ObjectiveTo systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN0 papillary thyroid carcinoma. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), WanFang Data, CBM and CNKI were searched to collect the studies about total thyroidectomy (TT)+PCND versus TT alone for stage cN0 papillary thyroid carcinoma from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. ResultsA total of 10 studies involving 3 661 patients were included. The results of meta-analysis showed that, compared with TT alone, TT+PCND had higher transient hypocalcemia (OR=2.50, 95%CI 2.05 to 3.03, P<0.000 01), higher permanent hypocalcemia (OR=3.11, 95%CI 1.82 to 5.30, P<0.000 1), and lower recurrence (OR=0.66, 95%CI 0.47 to 0.93, P=0.02). But there were no significant differences between two groups in transient laryngeal nerve palsy or permanent laryngeal nerve palsy. ConclusionTT+PCND is safe and feasible for treating stage cN0 papillary thyroid carcinoma when its indications are strictly controlled. However, due to limited quantity and quality of the included studies, more high-quality randomized controlled trials are needed to verify the abovementioned conclusion.
ObjectiveTo investigate the risk factors for central lymph node metastasis (CLNM) in patients with clinically negative lymph node (cN0 stage) papillary thyroid carcinoma (PTC).MethodsThe clinicopathological data of 250 patients with cN0 PTC who underwent thyroidectomy and central lymph node dissection (CLND) in Department of General Surgery of Xuzhou Central Hospital from June 2016 to June 2019 were retrospectively analyzed. The influencing factors of CLNM in patients with cN0 PTC were analyzed by univariate analysis and binary logistic regression, and then R software was used to establish a nomogram prediction model, receiver operating characteristic curve was used to evaluate the differentiation degree of the model, and Bootstrap method was used for internal verification to evaluate the calibration degree of the model.ResultsCLNM occurred in 147 of 250 patients with cN0 PTC, with an incidence of 58.8%. Univariate analysis showed that multifocal, bilateral, tumor diameter, and age were correlated with CLNM (P<0.01). The results of binary logistic regression analysis showed that multifocal, bilateral tumors, age≥45 years old, and tumor diameter>1 cm were independent risk factors for CLNM in patients with cN0 PTC (P<0.05). The area under the curve (AUC) of the nomogram prediction model established on this basis was 0.738, and the calibration prediction curve in the calibration diagram fitted well with the ideal curve.ConclusionsCLNM is more likely to occur in PTC. The nomogram model constructed in this study can be used as an auxiliary means to predict CLNM in clinical practice.
Objective To investigate the expression and clinical significance of Notch-1 protein in papillary thyroid carcinoma (PTC) tissues and cervical lymph node metastases. Methods Immunohistochemical method was used to detect the expression of Notch-1 protein in 69 cases of PTC tissues, along with tumor adjacent tissues and 34 cases of metastatic lymph node tissues, and to analyze its role in PTC and metastatic lymph node tissue. Results Compared with PTC tissues or cervical lymph node metastases and tumor adjacent tissues, the positive rates of expression of Notch-1 protein in PTC tissues or cervical lymph node metastases were significantly lower than that in cancer adjacent tissues (P＜0.05). The expression of Notch-1 protein was correlated with the tumor size and capsule invasion of patients with PTC. Conclusions Notch-1 protein expression is decreased in PTC tissues and metastatic lymph node tissues, suggesting that the Notch-1 protein may play an important role in the development, invasion and metastasis of PTC. There is no significant difference in the positive rates of Notch-1 protein expression in PTC tissues and metastatic lymph node tissues, it's suggested that the malignant degree of cancer cells in lymph node metastasis is not significantly increased, and the biological behavior remained relatively stable.
