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van Kinschot CMJ, Oudijk L, van Noord C, Korevaar TIM, van Nederveen FH, Peeters RP, van Kemenade FJ, Visser WE. Predictors of treatment response in lymphogenic metastasized papillary thyroid cancer: a histopathological study. Eur J Endocrinol 2024; 190:374-381. [PMID: 38652802 DOI: 10.1093/ejendo/lvae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Lymph node metastases in papillary thyroid cancer (PTC) increase the risk for persistent and recurrent disease. Data on the predictive value of histopathological features of lymph node metastases, however, are inconsistent. The aim of this study was to evaluate the prognostic significance of known and new histopathological features of lymph node metastases in a well-defined cohort of PTC patients with clinically evident lymph node metastases. METHODS A total of 1042 lymph node metastases, derived from 129 PTC patients, were reexamined according to a predefined protocol and evaluated for diameter, extranodal extension, cystic changes, necrosis, calcifications, and the proportion of the lymph node taken up by tumor cells. Predictors for a failure to achieve a complete biochemical and structural response to treatment were determined. RESULTS The presence of more than 5 lymph node metastases was the only independent predictor for a failure to achieve a complete response to treatment (odds ratio [OR] 3.39 [95% CI, 1.57-7.33], P < .05). Diameter nor any of the other evaluated lymph node features were significantly associated with the response to treatment. CONCLUSIONS Detailed reexamination of lymph nodes revealed that only the presence of more than 5 lymph node metastases was an independent predictor of failure to achieve a complete response to treatment. No predictive value was found for other histopathological features, including the diameter of the lymph node metastases. These findings have the potential to improve risk stratification in patients with PTC and clinically evident lymph node metastases.
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Affiliation(s)
- Caroline M J van Kinschot
- Department of Internal Medicine, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Lindsey Oudijk
- Academic Center for Thyroid Diseases, Department of Pathology, Erasmus Medical Center, 3079 DZ Rotterdam, The Netherlands
| | - Charlotte van Noord
- Department of Internal Medicine, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Tim I M Korevaar
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | | | - Robin P Peeters
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Folkert J van Kemenade
- Academic Center for Thyroid Diseases, Department of Pathology, Erasmus Medical Center, 3079 DZ Rotterdam, The Netherlands
| | - W Edward Visser
- Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
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Xu H, Wu W, Zhao Y, Liu Z, Bao D, Li L, Lin M, Zhang Y, Zhao X, Luo D. Analysis of preoperative computed tomography radiomics and clinical factors for predicting postsurgical recurrence of papillary thyroid carcinoma. Cancer Imaging 2023; 23:118. [PMID: 38098119 PMCID: PMC10722708 DOI: 10.1186/s40644-023-00629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Postsurgical recurrence is of great concern for papillary thyroid carcinoma (PTC). We aim to investigate the value of computed tomography (CT)-based radiomics features and conventional clinical factors in predicting the recurrence of PTC. METHODS Two-hundred and eighty patients with PTC were retrospectively enrolled and divided into training and validation cohorts at a 6:4 ratio. Recurrence was defined as cytology/pathology-proven disease or morphological evidence of lesions on imaging examinations within 5 years after surgery. Radiomics features were extracted from manually segmented tumor on CT images and were then selected using four different feature selection methods sequentially. Multivariate logistic regression analysis was conducted to identify clinical features associated with recurrence. Radiomics, clinical, and combined models were constructed separately using logistic regression (LR), support vector machine (SVM), k-nearest neighbor (KNN), and neural network (NN), respectively. Receiver operating characteristic analysis was performed to evaluate the model performance in predicting recurrence. A nomogram was established based on all relevant features, with its reliability and reproducibility verified using calibration curves and decision curve analysis (DCA). RESULTS Eighty-nine patients with PTC experienced recurrence. A total of 1218 radiomics features were extracted from each segmentation. Five radiomics and six clinical features were related to recurrence. Among the 4 radiomics models, the LR-based and SVM-based radiomics models outperformed the NN-based radiomics model (P = 0.032 and 0.026, respectively). Among the 4 clinical models, only the difference between the area under the curve (AUC) of the LR-based and NN-based clinical model was statistically significant (P = 0.035). The combined models had higher AUCs than the corresponding radiomics and clinical models based on the same classifier, although most differences were not statistically significant. In the validation cohort, the combined models based on the LR, SVM, KNN, and NN classifiers had AUCs of 0.746, 0.754, 0.669, and 0.711, respectively. However, the AUCs of these combined models had no significant differences (all P > 0.05). Calibration curves and DCA indicated that the nomogram have potential clinical utility. CONCLUSIONS The combined model may have potential for better prediction of PTC recurrence than radiomics and clinical models alone. Further testing with larger cohort may help reach statistical significance.
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Affiliation(s)
- Haijun Xu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wenli Wu
- Medical Imaging Center, Liaocheng Tumor Hospital, Liaocheng, 252000, China
| | - Yanfeng Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
| | - Zhou Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Dan Bao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lin Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Meng Lin
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ya Zhang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Xinming Zhao
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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Hei H, Luo Z, Zheng C, Gong W, Zhou B, Fang J, Qin J. Lymph node ratio independently associated with postoperative thyroglobulin levels in papillary thyroid cancer. Oral Oncol 2023; 146:106563. [PMID: 37690364 DOI: 10.1016/j.oraloncology.2023.106563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES To investigate the impact of the lymph node ratio (LNR) on postoperative thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). PATIENTS AND METHODS This was a retrospective, cohort study. The association between clinicopathological variables and postoperative unstimulated Tg (uTg) levels, preablative-stimulated Tg (sTg) levels, and postablative unstimulated Tg levels was analysed. RESULTS A total of 300 patients with PTC were identified. Multivariate logistic analysis showed that M classification (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.62-3.34), and postoperative thyroid-stimulating hormone levels (OR, 1.01; 95% CI, 1.01-1.02) were independently associated with postoperative uTg levels. One hundred and sixteen patients underwent radioactive iodine (RAI) therapy. Multivariate analysis showed that LNR in the central neck (OR, 1.24; 95% CI, 1.02-1.51), LNR in the lateral neck (OR, 1.73; 95% CI, 1.09-2.77), RAI dose (OR, 1.43; 95% CI, 1.21-1.69), and M classification (OR, 1.79; 95% CI, 1.22-2.61) were independently associated with preablative sTg levels. Tumour size (OR, 1.01; 95% CI, 1.00-1.01), LNR in the central neck (OR, 1.28; 95% CI, 1.08-1.51), LNR in the lateral neck (OR, 1.66; 95% CI, 1.10-2.49), RAI dose (OR, 1.54; 95% CI, 1.34-1.79), and M classification (OR, 1.56; 95% CI, 1.12-2.19) were also independently associated with postablative uTg levels. CONCLUSION LNR was independently associated with postoperative Tg levels in patients with PTC. Patients with high LNR were more likely to have incomplete biochemical responses after surgery.
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Affiliation(s)
- Hu Hei
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Ziyu Luo
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Chen Zheng
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Wenbo Gong
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Bin Zhou
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China
| | - Jugao Fang
- Department of Otolaryngology, Head and Neck Surgery, Thyroid Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jianwu Qin
- Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450008, China.
