Predictive value of preablative stimulated thyroglobulin in detection of distant metastases in children and adolescents with differentiated thyroid cancer / 中华核医学与分子影像杂志

Objective:To explore the value of preablative stimulated thyroglobulin (ps-Tg) in predicting distant metastasis (DM) at the time of 131I therapy in children and adolescents with differentiated thyroid cancer (DTC). Methods:From January 2016 to March 2020, 54 children and adolescents who underwent total thyroidectomy due to DTC in Peking Union Medical College Hospital were retrospectively reviewed and divided into 2 groups according to the presence of DM or not: M0 group( n=29, 10 males, 19 females, age (16.3±3.8) years) and M1 group( n=25, 13 males, 12 females, age (12.4±4.3) years). Independent-sample t test, χ2 test (or Fisher′s exact test) and Mann-Whitney U test were used to analyze the general characteristics between the two groups. According to status of regional lymph node (RLN) at the time of 131I therapy, the two groups were further divided into M1RLN+ ( n=8) and M1RLN-( n=17), M0RLN+ ( n=5) and M0RLN-( n=24) subgroups. Mann-Whitney U test was used to analyze the different ps-Tg levels between M0 and M1, M1RLN+ and M1RLN-, as well as M0RLN+ and M0RLN-groups. The receiver operating characteristic (ROC) curve analysis was employed to obtain a cut-off value of ps-Tg as a predictor of DM. Results:Patients with DM tended to have higher ps-Tg level (medians: 406.80 μg/L vs 7.90 μg/L, U=690.000, P<0.001), younger age ( t=-3.559, P=0.001), larger tumor size ( t=3.523, P=0.001), more advanced T stage ( U=506.500, P=0.010) and more multifocality( P=0.013) in comparison with those without DM. Though ps-Tg did not significantly differ between M1RLN+ group and M1RLN-group ( U=98.500, P>0.05) or between M0RLN+ group and M0RLN-group ( U=63.000, P>0.05), the two RLN+ groups tended to hold higher medians than the two RLN-groups (18.05 vs 5.71 μg/L; 1 698.50 vs 216.40 μg/L). In order to avoid the possible influence on the ps-Tg cut-off value, 13 RLN+ samples were removed, and the area under the ROC curve was 0.946 (95% CI: 0.883-1.000). The ps-Tg level of 55.87 μg/L was established as the optimal cut-off value to distinguish M0RLN- from M1RLN-, with the sensitivity and specificity of 14/17 and 95.8%(23/24), respectively. Conclusion:Ps-Tg holds a high predictive value in identifying DM, which may be of great help in avoiding inadequate 131I treatment in children and adolescents with metastatic DTC ignored by radiological examinations.

Effect of / 中国针灸

OBJECTIVE@#To observe the efficacy of @*METHODS@#A total of 58 participants were included. Of them, 29 patients with insomnia were included into an observation group, and 29 healthy participants were included into a control group. The patients in the observation group were treated with @*RESULTS@#The total effective rate was 89.7% (26/29) in the observation group. In the observation group, the scores of PSQI, ISI and DISS, the A, B speed of NCT were all decreased after treatment (@*CONCLUSION@#The

Perioperative localization of ectopic functioning parathyroid gland in patients with hyperparathyroidism / 中华普通外科杂志

Objective:To investigate the value and influence factors of preoperative and intraoperative localization of ectopic hyperparathyroidism (EHPT).Methods:Results of 99mTc-sestamibi ( 99mTc-MIBI), neck ultrasound, contrast CT and intraoperative local venous parathyroid hormone (IOLVPTH) were retrospectively analyzed in 205 patients with primary hyperparathyroidism (PHPT) suspected of EHPT. Results:Incidence of EHPT was 16.6% (34 cases), and 36 ectopic lesions were detected. The proportion of EHPT in antero-superior mediastinum, intrathyroidal, in the retropharyngeal region, in carotid sheath, in the prevertebral region and intrapericardial were 44.1% (15 cases), 29.4% (10 cases), 11.8% (4 cases), 5.9% (2 cases), 5.9% (2 cases) and 2.9% (1 cases), respectively. Contrast CT was the most sensitive (86.1%, 31 lesions/36 lesions) for EHPT, followed by 99mTc-MIBI (66.7%, 24 lesions/36 lesions), IOLVPTH monitoring (61.8%, 21 lesions/34 lesions) and neck ultrasound (55.6%, 20 lesions/36 lesions). Contrast CT was most sensitive,100% in detecting deep-located EHPT lesions, whereas IOLVPTH had advantages in detecting intrathyroidal EHPT lesions, with a sensitivity of 100.0%.The combined use of 99mTc-MIBI and neck ultrasound showed a sensitivity of 77.8% in the localization of EHPT. Conclusions:Contrast CT is highly sensitive in the localization of EHPT. The combined use of preoperative imaging and IOLVPTH monitoring helps to higher localization for EHPT.

