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As the elderly population continues to rise, the issue of disease diagnosis and treatment in the elderly population is becoming a hot topic of concern. Differentiated thyroid cancer is the most common endocrine malignancy in the world, and patients with differentiated thyroid cancer in the elderly have a worse clinical prognosis and higher risk of recurrence and metastasis. Moreover, due to the special characteristics and complexity of the elderly population, patients with differentiated thyroid cancer in the advanced age group have special features in terms of morbidity, preoperative diagnosis, treatment options, and postoperative management compared with other populations. This article reviews the current status of diagnosis and treatment of differentiated thyroid cancer in the elderly, taking into account the findings and opinions of domestic and international studies.
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Anaplastic thyroid cancer (ATC) is a rare malignancy, accounting for 1%-2% of all thyroid cancers, however, ATC accounts for the majority of deaths from thyroid cancer. Currently, the main comprehensive treatments are surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy. Based on the latest American Thyroid Association guidelines and the related literatures, we summarize the most reasonable and effective therapeutic strategies to improve the survival rate of patients with ATC as well as the quality of life.
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With the gradual popularization of high-resolution ultrasound, the wide application of fine-needle aspiration biopsy technology under ultrasound guidance, and the rapid development of molecular marker detection technology, the detection rate of papillary thyroid microcarcinoma (PTMC) has increased year by year.The main clinical treatment method for PTMC is surgery or active surveillance. In recent years, with the good application of thermal ablation technology in the treatment of liver cancer, benign thyroid nodules and other tumors, many scholars at home and abroad advocate applying this technology in the treatment of PTMC.However, there is still a lack of multicenter, prospective long-term studies with large sample size to confirm the safety and effectiveness.Therefore, it is highly controversial whether thermal ablation should be applied to the initial treatment of PTMC.This paper will comment on this hot issue.
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As a treatment option for cancer, thermal ablation has satisfactory effects on many types of solid tumors (such as liver and renal cancers). However, its clinical applications for the treatment of thyroid nodules and metastatic cervical lymph nodes are still under debate both in China and abroad. In 2015, the “Zhejiang Expert consensus on thermal ablation for thyroid benign nodules, microcarcinoma, and metastatic cervical lymph nodes (2015 edition),” was released by the Thyroid Cancer Committee of Zhejiang Anti-Cancer Association, China. To further standardize the application of thermal ablation for thyroid tumors, the Thyroid Tumor Ablation Experts Group of Chinese Medical Doctor Association has organized many seminars and finally produced a consensus to formulate the “Expert consensus workshop report: Guidelines for thermal ablation of thyroid tumors (2019 edition).”
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Objective:To investigate the potential risk factors of the tumor abnormal protein (TAP) in papillary thyroid carcinoma (PTC) and analyze the clinical significance of TAP.Methods:The clinical data of 792 patients who underwent thyroid surgery in the thyroid surgery department of the First Affiliated Hospital of Zhengzhou University from Jun. 2018 to Jun. 2019 was collected, of whom 564 were PTC patients and 228 were benign thyroid tumor patients. Patients were divided into two groups by postoperative pathology: PTC group and thyroid benign tumor group. The potential risk factors the TAP in PTC were analyzed by univariate and multivariate Logistic regression analysis, and then the diagnostic value of TAP for PTC was assessed by ROC curve analysis.Results:Multivariate analysis showed that tumor maximum diameter (≥1.0 cm) ( OR:1.555; 95% CI: 1.031~2.344, P=0.035) and multifocal tumor ( OR:1.789; 95% CI: 1.098~2.916, P=0.019) were risk factors for elevation of TAP. Gender, age, body weight, extracapsular extension of cancer, invasive growth of cancer, Hashimoto's thyroiditis, central lymph node metastasis, lateral lymph node metastasis, and BrafV600E mutation were not associated with TAP ( P>0.05) . TAP in patients with PTC was significantly higher than that in patients with benign thyroid tumors[ (122.36±49.37) μm 2 vs (105.04±40.61) μm 2, P<0.001]. The sensitivity and specificity of TAP in diagnosing PTC were 78.90% and 40.35%, respectively. Conclusions:Tumor maximum diameter (≥1.0 cm) and multifocal tumor in PTC were risk factors for elevation of TAP. TAP has certain clinical value in differentiating PTC and thyroid benign tumor, which could be used as an auxiliary indicator.