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Tri BDM, Chi BDP, Hiep BT, Trung NH, Minh TD, Dung NTN, Bui TD, Tran VQ, Nguyen HT. Relationship of Recurrence Rate with some Characteristics in Patients with Thyroid Carcinoma. Indian J Endocrinol Metab 2023; 27:544-551. [PMID: 38371183 PMCID: PMC10871007 DOI: 10.4103/ijem.ijem_134_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 06/25/2023] [Indexed: 02/20/2024] Open
Abstract
Background Determining the clinical and subclinical characteristics related to the recurrence status in patients with a thyroid carcinoma has great significance for prognosis, prediction of recurrence and monitoring of treatment outcomes. This study aimed to determine the association between recurrence rate and some characteristics in patients with thyroid carcinoma. Patients and Methods The study was conducted by descriptive method with longitudinal follow-up on 102 thyroid carcinoma patients at 103 Military Hospital, Hanoi, Vietnam, from July 2013 to December 2016. Results Univariate analysis showed that there was a relationship between the recurrence characteristics in the studied patients and the characteristics of lymph node metastasis (P = 0.026; OR = 15; 95% CI = 1.4-163.2) and BRAF V600E mutation status (P = 0.01; OR = 3.41; 95% CI = 1.31-8.88). When analysing the multivariable Logistic regression model, there was a positive correlation between the occurrence of BRAF V600E gene mutation (P = 0.032; OR = 17.649; 95% CI = 1.290-241.523) and male sex (P = 0.036; OR = 12.788; 95% CI = 1.185-137.961) and the occurrence of recurrence in study patients. The mean time to relapse was earlier in male patients than in female patients (P = 0.02). The mean time to relapse in patients with the BRAF V600E mutation (31.81 ± 1.14 months) was shorter than the mean time to relapse in the group without the mutation (57.82 ± 2.08 months) (P = 0.01). The group of patients with mutations in the BRAF V600E gene increased the risk of recurrence compared with the group without the mutation (HR = 9.14, P = 0.04). Conclusion There is a positive correlation between recurrence and masculinity, lymph node metastasis and the occurrence of BRAF V600E mutations in thyroid carcinoma patients.
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Affiliation(s)
- Bui D. M. Tri
- Centre for Health Professionals Training, Ho Chi Minh City, Vietnam
| | - Bui D. P. Chi
- Department of Diagnostic Imaging, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Bui T. Hiep
- Department of Pharmacology - Clinical Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Nguyen H. Trung
- Department of Military Hygiene, Vietnam Military Medical University, Hanoi, Vietnam
| | - Tong D. Minh
- Department of Military Hygiene, Vietnam Military Medical University, Hanoi, Vietnam
| | | | - Thanh D. Bui
- Military Medical Hospital 175, Ho Chi Minh City, Vietnam
| | - Viet Q. Tran
- Military Medical Hospital 175, Ho Chi Minh City, Vietnam
| | - Hiep T. Nguyen
- Department of Family Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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Iizuka Y, Katagiri T, Ogura K, Inoue M, Nakashima R, Nakamura K, Mizowaki T. Recurrence-free survival and prognosis after adjuvant therapy with radioactive iodine-131 in patients with differentiated thyroid carcinoma. Sci Rep 2023; 13:10795. [PMID: 37402838 DOI: 10.1038/s41598-023-37899-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023] Open
Abstract
This study aimed to assess recurrence-free survival (RFS) rates and recurrence-related factors of patients who received adjuvant therapy (AT) with radioactive iodine (RAI) for differentiated thyroid cancer (DTC) following thyroidectomy. We evaluated 284 patients who underwent AT between January 2011 and July 2020 at our hospital. Recurrence was defined as visible recurrent lesions on image analysis or need for repeat surgery with pathologically confirmed recurrent lesions. RFS rate and prognostic factors were statistically evaluated. The median observation period was 30.2 months (range, 5.7-294 months). Overall, 192 patients were female and 92 were male, and the median age was 54 years (range, 9-85 years). Initial assessment revealed 39 recurrence cases. The 3-year RFS rate was 85.8% (95% confidence interval: 81.1-90.9%). Univariate analysis revealed that histology (except for papillary carcinoma), Tg level > 4 ng/dL before AT, and AT result significantly exacerbated the RFS rate. In multivariate analysis, histology and AT result were also important contributors to the worsening RFS rate. Results of AT can be determined relatively early and are important in predicting future recurrence in patients with DTC. Increasing the success rate of AT may lead to an improved prognosis.
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Affiliation(s)
- Yusuke Iizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan.
- Department of Radiation Oncology, Shizuoka City Shizuoka Hospital, 10-93, Ote-machi, Aoi-ku, Shizuoka-shi, Shizuoka, 420-8630, Japan.
| | - Tomohiro Katagiri
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Kengo Ogura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Minoru Inoue
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Ryota Nakashima
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, 54, Shogoin Kawahara-cho, Sakyo-ku, Kyoto-shi, Kyoto, 606-8507, Japan
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Yang Z, Heng Y, Zhao Q, Hao D, Tao L, Deng X, Cai W, Qiu W. The proposed modification of TNM staging and therapeutic strategy for skip metastasis in papillary thyroid carcinoma: A multicenter retrospective cohort study. Cancer Med 2023. [PMID: 37140212 DOI: 10.1002/cam4.6018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/18/2023] [Accepted: 04/19/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Skip metastasis is a special type of lateral lymph node metastasis, which is not classified definitely by the eighth edition of the AJCC TNM staging system. The aim of the research was to study the prognosis of skip metastasis in PTC patients, and carry out a more appropriate N staging for skip metastasis. METHODS Study subjects were 3167 patients with papillary thyroid carcinoma (PTC), who underwent thyroidectomy at three clinical centers from 2016 to 2019. We identified two well-balanced cohorts matched on the basis of propensity score. RESULTS During a median follow-up of 42 months, recurrence occurred in 68 (4.3%) patients with lymph node metastasis. 34 cases recurred in 1120 patients with central lymph node metastasis (N1a), and 34 recurred in 461 patients with lateral lymph node metastasis (N1b), among which 73 patients were diagnosis with skip metastasis. The RFS of N1a was significantly lower than that of N1b (p < 0.001). After propensity-score matching, recurrence rate was significantly lower in the skip metastasis group than in the LLNM group (p = 0.039), whereas the rate was similar in the skip metastasis groups and the CLNM group (p = 0.29). CONCLUSIONS In conclusion, our study indicated that, among patients with LLNM, those with positive skip metastasis showed significantly lower recurrence, exhibiting a similar rucurrence tendency as patients with CLNM. Thus, skip metastasis could be categorized into N1a stage rather than N1b stage based on the AJCC TNM staging system. The downstaging of skip metastasis may reveal more conservative treatment strategy.
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Affiliation(s)
- Zheyu Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu Heng
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Qiwu Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ding Hao
- Department of General Surgery, Civil Aviation Shanghai Hospital, Shanghai, China
| | - Lei Tao
- Department of Otolaryngology, Eye Ear Nose & Throat Hospital, Fudan University, Shanghai, China
| | - Xiaxing Deng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of General Surgery, Civil Aviation Shanghai Hospital, Shanghai, China
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Guo P, Wang X, Xia L, Shawureding N, Hu Z. Analysis of factors associated with the prognosis of papillary thyroid cancer and the construction of a survival model. Cancer Med 2022; 12:7868-7876. [PMID: 36560883 PMCID: PMC10134317 DOI: 10.1002/cam4.5555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the survival prediction value of lymph node ratio (LNR) and preoperative thyroglobulin (Tg) in the prognosis of thyroid papillary carcinoma (PTC). METHODS A total of 495 patients with PTC and lymph node metastasis treated at the Cancer Hospital of Xinjiang Medical University were selected for a retrospective study. The disease-free survival (DFS) of patients was the follow-up endpoint. DFS was calculated for all patients. The Cox proportional risk regression model and nomogram were used to predict the survival prognosis of PTC with lymph node metastasis by index. LNR and preoperative Tg level cutoff values were obtained using ROC curves. To express DFS, Kaplan-Meier survival curves were created. Using 3- and 5-year calibration curves and AUC values, the prognostic models' precision and discrimination were assessed. Clinical decision curve analysis was used to forecast clinical benefitability. Finally, the results were validated using internal cross-validation. RESULTS The cutoff values of LNR and preoperative Tg level were 0.295 and 50.24, respectively, and they were divided into two groups according to the cutoff values. Multifactorial Cox regression models showed that NLNM, LNR, and preoperative Tg level (all p < 0.05) were independent risk factors affecting the prognosis of PTC with lymph node metastasis. Kaplan-Meier curves showed higher DFS rates in the group with low NLNM (<10), LNR (<0.295), and preoperative Tg level (<50.24) groups. The 3-year and 5-year calibration curves showed good agreement. A ROC curve analysis was performed on the nomogram model, and its AUC values at 3 and 5 years were, respectively, 0.805 and 0.793. Clinical decision curves indicate good clinical benefit. Finally, internal cross-validation demonstrated the legitimacy of the prognostic model. CONCLUSION The LNR and preoperative Tg levels, in combination with other independent factors, were effective in predicting the survival prognosis for patients with PTC.
