Impact of Postoperative Radiotherapy on the Prognosis of Early-Stage (pT1-2N0M0) Oral Tongue Squamous Cell Carcinoma.

PURPOSE: To identify subgroups of patients with early-stage (pT1-2N0M0) oral tongue squamous cell carcinoma (OTSCC) who may benefit from postoperative radiotherapy (PORT). PATIENTS AND METHODS: This retrospective cohort study included 528 patients diagnosed between October 2009 and December 2021. Clinicopathological characteristics and treatments with or without PORT were analyzed for their impact on outcomes. RESULTS: Among 528 patients who underwent radical surgery (median age, 62 years [IQR, 52-69]), 145 (27.5%) also underwent PORT. Multivariate analyses revealed that PORT was associated with improved survival outcomes, whereas moderate-to-poor differentiation, perineural infiltration (PNI), lymphovascular invasion (LVI), and increasing depth of invasion (DOI) were associated with poorer survival outcomes. For patients with moderate-to-poor differentiation, the surgery + PORT group showed improved outcomes compared with the surgery-alone group. After propensity score matching, the results were as follows: overall survival (OS), 97% versus 69%, P = .003; disease-free survival (DFS), 88% versus 50%, P = .001. After excluding cases with PNI/LVI, the differences persisted: OS, 97% versus 82%, P = .040; DFS, 87% versus 64%, P = .012. Similar survival benefits were observed in 104 patients with PNI and/or LVI (OS, 81% v 58%; P = .022; DFS, 76% v 47%; P = .002). In subgroups with DOI >5 mm or close margins, PORT contributed to improved DFS (80% v 64%; P = .006; 92% v 66%; P = .049) but did not significantly affect OS. CONCLUSION: Patients with moderately-to-poorly differentiated pT1-2N0M0 OTSCC benefited from PORT. Our study provided evidence that patients with PNI and/or LVI who underwent PORT had improved survival. PORT also offered DFS benefit among patients with DOI >5 mm.

Risk factors for parapharyngeal and retropharyngeal metastases in papillary thyroid cancer: a matched case-control study.

PURPOSE: To analyze risk factors for parapharyngeal (PP) and retropharyngeal (RP) metastases in papillary thyroid cancer (PTC). METHODS: A matched case-control study was conducted, comprising 130 age- and sex-matched cases of PTC. Among these cases, 50 had PP/RP metastases, 50 had central and/or lateral neck lymph node metastases, and 30 showed no lymph node metastases. Preoperative thyroid function test, computed tomography images, and postoperative pathological findings were collected. Associations between cases were assessed using univariate conditional logistic regression analysis, followed by multivariate conditional logistic regression analysis, and backward stepwise selection to predict risk factors for PP/RP metastases. RESULTS: The study found that thyroglobulin was significantly associated with the development of PP/RP metastases [136.10(16.55-312.60) vs. 27.60(10.28-55.62) vs. 8.74(6.35-21.10) P < 0.001]. CONCLUSIONS: The study concludes that thyroglobulin is a significant risk factor for PP/RP metastases in PTC. This finding emphasizes the importance of monitoring thyroglobulin levels in PTC patients to identify those at risk of developing PP/RP metastases.

Circular RNA VANGL1 Facilitates Migration and Invasion of Papillary Thyroid Cancer by Modulating the miR-194/ZEB1/EMT Axis.

Circular RNAs (circRNAs) are often aberrantly expressed in human tumors and also serve a critical regulatory role in papillary thyroid cancer (PTC). The aim of this study is to investigate the expression pattern and biological role of circVANGL1 in PTC. The results revealed that circVANGL1 was significantly upregulated in human PTC samples. In addition, high circVANGL1 expression was closely associated with adverse clinical parameters of PTC patients. Our in vitro experiments further indicated that the knockdown of circVANGL1 using siRNA obviously repressed migration, proliferation, EMT, and invasion of PTC cells, while opposite effects were induced by its overexpression. We further noted that circVANGL1 could interact with miR-194 directly in PTC, and serve as a ceRNA to regulate ZEB1 function. Moreover, miR-194 inhibition markedly abrogated the effects of circVANGL1 knockdown in PTC cells. Therefore, our results provide convincing evidence that circVANGL1 may exert oncogenic effects in PTC, partly via regulating the miR-194/ZEB1 axis.

