Relationship between preoperative serum TSH levels and expression of VEGF in papillary thyroid carcinoma

The role of vascular endothelial growth factor in the development of papillary thyroid carcinoma in patients with lymphocytic thyroiditis

BACKGROUND

Vascular endothelial growth factor (VEGF) plays a pivotal role in the pathogenesis of autoimmune chronic inflammatory conditions and papillary thyroid carcinoma (PTC). We hypothesized that, as VEGF expression is increased both in PTC and in lymphocytic thyroiditis (LT), it may stimulate the development of PTC in patients with LT. To evaluate this, we examined both tumor and adjacent non-tumoral tissues of PTC patients with and without LT.

METHODS

A total of 50 patients with PTC (52.50±7.41 years) and 17 patients with nodular goiter (NG) (50.47±10.38 years) were included in the study. According to the presence of LT, patients with PTC were further divided into two groups. Immunohistochemical analyses of VEGF were conducted in all patients and for PTC patients, both tumor tissue and adjacent non-tumoral tissue were evaluated.

RESULTS

The scores for intensity of staining and percentage of labeled thyrocytes for VEGF were found to be significantly higher in the PTC patients than in the NG patients (P<0.001, P<0.001, respectively). The tumor tissue revealed similar scores for PTC patients with LT and without LT. However, the scores in adjacent non-tumoral tissue were higher in PTC patients with LT than in patients without LT (P=0.004, P=0.01, respectively).

CONCLUSIONS

To the best of our knowledge, our results are the first to demonstrate that the expression of VEGF in adjacent non-tumoral tissue were higher in PTC patients with LT than in those without, which shows a possible role of VEGF expression in the progression of PTC in the presence of LT.

Identification of Serpin peptidase inhibitor clade A member 1 (SERPINA1) might be a poor prognosis biomarker promoting the progression of papillary thyroid cancer

BACKGROUND

Papillary thyroid carcinoma (PTC) is the most prevalent malignancy within the endocrine system, exhibiting a rapid growth rate in recent years. Serpin peptidase inhibitor clade A member 1 (SERPINA1) has been previously proposed as a diagnostic biomarker; however, it's potential molecular relevance and biological function in PTC remains largely unexplored.

METHODS

Our study utilized multi-omics bioinformatic data from several public databases, supplemented with transcriptional profiles using our local cohort comprising 79 paired PTC samples.

RESULTS

Using multi-omics profiling of a PTC cohort, we have identified SERPINA1 as a potential oncogene involved in PTC progression. Our clinical analysis revealed a significant association between SERPINA1 expression and mutations in BRAFV600E and RAS. Furthermore, SERPINA1 level was correlated with clinicopathological factors in patients with PTC and with a worse prognosis in early-stage patients. Functionally, we found a strong correlation between SERPINA1 expression and increased infiltration of dendritic cells and regulatory T-cells, suggesting an elevated level of immune infiltration. Moreover, SERPINA1 knockdown reduced the proliferative and migrational ability of PTC cells in vitro.

CONCLUSION

Our study highlights the high expression of SERPINA1 in PTC and its potential role in shaping the immune microenvironment, thereby promoting disease progression. These findings suggest that SERPINA1 could serve as a promising therapeutic target for intervention in PTC.

Clinicopathological and surgical comparisons of differentiated thyroid cancer between China and the USA: A multicentered hospital-based study

Background

Thyroid cancer (TC), was the fastest-rising tumor of all malignancies in the world and China, predominantly differentiated thyroid cancer (DTC). However, evidence on TC stage distribution and influencing factors of late-stage were limited in China.

Methods

We carried out a retrospective study and enrolled TC patients who were first diagnosed and hospitalized in 8 hospitals in China in 2017. Logistic regression was used to evaluate associations between influencing factors and DTC stage. We extracted eligible primary DTC records newly diagnosed in 2017 from the USA's Surveillance, Epidemiology, and End Results (SEER) database. We compared clinicopathological features and surgical treatment between our DTC records and those from the SEER database.

Results

A total of 1970 eligible patients were included, with 1861 DTC patients with known stage. Among patients ≥45 years old, males (OR = 1.76, 95%CI 1.17-2.65) and those with new rural cooperative medical scheme insurance (NCMS) (OR = 1.99, 95%CI 1.38-2.88) had higher risks of late-stage DTC (stage III-IV). Compared with SEER database, over-diagnosis is more common in China [more DTC patients with onset age< 45 years old (50.3 vs. 40.7%, P < 0.001), with early-stage (81.2 vs. 76.0%, P < 0.001), and with tumors<2cm (74.9 vs. 63.7%, P < 0.001)]. Compared with the USA, TC treatment is more conservative in China. The proportion of lobectomy in our database was significantly higher than that in the SEER database (41.3 vs. 17.0%, P < 0.001).

