Prediction of novel target genes and pathways involved in tall cell variant papillary thyroid carcinoma

Collagen XI alpha 1 chain, a potential therapeutic target for cancer

Extracellular matrix (ECM) plays an important role in the progression of cancer. Collagen is the most abundant component in ECM, and it is involved in the biological formation of cancer. Although type XI collagen is a minor fibrillar collagen, collagen XI alpha 1 chain (COL11A1) has been found to be upregulated in a variety of cancers including ovarian cancer, breast cancer, thyroid cancer, pancreatic cancer, non-small-cell lung cancer, and transitional cell carcinoma of the bladder. High levels of COL11A1 usually predict poor prognosis, while COL11A1 is related to angiogenesis, invasion, and drug resistance of cancer. However, little is known about the specific mechanism by which COL11A1 regulates tumor progression. Here, we have organized and summarized the recent developments regarding elucidation of the relationship between COL11A1 and various cancers, as well as the interaction between COL11A1 and intracellular signaling pathways. In addition, we have selected therapeutic agents targeting COL11A1. All these indicate the possibility of using COL11A1 as a target for cancer treatment.

Prognostic and Therapeutic Role of Angiogenic Microenvironment in Thyroid Cancer

Simple Summary

Angiogenesis is an essential event for the progression of solid tumors and is promoted by angiogenic cytokines released in the tumor microenvironment by neoplastic and stromal cells. Over the last 20 years, the role of the microenvironment and the implication of several angiogenic factors in tumorigenesis of solid and hematological neoplasms have been widely studied. The tumor microenvironment has also been well-defined for thyroid cancer, clarifying the importance of angiogenesis in cancer progression, spread, and metastasis. Furthermore, recent studies have evaluated the association of circulating angiogenic factors with the clinical outcomes of differentiated thyroid cancer, potentially providing noninvasive, low-cost, and safe tests that can be used in screening, diagnosis, and follow-up. In this review, we highlight the mechanisms of action of these proangiogenic factors and their different molecular pathways, as well as their applications in the treatment and prognosis of thyroid cancer.

Abstract

Thyroid cancer is the most common endocrine malignancy, with a typically favorable prognosis following standard treatments, such as surgical resection and radioiodine therapy. A subset of thyroid cancers progress to refractory/metastatic disease. Understanding how the tumor microenvironment is transformed into an angiogenic microenvironment has a role of primary importance in the aggressive behavior of these neoplasms. During tumor growth and progression, angiogenesis represents a deregulated biological process, and the angiogenic switch, characterized by the formation of new vessels, induces tumor cell proliferation, local invasion, and hematogenous metastases. This evidence has propelled the scientific community’s effort to study a number of molecular pathways (proliferation, cell cycle control, and angiogenic processes), identifying mediators that may represent viable targets for new anticancer treatments. Herein, we sought to review angiogenesis in thyroid cancer and the potential role of proangiogenic cytokines for risk stratification of patients. We also present the current status of treatment of advanced differentiated, medullary, and poorly differentiated thyroid cancers with multiple tyrosine kinase inhibitors, based on the rationale of angiogenesis as a potential therapeutic target.

Short-term recovery in patients suffering hypoparathyroid after thyroidectomy: a case control study

Background

Postoperative hypoparathyroidism is the main reason for outpatient follow-up and long-term oral calcium and calcitriol treatment. Our study investigated the influencing factors and powerful predictors of short-term postoperative parathyroid function recovery.

Methods

Logistic regression was used to compare the clinicopathological characteristics; surgical details; and serum calcium (Ca), magnesium (Mg), and phosphorus (P) concentrations of patients. A receiver operating characteristic (ROC) curve was used to analyze the predictors of normal parathyroid hormone (PTH).

Results

Among the 111 patients with PTH < 10 pg/mL on the first postoperative day, most patients experienced a return to normal PTH (PTH > 15 pg/mL) within 30 days postoperatively. Univariate analysis showed that Pod (postoperative day) 1 PTH, Pod3 PTH, Pod7 Ca, Pod7 Mg, and Pod7 P (P < 0.05) were associated with parathyroid function recovery to normal on the seventh postoperative day. Multivariate logistic regression analysis revealed the following independent risk factors for normal PTH levels at Pod7 after thyroidectomy: Pod3 PTH (P = 0.038), Pod1 PTH (P = 0.056), Pod7 Mg (P = 0.001), Pod7 P (P = 0.020), and the number of parathyroid glands in situ intraoperatively. The combined sensitivity of serum magnesium concentration and phosphorus concentration to predict parathyroid function recover to normal on the seventh postoperative day was 82.76%, with a sensitivity of 76.83%.

Conclusion

Serum magnesium, phosphorus and PTH concentrations are important influencing factors and effective predictors of short-term postoperative parathyroid function recovery to normal. Serum ion is an effective auxiliary diagnostic method for hypoparathyroidism after thyroidectomy.

