Preoperative comprehensive malignancy risk estimation for thyroid nodules: Development and verification of a network-based prediction model

BackgroundIn order to avoid excessive treatment of thyroid nodules in the clinic, it is necessary to find a simple and practical analysis method to comprehensively and accurately reflect benign or malignant thyroid nodules. This study aimed to construct and validate a comprehensive and reliable network-based predictive model using a variety of imaging and laboratory criteria for thyroid nodules to stratify the risk of malignancy prior to surgery.MethodsWe retrospectively analyzed data from patients who underwent surgical treatment for thyroid nodules at the Thyroid and Breast Diagnosis and Treatment Center of Weifang Hospital of Traditional Chinese Medicine between January 2018 and December 2020. Binary logical regression analysis was performed to predict whether nodules were malignant or benign. The developmental dataset included 457 patients (January 2018–December 2020). The validation set included separate data points (n = 225, January 2018–December 2020).ResultsIn this study, criteria that showed significant predictive value for malignant nodules included TI-RADS: 4b (p = 0.065); Bethesda IV, Bethesda V, Bethesda VI (P < 0.0001); BRAF^V600E mutation (P < 0.0001); Calcitonin>5 pg/ml (p = 0.0037); and FNA-Tg>30 ng/ml (p = 0.0003). A 10-grade risk scoring system was developed. The risk of malignancy risk ranged from 2.06% to 100% and was positively associated with increasing risk grade. The areas under the receiver-operating characteristic curve of the development and validation sets were 0.972 and 0.946, respectively.ConclusionA simple, comprehensive and reliable web-based predictive model was designed using a variety of imaging and laboratory criteria to stratify thyroid nodules by probability of malignancy.     

基于TCGA数据库乳头状甲状腺癌miRNA预后风险模型的建立与分析CSCD

目的构建基于微小RNA(miRNA)表达的预测乳头状甲状腺癌(papillary thyroid carcinoma,PTC)患者预后的生存模型。方法从TCGA数据库官方网站上下载PTC miRNA测序数据和患者的临床资料,利用R3.6.0软件中的edgeR包筛选表达失调的miRNA。利用单因素Cox及Lasso回归分析筛选出与患者预后相关的miRNA(P<0.05),进一步使用多因素Cox回归分析建立预后模型的风险评分方程risk score,构建生存预后模型,使用受试者工作特征曲线(ROC)来评价模型的敏感度和特异性。结果与正常甲状腺组织相比,PTC组织中失调表达的miRNA共有75个(|log foldchange|≥2,FDR<0.05),多因素Cox回归分析最终得到基于8个miRNA(hsa-mir-6730、hsa-mir-4709、hsa-mir-196a-2、hsa-mir-146b、hsa-mir-6860、hsa-mir-509-3、hsa-mir-513c、hsa-mir-515-1)的预测患者预后的风险模型。ROC曲线下面积(AUC)分析显示,该模型具有较好的敏感度和特异性(AUC>0.8)。结论成功构建了基于miRNA表达的风险预测模型,该模型可有效预测PTC患者的预后。     

福建平潭综合实验区2013—2015年甲状腺癌发病调查分析

目的 调查核实平潭综合实验区甲状腺癌是否高发,并分析其发病特征。方法 选择福建省肿瘤发病报告系统中发病日期为2013—2015年的平潭户籍甲状腺癌病例;通过查阅医院病历资料核实基本信息和诊断信息,随访排除非户籍病例。计算粗发病率、标化率、累积率,分析甲状腺癌在不同性别、年龄发病情况,及不同病理类型和不同大小肿瘤的构成。中国人口标化率根据2000年中国标准人口构成计算,世界人口标化率按Segi′s世界人口构成计算。结果 2013—2015年平潭综合实验区甲状腺癌新发病例共881例;其中男性205例,女性676例。甲状腺癌粗发病率为69.30/10万,中标率为65.27/10万;男性粗发病率及中标率分别为31.78/10万和29.87/10万;女性粗发病率及中标率分别为107.95/10万和101.19/10万;女性发病是男性的3.18倍。男、女性中位发病年龄分别为46岁和47岁。男性在40-年龄组达到发病高峰,女性在45-年龄组和55-年龄组形成两个发病高峰。乳头状癌、滤泡状癌、髓样癌及其他病理类型占比分别为96.52%、1.80%、0.60%和1.08%。肿瘤最大径≤10 mm的微小癌占77.29%。结论 平潭综合实验区甲状腺癌发病高于同期福建省及全国平均水平,以乳头状癌为主,微小癌占比较高。     