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Affiliation(s)
- Peng Guo
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Xinhua Wang
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Luhua Xia
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Nadiremu Shawureding
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
| | - Zhiheng Hu
- Department of Nuclear Medicine, The Affiliated Cancer Hospital of Xinjiang Medical University, People's Republic of China
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Kang JG, Choi JE, Kang SH. Risk factors for level V metastasis in patients with N1b papillary thyroid cancer. World J Surg Oncol 2022; 20:327. [PMID: 36180912 PMCID: PMC9524026 DOI: 10.1186/s12957-022-02782-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and its incidence has increased. Lateral lymph node metastasis (LLNM) implies a worse prognosis than central lymph node metastasis, with a higher recurrence rate and decreased disease-free survival. The 2015 American Thyroid Association guidelines recommend compartmental node dissection in patients with LLNM to reduce the risk of recurrence and mortality. The purpose of this study was to identify the risk factors for level V lymph node (LN) metastasis in patients with N1b papillary thyroid cancer (PTC). METHODS A total of 110 consecutive patients who underwent total thyroidectomy with lateral neck dissection for PTC between April 2016 and April 2022 were retrospectively enrolled. Based on level V metastasis, 94 patients were divided into two groups, and their clinicopathological characteristics were compared. Univariable analysis were used to assess the factors associated with level V metastasis. Spearman correlation analysis were used to assess the correlation between tumors and LN. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value for the number of metastatic LNs at each level for level V metastasis. RESULTS The number of metastatic LNs and lymph node ratio (LNR) in level II were significantly associated with level V metastasis (P = 0.011 and 0.001, respectively). The number of metastatic LNs in level II and those in the total number of levels correlated with the number of metastatic LNs in level V (rho = 0.331, 0.325, and P = 0.001, 0.001, respectively). The cutoff value for the number of metastatic LNs in level II was defined as 2.5 (area under the curve = 0.757, sensitivity = 50%, specificity = 82.5%, 95% confidence interval [CI] 0.626-0.889, P = 0.002). Simultaneous 3-level metastasis (level II, III, and IV) and 3-level with ≥ 2.5 metastatic LNs in level II were significantly associated with level V metastasis (P = 0.003 and 0.002). CONCLUSIONS The number of metastatic LNs and LNR in level II, simultaneous 3-level metastasis (level II, III, and IV), and 3-level with ≥ 2.5 metastatic LNs in level II were significantly associated with level V metastasis. (P = 0.011, 0.001, 0.003, and 0.002, respectively). In the future, larger-scale multi-institutional studies were needed to find out predictors for level V metastasis.
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Affiliation(s)
- Jin Gu Kang
- Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchoong-ro, Namgu, Daegu, 42415, South Korea
| | - Jung Eun Choi
- Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchoong-ro, Namgu, Daegu, 42415, South Korea
| | - Su Hwan Kang
- Department of Surgery, Yeungnam University College of Medicine, 170 Hyunchoong-ro, Namgu, Daegu, 42415, South Korea.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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Kang IK, Kim K, Park J, Bae JS, Kim JS. Central Lymph Node Ratio Predicts Recurrence in Patients with N1b Papillary Thyroid Carcinoma. Cancers (Basel) 2022; 14:3677. [PMID: 35954338 PMCID: PMC9367408 DOI: 10.3390/cancers14153677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The lymph node ratio (LNR) is an emerging predictive marker for recurrence in papillary thyroid carcinoma (PTC). The purpose of this study was to investigate the association between LNR and disease-free survival (DFS) in patients with N1b PTC. Unlike that in the lateral or whole neck, LNR in the central compartment (CLNR) was found to have prognostic significance. The high-CLNR group (CLNR ≥ 0.7) had worse DFS and was 4.5 times more likely to experience recurrence in patients with N1b PTC. Abstract The lymph node ratio (LNR) indicates the number of metastatic lymph nodes (LNs) to the total number of LNs. The prognostic value of LNR in papillary thyroid carcinoma (PTC) and other solid tumors is known. This study aimed to investigate the relationship between LNR and disease-free survival (DFS) in patients with PTC with lateral LN metastases (N1b PTC). A total of 307 patients with N1b PTC who underwent total thyroidectomy and therapeutic central and lateral LN dissection were retrospectively analyzed. The DFS and recurrence risk in the patients with LNR, central-compartment LNR (CLNR), and lateral-compartment LNR (LLNR) were compared. The mean follow-up duration was 93.6 ± 19.9 months. Eleven (3.6%) patients experienced recurrence. Neither LNR nor LLNR affected the recurrence rate in our analysis (p = 0.058, p = 0.106, respectively). However, there was a significant difference in the recurrence rates between the patients with low and high CLNR (2.1% vs. 8.8%, p = 0.017). In the multivariate analysis, CLNR ≥ 0.7 and perineural invasion were independent predictors of tumor recurrence. High CLNR was associated with an increased risk of recurrence, and was shown to be a significant predictor of prognosis in patients with N1b PTC.
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11
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Dong W, Horiuchi K, Noguchi E, Okamoto T. Predictive value of metastatic lateral lymph node ratio for recurrence in pathologically lateral lymph node-positive papillary thyroid cancer patients with palpable lymph nodes. Head Neck 2022; 44:1623-1630. [PMID: 35452140 DOI: 10.1002/hed.27067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/21/2022] [Accepted: 04/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study aimed to identify the predictive value of the extent of metastatic lymph nodes in the central and lateral neck compartment for recurrence in papillary thyroid cancer (PTC) patients with pathologically lateral lymph node metastasis (pN1b). METHODS This study enrolled 252 patients with pN1b from PTC. RESULTS During a mean follow-up of 17.6 years, 55 (21.8%) patients experienced recurrence. Patients with palpable lymph nodes were more likely to have a recurrence than those with nonpalpable lymph nodes (30.1% vs. 17.8%, relative risk 1.7, 95%CI: 1.1-2.7). For patients with palpable metastatic lymph nodes, lymph node ratio of lateral lymph nodes ≥0.5 (aHR = 2.906, 95%CI: 1.29-6.54) and age ≥55 years (aHR = 2.508, 95%CI: 1.12-5.63) were independent prognostic factors. For those without palpable nodes, age ≥55 years (aHR = 2.224, 95%CI: 1.08-4.60) and tumor size >4 cm (aHR = 2.168, 95%CI: 1.01-4.66) were independently predictive of worse RFS. CONCLUSIONS Palpable lymph nodes were approximately twice as likely to recur as nonpalpable nodes. Metastatic lateral lymph node ratio predicts recurrence in pN1b PTC patients with palpable lymph nodes, but not those without ones.