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In recent years, the incidence of thyroid cancer has increased significantly. The prognosis of early thyroid cancer is relatively good, which makes early diagnosis and standardized treatment become the key. This article will discuss early prevention methods, health screening, early diagnosis standards, standardized treatment and medical services for thyroid cancer, and summarize the progress made in the early prevention and treatment of thyroid cancer in my country and the problems that that need further improvement. To provide healthy protection for the building of a moderately prosperous society in all respects.
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Objective To investigate the clinical and pathological characteristics of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC),and provide a basis for the individualized surgical procedure.Methods Retrospectively analyzed the clinical data of 940 PTMC patients admitted to the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,from January 2016 to June 2018,including 206 males and 734 females,with a gender ratio of 1.0∶ 3.6.Age ranged from 18 to 78,with an average of (45.5± 10.6) years.The correlation between gender,age,cancer size,muhifocality,BRAFV600E gene mutation,complicated with hashimoto's thyroiditis,extrathyroidal extension and lymph node metastasis were analyzed.SPSS 21.0 software was used for statistical analysis.Chi-square test or rank sum test was adopted for comparison between groups,and logistic regression analysis was adopted for multivariate analysis.Results There were 397 (42.2％) patients with central lymph node metastasis (CLNM) and 104 (11.1％) patients with lateral lymph node metastasis (LLNM).Univariate analysis showed that male,age ＜ 55 years old (x2 =24.485,P ＜ 0.001),bilateral cancer foci (x2 =8.100,P =0.004),larger length-diameter (Z =-0.016,P ＜0.001),and BRAFV600E gene mutation (x2 =4.918,P =0.027) had a higher CLNM positive proportion,and LLNM positive proportion was higher in male (x2 =6.584,P =0.010),bilateral cancer foci (x2 =26.669,P ＜0.001),larger length-diameter (Z=-4.991,P ＜0.001),extra-glandular invasion (x2 =16.862,P ＜0.001).Multivariate logistic regression analysis showed that gender (OR =2.091,P ＜0.001),age (OR =1.551,P =0.010),cancer lesion length (OR =5.285,P ＜ 0.001) and BRAFV600E gene mutation (OR =1.648,P =0.038) were independent risk factors for CLNM in PTMC patients.Gender (OR =1.657,P =0.032),bilateral lesion (OR =2.610,P ＜ 0.001),tumor length diameter (OR =7.420,P ＜ 0.001) and extrathyroidal extension (OR =2.611,P =0.005) were independent risk factors for LLNM.The optimal critical values of tumor lesion length-diameter for risk assessment in CLNM and LLNM were 0.6 cm and 0.8 cm,respectively.Conclusions For PTMC patients with negative cervical lymph node had risk factors for lymph node metastasis,preventive dissection of central lymph nodes was recommended,and preventive dissection of lateral lymph nodes should also be comprehensively considered,by evaluating the extrathyroidal extension.
