甲状腺乳头状微小癌颈侧区淋巴结转移相关因素分析

目的 分析甲状腺乳头状微小癌(papillary thyroid microcarcinoma,PTMC)的临床病理因素与颈侧区淋巴结转移之间的关系.方法 回顾性分析2007年1月至2010年12月本院收治的141例行中央区及颈侧区淋巴结清扫的PTMC患者资料,探讨患者临床病理因素与颈侧区淋巴结转移之间的关系.结果 141例PTMC患者中出现颈侧区淋巴结转移的有56例.单因素及多因素分析均发现肿瘤多发病灶、中央区淋巴结转移、合并桥本甲状腺炎及肿瘤位于甲状腺上极与颈侧区淋巴结转移显著相关(P＜0.05).9例患者(6.4％)出现淋巴结跳跃性转移,单因素分析发现肿瘤位于甲状腺上极与淋巴结跳跃性转移相关.结论 对于病理证实的PTMC患者,如出现肿瘤多发病灶、中央区淋巴结转移、合并桥本甲状腺炎及肿瘤位于甲状腺上极则需注意颈侧区淋巴结转移可能.淋巴结跳跃性转移发生少见,当肿瘤位于甲状腺上极时,即使中央区淋巴结未见转移,仍需注意颈侧区淋巴结转移可能.     

Treatment strategies and predicting lymph node metastasis in elderly patients with papillary thyroid microcarcinoma

This study aims to explore the prognostic variables for elderly papillary thyroid microcarcinoma (PTMC) patients as well as create a nomogram that could predict the occurrence of cervical lymph node metastasis (CLNM) on the basis of a large population database with high quality.A total of 5165 PTMC patients from Surveillance, Epidemiology, and End Results database database were enrolled in the study. In the meantime, we retrospectively collected 205 PTMC patients who underwent thyroidectomy in our medical center as an external control to test the accuracy of the model. The independent predictors of survival were identified by multivariate Cox regression analysis. Risk factors were selected as nomogram parameters to develop a model to predict CLNM. The C-index and calibration plots were used to evaluate CLNM model discrimination. The predictive nomogram was further validated in the external validation set.76.8% of the enrolled patients underwent thyroidectomy. Overall survival and cancer-specific survival were significantly better in patients who underwent surgery than in those who did not (P < .001). Sex, tumor size, and extent of tumor were included in a multivariable logistic regression model to predict lymph node metastasis. The nomogram had good discrimination with a C-index of 0.71. The calibration curves showed perfect agreement between nomogram predictions and actual observations.Elderly PTMC patients who received a surgical approach without radiotherapy showed survival advantage than those with other treatment strategies. Moreover, a nomogram model was established to predict the risk of CLNM, which will help clinicians in making treatment decisions.     

颈部淋巴结转移与甲状腺乳头状癌的治疗及预后

颈部淋巴结转移在甲状腺乳头状癌中较为普遍.尽管颈部淋巴结转移可独立预测甲状腺乳头状癌的复发,但其对于肿瘤预后的影响仍有争议.预防性中央区淋巴结对甲状腺乳头状癌患者的价值尚不清楚,尤其是术前无颈部淋巴结转移的临床或影像学证据时.对于存在危险因素的甲状腺乳头状癌患者,如男性、年龄大于45岁、肿瘤直径＞4 cm、多灶性和甲状腺外侵犯以及BRAF基因突变阳性等,术前应认真评估颈部淋巴结,必要时可行预防性中央区淋巴结清扫.     