软坚散结法治疗甲状腺结节有效性 和安全性Meta分析

目的:系统评价具有软坚散结功效的中药复方治疗甲状腺结节的疗效和安全性。方法:检索具有软坚散结功效的中药复方治疗甲状腺结节的RCTs,进行方法学质量评价并提取数据,用Revman5.3软件进行Meta分析。结果:纳入34篇临床随机对照试验。分析结果显示中药+西药组vs西药组、中药组vs西药组,在总有效率、甲状腺结节直径缩小方面差异有统计学意义。结论:中药治疗甲状腺结节疗效优于西药治疗,且不良反应少,相对安全。     

一例分化型甲状腺癌患者健康管理全科医生教学案例分析

甲状腺癌已成为北京市增长较快的恶性肿瘤。本文通过介绍1例由全科医生首诊、术后连续随访4年的分化型甲状腺癌患者的诊疗经过，采用临床案例教学方法，重点关注甲状腺结节良恶性的鉴别，全科医生接诊甲状腺结节患者的诊治流程及对甲状腺癌患者术后长期监测、健康管理的内容，引导患者规范诊治，以期为逐步实现甲状腺癌患者个体化、不同风险分层的高质量管理，提高在职全科医生、全科医学专业住院医师规范化培训的学员对甲状腺结节、分化型甲状腺癌患者的规范诊治水平，提供参考。     

The prognostic value of lymph node ratio in Medullary thyroid carcinoma: A multi-center study

IntroductionThe lymph node ratio (LNR), which represents the proportion of metastatic lymph nodes resected, has been found to be a prognostic variable in several cancers, but data for Medullary thyroid carcinoma (MTC) are sparse. The aim of this study was to determine the value of the LNR in predicting outcome in patients with MTC.Materials and methodsA retrospective multicenter study design of 107 patients with MTC who underwent total thyroidectomy with neck dissection between 1984 and 2016. The association of LNR with patient and tumor characteristics and prognostic factors was evaluated.ResultsStudy population consisted of 53.3% female, mean age at diagnosis was 50.3 ± 18.4 years; 16.8% had inherited MTC. LNR was positively correlated with tumor size (p = 0.018) and inversely correlated with age at diagnosis (p = 0.024). A higher LNR was associated with extrathyroidal extension (p < 0.001), multifocality (p = 0.001), bilateral tumor (p = 0.002), distant metastases (p < 0.001), and tumor recurrence (OR = 14.7, p < 0.001). LNR was also correlated to postoperative calcitonin levels (p < 0.001) and carcinoembryonic antigen (p = 0.011). LNR >0.1 was associated with shorter disease-specific survival in patients at risk: tumor larger than 20 mm at diagnosis (p = 0.013), sporadic MTC (p = 0.01), and age above 40 years at diagnosis (p = 0.004). Cox multivariate survival analysis revealed LNR as the only significant independent factor for disease free survival (p = 0.005).ConclusionsThis study showed that LNR correlates well with patient and tumor characteristics and prognostic variables. We suggest that LNR should be considered an important parameter for predicting outcome in MTC.     

基于聚类分析和因子分析的肺小结节患者中医证候特点研究

目的分析肺小结节患者中医证候分布特点,为中医治疗肺小结节提供参考依据。方法收集385例肺小结节患者中医四诊信息,运用聚类分析、因子分析方法对肺小结节患者的中医证候特点和分布规律进行分析。结果肺小结节患者中医症状以虚为主,神疲乏力、夜寐不安、舌红、咳嗽、口渴、口干咽燥、面萎黄、气短、脉细弱、食少纳呆等居多。中医证候以肺脾气虚证最多,占52.2%,其余依次为肺阴亏虚证、气虚血瘀证、肝肾不足证。肺脾气虚证主症为喘息、大便稀溏、腹胀、食少纳呆、神疲乏力、自汗、舌淡红、齿痕舌、苔薄白、脉细弱,次症为夜寐不安、面萎黄;肺阴亏虚证主症为口干咽燥、口渴、咳嗽、痰少难咳、盗汗、痰中血丝、裂纹舌、苔少、脉细,次症为烦躁易怒、面红润、舌红;气虚血瘀证主症为头晕、胸痛、气短、面晦黯、舌黯红,次症为心悸;肝肾不足证主症为胸胁隐痛、喜太息、脉细弦、苔白、腰膝酸软、胸闷、耳鸣、便秘,次症为浮肿。结论肺小结节中医证候以肺脾气虚证、肺阴亏虚证、气虚血瘀证、肝肾不足证为主,正气亏虚是肺小结节变化发展的主要病机。