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Objective:To analyze the clinical significance of multigene assay in papillary thyroid carcinoma（PTC）. Methods:Patients who underwent thyroidectomy in a tertiary hospital from August 2021 to May 2022 were enrolled. The eight-gene panel was used to detect the tumor tissue of patients, and the correlation between gene mutations and clinical features was analyzed. Results:Among 161 patients, mutation rate of BRAF V600E, RET/PTC1 and TERT promotor were 82.0%, 6.8% and 4.3%, respectively. BRAF V600E mutation was more common in male patients（P=0.023）. TERT promotor-mutated tumors had a large diameter（P=0.019）, a high proportion of multifocal lesions（P=0.050）, and a large number of lymph node metastases（P=0.031）. Among 89 patients who completed preoperative BRAF detection, there was a strong consistency between the preoperative aspiration test and postoperative panel（Cohen κ=0.694, 95%CI: 0.482-0.906, P<0.01）. In the hematoxylin-eosin sections obtained from 80 patients, BRAF V600E was still the main type of gene mutation, and the classical/follicular type was more distributed. TERT promotor and RET/PTC1 mutation were the main genetic events for tall-cell/columnar/hobnail type and diffuse sclerosing type, respectively. One-way ANOVA showed that there were differences in diagnosis age（P=0.029） and tumor size（P<0.01） among different pathological types. Conclusion:As a simple and feasible clinical detection method for PTC, the multigene assay can supplement the identification of important genetic events other than BRAF V600E, and provide more prognostic information and follow-up hints for postoperative patients.
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Humans , Male , Thyroid Cancer, Papillary/genetics , Thyroid Neoplasms/pathology , Proto-Oncogene Proteins B-raf/genetics , Clinical Relevance , Carcinoma, Papillary/pathology , MutationABSTRACT
Objective:To explore the construction and application methods of multicenter bone tumor-specific database.Methods:Experts from multiple centers including Shanghai General Hospital, Shanghai Changzheng Hospital, Zhongshan Hospital, Shanghai Sixth People's Hospital, Ruijin Hospital, Fudan University Shanghai Cancer Center and Shanghai Ninth People's Hospital established a standard dataset for bone tumors through research and discussion. Clinical data will be automatically collected and standardized according to standard fields. A database will be built and a users' interface will be developed to ensure secure data storage, while providing services such as exporting raw data, visualizing statistical analysis, establishing clinical queue research projects, et al. Finally, the bone tumor database will be shared by integrating with the Shenkang's Big Data Platform to achieve multi-center data integration.Results:A standard data set for bone tumors containing 603 fields has been established and published. An automated data collection system for bone tumors has been established, including complete data collection, data collation and visualization functions. The data categories include modules such as patients' electronic case information, laboratory information on blood routine, biochemistry and tumor markers, imaging information, surgery information, pathology information and radiotherapy records. Personal information such as patients' names and ID numbers are desensitized and encrypted and can be exported for further research. From 2015 to 2023, the total number of bone tumor cases collected in the database was 10,789. From 2015 to 2019, 112 cases of the osteosarcoma cohort were retrospectively analyzed for admission, with a statistical 5-year survival rate of 68%.Conclusion:A regional bone tumor specialty big data network and data sharing platform has been established, along with data sharing mechanisms and standards including data standards, security standards, and quality evaluation standards. This provides data and efficient new solutions for the construction of China's bone tumor database, as well as a research and development platform for standardized diagnosis and treatment of bone tumors and new technologies.
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Objective Create patient-derived xenograft (PDX) model of bone and soft tissue sarcoma,and analyze the success rate of PDX model,observe the effects of chemotherapy on PDX models and its coincidence,and provide a theoretical basis for screening sensitive second and third line drugs.Methods Collected 31 cases of bone and soft tissue sarcoma from January 2015 to May 2016,which included 12 male and 19 female,with an average age of (28.5±19.9) y.The tumor tissue was obtained the day of operation,and it was cut into 2 mm3 pieces and injected into the flank of BAL B/C nude mice or SCID mice.Tumor was passaged when the diameter reached 1-2 cm and the P0 tissue was froze.If there was no obvious tumor mass grows out for 3 months,the model creation will be stopped.We inoculated the mice with patients sample with or without chemotherapy,observed the effect of chemotherapy on the success rate of PDX modeling and the success rate of modeling of different pathological types,and also observed the relationship between the success rate of PDX modeling and the prognosis of patients.For the drug sensitivity test,3 mice was used in each group,and chemotherapy was given,T/C was used to evaluate the inhibition ratio after drug treatment.Results 31 PDX models were inoculated.The total success rate is 45.2％.Pathology of the PDX models and their success rates:24 osteosarcoma models,success rate is 37％;2 leiomyosarcoma models,success rate is 100％;2 chondrosarcoma models,success rate is 50％;1 Ewing sarcoma model successed;1 fibrosarcoma model and 1 synovial sarcoma model,were not successed.Post chemotherapy model success rate is 33％ (4/12),compared with 53％(10/19) of model success rate that without chemotherapy.And there is relationship between success rate of PDX model creation and patient outcome.The faster the PDX model creation,the worse the outcome.The drug sensitivity of PDX model coincides the clinical situation.Conclusion The success rate of creating PDX model of bone and soft tissue sarcoma is around 30％-40％,and it is related to the pathology and whether got chemotherapy or not,PDX models coincide sarcomas clinical situation,and it is hopefully to use PDX model in selecting personalized drugs.