Efficacy and safety of pregabalin for chronic neuropathic pain: A meta-analysis

@#To assess the efficacy and safety of pregabalin during short-term treatment in adults with neuropathic pain. We searched the PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Clinical Trials databases. Twelve eligible articles were finally selected. Efficacy outcomes included change in Daily Pain Rating Scale score (DPRS; 0 = ‘no pain’ to 10 = ‘worst possible pain’) and sleep interference score (0 = ‘pain does not interfere with sleep’ to 10 = ‘completely interferes’). Safety was based on adverse events, serious adverse events (SAEs) and the incidence of treatment emergent adverse events (TEAEs) .The authors used the Cochrane Collaboration’s Risk of Bias Tool to assess the risk of bias in included trials. Review Manager 5.3 was used for all statistical analyses. Data from 12 articles including 3,169 patients (pregabalin, n = 1,677; placebo, n =1,492) were analyzed. Mean changes in the daily pain rating scale score [MD=-0.65, 95%CI(-0.88,-0.41), P<0.001] and daily sleep interference score in patients that received pregabalin were compared to those that received placebo [MD=-0.81, 95%CI(-1.16,-0.46), P<0.001]. The incidence of any TEAE was significantly increased in patients that received pregabalin [OR=1.70, 95%CI (1.44,2.01), P<0.001]. Serious adverse events (SAEs) rate in the pregabalin group was higher than the placebo group [OR=2.09, 95%CI (1.49,2.93), P<0.001], while there was no significant difference in the incidence rate of discontinuation [OR=1.29, 95%CI (0.79,2.11), P = 0.31]. Comparative results revealed pregabalin (150-600 mg/day) significantly reduced the symptoms of neuropathic pain in adults and its safety was acceptable

Toxoplasmosis presenting with multiple cranial nerve palsies and cavernous sinusitis: A case report

@#Toxoplasmosis is a worldwide zoonosis caused by an intracellular protozoan parasite, Toxoplasma gondii. We report here a diabetic patient who was diagnosed as toxoplasmosis with multiple cranial nerve palsies and cavernous sinusitis. A 37-year-old male presented with an 11-day history of gingival pain, one day history of ptosis and diplopia. He has been having diabetes mellitus for 6 years, and has a history of contact with cats. After admission, his symptoms worsened with right 3rd to 7th cranial nerve palsies. The brain magnetic resonance imaging (MRI) showed cavernous sinusitis in the right sellar region. Serology for toxoplasma was positive for IgM and negative IgG. The patient was treated with oral clindamycin (900 mg/day) and dexamethasone (15 mg/day). The right visual acuity and lid-conjunctival swelling improved after 3 days. At follow-up after a month, the movement of the right eye significantly improved. This case demonstrate the rare occurrence of multiple cranial nerve (3rd to 7th) palsies from toxoplasmosis cavernous sinusitis, which is a potentially treatable condition.

Effect of Lymph Node Metastasis on Change of Positive Thyroglobulin Antibody in Differentiated Thyroid Carcinoma after Initial Treatment / 中国医学科学院学报

Objective To investigate the influence of lymph node metastasis on the change of positive thyroglobulin antibody(TgAb)in differentiated thyroid carcinoma after initial treatment.Methods We retrospectively analyzed the clinical data of 98 differentiated thyroid carcinoma patients with positive TgAb(≥115 IU/ml)before radioiodine(RAI)therapy.All of whom underwent total or near total thyroidectomy,neck lymph node dissection,and subsequent RAI therapy.Patients were divided into negative group(n=83)and non-negative group(n=15)according to the disappearance of positive TgAb or not after a mean follow-up of 21.0 months.Analysis of variance,χtest,and Mann-Whitney rank-sum test were applied to compare the basic clinical features including number of metastatic lymph nodes,lymph node metastasis rate and node stage,and dose of RAI ablation.The receiver operating characteristic curves were employed to evaluate the predictive values of TgAb levels(negative or positive)and optimal cut-off points.Multivariate analyses were further performed to explore the independent indicators for persistent positive TgAb. Results Compared with the negative group,the proportions of N1a and N1b in the non-negative group were significantly higher,with no N0 in the non-negative group(Fisher's Exact Test,P=0.032).The median metastatic lymph node rate was also significantly higher in the non-negative group(Mann-Whitney U=-3.498,P=0.000).The cut-off value for metastatic lymph node rate to predicting disappearance of positive TgAb was 24%,and its sensitivity was 71.4%.The multivariate analysis showed that only lymph node stage(OR=3.183,P=0.038)was the independent indicator for persistent positive TgAb. Conclusions Lymph node stage was an independent indicator for the disappearance of positive TgAb.A metastatic lymph node rate of higher than 24% may be predictive for the disappearance of positive TgAb.