ObjectiveTo detect the expression of programmed cell death ligand 1 (PD-L1) in papillary thyroid carcinoma (PTC) and PTC with coexistent Hashimoto’s thyroiditis (HT) tissues, and to explore its clinical significance of its expression.MethodsThe PTC patients who underwent thyroidectomy at the Thyroid Surgery Department of the Affiliated Hospital of Guizhou Medical University from March 2017 to May 2019 were retrospectively collected. Immunohistochemical staining was used to detect the expression of PD-L1 in the PTC tissues, PD-L1 staining positive cells ≥20% was judged as positive expression, <20% was judged as negative expression. The relationship between PD-L1 positive expression rate and clinicopathologic characteristics of patients with PTC were analyzed, and the correlation between the presence of HT in PTC tissues and PD-L1 positive expression was studied.ResultsA total of 138 patients with PTC were included in this study, including 104 patients with PTC alone and 34 PTC patients with coexistent HT. The positive rate of PD-L1 expression in the 138 cases of PTC tissues was 35.5% (49/138), among which was 43.3% (45/104) in the pure PTC tissues, and 11.8% (4/34) in the PTC tissues with HT, the latter was significantly lower than the former (P=0.001). The results of univariate analysis showed that the positive rate of PD-L1 expression was related to the tumor size, the presence or absence of extraglandular invasion and HT in PTC patients (P<0.05), and the results of Spearman correlation analysis showed that the positive rate of PD-L1 expression was positively correlated with tumor size (rs=0.173, P=0.041) and extraglandular invasion (rs=0.197, P=0.021), and negatively correlated with whether TH was merged (rs=–0.284, P=0.001). The multivariate analysis results showed that the positive rate of PD-L1 expression was closely related to whether PTC with coexistent HT [OR=5.720, 95%CI (1.879, 17.411), P=0.002], and it was not found to be related to tumor size and presence of extraglandular invasion (P>0.05).ConclusionsPositive rate of PD-L1 expression has a certain relationship with tumor size and presence or absence of extraglandular invasion, and which in PTC patients with or without HT is significantly different, that is, positive rate of PD-L1 expression in PTC with HT is lower suggests that coexistent HT might be an inhibitory factor in occurrence of PTC, and immune microenvironment-related factors of PTC might be involved in occurrence and development of thyroid cancer.
ObjectiveTo investigate the risk factors for hypoparathyroidism following radical surgery for patients with thyroid papillary carcinoma (PTC).MethodsA retrospective analysis was made on 192 patients with PTC who underwent radical thyroidectomy in the Department of Head Neck and Thyroid Surgery of Henan Cancer Hospital from January 2019 to January 2020. There were 52 males and 140 females with a median age of 48 years. The risk factors of hypocalcemia and hypoparathyroidism syndrome were screened by χ2 test and binary logistic regression analysis.ResultsIn 192 patients the proportion of patients with normal or hypoparathyroidism after operation were 62.5% (120/192) and 37.5% (72/192), respectively. Univariate analysis showed that complications, Hashimoto’s thyroiditis (HT), total thyroidectomy, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were risk factors for postoperative hypoparathyroidism in patients with PTC. Binary logistic regression analysis showed that: ① HT, N1a staging and Ⅵ lymph node dissection were independent risk factors for postoperative hypocalcemia [without HT: OR=0.313, 95%CI (0.129, 0.760), P=0.010; N1a staging: OR=3.457, 95%CI (1.637, 7.301), P=0.001; without Ⅵ lymph node dissection: OR=0.115, 95%CI (0.041, 0.323), P<0.001]. ② HT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted were independent risk factors for postoperative low parathyroid hormone [without HT: OR=0.285, 95%CI (0.117, 0.698), P=0.006; N1a staging: OR=3.747, 95%CI (1.762, 7.968), P=0.001; without Ⅵ lymph node dissection: OR=0.112, 95%CI (0.039, 0.317), P<0.010; planted parathyroid: OR=0.464, 95%CI (0.221, 0.978), P=0.043].ConclusionHT, N1a staging, Ⅵ lymph node dissection and parathyroid not planted are vital risk factors for hypoparathyroidism in patients with PTC after radical thyroidectomy.
