ABSTRACT
Objective:To investigate the effectiveness, safety, and advantages of modified radical neck dissection by gasless unilateral axillary approach (GUA-MRND) in the surgical management of selected patients with papillary thyroid cancer.Methods:We retrospectively analyzed patients with papillary thyroid cancer who underwent GUA-MRND (endoscopic group, n=16) versus unilateral open modified radical neck dissection (MRND) (open group, n=32) during the period from Jan. 2019 to Jun. 2021, including the differences in surgical efficiency, complication rate, and incisional satisfaction.Results:Compared MRND with GUA-MRND, the patients were younger ( P<0.05) , operative time and postoperative drainage anterior ( P<0.01) were slightly inferior in the latter, but it had obvious advantages in cervical swallowing discomfort and incision satisfaction evaluation ( P<0.05) . There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury, intraoperative and postoperative bleeding, hematoma, infection, lymphatic or chylous leakage and supraclavicular numbness after surgery ( P>0.05) . The number of dissected lymph nodes in area II in the GUA-MRND was lower ( P<0.05) , but it was significantly higher ( P<0.01) in area III. And the average regional cleaning efficiency in the GUA-MRND was level Ⅲ (35.5%) , level Ⅵ (28.59%) , level Ⅳ (23.21%) , level Ⅱ (7.18%) and level Ⅴ (7.12%) , suggested that GUA-MRND had higher efficacy for level III, level Ⅵ and Level IV. Conclusion:GUA-MRND is safe, effective, and has high cosmetic satisfaction in the treatment of selected patients with lateral cervical lymph node metastases from papillary thyroid cancer.
ABSTRACT
Objective:To compare the postoperative neck pain, discomfort and swallowing difficulty in patients with papillary thyroid cancer (PTC) after conventional open thyroidectomy (COT) and endoscopic thyroidectomy using the gasless unilateral axillary approach (ET-UA) .Methods:The study included 117 female patients with PTC who underwent unilateral thyroid lobectomy plus central neck dissection using COT ( n=68) or ET-UA ( n=48) performed by the same experienced surgeon. Subjective neck pain, discomfort and swallowing alterations were assessed by questionnaire 3 day and 6 months postoperatively. Surgical scar and cosmetic satisfaction evaluation were implemented 6 months postoperatively. SPSS 20.0 was used for statistical analysis, the rate or composition ratio was compared by the χ2 test or the exact probability method, and the significance test of the difference in sample means was tested by analysis of variance. Results:Three days after surgery, the neck pain scores of COT group and ET-UA group were (2.13±1.07) and (2.31±1.07) ( P=0.368) ; the neck injury index was (5.13±3.02) and (5.31±3.00) ( P=0.748) ; the dysphagia index was 5 (0.49±3.47) and (3.77±2.96) ( P=0.006) . At 6 months postoperatively, the neck pain scores in COT group and ET-UA group group were (0.52±0.61) and (0.60±0.74) ( P=0.510) ; the neck injury index was (2.10±1.71) and (2.38±2.35) ( P=0.467) ; the dysphagia index was (2.68±2.36) and (1.81±1.83) ( P=0.034) , respectively. Conclusion:Our preliminary study shows that there is no significant differences in postoperative neck pain or discomfort between COT groups and ET-UA group, whereas the impact of ET-UA on swallow function is relatively small than COT.
