ObjectiveTo systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN0 papillary thyroid carcinoma. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), WanFang Data, CBM and CNKI were searched to collect the studies about total thyroidectomy (TT)+PCND versus TT alone for stage cN0 papillary thyroid carcinoma from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. ResultsA total of 10 studies involving 3 661 patients were included. The results of meta-analysis showed that, compared with TT alone, TT+PCND had higher transient hypocalcemia (OR=2.50, 95%CI 2.05 to 3.03, P<0.000 01), higher permanent hypocalcemia (OR=3.11, 95%CI 1.82 to 5.30, P<0.000 1), and lower recurrence (OR=0.66, 95%CI 0.47 to 0.93, P=0.02). But there were no significant differences between two groups in transient laryngeal nerve palsy or permanent laryngeal nerve palsy. ConclusionTT+PCND is safe and feasible for treating stage cN0 papillary thyroid carcinoma when its indications are strictly controlled. However, due to limited quantity and quality of the included studies, more high-quality randomized controlled trials are needed to verify the abovementioned conclusion.
Objective To analyze the expression differences of FoxP3 protein in papillary thyroid carcinoma (PTC) and nodular goiter, and to explore the correlation between FoxP3 and the clinicopathological characteristics of PTC patients and the therapeutic dose of 131I. Methods Immunohistochemical method was used to detect the expression of FoxP3 protein in 128 cases of PTC tissues (42 cases were treated with 131I after operation) and 20 cases of nodular thyroid tissues, and the relationship between it and the clinicopathological characteristics of PTC patients and the dose of 131I treatment was also analyzed. Results The positive rate of FoxP3 protein expression in PTC tissues was 46.09%, which was higher than that in nodular goiter tissues (0.00%), and the difference was statistically significant (P<0.001). The expression of FoxP3 protein in PTC was correlated with gender, extraglandular invasion and tumor diameter (P values were 0.041, 0.039, and 0.007, respectively), but had no correlation with age, capsular invasion, TNM staging, lymph node metastasis, and distant metastasis (P>0.05). The results of binary logistic regression analysis suggest that tumor diameter was an independent risk factor affecting FoxP3 protein expression [OR=0.389, 95%CI (0.180, 0.840), P=0.016]. By drawing the receiver operating characteristic (ROC) curve, it was shown that the area under the curve (AUC) was 0.643 when the tumor diameter was 1.05 cm, the sensitivity to predict the increase in FoxP3 protein expression was 64.41%, and the specificity was 57.97%, P=0.006. Among 42 patients with PTC who underwent 131I treatment after surgery, the therapeutic dose of 131I was related to the expression of FOXP3 protein (P=0.031). It was shown that patients with positive expression of FoxP3 protein were given more dose of 131I after surgery. Conclusions The positive rate of FoxP3 protein expression in PTC is higher than that of nodular goiter. Its high expression means that the patient has poor pathological characteristics and larger 131I treatment dose, suggesting that FoxP3 may be involved in the malignant progression of PTC.
ObjectiveTo investigate the predictive value of pretracheal lymph node (Ⅵc) subdivision for contralateral central lymph node (CLN) metastasis in clinical lymph node negative (cN0) unilateral papillary thyroid carcinoma (PTC). MethodsThe data of patients with cN0 unilateral PTC who initially underwent total thyroidectomy and bilateral CLN dissection in the Department of Thyroid Surgery of West China Hospital, Sichuan University from July 2017 to June 2021 were collected retrospectively. The Ⅵc subdivision was divided into right anterior trachea (Ⅵc1) and left anterior trachea (Ⅵc2); If the lymph nodes crossed the middle line of trachea, which would be included in the side of cancer focus. ResultsA total of 175 patients were included in this study, and the incidences of lymph nodes metastasis in the prelaryngeal (Ⅵd), Ⅵc, ipsilateral Ⅵc, contralateral Ⅵc, ipsilateral central, and contralateral central regions were 54 cases (30.9%), 118 cases (67.4%), 85 cases (48.6%), 72 cases (41.1%), 108 cases (61.7%), and 43 cases (24.6%), respectively. The results of the univariate analysis found that the contralateral CLN metastasis was associated with the lymph node metastases of Ⅵd, Ⅵc, contralateral Ⅵc, and ipsilateral central regions; The results of the multivariate analysis found that the lymph node metastases of Ⅵd and contralateral Ⅵc regions increased the probability of contralateral CLN metastasis (OR=4.444, P<0.001; OR=6.655, P=0.001). ConclusionsFrom the results of the study,Ⅵc subdivision is reasonable and effective, and has a certain predictive value for the metastasis of contralateral CLN in cN0 unilateral papillary thyroid carcinoma. And bilateral CLN dissection should be recommended in patients with a positive intraoperative frozen section result of contralateral pretracheal lymph node metastasis.