The relationship between the rate of involved lymph nodes and distant metastasis in papillary thyroid carcinoma / 中国癌症杂志

Background and purpose:Lymph node metastasis commonly occurs in papillary thyroid carcino-ma (PTC). The object of this study was to investigate the relationship between the rate of involved lymph nodes (LR) and distant metastasis (DM) in PTC, and its potential value in predicting the risk of DM.Methods:PTC patients were divided into two groups as M0 (121 cases) and M1 (41 cases) according to the presence of distant metastases or not. The t-text andχ2 test were used to evaluate the statistical differences in basic clinicopathological features between the two groups. Multivariate analysis was used to quantify LR as an independent factor of DM. The receiver operating charac-teristic (ROC) curve was employed to evaluate the clinical value of LR and the number of involved lymph node (LNs) for predicting DM and optimal cut-off point respectively. The cumulative risk of distant metastasis curves according to the LR and LNs status were constructed with the Kaplan-Meier method, and the Log-rank test was used to compare these curves.Results:There were no statistical differences in age and multifocality between two groups (P>0.05), while signiifcant differences in gender, extrathyroidal invasion and tumor size were observed. LR is an independent indicator for predicting DM (OR=1.133,P=0.000). An increase in LR was signiifcantly associated with DM. Patients with more than 15 involved LNs had the steepest increasing pattern in the cumulative risk of DM compared with those who had less than 15 involved LN (P=0.002).Conclusion:LR may be an independent predictive marker for distant metastases in PTC, and its combination with LNs might better predict the risk of DM.

The relationship between the number of dissected central lymph nodes and clinical outcome in pN1a papillary thyroid carcinoma / 中国癌症杂志

Background and purpose: Neck lymph node metastasis, most of which presents in central neck compartment, is common in patients with papillary thyroid carcinoma (PTC). The objective of this study was to investigate the relationship between the number of dissected central neck lymph nodes and clinical outcome after radioactive iodine (RAI) ablation in pN1a PTC with no more than 5 lymph nodes involvement. Methods: A total of 167 PTC patients who had 1-5 proven metastatic lymph nodes according to postoperative pathological diagnosis were retrospectively analyzed, all of whom underwent total or near total thyroidectomy and central lymph node dissection. After a median follow-up period of 26 months, the clinical outcome of each patient was evaluated as excellent response (ER), indeterminate response (IDR), bio-chemical incomplete response (BIR), or structural incomplete response (SIR) according to the new American Thyroid As-sociation guidelines. The accumulative ER rate (ERn) was calculated in patients with different numbers of dissected lymph nodes (ERn was defined as the proportion of patients who achieved ER with the dissected lymph node number of ≤n). The relationship between the number of dissected central neck lymph nodes and ERn were investigated. Results: As the increase in the number of dissected central neck lymph nodes,there was also an overall increase in ERn, especially when n rose from 1 to 10. The values of ER1, ER5, ER10 and ER30 were 25.0%, 66.7%, 74.7% and 79.1%, respectively. Besides, the proportion of patients who achieved ER was higher in those with 10 or more dissected lymph nodes than in those with less than 10 (85.7% vs 73.3%, P=0.05). In the multivariate logistic regression analysis, both the dissected central lymph node number of ≥10 (OR=2.720, 95%CI: 1.052-7.033, P=0.039) and the level of preablation stimulated thyroglobulin (OR=0.955, 95%CI: 0.926-0.984, P=0.003) were shown to contribute independently to ER. Conclusion: As the increas-ing number of dissected central neck lymph nodes, the percentage of pN1a PTC patients that achieved ER after RAI ablation generally rises. In pN1a PTC patients with no more than 5 lymph nodes involvement, a central compartment dissection with 10 or more lymph nodes might help them achieve ER after RAI ablation.

Analysis of incidence and mortality for upper digestive tract cancers and results of early detection and treatment program in Feicheng, Shandong Province / 中华预防医学杂志