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Affiliation(s)
- Wenwu Dong
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China.,Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kiyomi Horiuchi
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Eiichiro Noguchi
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo, Japan
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12
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Wang C, Wang Y, Fu Z, Huang W, Yu Z, Wang J, Zheng K, Zhang S, Li S, Chen J. MiR-29b-3p Inhibits Migration and Invasion of Papillary Thyroid Carcinoma by Downregulating COL1A1 and COL5A1. Front Oncol 2022; 12:837581. [PMID: 35530352 PMCID: PMC9075584 DOI: 10.3389/fonc.2022.837581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction MicroRNAs (miRNAs) are small noncoding RNA molecules that regulate genetic expression and are also vital for tumor initiation and development. MiR-29b-3p was found to be involved in regulating various biological processes of tumors, including tumor cell proliferation, metastasis, and apoptosis inhibition; however, the biofunction and molecule-level mechanisms of miR-29b-3p inpapillary thyroid carcinoma (PTC) remain unclear. Methods The expression of miR-29b-3p in PTC samples was tested via qRT-PCR. Cellular proliferation was analyzed by CCK-8 and EdU assays, and cellular migratory and invasive abilities were assessed utilizing wound-healing and Transwell assays. In addition, protein expressions of COL1A1, COL5A1, E-cadherin, N-cadherin, Snail, and Vimentin were identified via Western blot (WB) assay. Bioinformatics, qRT-PCR, WB, and dual luciferase reporter assays were completed to identify whether miR-29b-3p targeted COL1A1 and COL5A1. In addition, our team explored the treatment effects of miR-29b-3p on a murine heterograft model. Results Our findings revealed that miR-29b-3p proved much more regulated downward in PTC tissue specimens than in adjacent non-cancerous tissues. Meanwhile, decreased expression of miR-29b-3p was strongly related to the TNM stage of PTC patients (p<0.001), while overexpression of miR-29b-3p in PTC cells suppressed cellular migration, invasion, proliferation, and EMT. Conversely, silencing miR-29b-3p yielded the opposite effect. COL1A1 and COL5A1 were affirmed as the target of miR-29b-3p. Additionally, the COL1A1 and COL5A1 were highly expressed in PTC tumor samples than in contrast to neighboring healthy samples. Functional assays revealed that overexpression of COL1A1 or COL5A1 reversed the suppressive role of miR-29b-3p in migration, invasion, and EMT of PTC cells. Finally, miR-29b-3p agomir treatment dramatically inhibited Xenograft tumor growth in the animal model. Conclusions These findings document that miR-29b-3p inhibited PTC cells invasion and metastasis by targeting COL1A1 and COL5A1; this study also sparks new ideas for risk assessment and miRNA replacement therapy in PTC.
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Affiliation(s)
- Congjun Wang
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Ye Wang
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Zhao Fu
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Weijia Huang
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Zhu Yu
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Jiancheng Wang
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Kaitian Zheng
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Siwen Zhang
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
| | - Shen Li
- Department of Gastrointestinal, Hernia and Enterofistula Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Junqiang Chen
- Department of Gastrointestinal Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Clinical Research Lab, Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, Nanning, China
- *Correspondence: Junqiang Chen,
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14
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Fortune EC, Mercado CE, Drew PA, Morris CG, Amdur RJ. Adjuvant I-131 therapy for T0-3 N1b M0 differentiated thyroid cancer with many (≥ 5) positive nodes. Rep Pract Oncol Radiother 2022; 27:121-124. [PMID: 35402034 PMCID: PMC8989455 DOI: 10.5603/rpor.a2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background In patients with well-differentiated thyroid cancer, there is controversy about the prognostic importance of a large number of positive neck nodes and the potential value of radioiodine therapy. The purpose of this study was to evaluate this issue in the group of patients for whom it is most clinically important - those with classic histology and favorable T and M stage. Materials and methods Twenty-five patients met the following inclusion criteria: classic histology of papillary or follicular thyroid carcinoma treated with total thyroidectomy and neck dissection followed by adjuvant I-131 treatment in our department between January 1, 2003, and December 31, 2013; adult age of > 21 years; and American Joint Committee on Cancer (AJCC ) stage (8th edition) of T0-3, N1b with ≥ 5 positive nodes, and M0. Results The median positive node number was 10 (range, 5-31). The median adjuvant I-131 dose was 158 mCi (range, 150-219 mCi). The median follow-up in patients without recurrence after treatment was 7.3 years. The 10-year actuarial rates were favorable: overall survival, 100%; freedom from visible recurrence, 82%; and visible or biochemical recurrence, 72%. Conclusion Recurrence was infrequent in our study population with ≥ 5 positive nodes following moderate-dose adjuvant I-131 treatment. These results are valuable in directing initial adjuvant therapy and follow-up intensity. Our results do not inform the question of the use of postoperative thyroglobulin (Tg) level to select N1b patients for low-dose I-131 treatment.
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Affiliation(s)
- E Charles Fortune
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Catherine E Mercado
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Peter A Drew
- Department of Pathology, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, United States
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15
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Li P, Chen J, Zou J, Zhu W, Zang Y, Li H. Circular RNA coiled-coil domain containing 66 regulates malignant development of papillary thyroid carcinoma by upregulating La ribonucleoprotein 1 via the sponge effect on miR-129-5p. Bioengineered 2022; 13:7181-7196. [PMID: 35264065 PMCID: PMC8973727 DOI: 10.1080/21655979.2022.2036304] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Circular RNAs (circRNAs) play vital roles in the development and progression of various diseases. CircRNA coiled-coil domain containing 66 (circ-CCDC66) has been reported to be involved in several cancers, but its biological function and underlying mechanism in papillary thyroid carcinoma (PTC) remain unclear. We detected the relative expression level of circ-CCDC66 in PTC specimens and cell lines using real-time reverse transcription PCR. In addition, EdU assay, transwell assay, and xenograft analysis were performed to measure the effect of circ-CCDC66 on the proliferative, migratory, and invasive capacities of PTC cells. We also investigated the potential mechanism of circ-CCDC66 by bioinformatics analysis, RNA immunoprecipitation, and dual-luciferase reporter assay. We observed that circ-CCDC66 expression was upregulated in PTC specimens and cell lines and was correlated with poor clinical characteristics of PTC patients. Moreover, in vitro experiments demonstrated that knockdown of circ-CCDC66 markedly suppressed the proliferative, migratory, and invasive capacities of PTC cells. Mechanistically, miR-129-5p was a target gene of circ-CCDC66 and was downregulated in PTC tissues. LARP1, a downstream target of miR-129-5p, was upregulated in PTC tissues. In addition, we confirmed that inhibition of circ-CCDC66 could repress xenograft tumor growth. Circ-CCDC66 promoted PTC proliferation, migration, invasion, and tumor growth by sponging miR-129-5p and promoting LARP1 expression.
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Affiliation(s)
- Peipei Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Neurosurgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA(Wuxi Taihu Hospital), Wuxi, China
| | - Junhui Chen
- Department of Neurosurgery, Wuxi Clinical Medical School of Anhui Medical University, 904th Hospital of PLA(Wuxi Taihu Hospital), Wuxi, China
| | - Jun Zou
- Department of Otolaryngology, Wuxi No. 5 People's Hospital, Wuxi, China
| | - Wei Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yan Zang
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongwu Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
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16
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Ryu YJ, Kwon SY, Lim SY, Na YM, Park MH. Predictive Factors for Skip Lymph Node Metastasis and Their Implication on Recurrence in Papillary Thyroid Carcinoma. Biomedicines 2022; 10:biomedicines10010179. [PMID: 35052858 PMCID: PMC8773669 DOI: 10.3390/biomedicines10010179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Skip lymph node (LN) metastases in papillary thyroid carcinoma (PTC) belong to N1b classification in the absence of central neck LN involvement. This study aimed to evaluate the predictive factors of skip metastases and their impact on recurrence in PTC patients with pN1b. A total of 334 PTC patients who underwent total thyroidectomy with LN dissection (central and lateral neck compartment) followed by radioactive iodine ablation were included. Patients with skip metastases tended to have a small primary tumor (≤1 cm) and single lateral neck level involvement. Tumor size ≤ 1 cm was an important predictive factor for skip metastases. Univariate analysis for recurrence showed that patients with a central LN ratio > 0.68, lateral LN ratio > 0.21, and stimulated thyroglobulin (Tg) levels > 7.3 ng/mL had shorter RFS (recurrence-free survival). The stimulated Tg level was associated with shorter RFS on multivariate analysis (>7.3 vs. ≤7.3 ng/mL; hazard ratio, 4.226; 95% confidence interval, 2.226−8.022; p < 0.001). Although patients with skip metastases tended to have a small primary tumor and lower burden of lateral neck LN involvement, there was no association between skip metastases and RFS in PTC with pN1b. Stimulated Tg level was a strong predictor of recurrence.