ObjectiveTo investigate the correlation between the expressions of bone morphogenetic protein 4 (BMP4) and sma and mad homologue 4 (Smad4) and their clinicopathological features in papillary thyroid carcinoma (PTC).MethodsEighty patients with PTC confirmed by pathology in the Pingdingshan Second People’s Hospital from March 2018 to March 2020 were selected as the research objects, the cancer tissues and adjacent tissues removed during surgery were collected. The mRNA expression levels of BMP4 and Smad4 were detected by real-time quantitative PCR (qRT-PCR). The correlation between BMP4 and Smad4 mRNA expression levels was analyzed by Pearson method. The expressions of BMP4 and Smad4 protein were detected by immunohistochemistry. The correlation between the expressions of BMP4 and Smad4 protein and clinicopathological features of PTC was analyzed.ResultsThe mRNA expression levels of BMP4 and Smad4 in PTC tissues were lower than those in adjacent tissues (P<0.05). Pearson analysis showed that there was a positive correlation between expressions of BMP4 mRNA and Smad4 mRNA in PTC cancer (r=0.660, P<0.05). BMP4 and Smad4 protein were localized in cytoplasm, and the cytoplasm was stained yellow or brown yellow. The results of immunohistochemistry showed that the expression positive rate of BMP4 in cancer tissues of PTC patients was lower than that in adjacent tissues (18.8% vs 97.5%, χ2=101.916, P<0.05), and the expression positive rate of Smad4 protein in cancer tissues of PTC patients was also lower than that in adjacent tissues (11.3% vs 93.8%, χ2=109.173, P<0.05). The expressions of BMP4 and Smad4 protein in PTC patients were correlated with the tumor size, TNM stage, lymph node metastasis, degree of infiltration and multiple foci (P<0.05).ConclusionsThe expression levels of BMP4 mRNA and Smad4 mRNA in PTC tissues are decreased, and the expression of BMP4 protein and Smad4 protein are closely related to tumor size, TNM stage and lymph node metastasis, which may be used as new therapeutic targets.
Objective The aim of this study is to review the association between long non-coding RNA (lncRNA) and papillary thyroid carcinoma (PTC). Method The relevant literatures about lncRNA associated with PTC were retrospectively analyzed and summarized. Results The expression levels of noncoding RNA associated with MAP kinase pathway and growth arrest (NAMA), PTC susceptibility candidate 3 (PTCSC3), BRAF activated non-coding RNA (BANCR), maternally expressed gene 3 (MEG3), NONHSAT037832, and GAS8-AS1 in PTC tissues were significantly lower than those in non-thyroid carcinoma tissues. The expression levels of ENST00000537266, ENST00000426615, XLOC051122, XLOC006074, HOX transcript antisense RNA (HOTAIR), antisense noncoding RNA in the INK4 locus (ANRIL), and metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in PTC tissues were upregulated in PTC tissues, comparing with the non-thyroid carcinoma tissues. These lncRNAs were possibly involved in cell proliferation, migration, and apoptosis of PTC. Conclusion LncRNAs may provide new insights into the molecular mechanism and gene-targeted therapy of PTC and become new molecular marker for the diagnosis of PTC.
ObjectiveTo summarize potential related proteins in thyroid papillary carcinoma metastasis and explore its mechanism.MethodThe relevant literatures on the potential related proteins of papillary thyroid carcinoma metastasis at home and abroad were reviewed.ResultsThe previous studies had shown that many biological indicators might be associated with the metastasis of papillary thyroid carcinoma, such as the interleukin-13 receptor alpha 2, chemokine receptor 7, low-density lipoprotein receptor-related protein 4, cytokine receptor-like factor 1, Rho-related protein kinase 1, and astrocyte up-regulated gene-1 were involved in the proliferation, migration, and metastasis of papillary thyroid carcinoma, which might be the potential therapeutic target for the papillary thyroid carcinoma.ConclusionsThyroid papillary carcinoma metastasis-associated proteins play an important role in tumor metastasis. Some progress has been made in study of metastasis mechanisms, its role and mechanism in lymphatic metastasis should be further studied.