Objective@#To investigate the trend of esophageal and stomach cancer incidence and mortality in Feicheng during 2000 to 2013, and to evaluate the effects of the national project of screening for upper digestive tract cancers from 2006 to 2015 in Feicheng.@*Methods@#We collected 26 569 cases, which were coded of C15 and C16 in the 10th edition of international classification of diseases (ICD) during the period of 2000-2013. The data came from cancer registration system of Feicheng, Shandong Province, China. These cases already covered 21 679 882 person-year. The annual percent change (APC) of incidence and mortalit were analyzed. The risk factors of upper gastrointestinal cancer were investigated and evaluated for people aging 40-69 in three street offices and eleven townships of Feicheng, and endoscopic screening was conducted among people who was in high risk. The corresponding data were used to analyze the early detection project of upper gastrointestinal cancer screening and early diagnosis, with the index of detection rate, early diagnosis rate, early treatment rate and other indicators.@*Result@#There were 26 569 new cases of esophageal cancer and gastric cancer occurred in Feicheng from 2000 to 2013. The incidence of esophageal cancer gradually increased since 2000 with 76.06 per 100 000 people (575/756 005) and reached the peak in 2010 with incidence rate of 118.76 per 100 000 people (852/717 429), with the annual percent change at about 4.3% (95%CI: 2.7%-5.9%) and showed a downward trend after then but has no significance, with APC about-7.1% (95%CI:-15.8%-2.5%). The incidence of gastric cancer was increased from 2000 with an incidence rate of 37.70 per 100 000 people (285/756 005) to 2013 with an incidence rate of 54.59 per 100 000 (538/985 512), with an annual percent change of about 3.3% (95%CI: 2.1%-4.5%). Esophageal cancer and gastric cancer mortality showed a relatively stable trend during 2000 to 2013, esophageal cancer with APC about 0.1% (95%CI: -1.3%-1.5%) and stomach cancer with APC about 0.8% (95%CI: -0.5%-2.0%). From 2006 to 2015, 58 579 residents aged 40-69 years old participated cancer screening project covered 206 105 populations in Feicheng. There were 1 124 invasive cancers and in situ cases from upper digestive tract were detected, with the detective rate at 1.92%. Among those cases, 941 cases were in early stage with the early diagnosis rate of 83.72%, and about 88.97% of detected patients received appropriate treatment after diagnosis.@*Conclusion@#The incidence of esophageal cancer and gastric cancer with a very high level of incidence and mortality, this made the prevention and control situation was still very serious. The project of cancer screening, early diagnosis and treatment on upper digestive tract cancers in Feicheng plays a positive role on cancer control.

Relationship between the initial change of Tg and outcome in differentiated thyroid carcinoma patients with pulmonary metastases after 131I treatment / 中华核医学与分子影像杂志

Objective To investigate the relationship between the initial change of Tg and clinical outcome in DTC patients with pulmonary metastases after 131I treatment.Methods A total of 47 DTC patients (13 males,34 females;average age (41.6±16.3) years) with pulmonary metastases from January 2008 to June 2014 were retrospectively analyzed.Patients were divided into 3 groups according to the variation of Tg: G1 with a declined (more than 50％) Tg;G2 with a declined (less than 50％) Tg or an increased (less than 10％) Tg;G3 with an increased (more than 10％) Tg.The median follow-up time was 1 501 d.Clinical outcomes were divided into remission,stable disease and progressive disease according to the serum test and imaging results.Data analysis was performed by χ2 test and Fisher exact test.Results The percentage of G1,G2,G3 patients was 44.7％(21/47),40.4％(19/47),and 14.9％(7/47) respectively.Results of follow-up showed 19.0％(4/21) patients achieved remission and 81.0％(17/21) with stable disease in G1.There were 2/19 with remission,12/19 with stable disease and 5/19 with progression disease in G2.All patients (7/7) had progressive disease in G3.The clinical outcome was related to the variation of Tg after 131I treatment (Fisher exact test,P<0.01).Conclusions Initial Tg after 131I treatment could be a predictor to the outcome of patients.The increased Tg level indicates a high possibility of 131I refractory disease.

Clinical Outcome of Radioiodine Therapy in Low-intermediate Risk Papillary Thyroid Carcinoma with BRAF(V600E) Mutation / 中国医学科学院学报

Objective To evaluate the impact of BRAF(V600E) gene status on clinical outcome of radioiodine((131)I) therapy in low-intermediate risk recurrent papillary thyroid carcinoma (PTC). Methods Totally 135 PTC patients were enrolled and divided into two groups according to BRAF(V600E) gene status:BRAF(V600E) mutation group(n=105) and BRAF(V600E) wild group(n=30). The median follow-up time was 2.16 years(1.03-4.06 years),and clinical outcome after initial (131)I ablation therapy was divided into excellent response(ER),acceptable response(AR),and incomplete response(IR) according to the serological and imageological follow-up results. The cinical outcomes were then compared between these two groups. Results There was no significant difference in clinicopathological features and initial radioactive iodine dose between BRAF(V600E) mutation and wild groups (P>0.05). ER,AR,and IR after (131)I ablation therapy accounted for 74.3%,20.0%,and 5.7% in BRAF(V600E) mutation group and 73.3%,20.0%,and 6.7% in BRAF(V600E) wild group,and no statistical difference was found (P=0.891). Conclusion For low-intermediate risk recurrent PTC,BRAF(V600E) gene status may have no impact on the response to (131)I ablation therapy,and thus this molecular feature should not be used as an independent weighting factor for risk assessment in this population.