Objective To construct and compare risk prediction models for skip metastasis in papillary thyroid carcinoma (PTC) patients with lateral lymph node metastasis (N1b) by using multiple machine learning algorithms, and to provide clinical guidance through model interpretation and visualization. MethodsA retrospective analysis of 573 N1b PTC patients who were admitted between November 2011 and August 2024 in Zhongshan Hospital Affiliated to Xiamen University and undergone primary surgery were conducted. Patients were randomly divided into training (n=402) and testing (n=171) sets according to 7∶3 ratio by using R package caret. The training set was used to build the model, and the test set was used for model validation. Five machine learning models including logistic regression (LR), decision tree (DT), random forest (RF), support vector machine (SVM), and extreme gradient boosting (XGBoost) by using 10-fold cross-validation on the training set to determine hyperparameters, then refited the models and validate them on the test set. Model performance was evaluated via area under the curve (AUC). Shapley additive explanations (SHAP) was employed for interpretability, and the optimal model was deployed as a web-based calculator using R Shiny. ResultsThe overall skip metastasis rate was 12.7% (73/573) in N1b PTC patients, with 12.9% (52/402) in the training set and 12.3% (21/171) in the testing set (P>0.05 for baseline comparisons). Eleven predictors (age, age≥55, sex, maximum tumor diameter, maximum tumor diameter≤1 cm, upper pole involvement, multifocality, unilateral lobe involvement, extrathyroidal extension, capsular invasion, and Hashimoto thyroiditis) were used to develop the model. Each model’s AUC of the training set: XGBoost, 0.824±0.070 ［95%CI (0.780, 0.868)］; LR, 0.802±0.065 ［95%CI (0.762, 0.842)］; DT, 0.773±0.141 ［95%CI (0.685, 0.861)］; RF, 0.767±0.068 ［95%CI (0.725, 0.809)］; SVM, 0.647±0.103 ［95%CI (0.583, 0.711)］. Each model’s AUC of the testing set: XGBoost, 0.777 ［95%CI (0.667, 0.887); LR, 0.769 ［95%CI (0.655, 0.883)］; DT, 0.737 ［95%CI (0.615, 0.858)］; RF, 0.757 ［95%CI (0.649, 0.865)］; SVM, 0.674 ［95%CI (0.522, 0.826)］. XGBoost was the optimum model which achieved the highest AUC in both training and testing sets. SHAP analysis identified the top six predictors: upper pole involvement (mean absolute SHAP: 0.249), maximum tumor diameter (0.119), extrathyroidal extension (0.078), age (0.065), unilateral lobe involvement (0.018), and capsular invasion (0.013). The XGBoost-based web calculator was accessible. ConclusionsThe XGBoost model demonstrates superior predictive performance among five machine learning algorithms. The developed web-based calculator offers clinical utility for assessing skip metastasis risk in N1b PTC patients.
ObjectiveTo detect the expression of Ki-67 in papillary thyroid carcinoma (PTC) and investigate its clinical significance. MethodsA retrospective analysis was conducted on PTC patients treated at West China Hospital of Sichuan University from August 2024 to February 2025. The relation between the Ki-67 expression in the postoperative pathological tissues and clinicopathologic features was analyzed. Additionally, the concordance of Ki-67 expression between the preoperative fine-needle aspiration samples and postoperative pathological tissues was evaluated by Bland-Altman analysis. The significance level was set at α=0.05. ResultsA total of 290 PTC patients met the inclusion and exclusion criteria were enrolled. Patients with classical PTC, M1 classification, TNM stage Ⅳ, and those achieving thyroid stimulating hormone (TSH) suppression targets at one month postoperatively had higher Ki-67 expression than those with follicular variant PTC, M0 classification, TNM stages Ⅰ–Ⅲ, or inadequate TSH suppression (all P＜0.05). No significant differences were observed in other subgroups (P>0.05). Furthermore, Bland-Altman analysis of 27 paired samples showed a mean bias of 1.269% between preoperative and postoperative measurements. Elevated variability occurred in high Ki-67 cases, with 11.1% (3/27) exceeding ±6% limits of agreement. ConclusionsThe study demonstrates that Ki-67 expression correlates with malignant attributes including tumor aggression and advanced disease. It may serve as a prognostic biomarker for assessing malignant potential in PTC.