Biodegradable iron oxide nanoparticles for intraoperative parathyroid gland imaging in thyroidectomy.

Parathyroid gland (PG) injury is the most common complication of thyroidectomy owing to the lack of approaches for surgeons to effectively distinguish PGs from surrounding thyroid glands (TGs) in the operation room. Herein, we report the development of biodegradable iron oxide nanoparticles (IONPs) as a promising contrast agent candidate for intraoperative PG visualization. We elucidated that locally administrated dark-colored IONPs readily diffuse in TGs but cannot infiltrate tissue-dense PGs, yielding a distinguishable contrast enhancement between PGs and TGs by naked eye observation. We performed unbiased and quantitative in vivo screenings to optimize particle size and concentration of IONPs for PG/TG contrast enhancement. Moreover, in vivo applications of IONPs via the local administration route demonstrate no adverse toxicities and can be biodegraded in the thyroid microenvironment within 3 months. To our knowledge, these promising findings provide the first in vivo evidence that IONPs can serve as a safe, biodegradable, and effective contrast agent candidate for improving PG visualization in thyroidectomy.

TERT genetic polymorphism rs2736100 is associated with an aggressive manifestation of papillary thyroid carcinoma.

Objectives: TERT rs2736100 genetic polymorphism is commonly found in human malignancies, indicating its key role in cancer cell transformation. The aim of this study is to investigate the effects of the functional TERT rs2736100 genetic polymorphism on the outcomes of papillary thyroid carcinoma (PTC) patients. Materials and methods: We performed a retrospective study on the relationship between rs2736100 and clinicopathological outcomes of PTC in 500 patients (378 females and 122 males) aged 43.8 ± 11.4 years (range 15-74 years) with a median follow-up of 60 months (range, 1-455 months). Results: TERT rs2736100 genetic polymorphism (TG/GG vs. TT) was significantly associated with several high-risk clinicopathological features such as tumor spread, extrathyroidal extension, central/lateral lymph node metastases, and Stage T III or IV disease. However, in Kaplan-Meier survival analyses, the rs2736100 mutation was unrelated to overall disease-free survival with a log-rank value of p > 0.05. In Cox-regression analyses, the overall survival rate of recurrence/neo-metastasis was related to a larger tumor size, younger age, and tumor spread but unrelated to the rs2736100 mutation. Conclusions and significance: TERT rs2736100 genetic polymorphism mutation is more likely to manifest with aggressive clinicopathological characteristics but cannot worsen prognosis in PTC.

Combined expression of the BRAFV600E mutation and PD-L1 in early papillary thyroid carcinoma and its relationship with clinicopathological features and recurrence-a retrospective cohort study.