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Objective@#To investigate the clinical and pathological characteristics of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC), and provide a basis for the individualized surgical procedure.@*Methods@#Retrospectively analyzed the clinical data of 940 PTMC patients admitted to the Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, from January 2016 to June 2018, including 206 males and 734 females, with a gender ratio of 1.0∶3.6. Age ranged from 18 to 78, with an average of (45.5±10.6) years. The correlation between gender, age, cancer size, multifocality, BRAFV600E gene mutation, complicated with hashimoto′s thyroiditis, extrathyroidal extension and lymph node metastasis were analyzed. SPSS 21.0 software was used for statistical analysis. Chi-square test or rank sum test was adopted for comparison between groups, and logistic regression analysis was adopted for multivariate analysis.@*Results@#There were 397 (42.2%) patients with central lymph node metastasis (CLNM) and 104 (11.1%) patients with lateral lymph node metastasis (LLNM). Univariate analysis showed that male, age < 55 years old (χ2=24.485, P<0.001), bilateral cancer foci (χ2=8.100, P=0.004), larger length-diameter (Z=-0.016, P<0.001), and BRAFV600E gene mutation (χ2= 4.918, P=0.027) had a higher CLNM positive proportion, and LLNM positive proportion was higher in male (χ2=6.584, P=0.010), bilateral cancer foci (χ2=26.669, P<0.001), larger length-diameter (Z=-4.991, P<0.001), extra-glandular invasion (χ2=16.862, P<0.001) . Multivariate logistic regression analysis showed that gender (OR=2.091, P<0.001), age (OR=1.551, P=0.010), cancer lesion length (OR=5.285, P<0.001) and BRAFV600E gene mutation (OR=1.648, P=0.038) were independent risk factors for CLNM in PTMC patients. Gender (OR=1.657, P=0.032), bilateral lesion (OR=2.610, P<0.001), tumor length diameter (OR=7.420, P<0.001) and extrathyroidal extension (OR=2.611, P=0.005) were independent risk factors for LLNM. The optimal critical values of tumor lesion length-diameter for risk assessment in CLNM and LLNM were 0.6 cm and 0.8 cm, respectively.@*Conclusions@#For PTMC patients with negative cervical lymph node had risk factors for lymph node metastasis, preventive dissection of central lymph nodes was recommended, and preventive dissection of lateral lymph nodes should also be comprehensively considered, by evaluating the extrathyroidal extension.
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Objective To investigate the application effect of glucocorticoids on perioperative period of complicated thyroid cancer surgery.Methods All patients were from Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University.A total of 373 patients with thyroid surgery longer than 3 hours from Jan.2017 to Dec.2017 were as the control group.386 patients with thyroid surgery longer than 3 hours from Jan.2018 to Dec.2018 were included in the observation group.Patients in the control group were not treated with glucocorticoids during perioperative period,and patients in the observation group were treated with glucocorticoids during perioperative period.Several factors were compared between the two groups,including postoperative drain removal time,postoperative hospitalization time,postoperative complication rate,the incidence of postoperative infection and delayed wound healing.Results The postoperative drain removal time [(2.5±0.42) vs (3.2±0.63),t=25.72,P＜0.001)] and the postoperative hospitalization time [(3.6±0.57) vs (4.8±0.71),t=18.07,P＜0.001)] in the observation group was shorter than in the control group.The incidence of complications in the observation group was lower than that in the control group,such as postoperative coarse respiratory sounds (3.1％ vs 6.7％,x2=4.790,P=0.029),mild to moderate dyspnea (1.0％ vs 3.2％,x2=4.191,P=0.041),cough (8.3％ vs 14.2％,x2=5.366,P=0.021),sore throat (4.9％ vs 9.4％,x2=4.952,P=0.026),headache (8.8％ vs 11.5％,x2=4.392,P=0.036) and nausea (3.6％ vs 8.6％,x2=7.235,P=0.007),however,the incidence of hoarseness between the two groups was statistically significant (1.6％ vs 2.1％,x2=0.352,P=0.553).There was no significant difference in the incidence of postoperative infection (2 cases vs 1 case,x2=0.299,P=0.585) or delayed wound healing (3 cases vs 3 cases,x2=0.002,P=0.964) between the two groups.Conclusion The application of glucocorticoids in patients with complicated thyroid cancer surgery can effectively reduce the incidence of complications and shorten the hospitalization time of patients.