ABSTRACT
Objective:To determine the technical feasibility,intraoperative safety,and efficacy of endoscopic thyroidectomy using the gasless unilateral axillary approach.Methods:We analyzed 11 patients diagnosed with papillary thyroid carcinoma who underwent an endoscopic thyroidectomy between February and April 2017 using a gasless unilateral axillary approach at the Department of Head and Neck Surgical Oncology,Zhejiang Cancer Hospital.Additionally,we compared the clinical features,early surgical outcomes,surgi-cal complications and postoperative satisfaction of endoscopic thyroidectomy with those of 11 patients who underwent conventional open thyroidectomies during the same period.Result:In the endoscopic group,the mean age of patients((35.6±2.6)years was young-er than that of the open thyroidectomy group[(48.5±2.3)years,(P=0.002)].The endoscopic thyroidectomy(unilateral lobectomy)pro-cedure was successfully completed in all patients. The rate of central compartment neck dissection was not different between the groups[(2.4±1.7)vs.(2.8±1.6),P>0.05].The operative time was longer and the amount of drainage was higher in the endoscopic than in the open group[(123.9±28.1)min vs.(48.6±9.8)min,P<0.01;(145.9±81.8)mL vs.(87.7±18.9)mL,P<0.01].Everage length of hospi-talizntion was 1 day longer in the endoscopic group. The complication rate was not statistically significantly different between the groups.The postoperative pain score of the neck and anterior chest was not different between the groups except the anterior chest pain score at day 3 after operation.The cosmetic satisfaction was greater in the endoscopic group(P<0.01).Conclusions:Endoscopic thyroidectomy using a gasless unilateral axillary approach for the management of selected patients presenting with papillary thyroid carcinoma is a safe,feasible,and cosmetically superior procedure.
ABSTRACT
Objective@#To investigate the clinical characteristics, treatment outcomes and prognostic factors in patients with anaplastic thyroid cancer.@*Methods@#Clinical data of 56 patients with anaplastic thyroid cancer at Zhejiang Cancer Hospital from January 2006 to June 2016 were retrospectively reviewed and followed up.@*Results@#Of the 56 patients, there were 24 male and 32 female. The median age was 65 years old. At diagnosis, 10 patients have different degrees of breathing difficulty; 8 patients have varying degrees of dysphagia, and 12 patients have hoarseness. Distant metastases were found in 23 patients at presentation. Patient staging was performed in accordance with the tumor-node-metastasis system as follows: stage ⅣA (n=19), stage ⅣB (n=14) and stage ⅣC (n=23). The median survival time of 56 patients was 4.5 months.The overall 1-year survival rate was 5.4%. Univariate analysis showed that radiotherapy and multimodality therapy were prognostic factors for 1-year overall survival (both of P<0.05). The overall 1-year survival rate of the patients who received precision radiotherapy was 16.7%, which was higher than who received the other radiation therapy (4.0%, P=0.040). Furthermore, the overall 1-year survival rate of the patients who received surgery combined with radiotherapy was 12.5%, which was higher than who received the other treatments(4.2%, P=0.040). Multivariate analysis indicated that radiotherapy was independently associated with improved survival (P=0.020).@*Conclusions@#Patients with anaplastic thyroid cancer should receive multimodality therapies combining surgery with radiotherapy. Radiotherapy is independently associated with improved overall survival. Notably, the precision radiotherapy that based on image guidance has a significantly beneficial impact on the prognosis of patients.
ABSTRACT
Objective@#To investigate the effect of icariin (ICA) on the bisphenol A (BPA)-enhanced proliferation function of thyroid carcinoma cell B-CPAP and underlying mechanism.@*Methods@#The proliferation of Gastric B-CPAP cell line was evaluated by cell counting kit-8 (CCK-8). Apoptosis and ROS expression in B-CPAP cells were detected by flow cytometry. The expression of superoxide dismutase (SOD) and malondialdehyde (MDA) in B-CPAP cells were measured by individual assay kits. The expressions of Bcl-2 and γ-HA2X were detected by Western blot. SPSS 18.0 software was used to analyze the data.@*Results@#B-CPAP cell activity was promoted by treatment with 3×10-7mol/L BPA for 48 h, with significant difference in absorbance between BPA and control groups (1.089±0.053 vs 0.935±0.010, P<0.05). The cell activities of BPA+ ICA25, BPA+ ICA50, BPA+ ICA100 and BPA+ ICA200 groups was 0.780±0.036, 1.007±0.050, 0.958±0.033 and 0.625±0.064, respectively (all P<0.01). The proliferation of B-CPAP cells treated with BPA for 72 hours showed a similar trend to 48 hours. There was no significant difference between all treatment groups in 24 hours. The apoptosis rate was (19.272±0.186)% in BPA-treated cells, and was (22.412±0.238)% in control cells (P<0.05). The apoptosis rates of BPA+ ICA50 and BPA+ ICA200 groups were (23.688±0.412)% and (30.270±0.696)%, respectively (P<0.01). The intracellular accumulation of ROS in BPA, BPA+ ICA50, and BPA+ ICA200 groups were 806±21, 1 772±37, 2 041±16, respectively (P<0.01). The expressions of anti-apoptotic protein Bcl-2 in control, BPA, BPA+ ICA50, BPA+ ICA200 groups were 7 120±151, 9 801±286, 5 902±171 and 4 203±216, respectively (P<0.01).@*Conclusion@#BPA can promote the proliferation of thyroid carcinoma B-CPAP cells and decrease the apoptosis of cells, and this effect can be inhibited by ICA. The possible mechanism is to induce high expression of intracellular ROS and inhibit the expression of antioxidase system, leading to cell oxidative damage, thereby inducing apoptosis.