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Affiliation(s)
- Young-Jae Ryu
- Department of Surgery, Chonnam National University Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Gwangju 58128, Korea; (Y.-J.R.); (S.-Y.L.); (Y.-M.N.); (M.-H.P.)
| | - Seong-Young Kwon
- Department of Nuclear Medicine, Chonnam National University Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Gwangju 58128, Korea
- Correspondence: ; Tel.: +82-61-379-7273
| | - Soo-Young Lim
- Department of Surgery, Chonnam National University Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Gwangju 58128, Korea; (Y.-J.R.); (S.-Y.L.); (Y.-M.N.); (M.-H.P.)
| | - Yong-Min Na
- Department of Surgery, Chonnam National University Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Gwangju 58128, Korea; (Y.-J.R.); (S.-Y.L.); (Y.-M.N.); (M.-H.P.)
| | - Min-Ho Park
- Department of Surgery, Chonnam National University Medical School, 322 Seoyang-ro Hwasun-eup, Hwasun-gun, Gwangju 58128, Korea; (Y.-J.R.); (S.-Y.L.); (Y.-M.N.); (M.-H.P.)
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17
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Eun NL, Kim JA, Gweon HM, Youk JH, Son EJ. Preoperative Nodal US Features for Predicting Recurrence in N1b Papillary Thyroid Carcinoma. Cancers (Basel) 2021; 14:cancers14010174. [PMID: 35008339 PMCID: PMC8750311 DOI: 10.3390/cancers14010174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/13/2021] [Accepted: 12/24/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary The presence of lateral neck lymph node (LN) metastasis (N1b) is a known prognostic factor for poor prognosis and high morbidity after surgery in papillary thyroid carcinoma (PTC). Previous studies have suggested that tumor size and metastatic LN characteristics, including LN size, number, ratio, and extranodal extension, are associated with recurrence; however, the prognostic role of imaging features of LNs in the lateral neck have rarely been reported. In this study, we investigated whether ultrasound imaging features of lateral neck LN metastases can be prognostic markers for predicting recurrence and thereby guide surgical extent and posttreatment surveillance in N1b PTC. Abstract This study aimed to investigate whether preoperative ultrasonographic (US) features of metastatic lymph nodes (LNs) are associated with tumor recurrence in patients with N1b papillary thyroid carcinoma (PTC). We enrolled 692 patients (mean age, 41.9 years; range, 6–80 years) who underwent total thyroidectomy and lateral compartment LN dissection between January 2009 and December 2015 and were followed-up for 12 months or longer. Clinicopathologic findings and US features of the index tumor and metastatic LNs in the lateral neck were reviewed. A Kaplan-Meier analysis and Cox proportion hazard model were used to analyze the recurrence-free survival rates and features associated with postoperative recurrence. Thirty-seven (5.3%) patients had developed recurrence at a median follow-up of 66.5 months. On multivariate Cox proportional hazard analysis, male sex (hazard ratio [HR], 2.277; 95% confidence interval [CI]: 1.131, 4.586; p = 0.021), age ≥55 years (HR, 3.216; 95% CI: 1.529, 6.766; p = 0.002), LN size (HR, 1.054; 95% CI: 1.024, 1.085; p < 0.001), and hyperechogenicity of LN (HR, 8.223; 95% CI: 1.689, 40.046; p = 0.009) on US were independently associated with recurrence. Preoperative US features of LNs, including size and hyperechogenicity, may be valuable for predicting recurrence in patients with N1b PTC.
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Affiliation(s)
| | | | | | | | - Eun Ju Son
- Correspondence: ; Tel.: +82-2-2019-3510; Fax: +82-2-3462-5472
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18
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Xu J, Liao M. Long noncoding RNA SNHG6 promotes papillary thyroid cancer cells proliferation via regulating miR-186/CDK6 axis. Gland Surg 2021; 10:2935-2944. [PMID: 34804881 DOI: 10.21037/gs-21-586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/16/2021] [Indexed: 11/06/2022]
Abstract
Background Papillary thyroid cancer (PTC) is a common endocrine malignancy, and its incidence rate has been increasing in recent years. Long noncoding RNAs (lncRNAs) participate in cell biological processes through a variety of regulatory ways, and play an essential role in tumor development. Methods This study explored the expression of lncRNA small nucleolar RNA host gene 6 (SNHG6) in PTC by bioinformatics analysis, and quantitative real-time PCR (qRT-PCR). Cell counting kit-8 (CCK-8) assay, colony formation assay, and 5-ethynyl-2'-deoxyuridine (EdU) assay were used to study the effect of SNHG6 on the proliferation of PTC cells. Luciferase reporter gene assay and western blot were used to study the mechanism. Results SNHG6 was highly expressed in PTC tissue samples and cell lines. In vitro, overexpression of SNHG6 promoted the proliferation of PTC cells, while silencing SNHG6 inhibited the proliferation of PTC cells. miR-186 is the downstream target of SNHG6. SNHG6 regulates the proliferation of PTC cells through miR-186. In addition, CDK6 is the target gene of miR-186, which can inhibit the expression of CDK6 protein. SNHG6 can promote the expression of CDK6 by regulating miR-186. Conclusions SNHG6 is highly expressed in PTC and can promote the proliferation of PTC cells by regulating the miR-186/CDK6 axis, which is expected to become a potential therapeutic target for PTC.
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Affiliation(s)
- Jian Xu
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Miaomiao Liao
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
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19
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Xu Y, Wang Y, Zhang X, Huang R, Tian R, Liu B. Prognostic value of lymph node ratio in children and adolescents with papillary thyroid cancer. Clin Endocrinol (Oxf) 2021; 95:649-656. [PMID: 33914928 DOI: 10.1111/cen.14491] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/20/2021] [Accepted: 04/25/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Neck lymph node (LN) metastasis is a common feature of paediatric papillary thyroid cancer, and LN ratio (LNR) is defined as the ratio of the number of positive LNs excised to the total number of removed. Unlike in adults, few data are available regarding the clinical implication of LNR in the paediatric population. Our purpose was to investigate the association of LNR with clinical outcomes in paediatric papillary thyroid cancer. DESIGN & METHODS The study retrospectively reviewed 136 consecutive children and adolescents with papillary thyroid cancer and LN involvement but no initial distant metastasis. Initial treatment, included in all patients a total thyroidectomy with central and/or lateral neck dissection followed by radioactive iodine ablation. Within the neck dissections, total number of LNs removed, total positive LNs and LN ratios were determined. The effect of clinicopathologic characteristics and intraoperative findings on persistent and recurrent diseases were analysed by univariate and multivariate analyses. RESULTS Median number of positive LNs was 9, and median LNR was 0.4. During a median follow-up of 49 months (range, 12.0-139 months), persistent disease occurred in 43 (31.6%) patients. The multivariable analysis showed that age and LNR were the independent factors predictive of persistent disease. Patients with a LNR >0.34 exhibited a threefold higher risk of persistent disease after initial therapy than the counterparts (P = .02). CONCLUSION Our findings suggest that LNR was an independent determinant predictive of persistent disease after initial therapy in children and adolescents with papillary thyroid cancer.