Clinical Outcome of (131)I Therapy in Differentiated Thyroid Cancer with Preablative Thyroglobulin below 10 ng/ml / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical outcome of (131)I therapy in differentiated thyroid cancer (DTC) with preablative stimulated thyroglobulin (ps-Tg) below 10 ng/ml and the value of ps-Tg for predicting clinical outcome.</p><p><b>METHODS</b>Totally 167 DTC patients with ps-Tg below 10 ng/ml were included and divided into three groups [excellent response (ER, n=131), acceptable response (AR, n=34), and incomplete response (IR, n=2)] according to the response to initial (131)I therapy. One-way analysis of variance, χ(2) test, and Kruskal-Wallis test were used to evaluate the statistical differences of clinicopathological features, recurrence risk, and ps-Tg value among the three groups. The ps-Tg value between ER group and non-ER group were compared by Mann-Whitney rank-sum test. The ROC curve and optimal cut-off point were analyzed to evaluate the clinical value of ps-Tg for predicting disease-free status.</p><p><b>RESULTS</b>There was significant difference in ps-Tg level (H=14.305, P=0.001) among three groups but not in age (F=0.831, P=0.755), sex (χ(2)=0.178, P=0.915), cervical lymph node metastases (χ(2)=1.475, P=0.478), TNM stage (H=1.063, P=0.588), and recurrence risk (H=2.947, P=0.229). The median level of ps-Tg in ER group was 2.20 ng/ml (1.10, 4.40), which was significantly lower than 4.40 ng/ml (2.70, 5.90) of non-ER groups (U=1424.50, P=0.000). Area under the ROC curve was 0.717. The cut-off value of ps-Tg was 2.35 ng/ml,with a sensitivity of 83.33%, specificity of 53.43%, and negative predictive value of 92.11%.</p><p><b>CONCLUSION</b>The serum ps-Tg value is a sensitive marker for predicting the disease-free status in DTC patients with ps-Tg below 10 ng/ml.</p>

Response to (131)I Therapy in Non-metastatic Differentiated Thyroid CancerPatients with Preablative Stimulated Thyroglobulin above 10 ng/ml / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the response of (131)I therapy and to explore the influencing factors in non-metastatic differentiated thyroid cancer (DTC) patients with preablative stimulated thyroglobulin (ps-Tg) above 10 ng/ml.</p><p><b>METHODS</b>The study included 157 DTC patients who had undergone total or near total thyroidectomy and subsequent (131)I therapy with ps-Tg>10 ng/ml, and they were divided into 3 groups as excellent response (ER, 49 cases), acceptable response (AR, 36 cases), and incomplete response (IR, 72 cases) according to the response to (131)I therapy. We compared the clinicopathologic features and ps-Tg levels among 3 groups, as well as ps-Tg levels between IR and non-IR groups. The ROC curve was employed to evaluate the predictive value of ps-Tg levels in (131)I therapy responses.</p><p><b>RESULTS</b>The three groups showed significant difference in ps-Tg levels (H=35.142, P<0.001), gender (χ(2)=6.82, P=0.033), extrathyroid invasion (H=31.380, P<0.001), and lymph metastases (H=14.375, P=0.001). The ps-Tg level in IR is higher than that in non-IR (U=1384.5, P<0.001), while it was not significantly different between ER and AR (U=771.5, P=0.326). The diagnostic critical point (DCP) of ps-Tg to differentiate IR and non-IR was 28.3 ng/ml (sensitivity 57.5%, specificity 87.1%), with a corresponding area under the ROC curve (AUC) of 0.774 (95%CI: 0.701-0.847).</p><p><b>CONCLUSIONS</b>Near-half (45.86%) non-metastatic DTC patients with ps-Tg above 10 ng/ml are more susceptible to IR. The level of ps-Tg>28.3 ng/ml may be a useful and sensitive diagnostic marker for predicting incomplete response.</p>

Outcome of radioiodine therapy in patients with papillary thyroid carcinoma concurrent with Hashimoto's thyroiditis / 中华核医学与分子影像杂志