ABSTRACT
Objective To investigate the clinical features of papillary thyroid microcarcinoma(PTMC) and the risk factors of central lymph node metastasis (CLNM) in PTMC patients.Methods The clinical data of 855 patients with PTMC who underwent prophylactic central lymph node dissection were retrospectively reviewed.Results In the present study,the rate of CLNM was 21.9％ (187/855) in PTMC patients.In the univariate analysis,the incidence of CLNM was significantly higher in male patients,age ＜ 45 years,tumor size ＞ 5 mm,capsular invasion,multiple tumor and intracapsular spread (31.4 ％ vs.19.5 ％,x2 =11.429,P =0.001;29.3 ％ vs.15.9 ％,x2 =22.416,P =0.000;30.0％ vs.14.3％,x2 =30.669,P=0.000;29.4％ vs.16.8％,x2 =19.233,P =0.000;30.0％ vs.19.9％,x2 =8.205,P =0.004;42.9％ vs.21.3 ％,x2 =5.549,P =0.018,respectively).Multivariate analysis showed that male gender,age ＜ 45 years,tumor size ＞ 5mm,multiplicity and capsular invasion were independent risk factors for CLNM in PTMC patients (95％ CI:0.380-0.834,0.349-0.693,1.450-3.060,1.078-2.229,1.024-2.373,respectively).Conclusion A routine prophylactic central lymph node dissection should be considered particularly in male PTMC patients with age ＜45 years,tumor size ＞5 mm,capsular invasion and tumor multiplicity.
ABSTRACT
Thyroid cancer is one of the commonest head and neck cancer. According to the recent research, VI lymph nodes (also called the front area, including thyrocricoid lymph nodes, tracheal surrounding lymph nodes, thyroid surrounding lymph node,recurrent laryngeal nerve lymph nodes, retropharyngeal lymph nodes) is the most common site of involvement in the differentiated thyroid carcinoma. Thyrocricoid lymph nodes known as the Delphian lymph node(DLN) is located between the thyroid cartilage and the cricoid cartilage. The DLN is one of the most accurate predictor. This paper reviewed the clinical significance of the DLN, the role of DLN metastasis in papillary thyroid cancer, and the relationship between tumor size, multicentricity and DLN metastasis. We also discussed the association between DLN metastasis and additional central compartment metastasis, as well as lateral compartment metastasis.