Objective To summarize the influencing factors of central lymph node metastasis in thyroid papillary carcinoma. Method Relevant literature about papillary thyroid carcinoma were reviewed and predictive factors of central lymph node metastasis were summarized. Results Studies had shown that, male, younger age, larger tumor size, multifocal, and BRAF mutations were risk factors for central lymph node metastasis in thyroid papillary carcinoma, while tumors located in the upper pole and combined with Hashimoto disease (HT) were the protective factors for central lymph node metastasis. Conclusions The central lymph node metastasis detection rate is low, so it is unable to meet with the preoperative diagnosis in papillary thyroid carcinoma. A large number of studies have confirmed that clinical pathological features have predictive value for preoperative lymph node diagnosis, and can provide a reference for the selection of surgical methods in thyroid papillary carcinoma.
ObjectiveTo summarize the prevention and treatment strategies and their effects on lymphatic leakage following transoral endoscopic thyroid cancer lateral neck lymph node dissection. MethodsA retrospective review was conducted, we collected clinical data from 47 patients with papillary thyroid carcinoma who underwent transoral endoscopic thyroidectomy and lateral neck lymph node dissection at our hospital from January 2021 to May 2023. A stepwise sequential treatment plan was adopted for patients with postoperative lymphatic leakage: low-fat, low-protein diet, continuous strong negative pressure suction, subcutaneous injection of Group A streptococcus in the surgical cavity, and ligation of the thoracic duct or lymphatic vessels through a small incision. The effectiveness of the sequential treatment plan was summarized. ResultsOut of the 47 patients, lymphatic leakage occurred in 5 cases postoperatively. Patient No.1 was cured of lymphatic leakage after sequential treatments including pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, subcutaneous injection of Group A streptococcus in the surgical cavity, and finally ligation of the thoracic duct or lymphatic vessels through a small incision. Patient No.20 was conservatively cured of lymphatic leakage with an initial surgical procedure involving pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet, continuous strong negative pressure suction postoperatively, and subcutaneous injection of Group A streptococcus in the surgical cavity. Patient No.28 recovered after only pectoralis major muscle flap occlusion of the jugular venous angle, low-fat, low-protein diet and continuous strong negative pressure suction postoperatively. Treatment process of patient No.30 was the same as Patient No.1, Patient No.36 was the same as Patient No.20. Through the stepwise sequential treatment measures, all 5 patients successfully recovered from lymphatic leakage; the postoperative hospital stay ranged from 3 to 17 days, with an average of 8.6 days. ConclusionsThe stepwise sequential treatment plan used in this study can effectively prevent and treat lymphatic leakage after transoral endoscopic thyroid cancer lateral neck lymph node dissection. Given the small sample size of this study, we believe that it is necessary to conduct long-term studies to confirm the durability and stability of these measures.
ObjectiveTo explore the location and characteristics of postoperative recurrence of papillary thyroid carcinoma. MethodsThe clinical data of 96 patients who underwent reoperation for papillary thyroid cancer at the Affiliated Cancer Hospital of Zhengzhou University from January 2017 to March 2024 were retrospectively analyzed. ResultsOut of 96 patients, 3 had thyroid recurrence, 89 had lymph node recurrence, and 4 had thyroid and lymph node recurrence. There were 69 cases of single recurrence and 27 cases of multiple recurrence. Ten cases underwent lobectomy and lateral area cleaning, 8 cases underwent central area cleaning, 33 cases underwent lateral area cleaning, and 45 cases underwent central area+lateral area cleaning. Postoperative pathological examination revealed that there was lymph node metastasis in 93 cases (16 cases in the central region, 44 cases in the lateral region, and 33 cases in both the central and lateral regions), with 3 cases remaining non metastatic; 58 cases had extracapsular invasion of lymph nodes. Compared with patients with multiple relapses, patients with single recurrence had younger age (t=–3.385, P=0.001), lower incidence of gross extracapsular invasion of lymph nodes during surgery (χ2=6.970, P=0.008), higher number of metastatic lymph nodes (t=4.034, P=0.001), and higher rate of lymph node metastasis in zones Ⅱ, Ⅲ, and Ⅳ (χ2=8.142, P=0.004; χ2=6.357, P=0.012; χ2=12.547, P<0.001). ConclusionsPostoperative recurrence of papillary thyroid cancer is mainly due to lymph node recurrence. The advanced age and the visible lymph node extracapsular invasion may increased risk of postoperative recurrence of papillary thyroid cancer. Lymph node metastasis in the central region is a possible cause of multiple relapses and surgeries.