单侧甲状腺乳头状癌伴同侧颈侧区淋巴结转移患者发生对侧中央区淋巴结转移的影响因素

目的 探讨伴同侧颈侧区淋巴结转移(LLNM)的单侧甲状腺乳头状癌(PTC)患者对侧中央区淋巴结(Cont-CLNs)转移的影响因素。方法 选取2018年7月至2022年7月江苏省原子医学研究所附属江原医院收治的LLNM-PTC患者127例,根据其是否发生Cont-CLNs转移,分成转移组(n=68)和非转移组(n=59)。收集患者的资料,包括性别、年龄、肿瘤大小、肿瘤回声、血流信号、有无微钙化、肿瘤数量、病变腺叶、结节性甲状腺囊肿、被膜侵犯、有无桥本甲状腺炎以及患侧中央区淋巴结、气管前淋巴结与喉前淋巴结转移发生率与术后并发症情况。采用二元logistic回归模型分析LLNM-PTC患者发生Cont-CLNs转移的影响因素。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。结果 转移组男性、微钙化、多发性肿瘤、被膜侵犯占比分别为75.00%(51/68)、47.06%(32/68)、55.88%(38/68)、47.06%(32/68),高于非转移组的37.29%(22/59)、16.95%(10/59)、18.64%(11/59)、15.25%(9/59),且转移组肿瘤最大径大于非转移组(P＜0.05)。转移组患侧中央区淋巴结、气管前淋巴结、喉前淋巴结转移率分别为51.47%(35/68)、44.12%(30/68)、50.00%(34/68),高于非转移组的20.34%(12/59)、15.25%(9/59)、16.95%(10/59),差异有统计学意义(P＜0.05)。二元logistic回归分析显示,男性、肿瘤太大、微钙化、多发性肿瘤、被膜侵犯、患侧中央区淋巴结转移、气管前淋巴结转移、喉前淋巴结转移是患者发生Cont-CLNs转移的独立危险因素,差异有统计学意义(P＜0.05)。结论 LLNM-PTC患者发生Cont-CLNs转移受多种因素影响,包括性别、肿瘤大小、微钙化、肿瘤数量、被膜侵犯以及患侧中央区、气管前、喉前的淋巴结转移,日后诊疗中需引起重视。     

Role of prophylactic ipsilateral central compartment lymph node dissection in papillary thyroid microcarcinoma

Central compartment lymph node (CCLN) management in patients without clinical or radiologic evidence of CCLN metastasis is debatable. The aim of the present study was to evaluate outcomes of surgery for papillary thyroid microcarcinoma (PTMC) with prophylactic ipsilateral CCLN dissection (PI-CCND) in a large cohort of patients treated at one single institution in a 5-year follow-up. Between January 2000 and December 2005, 2192 patients with papillary thyroid carcinoma underwent thyroid surgery. Inclusion criteria were patients with PTMC, absence of clinical or radiologic evidence of CCLN metastasis, and a follow-up for a period ≥60 months. Data from 842 patients were retrieved in the current retrospective cohort study. PI-CCND was routinely performed in addition to thyroid surgery in all cases. Ipsilateral CCLN metastasis was found in 218 patients (25.9%). Postoperative complications included 76 cases of transient hypoparathyroidism (9%), 11 cases of permanent hypoparathyroidism (2.6%), four cases of vocal cord palsy (0.5%), and one case of bleeding (0.1%). Univariate analysis and multivariate logistic regression analysis revealed that CCLN metastasis was statistically significantly correlated with tumor size and extracapsular invasion. Recurrence has been observed to date in 19 patients (2.26%). No CCLN site recurrence occured in patients who underwent PI-CCND. This study demonstrates the technical feasibility and safety of PI- CCND, which is a better way to determine lymph node status for a more accurate staging of disease and risk stratification. PI-CCND should be considered even if clinical or radiological exams are negative for CCLN metastasis.     