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Affiliation(s)
- Yangmengyuan Xu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xinyue Zhang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Huang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
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Zhou C, Duan D, Liu S. Predictive Value of a Prognostic Model Based on Lymphocyte-to-Monocyte Ratio Before Radioiodine Therapy for Recurrence of Papillary Thyroid Carcinoma. Technol Cancer Res Treat 2021; 20:15330338211027910. [PMID: 34191658 PMCID: PMC8252333 DOI: 10.1177/15330338211027910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the predictive value of a prognostic model based on the lymphocyte-to-monocyte ratio (LMR) before radioiodine treatment for the recurrence of papillary thyroid carcinoma (PTC). METHODS Clinicopathological data of 441 patients with papillary thyroid cancer were collected retrospectively. The Receiver operating characteristic (ROC) was used to determine the optimal cut-off value for predicting PTC recurrence by LMR before radioiodine treatment. Recurrence was the endpoint of the study, and survival was estimated by the Kaplan-Meier method, and any differences in survival were evaluated with a stratified log-rank test. Univariate and multifactorial analyses were performed using Cox proportional-hazards models to identify risk factors associated with PTC recurrence. RESULTS The ROC curve showed that the best cut-off value of LMR before radioiodine treatment to predict recurrence in patients with PTC was 6.61, with a sensitivity of 54.1%, a specificity of 73%, and an area under the curve of 0.628. The recurrence rate was significantly higher in the low LMR group (16%) than in the high LMR group (5%) (P = 0.001, χ2 = 12.005). Multifactorial analysis showed that LMR < 6.61 (P = 0.006; HR = 2.508) and risk stratification (high risk) (P = 0.000; HR = 5.076) before radioiodine treatment were independent risk factors predicting recurrence in patients with PTC. Patients with preoperative LMR < 6.61 and high risk stratification had the lowest recurrence-free survival rate and the shortest recurrence-free survival time. CONCLUSIONS The LMR-based prognostic model before radioactive iodine treatment is valuable for early prediction of PTC recurrence and it can be used in clinical practice as a supplement to risk stratification and applied in combination to help screen out patients with poorer prognosis early.
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Affiliation(s)
- Chunyan Zhou
- Department of Nuclear Medicine, Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Dong Duan
- Department of Nuclear Medicine, Chongqing General Hospital (Chongqing Hospital, University of Chinese Academy of Sciences), Liangjiang New Area, Chongqing, China
| | - Shuang Liu
- Department of Nuclear Medicine, Chongqing Medical University, Yuzhong District, Chongqing, China
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Wan D, Yang X, Li G, Du Y, Cao J, Gao Y, Shu Z, Zhou Y, Wei X, Guo R, Zhang R, Zhang G. A Set of Markers Related to Viral Infection Has a Sex-sensitive Prognostic Value in Papillary Thyroid Carcinoma. J Clin Endocrinol Metab 2021; 106:e2334-e2346. [PMID: 33395461 DOI: 10.1210/clinem/dgaa990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Although the incidence of papillary thyroid carcinoma (PTC) is significantly higher in females than in males, the prognosis of male PTC is more unfavorable. However, the cause of higher malignancy of PTC in male patients remains unclear. OBJECTIVE We conducted our analysis on microarrays datasets, tissue samples from PTC patients and the RNAseq datasets from TCGA with survival data. METHODS We searched all publicly available microarray datasets and performed a genome-wide meta-analysis comparing PTC and normal samples. Gene Ontology analysis was then conducted. The candidate genes were tested by quantitative real-time polymerase chain reaction. The analysis of prognostic value of genes was performed with datasets from The Cancer Genome Atlas. RESULTS After meta-analyses, 150 significantly differentially expressed genes (DEGs) were specifically found in male subjects. Gene Ontology analysis of these 150 genes revealed that the viral process was activated. Seven genes involved in the viral process in male patients showed a significantly differential expression between PTC and normal tissue. Survival analysis exhibited that the 7 genes, used in combination, were prognostically valuable and, of them, PSMB1 possessed a conspicuous prognostic value, especially in males. CONCLUSION In this study, we searched all publicly available microarray datasets and conducted a comprehensive analysis to understand the male propensity for higher malignancy. We found that markers of viral infection showed significantly differential expression only in male patients compared with their female counterparts and had a sex-sensitive prognostic value in PTC.
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Affiliation(s)
- Dongyi Wan
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Yang
- Department of Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ganxun Li
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yaying Du
- Division of Breast and Thyroid Surgery, Department of General Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Cao
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuan Gao
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiping Shu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Zhou
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiao Wei
- Department of Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rong Guo
- Department of Medical Imaging, China Three Gorges University, Yichang, Hubei, China
| | - Runhua Zhang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guopeng Zhang
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Xing Z, Qiu Y, Li Z, Zhang L, Fei Y, Zhu J, Su A. Predictors of thyroglobulin in the lymph nodes recurrence of papillary thyroid carcinoma undergoing total thyroidectomy. BMC Surg 2021; 21:53. [PMID: 33482804 PMCID: PMC7821408 DOI: 10.1186/s12893-021-01063-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/14/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To investigate the association between postoperative lymph nodes (LNs) recurrence and distinct serum thyroglobulin (Tg) levels in patients with papillary thyroid carcinoma (PTC). METHODS This study included PTC patients who underwent total thyroidectomy (TT) with at least central neck dissection and then re-operated due to recurrence of LNs between January 2013 and June 2018. These patients were grouped by negative or positive serum Tg levels according to the American Thyroid Association guidelines. RESULTS Of the 60 included patients, 49 underwent radioactive iodine (RAI) treatment. Maximum unstimulated Tg (uTg) ≥ 0.2 ng/mL were associated with larger diameter of recurrent LNs (P = 0.027), and higher rate of metastatic LNs (P < 0.001). Serum-stimulated Tg (off-Tg) ≥ 1 ng/mL (P = 0.047) and unstimulated Tg (on-Tg) ≥ 0.2 ng/Ml (P = 0.013) were associated with larger diameter of recurrent LNs. Number of metastatic LNs ≥ 8 was an independent predictor for postoperative maximum uTg ≥ 0.2 ng/mL (OR = 8.767; 95% CI = 1.392-55.216; P = 0.021). Ratio of metastatic LNs ≥ 25% was an independent predictor for off-Tg ≥ 1 ng/mL (OR = 20.997; 95% CI = 1.649-267.384; P = 0.019). CONCLUSION Postoperative Tg-positive status was associated with larger size of recurrent LNs. Number of metastatic LNs ≥ 8 and ratio of metastatic LNs ≥ 25% were independent predicators for uTg-positive and off-Tg-positive status, respectively.
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Affiliation(s)
- Zhichao Xing
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan, People's Republic of China
| | - Yuxuan Qiu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan, People's Republic of China.,Department of Ultrasound, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, China
| | - Zhe Li
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan, People's Republic of China
| | - Lingyun Zhang
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan, People's Republic of China
| | - Yuan Fei
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan, People's Republic of China
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan, People's Republic of China
| | - Anping Su
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, NO. 37 Guo Xue Xiang, Chengdu, Sichuan, People's Republic of China.
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Heng Y, Feng S, Yang Z, Cai W, Qiu W, Tao L. Features of Lymph Node Metastasis and Structural Recurrence in Papillary Thyroid Carcinoma Located in the Upper Portion of the Thyroid: A Retrospective Cohort Study. Front Endocrinol (Lausanne) 2021; 12:793997. [PMID: 35145480 PMCID: PMC8823057 DOI: 10.3389/fendo.2021.793997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aims to reveal the features of lymph node metastasis (LNM) and recurrence in papillary thyroid carcinoma (PTC) tumors located in the upper portion of the thyroid. METHODS A total of 1075 PTC patients were retrospectively reviewed, including 314 patients with a tumor in the upper portion of the thyroid. Another 103 PTC patients with upper portion diagonsis from three clinical centers were included for external validation. RESULTS The results showed no difference between the patients with a tumor in the upper portion of the thyroid and those with a tumor in the non-upper portion in terms of overall LNM rates. However, patients with a tumor in the upper portion were significantly more prone to LLNM and exhibited a significantly worse recurrence outcome than those with a tumor in other subregions. Multivariate analysis showed that four factors-age no more than 40, maximum tumor diameter no less than1.0 cm, the presence of thyroid capsular invasion, and tumor with ipsilateral nodular goiter-were independent risk factors for LLNM of the tumor in the upper thyroid. A predictive risk-scoring model was established based on these factors. CONCLUSIONS Patients with PTC located in the upper portion may have an exclusive lymphatic drainage pathway to the lateral neck region and are more prone to suffer from LLNM and tumor recurrence than those with a tumor located in other subregions. A new postoperative strategy selection flow chart was established based on our newly created risk-scoring model that can effectively predict the individualized possibility of LLNM for PTC patients with a tumor in the upper portion.