Overexpression of CRABP2 inhibits dexamethasone-induced apoptosis in human osteoblast cells

Background

The purpose of the current study was to explore the role and underlying mechanism of cellular retinoic acid binding protein 2 (CRABP2) in dexamethasone (DEX)-induced apoptosis in human osteoblast cells.

Methods

GSE10311 was downloaded from the Gene Expression Omnibus (GEO) database to identify the differentially expressed genes (DEGs) by the limma/R package. Primary human osteoblast was isolated and treated with different concentration of DEX (0, 10^-8, 10^-7, 10^-6, 10^-5, and 10^-4 mol/L), and cell viability and flow cytometry were used to detect cell proliferation and apoptosis. A CRABP2 overexpression plasmid (oe-CRABP2) was used to overexpress CRABP2, and western blotting was conducted to detect protein expression.

Results

We found that CRABP2 was downregulated in the DEX-treated group. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses indicated that DEGs were associated with PI3K/Akt signaling pathway. DEX downregulated CRABP2 gene and protein expression, inhibited viability, and induced human osteoblast apoptosis. Overexpression of CRABP2 reversed DEX-induced apoptosis in human osteoblast. Moreover, overexpression of CRABP2 delayed the progression of DEX-induced osteonecrosis of the femoral head (ONFH) animal model.

Conclusion

In conclusion, CRABP2 is effective at inhibiting DEX-induced human osteoblast apoptosis and delayed ONFH progression.

Incidence and Mortality Risk Spectrum Across Aggressive Variants of Papillary Thyroid Carcinoma

Importance

While well-differentiated papillary thyroid carcinoma (WDPTC) outcomes have been well characterized, the prognostic implications of more aggressive variants are far less defined. The rarity of these subtypes has led to their consolidation as intermediate risk for what are in fact likely heterogeneous diseases.

Objective

To analyze incidence, clinicopathologic characteristics, and outcomes for aggressive variants of papillary thyroid carcinoma (PTC).

Design, Setting, and Participants

This cohort study used data from 2000 to 2016 from hospital-based and population-based US cancer registries to analyze aggressive PTC variants, including diffuse sclerosing (DSV), tall-cell (TCV), insular, and poorly differentiated (PDTC) subtypes. These variants were compared against WDPTC and anaplastic cases. Data analysis was conducted from January 2019 to October 2019.

Main Outcomes and Measures

Age-adjusted incidence was calculated via annual percentage change (APC) using the weighted least-squares method. Overall survival and disease-specific survival were analyzed via Cox regression. Propensity-score matching was used to adjust survival analyses for clinical and demographic covariates.

Results

Collectively, 5447 aggressive PTC variants were identified (including 415 DSV, 3339 TCV, 362 insular, and 1331 PDTC cases), as well as 35 812 WDPTC and 2249 anaplastic cases. Over the study period, a substantial increase in aggressive variant incidence was observed (APC, 9.1 [95% CI, 7.33-10.89]; P < .001), surpassing the relative increases observed in WDPTC (APC, 5.1 [95% CI, 3.98-6.12]; P < .001) and anaplastic cases (APC, 1.9 [95% CI, 0.75-3.05]; P = .003; parallelism P < .007). Survival varied markedly based on histologic subtype, with a wide spectrum of mortality risk noted; 10-year overall survival was 85.4% (95% CI, 84.6%-86.3%) in WDPTC, 79.2% (95% CI, 73.6%-85.3%) in DSV, 71.9% (95% CI, 68.4%-75.6%) in TCV, 45.1% (95% CI, 40.2%-50.6%) in PDTC, 27.9% (95% CI, 20.0%-38.9%) in the insular variant, and 8.9% (95% CI, 7.5%-10.6%) in anaplastic cases (P < .001). These differences largely persisted even after adjusting for inherent differences in baseline characteristics by multivariable Cox regression and propensity-score matching.

Conclusions and Relevance

An upsurge in aggressive PTC incidence was observed at a rate beyond that seen in WDPTC or anaplastic thyroid carcinoma. Moreover, long-term survival outcomes for aggressive PTC subgroups exhibit heterogeneous clinical behavior and a wide range of mortality risk, suggesting that treatment should be tailored to specific histologic subtypes. Given increasing prevalence and disparate outcomes, further investigation to identify optimal therapeutic strategies is needed in these diverse, understudied populations.

Contemporary evaluation and management of tall cell variant of papillary thyroid carcinoma

PURPOSE OF REVIEW

The purpose of this review is to describe the contemporary evaluation and management of tall cell variant of papillary thyroid carcinoma with an emphasis on the clinical features.

RECENT FINDINGS

Tall cell variant of papillary thyroid carcinoma is the most common aggressive subtype. Within the last few years, the diagnostic criteria for this entity have evolved. Studies have elucidated a better understanding of the clinical implications and pathophysiology of this variant. In this review, the studies presented reflect cumulative and aggregated data from metaanalyses, systematic reviews, and large database investigations utilizing the current diagnostic criteria.