Conclusions

Unique risk factors are found to be associated with late-stage DTC in China. The differences in the aspect of clinicopathological features and surgical approaches between China and the USA indicate that potential over-diagnosis and over-surgery exist, and disparities on surgery extent may need further consideration. The findings provided references for other countries with similar patterns.

Major Vault Protein (MVP) Associated With BRAF V600E Mutation Is an Immune Microenvironment-Related Biomarker Promoting the Progression of Papillary Thyroid Cancer via MAPK/ERK and PI3K/AKT Pathways

Papillary thyroid cancer (PTC) is the most common malignancy of the endocrine system, with an increase in incidence frequency. Major vault protein (MVP) is the main structural protein of the vault complex that has already been investigated in specific cancers. Yet the underlying biological functions and molecular mechanisms of MVP in PTC still remain considerably uncharacterized. Comprehensive analyses are predicated on several public datasets and local RNA-Seq cohort. Clinically, we found that MVP was upregulated in human PTC than in non-cancerous thyroid tissue and was correlated with vital clinicopathological parameters in PTC patients. MVP expression was associated with BRAF V600E, RAS, TERT, and RET status, and it was correlated with worse progression-free survival in PTC patients. Functionally, enrichment analysis provided new clues for the close relationship between MVP with cancer-related signaling pathways and the immune microenvironment in PTC. In PTC with high MVP expression, we found CD8+ T cells, regulatory T cells, and follicular helper T cells have a higher infiltration level. Intriguingly, MVP expression was positively correlated with multiple distinct phases of the anti-cancer immunity cycle. MVP knockdown significantly suppressed cell viability and colony formation, and promoted apoptosis. In addition, downregulated MVP markedly inhibited the migration and invasion potential of PTC cells. The rescue experiments showed that MVP could reverse the level of cell survival and migration. Mechanistically, MVP exerts its oncogenic function in PTC cells through activating PI3K/AKT/mTOR and MAPK/ERK pathways. These results point out that MVP is a reliable biomarker related to the immune microenvironment and provide a basis for elucidating the oncogenic roles of MVP in PTC progression.

Influence of Body Mass Index on the Clinicopathologic Features of Papillary Thyroid Carcinoma

BACKGROUND

Epidemiologic studies have demonstrated an increased risk for papillary thyroid carcinoma (PTC) with increasing body mass index (BMI). However, the relationships between excess weight and the behavior of PTC are inconsistent. The aim of this study was to evaluate the impact of excess weight on clinicopathologic features of PTC and on patient outcomes.

METHODS

Data from 417 patients with PTC who underwent total thyroidectomy with cervical lymph node dissection were retrospectively analyzed. On the basis of World Health Organization standardized categories of BMI, patients were divided into 4 groups: underweight, normal weight, overweight, and obese. Histopathologic tumor features, stage at diagnosis, and disease status were determined by chart review. Logistic regression models were used to define associations between BMI and clinicopathologic features of PTC. Cox proportional-hazards models were used to assess associations between BMI and locoregional recurrence.

RESULTS

Overweight (odds ratio [OR], 3.90; P = .040) and obesity (OR, 9.19; P = .012) were independent predictors of vascular invasion. Furthermore, obesity (OR, 6.14; P = .004) was an independent predictor of extrathyroidal invasion. During follow-up (median, 29 months; range, 5-87 months), 48 patients (11.5%) experienced locoregional recurrence. There were no significant differences in locoregional recurrence of PTC among BMI groups. When adjusted for other confounding factors, extrathyroidal invasion (OR, 8.35; P < .001), vascular invasion (OR, 3.57; P < .001), cervical lymph node metastasis (OR, 3.71; P = .009), and advanced tumor-node-metastasis stage (OR, 3.81; P < .001) were identified as independent factors for locoregional recurrence.

CONCLUSIONS

Higher BMI was associated with extrathyroidal invasion and vascular invasion in patients with PTC, which suggests that excess weight is associated with aggressive clinicopathologic features of PTC. But patients with higher BMI did not have an increased risk for developing postoperative complications and locoregional recurrence.

Diagnostic accuracy of the McGill thyroid nodule score in paediatric patients

INTRODUCTION

Thyroid cancer is the most common paediatric endocrine cancer; accurate diagnosis and prompt management of paediatric thyroid nodules is critical. The McGill Thyroid Nodule Score (MTNS), based upon clinical, ultrasound (US) and cytology criteria, has recently been modified and studied in a pilot paediatric group with good results. We aim to describe the diagnostic accuracy of the paediatric modified MTNS (PMTNS) in a large paediatric cohort.

METHODS

We utilized an established retrospective cohort between 1996 and 2015 of 99 patients ≤21 years old with 131 thyroid nodules. Two experienced paediatric radiologists, blinded to pathology and radiology reports, reviewed US features. We abstracted cytology, histology and laboratory results, assigning each nodule a PMTNS. PMTNS performance was compared to FNA and histology.