Subject(s)
Humans , Carcinoma , Pathology , Carcinoma, Papillary , Lymph Nodes , Lymphatic Metastasis , Neck , Neck Dissection , Recurrent Laryngeal Nerve , Thyroid Cancer, Papillary , Thyroid Neoplasms , PathologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the aberrant promoter methylation of hMLH1 gene promoter and its clinical significance in papillary thyroid cancer (PTC).</p><p><b>METHODS</b>methylation of hMLH1 gene promoter in the cancer tissue and matched tumor-adjacent normal tissue of 152 PTC patients were detected by real-time methylation specific PCR (qMSP). The relationship between the methylation of hMLH1 gene promoter and clinicopathological features was analyzed.</p><p><b>RESULTS</b>The methylation rate of hMLH1 gene promoter in cancer tissues was 37.5% (57/152), of which 33 cases were totally methylated and 24 cases were partially methylated. The methylation rate of adjacent normal tissues was 5.3% (8/152)(all were partially methylated). The methylation rate of PTC tissues was significantly higher than that in the tumor-adjacent normal tissue (P < 0.01). The promoter methylation of hMLH1 gene in PTC was significantly correlated with age, size and number of the primary lesion, local invasion, T stage and lymph node metastasis (P < 0.05) , but not correlated with gender and clinical stage (P > 0.05).</p><p><b>CONCLUSION</b>Promoter methylation of hMLH1 gene is a common molecular event in PTC tissue, and it is significantly correlated with the progression of PTC.</p>
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Adaptor Proteins, Signal Transducing , Genetics , Metabolism , Age Factors , Carcinoma , Genetics , Metabolism , Pathology , Carcinoma, Papillary , DNA Methylation , Gene Expression Regulation, Neoplastic , Lymphatic Metastasis , MutL Protein Homolog 1 , Neoplasm Invasiveness , Neoplasm Staging , Nuclear Proteins , Genetics , Metabolism , Promoter Regions, Genetic , Genetics , Thyroid Neoplasms , Genetics , Metabolism , Pathology , Tumor BurdenABSTRACT
<p><b>OBJECTIVE</b>To assess the epidermal growth factor receptor (EGFR) status in salivary adenoid cystic carcinoma and explore its role in cancer invasion.</p><p><b>METHODS</b>Fifty-four patients with pathologically confirmed salivary adenoid cystic carcinoma (SACC) were divided into invasion group and non-invasion group. The EGFR expression was determined by immunohistochemstry (SP staining). The relations between the EGFR expression and the SACC clinical pathological characteristics were analyzed.</p><p><b>RESULTS</b>EGFR were mainly expressed in the cell membrane and cytoplasm in the tissue of SACC. The positive rate of EGFR expression in the tumor tissue was 75.9% (41/54), and EGFR was over-expressed in the cytoplasm. The positive rate of EGFR expression in invasion group was higher than that in the non-invasion group (10.0%, P < 0.05). EGFR expression were related with the SACC T stages, histological types, distant metastasis, lymph node metastasis, and nerve invasion (P < 0.05).</p><p><b>CONCLUSIONS</b>A higher expression of EGFR gene in the cytoplasm may have important effect on the progression of invasive carcinoma. Further investigations are required to develop new strategy in the treatment of salivary adenoid cystic carcinoma.</p>
Subject(s)
Female , Humans , Male , Middle Aged , Carcinoma, Adenoid Cystic , Metabolism , Pathology , Cell Membrane , Metabolism , Cytoplasm , Metabolism , Immunohistochemistry , Lymphatic Metastasis , Neoplasm Invasiveness , Neoplasm Metastasis , Neoplasm Staging , ErbB Receptors , Metabolism , Salivary Gland Neoplasms , Metabolism , PathologyABSTRACT
<p><b>OBJECTIVE</b>To investigate the prognosis of adenoid cystic carcinoma (ACC) in salivary gland and its influencing factors.</p><p><b>METHODS</b>Clinical and following-up data of 76 patients with ACC in salivary glands were reviewed. Major gland tumors represented 35.5% whereas minor gland tumors comprised 64.5% of the cohort, with 8 cases (10.5%) in stage I, 23 (30.3%) in stage II, 18 (23.7%) in stage III and 27(35.5%) in stage IV. Survival rates were calculated by Kaplan-Merier method. Cumulative survival curves were evaluated using the Log-rank test. Multivariate analysis was performed by Cox proportional hazard model.