SUMMARY

Overall, tall cell variant of papillary thyroid carcinoma represents an aggressive subtype of well-differentiated thyroid carcinoma with more prevalent high-risk features and a poorer clinical outcome.

Incremental diagnostic value of shear wave elastography combined with contrast-enhanced ultrasound in TI-RADS category 4a and 4b nodules

PURPOSE

To evaluate the diagnostic value of shear wave elastography (SWE) combined with contrast-enhanced ultrasonography (CEUS) in diagnosing thyroid imaging reporting and data system (TI-RADS) category 4a and 4b nodules.

METHODS

TI-RADS, SWE, and CEUS features of 71 thyroid nodules (23 benign, 48 malignant) confirmed by postoperative pathological results were retrospectively analyzed. The diagnostic efficiency of each single method and that of a combination of three methods were compared.

RESULTS

The sensitivity and specificity in diagnosing thyroid nodules were 70.83% and 65.22% for TI-RADS, 68.75% and 91.30% for SWE, 77.08% and 78.26% for CEUS, and 91.67% and 95.65% for TI-RADS + SWE + CEUS, respectively. The area under the curve for TI-RADS, SWE, CEUS, and TI-RADS + SWE + CEUS in diagnosing thyroid nodules were 0.680, 0.839, 0.799, and 0.937, respectively. A significant difference was observed between a combination of the three methods and any of them alone (p < 0.05).

CONCLUSION

Combining SWE and CEUS improves the differential diagnosis of TI-RADS category 4a and 4b nodules.

Magnesemia: an independent risk factor of hypocalcemia after thyroidectomy

Background

This study was designed to investigate the impact of serum magnesium (Mg) levels on hypocalcemia after thyroidectomy.

Patients and methods

In total, 242 patients with differentiated thyroid cancer were retrospectively analyzed.

Results

Multivariate regression analysis showed hypomagnesemia was an independent risk factor for hypocalcemia (P<0.001). While Mg in low levels (0.66 mmol/L ≤ Po-Mg ≤0.74 mmol/L) increased the risk of hypocalcemia, postoperative serum Ca (Po-Ca) levels were significantly lower in patients with hypomagnesemia than in patients with normomagnesemia (P=0.01), and the former patients suffered significant decreases in serum Ca (P=0.02). Compared to patients with a mild decline of serum Mg after surgery (ΔMg <0.17), serum Ca decline significantly increased (P<0.001) in patients with a severe decline of serum Mg (ΔMg ≥0.17), while the change in amounts of parathyroid hormone (PTH) after surgery was similar between the two groups (P>0.05). In patients with normal Po-Ca levels, hypomagnesemia increased the risk of symptoms related to hypocalcemia by 4.478 times (OR =5.478, 95% CI 1.724–17.403).

Conclusion

Hypomagnesemia, or even a low serum Mg level within the normal range, can increase the risk of hypocalcemia. After excluding the potential effects of PTH on serum magnesium and calcium, serum Mg reduction is one of the most important factors that influences postoperative serum Ca reduction. What’s more, hypomagnesemia is closely linked with symptoms.

Hashimoto's thyroiditis elicits decreased diagnostic efficacy of thyroid nodule ultrasound-guided fine needle aspiration

BACKGROUND

False negative (FN) or false positive (FP) results of thyroid ultrasound-guided fine needle aspiration (US-guided FNA) cause missed diagnosis of thyroid cancer or unnecessary thyroidectomy.

PURPOSE

To explore the impact of Hashimoto's thyroiditis (HT) on the diagnostic efficacy of US-guided FNA and to analyze the differences in diagnostic efficacy between US-guided FNA and thyroid ultrasonography (US) in patients with HT.

METHOD

Medical records were reviewed retrospectively. Patients with and without Hashimoto's thyroiditis (HT) were included in the exposure and non-exposure group, respectively.

RESULTS

HT was not an independent risk factor for thyroid cancer. The percentage of undetermined results of US-guided FNA (Bethesda I, III, IV) in the exposure group was significantly higher. The US-guided FNA's diagnostic sensitivity, specificity, and accuracy were significantly lower, and FP rate (FPR) and FN rate (FNR) were higher in the exposure group. In the exposure group, US tended to give higher diagnostic sensitivity, accuracy, PPV, NPV, and lower FPR and FNR. Receiver operating characteristic (ROC) curve analysis showed that, in the exposure group the diagnostic efficacy of thyroid US was significantly higher than of US-guided FNA.

CONCLUSION

HT tends to cause undetermined results and elicit lower diagnostic performance of US-guided FNA. In patients with HT, the diagnostic efficacy of thyroid US is, at least, not inferior to US-guided FNA.