Density of tumor-associated macrophages correlates with lymph node metastasis in papillary thyroid carcinoma

Background: Tumor-associated macrophages (TAMs) have recently been recognized as being important players in the tumoriogenesis of many cancers, including advanced thyroid cancer. However, a role in papillary thyroid carcinoma (PTC), the most prevalent thyroid cancer, has not been established. We hypothesized that TAMs also facilitate tumor progression in PTC. Methods: We investigated TAMs density in both benign thyroid lesions and PTC tumors by CD68 immunostaining. CD68-positive cell density was further associated with the clinicopathological characteristics of PTC patients. Finally, TAMs were isolated from PTC tumors and phenotyped by cytokine and receptor profiling. Results: The overall density of TAMs was found to be significantly higher in PTC tumors, compared with thyroid goiter and follicular adenoma. The density of TAMs was positively associated with lymph node metastasis in TNM (tumor-node-metastasis) stages III/VI compared with stages I/II. No association was observed in other common tumor features, including the BRAF mutation. The isolated TAMs presented with high levels of M2-associated cytokine and receptors, making M2 the predominant TAM phenotype. Conclusions: TAMs may play a functional role in the progression of PTC.     

甲状腺乳头状癌TERT启动子突变与颈部淋巴结转移关系的Meta分析

目的 采用Meta分析评价甲状腺乳头状癌患者端粒酶逆转录酶启动子(TERTp)突变与颈部淋巴结转移之间的关系。方法 检索PubMed、the Cochrane Library、Embase数据库、Web of Science、中国知网数据库、万方全文数据库,搜集甲状腺乳头状癌患者携带TERTp突变的病例对照研究或队列研究,检索截至2023年7月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,使用Review Manager 5.4和STATA 17.0进行Meta分析。结果 共检出文献369篇,最终纳入33项研究,包括12 683例患者。Meta分析表明,携带TERTp突变的PTC患者较未发生TERTp突变的PTC患者,发生颈部淋巴结转移的风险更高。结论 TERTp突变会增加PTC患者颈部淋巴结转移风险,是预测PTC患者发生淋巴结转移的重要参考因素。     

分化型甲状腺癌颈部淋巴结转移的相关危险因素分析

目的分析分化型甲状腺癌(DTC)患者的超声及实验室检查结果,探讨影响DTC颈部淋巴结转移的因素。方法选取2019-01～2019-12于该院接受手术治疗且经术后病理确诊为DTC的133例患者资料,根据术后病理结果是否存在颈部淋巴结转移分为转移组(78例)和无转移组(55例)。收集两组患者的一般临床资料、实验室检查资料及超声检查资料并进行比较,采用多元Logistic回归分析影响DTC颈部淋巴结转移的因素。结果与无转移组相比,转移组的男性人数比例较大,年龄较小,有结节内钙化的人数比例及结节直径较大,差异有统计学意义(P 0.05)。转移组血清促甲状腺激素(TSH)水平、抗甲状腺球蛋白抗体(TGAb)阳性率和抗甲状腺过氧化物酶自身抗体(TPOAb)阳性率高于无转移组,差异有统计学意义(P 0.05)。多因素Logistic回归分析结果显示,发生结节内钙化、TGAb阳性和较大的结节直径是促进DTC颈部淋巴结转移发生的危险因素(P 0.05),而较高的年龄和女性是DTC颈部淋巴结转移发生的保护因素(P 0.05)。结论男性、年龄小、结节直径大、结节内钙化、TGAb阳性是DTC患者发生颈部淋巴结转移的危险因素,术前完善超声及血清学检查对指导DTC手术及预后评估有重要意义。     

分区性颈淋巴结清扫术在治疗甲状腺癌颈淋巴结转移中的应用

目的 探讨分区性颈清术在治疗甲状腺癌颈淋巴结转移中的价值。方法 选择35例甲状腺癌颈淋巴结转移患者实施分区性颈淋巴结清扫术，同时选择实施传统清扫术的相同诊断的患者38例做对照组，对实施两种不同手术后的患者的生存率、复发情况、生存质量进行3年随访观察。结果 两组患者术后3年生存率无明显差别，而分区性清扫术后患者的生存质量明显优于行传统颈清扫术的患者。结论 应用分区性颈淋巴结清扫术可以在很大程度上取代传统的颈淋巴结清扫术，达到与传统手术相同的临床效果，同时又能最大限度地减少手术创伤，提高生存质量。     