Objective To evaluate the impact of low-dose 131I therapy and high-dose 131I therapy on the clinical outcome in PTC patients coexisting with Hashimoto's thyroiditis (HT).Methods A total of 140 non-distant metastatic PTC patients (16 males,124 females,age range:16-66 years) from July 2010 to December 2014 were enrolled in this retrospective study.Patients concurrent with HT (n=84,group A) were divided into low-dose group (1 110 MBq,n=56,group A1) and high-dose group (5 550 MBq,n=28,group A2) according to 131I ablation dose.Patients without HT (n =56) were enrolled as control group (group B),and received 1 110 MBq of 131I.The thyroid remnant ablation outcome was evaluated according to 131I diagnostic whole-body scan (Dx-WBS),neck ultrasonography (US),serum Tg and TgAb level 6-8 months after 131I ablation therapy.The successful ablation rates were compared by x2 test.Kruskal-Wallis rank sum test was also used.Results There were no significant differences among the 3 groups in terms of both clinicopathological features and postoperative remnant thyroid (H:0.203-2.944,x2:0.271-0.970,all P＞0.05).When negative Dx-WBS and US were deemed as successful ablation criterion,complete ablation rate was found significantly more in group B (94.6％,53/56) than that in group A1 (82.1％,46/56;x2=4.264,P＜0.05),but no significant difference was found between group A2 (85.7％,24/28) and group A1 (x2 =0.318,P＞0.05).When combining negative sTg (sTg＜1 μg/L,TgAb＜46 kU/L) with the above 2 criterions to assess remnant ablation outcome,group B also had a higher successful rate to achieve complete ablation (85.7％,48/56) compared with group A1 (75.6％,34/45),but without statistical significance (x2=2.978,P＞0.05),and no difference was observed between group A2 (12/15) and group A1 (x2=1.320,P＞ 0.05).Conclusion Non-distant metastatic PTC patients coexisting with HT has undesirable 131I ablation outcome compared with those without HT,increasing 131I dose is unhelpful to enhance efficiency of remnant ablation for PTC patients with HT.

The impact of lymph node metastatic rate on clinical outcome following131I therapy in patients with papillary thyroid carcinoma / 中国癌症杂志

Background and purpose:This study aimed to investigate the relationship between lymph node metastatic rate (LR) and response to radioiodine therapy in patients with papillary thyroid carcinoma (PTC).Methods:A total number of 143 PTC patients after radioiodine therapy were included and classified into 4 groups [Ⅰ(0%-10%),Ⅱ(>10%-25%),Ⅲ(>25%-50%),Ⅳ(>50%)] according to the lymph node metastatic rate, and the responses to initial radioiodine therapy after a median follow-up period of 20.7 months were evaluated. They were classiifed into 4 groups [excellent response (ER), indeterminate response (IDR), biochemical incomplete response (BIR), and struc-tural incomplete response (SIR)] according to the guideline proposed by 2015 American Thyroid Association. One-Way analysis of variance,χ2 test and Kruskal-Wallis test were used to evaluate the differences in basic clinicopathological features and clinical responses among the 4 groups. The ROC curve was analyzed to evaluate the clinical value of lymph node metastatic rate for predicting ER and optimal cut-off point.Results:There were no signiifcant differences in gender and T-stage among 4 groups (P>0.05). However,Ⅰ group was signiifcantly older than the other 3 groups (P=0.001). With the increase of lymph node metastatic rate, the number of ER cases decreased, while cases of BIR and SIR generally increased. Compared with the other 3 groups, less cases of ER (27.8%), while more BIR (27.8%) or SIR (11.1%) were observed in groupⅣ (H=18.816,P=0.000). Cut-off value of lymph node involved rate was 52.27%, with a better speciifcity of predicting ER. Area under the ROC curve was 0.668.Conclusion:The higher lymph node metastatic rate in patients with PTC, the worse clinical outcome it could be. A cut-off value of lymph node metastatic rate 52.27% is a speciifc independent predictor for the clinical outcome in PTC patients treated with radioiodine therapy.

Analysis of the clinicopathological characteristics for 1 306 cases of thyroid cancer in Qingdao / 中国癌症杂志

Background and purpose:The incidence of thyroid cancer (TC) is increasing worldwide. However, there were some differences among different regions. The purpose of this study was to investigate the incidence trends and clinicopathological characteristics of TC in Qingdao, a typical eastern coastal city, and to analyze the change in etiological spectrum of surgical thyroid diseases in recent years.Methods:A total of 2 251 patients who underwent thyroidectomy in 2014 due to thyroid nodules at the Affiliated Hospital of Qingdao University were retrospectively reviewed. The clinico-pathological characteristics were further analyzed among 1 306 patients with TC and compared with the corresponding data from the Surveillance Epidemiology and End Results (SEER) database as well as previous data from this hospital.Results:With the increasing number of thyroidectomy in Qingdao, there was also an increase in the proportion of TC in patients after thyroidectomy, from 34.8% in 2010 to 59.0% in 2014. Among those with TC, the male-to-female ratio was 1∶2.80, with a relatively high incidence among 20-54 year-old adults, who were younger than those reported in terms of distribution of age in SEER database (U=2 289,P=0.000). About 50.2% of the TC patients were overweight or obese, 78.2% TC patients had only asymptomatic nodules detected by ultrasound at initial diagnosis, while 16.6% had visible or palpable thyroid nodules. Only 5.2% presented hoarseness or other repression symptoms. Micro-carcinoma accounted for 61.7% of TC in 2014 at this hospital, which was significantly higher than the proportion in 2010 (37.7%). Lymph node involvement was significantly more frequent at this hospital than in SEER database (49.5%vs 26.0%,χ2=11.806,P=0.001). Even among patients with micro-carcinoma, 31.3% already presented lymph node metastases. The proportions of papillary, follicular, medullary and anaplastic carcinoma were 97.5%, 1.1%, 1.0% and 0.5%, respectively, among which the percentage of papillary carcinoma was higher than that in SEER database (U=4 654.5,P=0.055).Conclusion:There was an increase in the number of thyroidectomy in Qingdao, and the preoperative diagnostic accuracy of TC in this area kept rising. The in-cidence of TC was relatively high in a younger population, with more common lymph node involvements and an overweight trend. The increasing proportion of micro-carcinoma might be related to the popularization of health examination. However, the frequent lymph node metastasis in patients with micro-carcinoma is an important indicator of the invasive behavior of micro-carcinoma, which should not be overlooked.