</p><p><b>RESULTS</b>The regional recurrence rate was 28.9% and distant metastasis rate was 21.1%. The overall 5-year survival rate, tumor-free survival rate and tumor-related survival rate were 73.7%, 61.8% and 74.9% respectively. The overall 10-year survival rate, tumor-free survival rate and tumor-related survival rate were 48.2%, 39.8% and 56.2% respectively. Univariate survival analysis showed pathological type, clinical stage and perineural invasion were relevant to the prognosis of ACC and multivariate analysis showed they were the independent prognostic factors of ACC in salivary gland.</p><p><b>CONCLUSIONS</b>Clinical stage, pathological type and perineural invasion were the independent prognostic factors for adenoid cystic carcinoma in salivary gland. Surgery was the first choice for the treatment of adenoid cystic carcinoma in salivary gland, and postoperative radiotherapy may prolong the tumor-free survival time of patients in stage III and IV.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Adenoid Cystic , Diagnosis , Multivariate Analysis , Prognosis , Retrospective Studies , Salivary Gland Neoplasms , Diagnosis , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To investigate the prognosis of adenoid cystic carcinoma (ACC) in minor salivary glands and its influencing factors.</p><p><b>METHODS</b>Clinical data of 52 patients with ACC in minor salivary glands were reviewed. The distribution of stage was as follows: stage I (6%), stage II (21%), stage III (27%) and stage IV (46%). Counting data was analyzed by χ(2) test or Fisher's exact. Survival rates were calculated by Kaplan-Merier method. Statistical significance of differences in the cumulative survival curves was evaluated using the Log-rank test. Multivariate analysis was performed by Cox proportional hazard model.</p><p><b>RESULTS</b>All patients underwent primary tumor radical resection, 39 patients (75%) received postoperative radiation. The regional recurrence rate was 37% and distant metastasis rate was 21%. The 5-, 10-year cumulative local control rate were 68% and 63% respectively. The 5-, 10-year cumulative distant control rate were 86%, 68% respectively. The 5-, 10-year tumor specific survival rates were 70% and 54% respectively. Multivariate analysis showed that T stage, lymph node metastasis and perineural invasion were relevant to the tumor specific survival of ACC in minor salivary glands.</p><p><b>CONCLUSIONS</b>Recurrence and metastasis were the main cause of treatment failure of ACC in minor salivary glands. T stage, lymph node metastasis and perineural invasion were the independent prognostic factors of ACC in minor salivary glands. Radical surgery and reasonably postoperative radiotherapy were the main treatment strategy.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Carcinoma, Adenoid Cystic , Pathology , Radiotherapy , General Surgery , Cobalt Radioisotopes , Therapeutic Uses , Follow-Up Studies , Lung Neoplasms , Lymph Node Excision , Lymphatic Metastasis , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Neoplasm Staging , Particle Accelerators , Proportional Hazards Models , Radiotherapy, Adjuvant , Salivary Gland Neoplasms , Pathology , Radiotherapy , General Surgery , Salivary Glands, Minor , Survival RateABSTRACT
<p><b>OBJECTIVE</b>To explore the diagnosis and treatment and prognosis of sinonasal neuroendocrine carcinoma.</p><p><b>METHODS</b>The clinical data of 11 cases with sinonasal neuroendocrine carcinoma treated in Zhejiang Cancer Hospital from 1998 to 2010 were analyzed retrospectively. Ten cases were small cell type and one case was atypical carcinoid. One case by only operation, one case by only radiotherapy, one case by only chemotherapy, two cases by radiotherapy and chemotherapy, 6 cases by combined treatment based on surgery (surgery combined with radiotherapy and chemotherapy).</p><p><b>RESULTS</b>All cases have been followed up for 2 months to 12 years. Six cases by combined treatment one case died in 3 years and one case died in 4 years after treatment, one case has survived without tumor for 12 years and two cases have survived without tumor for 8 years, one case was still in treatment. Five cases of other treatment programs, four cases died in 12 months, one case died in 18 months.</p><p><b>CONCLUSIONS</b>There's no standard treatment plan. Combined treatment based on surgery should be adopted to nasal neuroendocrine carcinoma. Reccurrence is frequent and the prognosis is poor. The key to improving the survival rate of the disease is early accurate diagnosis and combined treatment.