Association of XIAP and P2X7 receptor expression with lymph node metastasis in papillary thyroid carcinoma

The expression of X-linked inhibitor of apoptosis (XIAP) and the P2X7 receptor were demonstrated in a variety of tumors. The purpose of the present study was to investigate the associations of XIAP and P2X7 receptor expression with the clinicopathological features of patients with papillary thyroid carcinoma (PTC). In this cross-sectional study, a total of 62 cases were examined, including 43 patients with PTCs and 19 with benign nodular goiters. XIAP and P2X7 receptor expression were examined by immunohistochemical methods on formalin-fixed, paraffin-embedded thyroid tissues. The staining intensity and extent were evaluated and scored using a semi-quantitative method. The immunohistochemical staining score integrating the intensity and extent of XIAP and P2X7 receptors in PTCs was higher than in nodular goiters. XIAP (OR: 5.6, 95% CI: 1.5-21.1, P=0.009) and P2X7 receptor (OR: 6.1, 95% CI: 1.5-24.4, P=0.007) expression were associated with lymph node metastasis in PTCs. In logistic regression analysis, P2X7 receptor expression, tumor size, and capsular infiltration were predictors for lymph node metastasis (P=0.001). Our results suggested that XIAP and P2X7 receptor expression may predict the aggressiveness of PTC.     

甲状腺乳头状微小癌的研究进展

甲状腺癌是最常见的内分泌系统恶性肿瘤,其中甲状腺乳头状癌（papillary thyroid carcinoma,PTC）占80%左右。甲状腺乳头状微小癌（papillary thyroid microcarcinoma,PTMC）是指直径≤1.0cm、无论有无淋巴结转移或远处转移的PTC。近年,随着甲状腺超声技术的不断发展和广泛应用,其临床检出率呈上升趋势。一般认为PTMC的恶性程度较低,总体预后良好。但也有文献报道在诊断PTMC的同时已发现存在区域淋巴结转移或远处转移。本文就PTMC的流行病学、临床生物学以及分子生物学特点作一综述。     

The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in papillary thyroid carcinoma

正Objective To explore the effect of Hashimoto’s thyroiditis(HT)on central lymph nodal metastasis(CLNM)in papillary thyroid carcinoma(PTC)patients.Methods A retrospective study of 179 patients who underwent thyroidectomy with nodal excision and with nodal excision     

Proteomic analysis of the papillary thyroid microcarcinoma

ObjectiveThe present study applied iTRAQ and LC-MS/MS techniques for proteome analysis and compared data between specimens of papillary thyroid microcarcinoma (PTMC) vs appropriate controls, in order to investigate the mechanisms underlying the invasion and metastasis process in PTMC development.Materials and methodsFresh-tissue specimens were collected from 40 patients with thyroid disease who underwent surgical treatment. Specimens were divided into four groups: normal histology (NH; n = 8), benign thyroid tumor (BTT; n = 10), classic PTMC with lymph node metastasis (PTC-LNM⁽⁺⁾; n = 11), and classic PTMC without lymph node metastasis (PTC-LNM^(?); n = 11). Proteomic studies were conducted on PTMC tissue samples without capsule invasion and with tumor diameter ranging from 0.5 cm to 1 cm, so as to focus the study on PTMC development excluding metastasis.ResultsA total of 8036 proteins were identified in the four groups. Based on protein function analysis, proteins that might be associated with PTMC invasion and metastasis were screened: alpha-actinin-1, alpha-1-antitrypsin, hepatoma-derived growth factor (HDGF), high-mobility group protein HMGI-C, and carbonic anhydrase 4. In addition, proteins involved in the focal adhesion pathway were examined. Immunohistochemistry confirmed the reliability of the iTRAQ results and the universality of differentially expressed proteins. The data showed that HDGF and high-mobility group protein HMGI-C are up-regulated in PTMC and that the focal adhesion pathway that promotes PTMC LNM is activated.ConclusionsThese findings provide insight into the mechanisms underlying PTMC invasion and metastasis.