RESULTS

Approximately 33% of nodules were malignant. The cohort was predominantly adolescent (mean age 15.4 ± 3.8 years). The average PMTNS for malignant and benign nodules, based on final histology, was 12.7 ± 4.3 and 1.7 ± 2.9, respectively. A PMTNS ≥8 resulted in a 93.2% sensitivity and 93.1% specificity for detecting malignancy, while a PMTNS ≥9 resulted in a 90.9% sensitivity and 96.6% specificity. However, Bethesda cytology category ≥4 independently had a 97.7% sensitivity and 94.0% specificity for detecting malignancy. The PMTNS had diminishing diagnostic accuracy in younger children compared with older children.

CONCLUSION

Paediatric modified McGill Thyroid Nodule Score predicts malignancy, perhaps due to the score's emphasis on cytology results; however, the score is less accurate in younger patients. While cytology results remain reliable, further work is needed to develop a non-invasive scoring system to predict malignancy in children.

Relationship between expression of vascular endothelial growth factor and cervical lymph node metastasis in papillary thyroid cancer: A meta-analysis

The aim of the present study was to examine the relationship between the protein expression of vascular endothelial growth factor (VEGF) and lymph node metastasis (LNM) in papillary thyroid cancer (PTC). VEGF-related articles that had been published until August 2016 were searched from the PubMed, EMBASE, and MEDLINE to identify the risk factors of LNM in PTC. RevMan 5.3 software was used for the meta-analysis. Finally, 9 articles met the inclusion criteria and were included in our meta-analysis. LNM was found to be present in 176 of 318 patients (57.8%) with high VEGF expression and in 71 of 159 patients (47.0%) with low VEGF expression. The overall OR was 2.81 (95% confidence interval, 1.49-5.29). LNM occurred more frequently in patients with high VEGF expression than in those with low VEGF expression (P=0.001). Heterogeneity was markedly decreased in the subgroup analyses of LNM in terms of the patients' country of origin and the detection methods. Our meta- analysis concluded that the VEGF protein expression is associated with LNM in PTC.

The effects of thyroid function on retinopathy of prematurity

OBJECTIVES

To assess whether TSH and fT4 have a role in the angiogenesis of vaso-obliteration and neovascularization which are the basic pathophysiology of ROP.

METHODS

In this retrospective case-control study, the control group (n = 56) included preterm newborns with risk for ROP while the laser group (n = 63) was recruited from cases who developed severe neovascularization and needed laser photocoagulation therapy. Considering the first (vaso-obliteration) and second (neovascularization) phases of the disease, in this study we researched the distribution of thyroid function tests between groups.

RESULTS

With regard to the first phase of the disease, TSH and fT4 showed no significant differences between the control and laser groups accordingly (P > 0.05). Likewise, in the second phase of ROP, there was no significant difference between the control and laser groups with respect to TSH and fT4 levels (P > 0.05).

CONCLUSION

We found that between the study groups, the levels of thyroid function tests did not have any significant differences, either in the first or the second phases of ROP which are the principal pathophysiology of the disease. Therefore, it was concluded that thyroid hormone values were not informative markers in the course of the disease in preterm babies at risk of developing ROP.

Relationship between VEGF protein expression and lymph node metastasis in papillary thyroid carcinoma among Asians: a meta-analysis

We carried out the current meta-analysis of relevant cohort studies in an attempt to investigate the relationships between vascular endothelial growth factor (VEGF) protein expression and lymph node (LN) metastasis in papillary thyroid carcinoma (PTC) among Asians. A range of electronic databases were searched, including Web of Science (1945∼2013), the Cochrane Library Database (Issue 12, 2013), MEDLINE (1966∼2013), EMBASE (1980∼2013), CINAHL (1982∼2013), and Chinese Biomedical Database (CBM) (1982~2013) with cross-referencing without language restrictions. Meta-analysis was conducted using the STATA 12.0 software. Crude odds ratio (OR) with their 95 % confidence interval (95 %CI) was calculated. Twelve clinical cohort studies with a total of 1,045 PTC patients were included in our meta-analysis, The results of our meta-analysis revealed that patients with VEGF-positive tumors had a 3.02-fold higher risk of LN metastasis than that of patients with VEGF-negative tumors (OR=3.02, 95 %CI=2.05~4.43, P<0.001). Furthermore, subgroup analysis by country suggested that VEGF-positive expression was associated with an increased risk of LN metastasis in PTC patients among Chinese populations (OR=3.33, 95 %CI=2.30~4.83, P<0.001), but not among Korean, Turkish, and Japanese populations (all P>0.05). Our findings support the view that VEGF protein expression may be correlated with LN metastasis in PTC patients, especially among Chinese populations.