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Carcinoma, Neuroendocrine , Diagnosis , Therapeutics , Combined Modality Therapy , Nose Neoplasms , Diagnosis , Therapeutics , Paranasal Sinus Neoplasms , Diagnosis , Therapeutics , Prognosis , Retrospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To investigate the evolution pattern of the Runx3 gene 5'-CpG island ~3478 bp region methylation in human salivary gland adenoid cystic carcinoma (SGACC).</p><p><b>METHODS</b>Quantitative MSP method was used to detect the methylation status of CpG island in various regions (No.1-10) of Runx3 promoter region, and Western blot was used for detection of the expression of Runx3 protein in 41 salivary gland SGACC samples and corresponding non-neoplastic salivary gland tissues. A Logistic model was used to analyze the risk ratio between the methylation status of CpG island in Runx3 gene and development of salivary SGACC, meanwhile, the possible association among the methylation of Runx3 gene, the clinicopathological parameters of SGACCs, and Runx3 protein expression was compared.</p><p><b>RESULTS</b>The results of qMSP showed that the hypermethylation initially occurred at the most 5' region of the Runx3 CpG island and spread to the transcription start site. The methylation rate was highest in region No. 1 and No. 2 among the successive ten regions ranging from the 5' region to the transcription start site within the Runx3 CpG island, and lowest in the transcription start site both in SGACCs and normal salivary glands. Furthermore, there was no methylation in the transcription start site in nomal salivary glands tissues. Together with the results of Logistic model analysis, those results indicate that the transcription start site within the Runx3 promoter CpG island is critical for gene silencing. Western blot results revealed that the Runx3 protein level in SGACC was significantly lower than that in normal salivary glands (P < 0.01). In combination of the results of qMSP, it is presumed that the Runx3 gene methylation is one of the reason inducing the down-regulation of Runx3 in SGACCs.</p><p><b>CONCLUSIONS</b>Methylation of the Runx3 CpG island spreads from the most 5'-region to the transcription start site in human salivary gland adenoid cystic carcinoma, and the transcription start site may be a critical region for the methylation of Runx3. The evolution pattern of Runx3 gene methylation is related to the tumorigenesis of SGACCs.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Adenoid Cystic , Genetics , Metabolism , Pathology , Core Binding Factor Alpha 3 Subunit , Genetics , Metabolism , CpG Islands , Genetics , DNA Methylation , Logistic Models , Salivary Gland Neoplasms , Genetics , Metabolism , Pathology , Salivary Glands , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To evaluate the disadvantage of nonstandard operation for thyroid papillary cancer, and the value of re-operation.</p><p><b>METHODS</b>Eight hundred and ninety three thyroid papillary cancer patients (332 patients who received nonstandard operation received re-operation and 561 patients who received first standard operation in Zhejiang Cancer Hospital from January 1990 to January 2000) were retrospectively reviewed.</p><p><b>RESULTS</b>Pathological results confirmed that there were 53.9% cases with residual cancer in re-operative specimen. The parathyroid was preserved in 74.1% cases in re-operation and 93.0% cases in standard operation (P < 0.01). The recurrent laryngeal nerve was injured in 3.3% cases in reoperation and 1.2% cases in standard operation (P < 0.05). The positive neck lymph node was 39.2% and 37.4% (P > 0.05), the 5-year local recurrence rate was 7.5% and 3.7% (P < 0.01), the total 5-year and 10-year cum-survival rates were 90.2%, 84.4% in patients with re-operation and 94.0%, 92.5% in patients with standard operation. The 10-year cum-survival rate were 67. 8% in patients with recurrence and 92. 9% in patients with non-recurrence in primary site respectively. Statistical analysis showed that the cancer recurrence influences the survival rate significantly (P < 0.01).</p><p><b>CONCLUSIONS</b>In consideration of the higher residual tumor rate in patients who received nonstandard operations, the re-operations were necessary. But the re-operation could also leads to higher recurrence rate and more functional injuries. The standardized primary operation should therefore be formulated and advocated.</p>