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Affiliation(s)
- Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Siqi Feng
- Department of General Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Zheyu Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Lei Tao, ; Wei Cai, ; Weihua Qiu,
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- *Correspondence: Lei Tao, ; Wei Cai, ; Weihua Qiu,
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- *Correspondence: Lei Tao, ; Wei Cai, ; Weihua Qiu,
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Yang Z, Heng Y, Zhao Q, Cao Z, Tao L, Qiu W, Cai W. A Specific Predicting Model for Screening Skip Metastasis From Patients With Negative Central Lymph Nodes Metastasis in Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:743900. [PMID: 34659126 PMCID: PMC8515125 DOI: 10.3389/fendo.2021.743900] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 12/19/2022] Open
Abstract
Skip metastasis is a specific type of papillary thyroid cancer lymph node metastasis (LNM). The present study aimed to clarify the typical clinical characteristics of skip metastasis and optimize the prediction model, so as to provide a more individual treatment mode for skip metastasis. We retrospectively analyzed 1075 PTC patients with different lymph node metastasis statuses from two clinical centers. Comparisons have been made between patients with skip metastasis and other types of LNM. Univariate and multivariate analyses were performed to detect the risk factors for skip metastasis with negative LNM, and a nomogram for predicting skip metastasis was established. The rate of skip metastasis was 3.4% (37/1075). Compared with other types of LNM, significant differences showed in tumor size, upper portion location, thyroid capsular invasion, and ipsilateral nodular goiter with the central lymph node metastasis (CLNM) group, and in age and gender with the lateral lymph node metastasis (LLNM) group. Four variables were found to be significantly associated with skip metastasis and were used to construct the model: thyroid capsular invasion, multifocality, tumor size > 1 cm, and upper portion. The nomogram had good discrimination with a concordance index of 0.886 (95% confidence interval [CI], 0.823 to 0.948). In conclusion, the significant differences between skip metastasis and other types of LNM indicated that the lymph node drainage pathway of skip metastasis is different from either CLNM or LLNM. Furthermore, we established a nomogram for predicting risk of skip metastasis, which was able to effectively predict the potential risk of skip metastasis in patients without preoperative LNM clue.
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Affiliation(s)
- Zheyu Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Qiwu Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zichao Cao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
| | - Weihua Qiu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
| | - Wei Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Cai, ; Weihua Qiu, ; Lei Tao,
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Siraj AK, Parvathareddy SK, Qadri Z, Siddiqui K, Al-Sobhi SS, Al-Dayel F, Al-Kuraya KS. Annual Hazard Rate of Recurrence in Middle Eastern Papillary Thyroid Cancer over a Long-Term Follow-Up. Cancers (Basel) 2020; 12:cancers12123624. [PMID: 33287340 PMCID: PMC7761718 DOI: 10.3390/cancers12123624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 01/02/2023] Open
Abstract
Predicting the pattern of recurrence in papillary thyroid cancer (PTC) is necessary to establish optimal surveillance and treatment strategies. We analyzed changes in hazard rate (HR) for tumor recurrence over time in 1201 unselected Middle Eastern PTC patients. The changes in risk were further analyzed according to clinical variables predictive of early (≤5 years) and late (>5 years) recurrence using Cox regression analysis to identify patient populations that remain at risk. Tumor recurrence was noted in 18.4% (221/1201) patients. The annualized hazard of PTC recurrence was highest during the first 5 years (2.8%), peaking between 1 and 2 years (3.7%), with a second smaller peak between 13 and 14 years (3.2%). Patients receiving radioactive iodine (RAI) therapy had lower recurrence hazard compared to those who did not (1.5% vs. 2.7%, p = 0.0001). Importantly, this difference was significant even in intermediate-risk PTC patients (0.7% vs. 2.3%; p = 0.0001). Interestingly, patients aged ≥55 years and having lymph node metastasis were at persistent risk for late recurrence. In conclusion, we confirmed the validity of the double-peaked time-varying pattern for recurrence risk in Middle Eastern PTC patients and our findings could help in formulating individualized treatment and surveillance plans.
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Affiliation(s)
- Abdul K. Siraj
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
| | - Sandeep Kumar Parvathareddy
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
| | - Zeeshan Qadri
- Human Cancer Genomic Research, Research Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
| | - Khawar Siddiqui
- Department of Pediatric Hematology-Oncology, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia;
| | - Saif S. Al-Sobhi
- Department of Surgery, King Faisal Specialist Hospital and Research Center, 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 Center, King Faisal Specialist Hospital and Research Center, P.O. Box 3354, Riyadh 11211, Saudi Arabia; (A.K.S.); (S.K.P.); (Z.Q.)
- Correspondence: ; Tel.: +966-1-205-5167
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Chen W, Li Z, Zhu J, Lei J, Wei T. Unilateral papillary thyroid carcinoma treated with contralateral central lymph node dissection: A nomogram to aid in decision-making. Medicine (Baltimore) 2020; 99:e22200. [PMID: 32957351 PMCID: PMC7505319 DOI: 10.1097/md.0000000000022200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The central lymph nodes of the neck are the most common sites of papillary thyroid carcinoma (PTC) but cannot be easily diagnosed preoperatively. Prophylactic central lymph node dissection (CLND), especially contralateral CLND, is not recommended in various guidelines due to its high risk. The aim of our study was to establish an objective point score based on preoperative and intraoperative data to guide the selection of patients for contralateral CLND.We retrospectively evaluated 1085 consecutive patients with PTC treated by thyroidectomy for inclusion in this study (the training cohort). Variables of contralateral central lymph node macro-metastasis (CLNMM) were investigated using univariate and multivariate analyses; subsequently, nomograms were developed and then validated in an independent cohort of patients (n = 326, the validation cohort).Univariate and multivariate analyses indicated that preoperative fine needle aspiration-proven ipsilateral lateral lymph node metastasis (LNM) (odds ratio [OR] 4.888, 95% confidence interval [CI] 1.587-41.280, P < .001) and cases with frozen-section pretracheal LNM (OR 19.015, 95% CI 2.949-186.040, P < .001) or Delphian LNM (OR 4.494, 95% CI 1.503-54.128, P < .001) were the 3 risk factors for contralateral CLNMM. A receiver operating characteristic curve indicated a cutoff value of 1 for the frozen-section pretracheal LNM number or the Delphian LNM number as a predictor of contralateral central lymph node metastasis (CLNM). The nomogram was then generated according to the 3 risk factors and well validated in the external cohorts, and the intraoperative frozen-section results were highly consistent with the postoperative pathological results.The proposed nomogram based on the 3 factors showed a good prediction of contralateral CLNMM in PTC.