Change of pre-ablative thyroid-stimulating hormone after thyroid hormone withdrawal and its response to 131I therapy in patients with low to intermediate risk differentiated thyroid cancer / 中华核医学与分子影像杂志

Objective To investigate the relationship between the change of pre-ablative TSH after thyroid hormone withdrawal(THW) and the response of subsequent 131I therapy in patients with low to intermediate risk DTC after total or near total thyroidectomy.Methods A total of 120 DTC patients (38 males,82 females,age (40.8±10.9) years) were enrolled in this retrospective study.Serial TSH levels determined on the day of THW and on the day of receiving 131I ablative therapy were monitored,which were marked as TSH1 and TSH2 accordingly.The THW duration (t) was recorded,the change of TSH was defined as △TSH and the change rate of TSH was calculated (V=△TSH/t).The responses to 131I therapy were classified as excellent response (ER),indeterminate response (IDR),biochemical incomplete response (BIR) and structural incomplete response (SIR) according to ATA guideline.According to the TSH2(mU/L) levels,patients were divided into G1 group (30≤TSH2＜60),G2 group (60≤TSH2＜90),G3 group (90≤TSH2＜ 120),G4 group (120≤TSH2＜150) and G5 group (TSH2 ≥ 150).Clinical and pathological features,THW duration,the change rate of TSH,residual thyroid,131 I dose and follow-up time were compared among these groups.In order to evaluate the relationship between response to 131I ablation and change rate of TSH,patients were divided into V1 group (V≤2.5),V2 group (2.5＜V≤5.0) and V3 group (V＞5.0),and their responses to 131I ablation were compared.Patients were classified into RI group (including ER and IDR)and R2 group (including BIR and SIR),the differences of clinical and pathological features,131I doses between the two groups were explored.Furthermore,logistic regression was performed to identify factors associated with BIR and SIR.Results Patients with male gender (x2=11.863),younger age (F =4.975),and faster TSH change rate (H =44.911) and lower thyroid residue (H =18.159) achieved a higher value of TSH2(all P＜0.05).G3 group presented the highest rate of ER (83.8％,31/37).The percentage of ER + IDR in V2 group was higher than those in V1 group and V3 group,which was 92.4％ (61/66),85.7％ (18/21) and 5/7,respectively,but the difference was not significant (U=407.5,P＞0.05).TSH2 level (OR=0.835) and pre-ablative Tg level (OR =1.196) were independent factors in predicting BIR and SIR (both P＜0.05).Conclusions The changing rate of TSH before 131 I ablation may not be associated with the response to 131I therapy in patient with low to intermediate risk DTC,while the level of TSH2 does.Patients with TSH2 ranging from 90 to 120 mU/L could be of help in achieving a better clinical response.

Effect of Selenious Yeast Tablets on the Thyroglobulin Antibody Level in ThyroglobulinAntibody-positive Patients with Differentiated Thyroid Cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the change of thyroglobulin antibodies (TgAb) after the application of selenious yeast tablet (SYT) in differentiated thyroid cancer (DTC) patients with positive TgAb (>115 U/ml).</p><p><b>METHODS</b>We enrolled 41 DTC patients with positive TgAb who had undergone total thyroidectomy and subsequent ¹³¹I therapy as well as applied SYT in group 1 (G1). Patients with an interval of more than 6 months between SYT use and ¹³¹I therapy or with repeated TgAb measurements before the use of SYTs were divided into group 2 (G2) and group 3 (G3), respectively. Changes in TgAb after application of SYT in both G1 and G2 were observed and analyzed by rank sum test. Comparison of TgAb gradient over certain time before and after the application was analyzed by t-test.</p><p><b>RESULTS</b>The proportions of patients with decreased or elevated TgAb were 85.4% and 14.6% in G1 and 90.9% and 9.1% in G2, respectively. Compared with the previous TgAb levels, TgAb decreased significantly after the application of SYT in either G1 (P=0.000) or G2(P=0.003). In G3, the TgAb level rose by 5.6% every month before applying SYT and fell 8.3% every month after the application (P=0.086).</p><p><b>CONCLUSION</b>Application of SYT in DTC patients with positive TgAb can effectively decrease the TgAb level.</p>