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Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for external branch of superior laryngeal nerve(EBSLN).Methods From Jan.2017 to Jun.2017,138 patients undergoing thyroidectomy were randomly divided into monitor group (n=69) and the control group (n=69).The monitor group were used IONM for EBSLN,while the control group were used conventional area protection.Results The overall incidence of EBSLN injury was 1.4％(1/69) in the monitor group,and the overall incidence of EBSLN injury was 11.6％(8/69) in the control group.There was statistical significance between the two groups.Conclusion The application of IONM in thyroidectomy can exactly identify EBSLN,and reduce the possibility of EBSLN injury remarkably.
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Objective To evaluate the relationship between clinicopathological features and central lymph nodes metastasis in patients with papillary thyroid microcarcinoma (PTMC),and aim to provide an appropriate operation in clinic.Methods The clinical data of 536 patients undergoing surgical treatment in Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2017,who had pathologically confirmed popillary thyroid microcarcinoma (PTMC) were retrospectively analyzed.Thyroidectomy and isthmectomy with central compartment neck dissection were performed in all patients.The patients were divided into two groups according to whether there existed central lymph node metastasis,and compared the differences of gender,age,number of cancer lesions,tumor breakthrough envelope,BRAFV600E gene mutation,and tumor maximum diameter in the central lymph node metastasis,respectively,by t-test x2-test.Univariate logistic regression analysis and multivariate binary logistic regression analysis were conducted to find risky factors.Results There existed difference between two groups by completing the gender,age,the BRAFV600E gene mutation and maximal tumor diameter(P ＜ 0.05).Univariate logistic regression analysis indicated that gender (P =0.046),age (P ＜ 0.01),maximal tumor diameter(P ＜0.01) and the BRAFV600E gene mutation(P =0.016) were significant predictors for central lymph nodes metastasis.And multivariate binary logistic regression analysis revealed that the rate of lymph node metastasis significantly increased in cases of larger tumor diameter(P ＜0.01),BRAFV600E gene mutation(P =0.035) and ageing below 45 years old (P ＜ 0.01).Conclusions The treatment for central lymph node metastasis of PTMC should be different considering elements including BRAF600E gene mutation prophylactic,ageing below 45 years old and larger tumor diameter.Therefore central lymphadenectomy should be performed when the primary lesion was resected.
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Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery.Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC (May 2014 to June 2015) were retrospectively reviewed,and the patients with preoperatively known high-risk characteristics were excluded.One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines.The proportion of patients who need secondary surgery was estimated basing on pathological characteristics.Result In this group,49％ patients would have to undergo a secondary surgery if they took lobectomy as the initial operation.Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery.Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation.
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Objective To clarify the role of BRAFV600E and TERT promoter mutations in cervical lymph node metastasis in papillary thyroid carcinoma.Methods The data of 432 patients with thyroid papillary carcinoma who underwent surgery from February 2017 to September 2017 at the First Affiliated Hospital of Zhengzhou University were analyzed retrospectively.The mutation of BRAFV600E and TERT promoter was detected by Sanger sequencing.The effect of BRAFV600E and TERT on cervical lymph node metastasis in patients with papillary thyroid carcinoma was analyzed by Chi-square test.Results The mutation rates of BRAFV600E and TERT promoter were 77.8％ (336/ 432) and 5.3％ (23/432) respectively in 432 papillary thyroid carcinoma patients.The probability of cervical lymph node metastasis in patients with BRAFV600E mutation was significantly higher than that in non-mutation patients (P ＜ 0.05).The probability of cervical lymph node metastasis in patients with TERT promoter mutation was significantly higher than that in non-mutated patients (P ＜ 0.05).Patients with both BRAFV600E and TERT promotermutation had a significantly higher incidence of cervical lymph node metastases than patients with the BRAFV600E mutation alone (P ＜ 0.05).Conclusions The mutations of BRAFV600E and TERT promoter are closely relevant to the occurrence of cervical lymph node metastasis in papillary thyroid carcinoma.Preoperative fine-needle aspiration cytology and postoperative routine pathological molecular diagnosis can help clinicians to develop a more rational treatment strategy,and a more accurate assessment of the risk of relapse.
