterns of aggressiveness and demography regarding lateral lymph node metastases and 7% had N1b disease and tumor <1 cm, underscoring the importance of lymph node evaluation in PTMC patients. More understanding of predictive factors, mechanisms for metastatic disease and causes of regional differences, is needed.
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Affiliation(s)
- Haytham Bayadsi
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden.
| | - Martin Bergman
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden
| | - Joakim Hennings
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, 901 85, Umeå, Sweden
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Effects of the Minimal Extrathyroidal Extension on Early Response Rates after (Adjuvant) Initial Radioactive Iodine Therapy in PTC Patients. Cancers (Basel) 2020; 12:cancers12113357. [PMID: 33202736 PMCID: PMC7696574 DOI: 10.3390/cancers12113357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The aim of our retrospective study was to evaluate the impact of minimal extrathyroidal extension on early response rate after (adjuvant) initial radioactive iodine therapy in patients with papillary thyroid cancer (PTC). We found that response rates after radioactive iodine (RAI) therapy in PTC patients were achieved irrespective of minimal extrathyroidal extension (mETE). Nonetheless, the risk of lymph node metastases involvement was significantly higher in the mETE patient group. Abstract Background: Extrathyroidal extension of differentiated thyroid cancer is a poor outcome factor but seems to be less significant in minimal extrathyroidal extension (mETE). However, the impact of mETE on response rate after (adjuvant) initial radioactive iodine (RAI) therapy remains unclear. We therefore compared response rates of patients with classical and follicular variants of papillary thyroid cancer (PTC) according to the updated eighth tumor-node-metastasis (TNM) classification to a control group. Methods: 455 patients with T3 (primary tumor > 4 cm) PTC according to the seventh classification who underwent total thyroidectomy followed by RAI therapy were screened. Patients formerly classified as T3 PTC solely due to mETE were reclassified into patients with T1 (primary tumor ≤ 2 cm) or T2 (primary tumor > 2 cm but ≤ 4 cm) +mETE and compared to a control group of T1/T2 −mETE PTC patients. Results: 138/455 patients were reclassified as T1/2 +mETE and compared to 317/455 T1/T2 −mETE control patients. At initial presentation, +mETE patients showed significantly higher rates of cervical lymph node metastases (p-value 0.001). Response rates were comparable in both groups (p-value n.s.). N1a/N1b-stage (Hazard ratio, HR 0.716; 95% CI 0.536–0.956, p-value 0.024) was identified as an independent prognostic factor for lower response rates. Conclusion: Response rates after RAI therapy were comparable in PTC patients irrespective of mETE but with higher rates of lymph node metastases.
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