ObjectiveTo compare the differences of curative effect, cosmetic effect, and shoulder-neck function protection effect between video-assisted lateral neck dissection (VALND) and traditional open thyroid surgery (OTS) in the treatment of papillary thyroid carcinoma (PTC) with lateral cervical lymph node metastasis. MethodsFifty patients with unilateral PTC accompanied by ipsilateral cervical lymph node metastasis who underwent sternal incision approach VALND at Cancer Hospital Affiliated to Fudan University and Pudong Hospital Affiliated to Fudan University from January 2013 to December 2019 were collected. And 100 patients with unilateral PTC and ipsilateral cervical lymph node metastasis who underwent OTS during the same period were randomly selected at a ratio of 1∶2 using the random number method. All patients underwent unilateral thyroid lobectomy (or total thyroid lobectomy) + isthmus resection + central area (zone Ⅵ) and cervical lymph node dissection on the affected side (zones Ⅱ–Ⅴ). The therapeutic effect was compared between the two groups. ResultsCompare to OTS group, the operation time of VALND group was longer ［(218.3±86.6) min vs. (185.7±42.8) min, P=0.002］, but the hospital stay was shortened ［(6.1±2.2) d vs. (7.3±1.6) d, P<0.001］. In terms of surgical efficacy, there were no statistically significant differences between VALND group and OTS group in the number of lymph node dissections, the number of lymph node metastases, and the postoperative tumor recurrence rate (P>0.05). As for surgical safety, the two groups had similar rates of postoperative complications including recurrent laryngeal nerve injury, hypoparathyroidism, postoperative hematoma and infection(P>0.05). In terms of postoperative recovery, the scar color, vascular distribution, thickness, and softness, as well as in shoulder stiffness, tightness, pain, and numbness scores of VALND group were significantly lower than those in OTS group (P<0.05). ConclusionsFor PTC patients with lateral cervical lymph node metastasis, there is no significant difference in surgical efficacy and safety between VALND and OTS. However, VALND shows obvious advantages in reducing the length of cervical incisions, improving cosmetic effects, and protecting cervical and shoulder functions. Therefore, VALND through the sternal notch approach has certain promotion and application value in clinical practice.
Objective To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma. Method Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized. Results Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis. Conclusions The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.
ObjectiveTo summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection. MethodsA retrospective review was conducted, we collected clinical data from 47 patients with papillary thyroid carcinoma who underwent transoral endoscopic thyroidectomy and lateral neck lymph node dissection at our hospital from January 2021 to May 2023. A stepwise sequential treatment plan was adopted for patients with postoperative lymphatic leakage: low-fat, low-protein diet, continuous strong negative pressure suction, subcutaneous injection of Group A streptococcus in the surgical cavity, and ligation of the thoracic duct or lymphatic vessels through a small incision. The effectiveness of the sequential treatment plan was summarized. ResultsOut of the 47 patients, lymphatic leakage occurred in 5 cases postoperatively. Patient No.1 was cured of lymphatic leakage after sequential treatments including pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, subcutaneous injection of Group A streptococcus in the surgical cavity, and finally ligation of the thoracic duct or lymphatic vessels through a small incision. Patient No.20 was conservatively cured of lymphatic leakage with an initial surgical procedure involving pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, and subcutaneous injection of Group A streptococcus in the surgical cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1, Patient No.36 was the same as Patient No.20. Through the stepwise sequential treatment measures, all 5 patients successfully recovered from lymphatic leakage; the postoperative hospital stay ranged from 3 to 17 days, with an average of 8.6 days. ConclusionsThe stepwise sequential treatment plan used in this study can effectively prevent and treat lymphatic leakage after transoral endoscopic thyroid cancer lateral neck lymph node dissection. Given the small sample size of this study, we believe that it is necessary to conduct long-term studies to confirm the durability and stability of these measures.
ObjectiveTo investigate the relationship between clinicopathologic characteristics of patients with papillary thyroid carcinoma (PTC) and diabetes mellitus (DM), and to provide basis for individualized diagnosis and treatment.MethodsThe patients who underwent the first thyroid surgery in the Renmin Hospital of Wuhan University from January 1, 2017 to September 15, 2020 and were pathologically diagnosed as PTC were collected. According to the presence or absence of DM, the clinical features were compared.ResultsThere were 2859 patients without DM and 133 patients with DM in 2992 patients. In patients with or without DM, there were no differences in lymph node metastasis, multiple, bilateral tumors, and extrathyroid invasion between the two groups (P>0.05). However, compared with the PTC patients without DM, the proportion of women with DM was lower (58.65% versus 76.71%, P<0.01), the proportions of age >55 years old (92.48% versus 66.32%, P<0.01) and capsule invasion (67.21% versus 63.11%, P=0.04) with DM were higer. After adjusting for age and gender, the multivariate analysis showed that the risks of larger tumor and capsular invasion in the patients with DM was 1.51 times [95%CI (1.06, 2.16), P=0.02] and 1.75 times [95%CI (1.16, 2.64), P<0.01] respectively as compared with in the patients without DM.ConclusionsIn PTC patients with DM, proportion of women is lower, proportions of elderly population (age >55 years old) and patients with capsular invasion are higer, tumor is larger. Therefore, patients with DM must not neglect regular examination of thyroid morphology and function, and PTC patients should also pay attention to control of blood glucose.