Relationship between Variation of Pre-ablation Stimulated Thyroglobulin and Distant Metastasis in Patients with Differentiated Thyroid Cancer / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the relationship between the dynamic variation of pre-ablation stimulated thyroglobulin(sTg)and distant metastasis in patietns with differentiated thyroid cancer(DTC).</p><p><b>METHODS</b>DTC patients after total or near total thyroidectomy were divided into two groups as M1 group(n=38)and M0 group(n=130)according to the presence of distant metastases or not. Clinical data including pre-ablation sTg and the corresponding thyrotropin(TSH)values were dynamically measured. The pre-ablation sTg and corresponding TSH collected at the first time were defined as Tg1 and TSH1,while as Tg2 and TSH2 at the last time. χ(2) test was used to compare the variation tendency of sTg between these two groups. Tg1,Tg2,pre-ablation sTg variation(∆Tg),and ∆Tg/∆TSH ratio between M0 and M1 were compared by Mann-Whitney rank-sum test. The receiver operating characteristic(ROC)curves and diagnostic critical point(DCP)were employed to evaluate the predictive values of the above indicators.</p><p><b>RESULTS</b>Both Tg1 and Tg2 of M1 were significantly higher than those of M0(the Mann-Whitney rank-sum test:Tg1 P<0.001,Tg2 P<0.001). The corresponding areas under the ROC curve(AUC)to differentiate the two groups were 0.921 and 0.942,respectively. The cut-off value of Tg2,which was more accurate in predicting distant metastasis,was 24.3 ng/ml with a sensitivity of 92.11% and a specificity of 83.85%. Both ∆Tg and ∆Tg/∆TSH between these two groups were significantly different(the Mann-Whitney rank-sum test:∆Tg P=0.002,∆Tg/∆TSH P<0.001). ∆Tg/∆TSH worked better than Tg2 in predicting distant metastasis with both higher accuracy(87.50%)and higher specificity(86.92%).</p><p><b>CONCLUSIONS</b>Dynamically tracing pre-ablation sTg may improve the accuracy and specificity of distant metastases prediction in DTC patients. ∆Tg/∆TSH,which means the ratio of sTg variation to TSH variation,may be a useful diagnostic marker for predicting distant metastases in DTC.</p>

Clinical Efficacy of Dasatinib, Nilotinib and Imatinib in Newly Diagnosed Patients with Chronic-Phase Chronic Myeloid Leukemia: A Three-year Retrospective Analysis / 中国实验血液学杂志

<p><b>OBJECTIVE</b>To evaluate efficacy and safety of second-generation tyrosine kinase inhibitors (TKI) dasatinib, nilotinib and imatinib in treatment of newly diagnosed patients with chronic-phase chronic myeloid leukemia (CML).</p><p><b>METHODS</b>The clinical data and follow-up results of 163 patients with chronic-phase chronic myeloid lenkemia(CP-CML) who were treated in our hospital during the nearly 3 years were analysed retrospectively, among 163 patients 47 received dasatinib, 43 received nilotinib and 73 received imatinib. The efficacy, disease progression and safety were evaluated.</p><p><b>RESULTS</b>After treatment for 3 months, the rate of complete hematologic response(CHR) in three treatment groups were 77%, 79% and 67%, respectivily, CHR at 12 months in three treatment groups were 92%, 91% and 90%, respectively. By 3 months, the rates of complete cytogenetic response(CCyR) with dasatinib and nilotinib were higher than that with imatinib (55%, 53% vs 33%)(P<0.05 for both comparisons), CCyR at 12 months in three treatment groups were 86%, 88% vs 69% (P<0.05 for both comparisons). The rates of major molecular response(MMR) for dasatinib (11%) and nilotinib (9%) by 3 months were significantly higher than that for imatinib (1%) (P<0.05 for both comparisons), MMR at 12 months in three treatment groups were 49%, 50% and 28%, respectively (P<0.05 for both comparison). Progression to the accelerated or blast phase of CML occurred in 2 (4%) patients received dasatinib, 2 (5%) received nilotinib and 6 (8%) received imatinib. The safety profiles of these 3 second-generation TKI treatments were similar.</p><p><b>CONCLUSION</b>Both dasatinib and nilotinib induced strikingly higher and faster rates of complete cytogenetic response and major molecular response, with a statistically significant difference from imatinib.</p>