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Objective To retrospectively analyze the treatment outcomes and failure patterns in patients with head?and?neck cancer of unknown primary head?and?neck cancer of unknown primary, and to compare the efficacy between elective mucosal irradiation and ipsilateral neck treatment. Methods The clinical data of patients with head?and?neck cancer of unknown primary who were admitted from January 2007 to December 2013 were retrospectively collected. Thirty?one patients received elective pharyngeal mucosal irradiation and 61 patients only received ipsilateral neck treatment. The SPSS 19. 0 software was used for comparison of the survival and local control between the two groups. Results In the 92 patients, the median age was 57 years;79. 3% had metastasis to level Ⅱ lymph nodes;the median follow?up time was 36. 5 months;the 3?year overall survival, mucosal control, and neck control rates were 89. 0%, 86. 6%, and 82. 4%, respectively. Primary sites were found in 15 patients, containing nasopharynx in 4 patients, oropharynx in 3 patients, oral cavity in 3 patients, throat and hypopharyngeal part in 3 patients, maxillary sinus in 1 patient, and esophagus in 1 patient. The patients undergoing elective pharyngeal mucosal irradiation had significantly higher 3?year mucosal control and neck control rates than those undergoing ipsilateral neck treatment ( 100% vs. 74. 9%, P= 0. 040;87. 5% vs. 62. 2%, P= 0. 037 ) . There was no difference in the 3?year overall survival rate between the two groups ( 83. 5% vs. 88. 7%, P= 0. 910 ) . Conclusions For patients with head?and?neck cancer of unknown primary, elective pharyngeal mucosal irradiation can reduce the incidence of primary site and increase the neck control rate. A new standard for target volume delineation should be established as soon as possible for elective prophylactic pharyngeal mucosal irradiation.
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Objective@#To investigate the rationality of management of active surveillance for papillary thyroid microcarcinoma (PTMC) and the main indications for active surveillance for PTMC.@*Methods@#In this study, two criteria were used to evaluate patients with PTMC: low-risk PTMC conditions defined by Kuma hospital and Chinese Association of Thyroid Oncology (CATO) consensus on PTMC management of active surveillance. The patients had received surgical treatment. Clinicopathological characteristics and prognosis of the patients in different groups were compared.@*Results@#A total of 778 patients were enrolled in the study, 565 (72.6%) of them met Kuma screening criteria and only 112 (14.4%) met CATO screening criteria. Kuma low-risk subgroup had lower incidence of cervical lymph node metastasis than Kuma high-risk PTMC subgroup(30.6% vs 47.9%, P<0.05). There were significant differences in multifocal lesions(6.3% vs 16.4%), extrathyroidal extension (1.8% vs 7.5%) and cervical lymph node metastasis(19.6% vs 38.0%) between low-risk and high-risk CATO PTMC subgroups. Patients in the CATO low-risk PTMC subgroup had lower recurrence and longer disease-free survival (DFS) than those in the CATO high-risk PTMC subgroup. But there was no significant difference in recurrence or DFS between Kuma low-risk and high-risk Kuma PTMC subgroups.The Chi-square test of Fisher′s exact probabilities test was used to compare clinicopathological characteristics of patients between different groups.Rates of disease-free survival were calculated using the Kaplan-Meier method.@*Conclusion@#CATO screening criteria is relatively strict and may be more suitable for Chinese patients with active surveillance for PTMC.
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Thyroid papillary carcinoma harbors higher rate of lymph node metastasis, so neck dissection is an important part of the treatment. Due to better prognosis, attention to postoperative function and appearance of the patients increased. Low-collar incision with cervical sensory nerve plexus preservation modiifed neck dissection can improve appearance and function in postoperative patients and is gradually applied in clinic. This review mainly examines the thoroughness and safety of this new neck dissection in thyroid papillary carcinoma patients.
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Schwannomas of the vagus nerve (SVN) and schwannomas of the cervical sympathetic nerve (SSN) are the two most common schwannomas in the carotid space. Because schwannomas are asymptomatic, moreover, the vagus nerve and the cervical sympathetic nerve have adjacent anatomical location, it is diffcult to differentiate SVN or SSN. In addition, the current surgical treatment of schwannomas still remains controversial. This article summarized the studies on SVN and SSN, and meanwhile discussed the advances in the diagnosis and management of the disease.