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Jin M, Ahn J, Lee YM, Sung TY, Kim WG, Kim TY, Ryu JS, Kim WB, Shong YK, Jeon MJ. Clinical Outcomes of N1b Papillary Thyroid Cancer Patients Treated with Two Different Doses of Radioiodine Ablation Therapy. Endocrinol Metab (Seoul) 2020; 35:602-609. [PMID: 32981302 PMCID: PMC7520585 DOI: 10.3803/enm.2020.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/06/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The optimal dose of radioactive iodine (RAI) therapy for N1b papillary thyroid carcinoma (PTC) is controversial. We evaluated the clinical outcome of N1b PTC patients treated with either 100 or 150 mCi of RAI. METHODS We retrospectively analyzed N1b PTC patients who underwent total thyroidectomy and postoperative RAI therapy at a tertiary referral center between 2012 and 2017. As the baseline characteristics differed between treatment groups, we performed exact matching for various pathological factors according to RAI dose. We evaluated the response to therapy and recurrence-free survival (RFS) in the matched patients. Structural recurrent/persistent disease was defined as new structural disease detected after initial therapy, which was confirmed by cytology or pathology. RESULTS Of the total 436 patients, 37 (8.5%) received 100 mCi of RAI and 399 (91.5%) received 150 mCi of RAI. After an exact 1:3 matching, 34 patients in the 100 mCi group and 100 patients in the 150 mCi group remained. There was no significant difference in response to therapy between the groups in the matched population (P=0.63). An excellent response was achieved in 70.6% (n=24) of patients in the 100 mCi group and 76.0% (n=76) in the 150 mCi group. Two (5.9%) patients in the 100 mCi group and four (4.0%) in the 150 mCi group had recurrence and there was no significant difference in RFS between the groups in the matched population (P=0.351). CONCLUSION There were no differences in response to therapy and RFS in N1b PTC patients according to RAI dose.
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Affiliation(s)
- Meihua Jin
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jonghwa Ahn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Mi Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yon Sung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Gu Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Kee Shong
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Ji Jeon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
The present study aimed to investigate the correlation between ultrasonographic features, basic fibroblast growth factor (bFGF), and the local invasiveness of papillary thyroid carcinoma (PTC).A total of 350 samples of thyroid nodules were collected. Routine ultrasonography was performed before the operation and routine pathological diagnosis and bFGF detection were performed after the operation.'These 350 samples of thyroid nodules included 90 samples of nodular goiter, 36 samples of focal thyroiditis, and 224 samples of PTC. A total of 326 thyroid nodules were examined for bFGF. The results revealed that the difference in the expression of bFGF between the benign and malignant groups was statistically significant (P < .05) and the difference in the positive expression of bFGF between the invasive and non-invasive PTC groups was statistically significant (P < .05).Whether the shape of PTC is regular or not and whether there is micro-calcification in PTC and other ultrasonographic features, the size and location of the lesions and the age of the patient help make a preliminary prediction of local invasiveness before the operation. Postoperative detection of bFGF is helpful for further risk assessments of PTC.
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Affiliation(s)
| | | | | | - Bin-Lin Ma
- Department of Breast and Head-neck Surgery, the Affiliated Tumor Hospital of Xinjiang Medical University, Urumqi, China
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Chen W, Wei T, Li Z, Gong R, Lei J, Zhu J, Huang T. Association of the Preoperative Inflammation-Based Scores with TNM Stage and Recurrence in Patients with Papillary Thyroid Carcinoma: A Retrospective, Multicenter Analysis. Cancer Manag Res 2020; 12:1809-1818. [PMID: 32210623 PMCID: PMC7073431 DOI: 10.2147/cmar.s239296] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/25/2020] [Indexed: 02/05/2023] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and prognostic nutritional index (PNI) have been reported to be prognostic biomarkers in various cancers. Our study evaluated whether the preoperative NLR, PLR and PNI predicted tumor-node-metastasis (TNM) stage and recurrence in papillary thyroid carcinoma (PTC) patients. Methods A total of 1873 patients with PTC from 9 centers in mainland China were retrospectively assessed. Receiver operating characteristic (ROC) curves were generated, and Kaplan-Meier analyses were performed to evaluate the prognostic value of inflammation-based scores. Univariate and multivariate analyses were conducted to identify risk factors for recurrence. Results A decreased PNI and an increased PLR were predictive of TNM stage (p=0.005 and p=0.030, respectively), while a decreased NLR was predictive of recurrence (p=0.040). Univariate and multivariate analyses indicated that N1 status (odds ratio (OR), 1.898; 95% confidence interval (CI), 1.253–2.874; p=0.002), NLR≤1.6 (OR, 1.596; 95% CI, 1.207–2.111; p=0.001) and PNI≤53.1 (OR, 1.511; 95% CI, 1.136–2.009; p=0.005) were independent factors that predicted recurrence. Conclusion The NLR, PLR and PNI have predictive value for TNM stage and recurrence in patients with PTC, but their predictive efficiency is limited. Caution should be used when considering clinical applications of inflammation-based scores.
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Affiliation(s)
- Wenjie Chen
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Tao Wei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Rixiang Gong
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Jingqiang Zhu
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, People's Republic of China
| | - Tao Huang
- Department of Breast and Thyroid Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
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Huang Z, Song M, Wang S, Huang J, Shi H, Huang Y, Yin Y, Liu Y, Wu Z. Preoperative serum thyroglobulin is a risk factor of skip metastasis in papillary thyroid carcinoma. Ann Transl Med 2020; 8:389. [PMID: 32355833 PMCID: PMC7186689 DOI: 10.21037/atm.2019.10.92] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lymph node metastasis of papillary thyroid carcinoma (PTC) was a significant risk factor of local recurrence and distant metastasis, and our study aimed to identify predictive factors of skip metastasis in PTC, helping surgeons to build a strategy when facing patients in N1b stage with clinical central lymph node-negative. METHODS A total of 304 patients who underwent total thyroidectomy with central and lateral lymph node dissection and were diagnosed PTC with lateral lymph node metastasis (LLNM) in the Department of General Surgery at Guangdong Provincial People's Hospital were enrolled. We collected clinicopathological characteristics and analyzed their correlation with skip metastasis by univariate and multivariate analysis. RESULTS The incidence of skip metastasis in PTC was 14.8%. Univariate analysis showed that age, tumor diameter, primary tumor location, and preoperative serum thyroglobulin (Tg) were risk factors. Age (P=0.049, OR =3.418), primary tumor location (P<0.001, OR =7.279), and Tg (P=0.038, OR =9.412) were independent predictors in PTC by multivariate analysis. CONCLUSIONS Skip metastasis of PTC was significantly associated with preoperative serum Tg ≤77 ng/mL, tumor diameter ≤10 mm, age ≥55, and tumor located in the upper lobe. It is the first time to demonstrate that Tg is associated with skip metastasis of PTC.
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Affiliation(s)
- Ziyang Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Muye Song
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Shujie Wang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Jianhao Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- Shantou University Medical College, Shantou 515041, China
| | - Hongyan Shi
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China
| | - Yijie Huang
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Ying Yin
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yongchen Liu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Zeyu Wu
- Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Kim Y, Roh JL, Song DE, Cho KJ, Choi SH, Nam SY, Kim SY. Risk factors for posttreatment recurrence in patients with intermediate-risk papillary thyroid carcinoma. Am J Surg 2020; 220:642-7. [PMID: 32035626 DOI: 10.1016/j.amjsurg.2020.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/18/2020] [Accepted: 01/26/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) is generally associated with favorable outcomes; however, intermediate-risk requires further evaluation. We therefore examined risk factors for posttreatment recurrence in patients with intermediate-risk PTC. METHODS This study involved 1782 patients who underwent thyroidectomy for intermediate-risk PTC. Univariate and multivariate Cox proportional hazard regression analyses were used to identify the significant factors predictive of posttreatment recurrence-free survival (RFS). RESULTS Of intermediate-risk factors, univariate analyses showed that clinical and pathological cervical lymph node (LN) positivity (cN1 and pN1), aggressive histology, and multifocality with microscopic extrathyroidal extension were significantly associated with RFS outcomes (all P < 0.05). In multivariate analyses, cN1, >5 pN1, and posttreatment radioactive iodine (RAI)-avid metastatic foci of intermediate risk remained the independent factors predictive of RFS (all P < 0.05). The combination of any three or more of these intermediate-risk factors appeared to increase the posttreatment recurrence rate. CONCLUSION Clinical nodal positivity, the number of positive LNs, and the presence of RAI-avid metastatic foci in the ATA intermediate-risk category might independently decrease RFS in patients with intermediate-risk PTC.
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