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Recurrent laryngeal nerve damage is one of the common complications in thyroidectomy.With the wide application of ultrasonic scalpel,intraoperative nuromonitoring,endoscopic thyroidectomy,meticulous dissection technique,the surgery methods has changed obviously,in the same time,new problems to protect recurrent laryngeal nerve in thyroidectomy has appeared.To be familiar with the anatomical characteristics of recurrent laryngeal nerve and to be skilled in using the new technique and new device are the keys to protect recurrent laryngeal nerve under new technologies and advanced conceptions.
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Recurrent laryngeal nerve damage is one of the common complications in thyroidectomy.With the wide application of ultrasonic scalpel,intraoperative nuromonitoring,endoscopic thyroidectomy,meticulous dissection technique,the surgery methods has changed obviously,in the same time,new problems to protect recurrent laryngeal nerve in thyroidectomy has appeared.To be familiar with the anatomical characteristics of recurrent laryngeal nerve and to be skilled in using the new technique and new device are the keys to protect recurrent laryngeal nerve under new technologies and advanced conceptions.
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Objective To investigate the application of intraoperative neuromonitoring (IONM) during thyroidectomy for non-recurrent laryngeal nerve (NRLN).Methods From Oct.2013 to Apr.2016,2846 patients underwent thyroidectomy with the application of IONM,and 11 patients with non-recurrent laryngeal nerve were analyzed.Results 11 cases of NRLN were all accurately identified by IONM,and no injury of NRLN occurred during thyroid surgery.Conclusions NRLN is uncommon in clinical and it is difficult to be predicted before surgery and easy to be injured.The application of IONM can reduce the possibility of NRLN injury remarkably.
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Thyroid carcinoma is the most frequent endocrine cancer.Recently, it has been discovered that telomerase reverse transcriptase promoter mutation can prevent cell tolemeres from shortening, leading to cell immortalization and plays an important role in the tumor genesis, invasiveness and metastasis of the thyroid carcinoma.Testing of telomerase reverse transcriptase promoter mutation is of great value in diagnosis, which also can be used as a prognostic maker of thyroid carcinoma.
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Objective To investigate the related factors of postoperative hypocalcemia after thyroid carc-er surgery.Methods 346 cases of thyroid carcer patients undergoing surgery from Jan .2013 to Dec.2013 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed .Results 129 cases developed hepocalcemia after thyroid surgery .Among the related factors that may cause postoperative hypocalcemia , the scope of surgery , parathyroid injury and secondary surgery might play important roles .Conclusions The inci-dence of postoperative hypocalcaemia is high after total thyroidectomy .Patients with reoperation and lymph node dissection have an increased rate of postoperative hypocalcaemia .In order to reduce hypocalcaemia incidence ,sur-gons need to protect parathyroid blood supply in thyroid surgery and give calcium after surgery .
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Objective To evaluate the curative effects of carbon nanoparticles on central lymphnode dis -section in papillary thyroid carcinoma ( PTC) .Methods 72 PTC patients were randomly divided into two groups:carbon nanoparticle group(n=32)and the control group(n=32).Patients in the carbon nanoparticle group were injected with carbon nanoparticles during surgery .Patients in the control group had conventional surgery .The number of lymph nodes being dissected ,lymph node metastasis , and the rate of hypoparathyroidism were compared between the two groups .Results The number of lymph nodes dissected in nanoparticle group ( n =312 ) was much bigger than that in the control group (n=189)(P0.01;χ2 =1.048).Conclu-sions The lymphatic tracer technique may improve the number of lymph nodes dissected in central region of PTC and reduce parathyroid gland damage .
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Thyroid cancer is the most common malignant endocrine tumor.The xenograft nude mice model of thyroid cancer have played an important role in studying thyroid cancer.Different mouse model has distinctive characters and limitations,so it is important to choose a suitable mice model due to the experiment purpose.In this paper,the authors will address the research progress of human thyroid cancer xenograft nude models.