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Background and purpose: The aim of this study was to determine the necessity of central compartment neck dissection in laryngeal cancer.Study Design: Retrospective study at a tertiary referral medical center. Methods:Patients with laryngeal squamous cell cancer who underwent neck dissection were evaluated, and a retrospective analysis of clinicopathologic factors and follow-up data were performed. Results: One hundred and eighteen patients from 1999 to 2009 were enrolled. There were 11.9% central compartment lymph node metastasis in all patients, including the 10 patients with central compartment lymph node metastasis in 34 patients underwent compartment neck dissection and 4 patients do not underwent compartment neck dissection but had central neck recurrence in the follow up time. Subglottic or pyriform extension were risk factors in central compartment lymph node metastasis and central neck recurrence (P=0.002). Central compartment lymph node metastasis had closed relationship with levelⅣmetastasis (P<0.001), extracapsular extension (P=0.001), vascular extension (P=0.015) and poor local control rates (P=0.035) respectively. Patients who were positive for lateral neck lymph node metastasis had poor disease-free survival rate (P=0.014) and poor local control rates (P=0.025), and supraglottic cancer had a trend to metastases to levelⅡ(P=0.044). Conclusion:Central compartment neck dissection might be considered a potential therapeutic approach for patients with laryngeal cancer.
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Background and purpose:Although cervical lymph node metastases is commonly found, papillary thyroid cancer(PTC) has a fairly good prognosis. The microarray or gene chip technique is an effective method to explore the biological behavior of cancers. This study aims to measure the differential expression of genes between papillary thyroid cancer with lymph node metastasis and normal thyroid tissue with the new technology. Methods:The total mRNA was extracted from the specimens of papillary thyroid cancer with lymph node metastasis and normal thyroid tissues. Both of samples were labeled with fluorescent Cy5 or Cy3, and then hybridized to the gene chip which it includes 14 112 human functional gene fragments. Differentially expressed genes were screened out by scanning and analyzing the fluorescent signals.Results:There are 1 212 differentially expressed gene fragments between the two groups that it account for 8.71% of the total sites. Among them, 22 sites showed remarkable difference with either upregulation or downregulation more than 8 times fold, 2 of 6 downregulation sites represent one same gene sequence: NM-001920, which is the mRNA of the protein decorin.Conclusions:Gene chip is an effective method to study the change of gene expression during the progression of a disease. As to PTC, it involves many genes. Decorin may be an important biomarker for the prediction of metastases to the cervical lymph nodes in PTC.
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Objective To study the value of CT in confirming the diagnosis of schwannoma of the cervical sympathetic nerve ( SSN) or vagus nerve (SVN) before operation.Methods From October 1988 to March 2001,45 SSNs and 14 SVNs confirmed by surgery and pathology were analyzed to discover the rules of displacement of common carotid artery (A),internal carotid artery (I) and internal jugular vein (V). Results 43 SSNs located at the level of common carotid bifurcation or/and upper neck with A or/and I abutting against and displacing to the lateral periphery of the tumor.In 35 SSNs with enhanced CT,the V was also abutted against and displaced to the lateral periphery of the tumor.The rest two SSNs located at the root of the neck with A and V anterolateral to but not abutting against the tumor.The growth of 12 SVNs all resulted in separation between the A or I and the V.The A or I was displaced to the medial periphery of SVN and the V to the lateral periphery.Their distance was 90? to 180?. Conclusion During the growth of SSN or SVN,the CT axial scan can still accurately reflect the anatomical positional relationships among A,I,and V with the cervical sympathetic nerve or vagus nerve.So CT is a very valuable tool in confirming the diagnosis of SSN or SVN preoperatively.
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Thyroid neoplasm is one of the most common endocrinal tumors. In general, thyroid cancer patients are usually presented with asymptomatic neck nodules. A differential diagnosis between malignant and benign thyroid neoplasm is very important for these patients. This review article primarily discusses biological markers used to aid the differential diagnosis of thyroid neoplasia, which may lead to a more rational approach to the treatment. It mainly describes the recent development of molecular biological markers VEGF-C, Cytokeratin-19, HBME-1, Pax8-PPAR and Galectin-3 for the differential diagnosis of thyroid neoplasms.
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Human papillomavirus is an oncogenic DNA virus and has more than 90 subtypes. High risk types (HPV 16, 18, 33) are associated with many kinds of malignant neoplasms of head and neck. The HPV DNA can induce mutations of p53, RB genes and increase cell transformation and over proliferation. The frequences of HPV positive are different in malignant neoplasms from different head and neck sites. HPV was more often detected in squamous cell carcinoma of oral cavity, oropharynx and larynx. In nasopharyngeal carcinoma, adenocarcinoma or lymphoma, the expression of HPV was quite low. The detection of HPV in cervical metastatic lymph nodes can improve diagnosis of primary sites.
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Purpose:To analyze the patterns of cervical lymph node metastasized from different primary sites of head and neck cancers based on computed tomography (CT) imaging study.Methods:We studied the CT showing the positional relationship between 160 patients with different primary sites of head and neck squamous cell carcinoma and their cervical lymph node metastases using our new modified classification retrospectively.Results:The metastatic rates of level Ⅱa, Ⅱc and Ⅴ were significantly different between nasopharyngeal and non nasopharyngeal carcinoma ( P