Background: Identifying the high recurrence group of patients with early-stage papillary thyroid cancer (PTC) is the greatest challenge in the management of this disease. It has been noted that B-type Rafkinase (BRAF) V600E mutation and programmed death ligand 1 (PD-L1) are associated in PTC and highly expressed in PTC, correlating in PTC as potential prognostic biomarkers. However, whether they can be used to predict the aggressiveness and recurrence of early PTC remains unclear. Methods: Clinicopathological data of 137 patients with early PTC [tumor-node-metastasis (TNM) stage I-II] who underwent surgery in Zhejiang Cancer Hospital between 2008 and 2010 were retrospectively analyzed. BRAFV600E mutation and PD-L1 was detected by immunohistochemistry. The median follow-up time was 136 months (interquartile range 5.8). The presence of tumor confirmed by imaging or pathology or lymph node metastasis was considered as tumor recurrence. The association of both alone and in combination with clinicopathological features and recurrence was statistically analyzed respectively. The risk of recurrence was assessed using Cox regression models. Results: Most of the 137 early PTC were female (78.1%). The mean age was 43.2±12.1 years. The median tumor size was 1.4 cm; 14 patients developed recurrence during follow-up period; 56 patients (40.9%) were detected positive for BRAFV600E mutation; 76 patients (55.5%) were detected positive for PD-L1. Patients with both BRAFV600E mutation and PD-L1 expression had larger tumors (P=0.038), were more likely to have extrathyroidal invasion (P=0.045), and had a lower rate of cervical lymph node metastasis (P=0.046). The recurrence rate was 17.5% (7/40) in patients with BRAFV600E mutation and PD-L1 double expression compared to 8.9% (4/45) in patients with BRAFV600E mutation and PD-L1 double negative [hazard ratio (HR) =1.267; 95% CI: 0.841-1.909; P=0.257]. Survival curves showed flatter recurrence-free survival (RFS) curves in positive BRAFV600E mutation only and PD-L1 expression only, whereas decreased sharply in positive expression of both BRAFV600E mutation and PD-L1; however, the differences were not significant (P>0.05). Conclusions: The combination of BRAFV600E mutation and PD-L1 to identify group at higher risk of recurrence in early PTC has insufficient clinical evidence and should be used with caution in the clinical management of PTC.

Radiosensitizing effect of c-Met kinase inhibitor BPI-9016M in esophageal squamous cell carcinoma cells in vitro and in vivo.

BACKGROUND: c-Met is the receptor of hepatocyte growth factor (HGF) which plays a key role in inhibiting apoptosis. BPI-9016M is a small-molecule c-Met inhibitor that can promote apoptosis and enhance the cytotoxicity of various DNA-damaging agents. Here, we evaluated the radiosensitizing potential of BPI-9016M in Eca109 human esophageal squamous cell carcinoma (ESCC) cells in vitro and in vivo. METHODS: Cell Counting Kit-8 (CCK-8) assay was used to measure cell viability. Clonogenic survival assay and a murine tumor xenograft in male nude mice were used to evaluate the radiosensitizing effect of BPI-9016M. Apoptosis was determined by the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining and flow cytometry experiment. Apoptosis-related proteins were detected by western blot. By evaluating the activation of the ATR-Chk1/ATM-Chk2 pathway to detect radiation-induced DNA double-strand break and homologous recombination repair. BPI-9016M induced a radiosensitizing effect in Eca109 cells and reduced the survival rate of clone formation in vitro. RESULTS: The combination of BPI-9016M with irradiation (IR) significantly delayed the growth of ESCC tumor xenografts than treatment alone (P<0.05). The radiosensitizing effects of BPI-9016M were due to increased apoptosis, such as the up-regulation of cleaved-caspase 3 and 9, down-regulation of mutant P53 and Bcl-2, the decreased of phosphorylation of ATR and ATM, and the inhibition of γ-H2AX accumulation in vitro and in vivo. CONCLUSIONS: These findings indicated that BPI-9016M exerts a radiosensitizing effect and enhances apoptosis by inhibiting homologous recombination DNA repair in irradiated ESCC cells.

The relationship between central lymph node metastasis and the distance from tumor to thyroid capsule in papillary thyroid microcarcinoma without capsule invasion.

BACKGROUND: This study aims to explore the predictive factors of central lymph node metastasis (CLNM) in patients with papillary thyroid microcarcinoma (PTMC) without capsule invasion. METHODS: From January 2016 to October 2018, 1,622 patients with PTMC, who underwent surgical treatment at Zhejiang Cancer Hospital, were enrolled in the present study. A model of multivariate logistic regression was developed to find the variables that were independently associated with CLNM. The results were presented in the odds ratio (OR) with a 95% confidence interval (CI). The nomogram for predicting CLNM was developed based on the results of the multivariate logistic regression analysis. The distance (distance >0) from tumor to capsule is defined as the shortest distance from the tumor boundary to the capsule or trachea. RESULTS: The multivariate logistic regression analysis indicated that age, gender, tumor maximum diameter, tumor mean diameter, and tumor volume were independently associated with CLNM. In the 692 cases without capsular invasion, the distance from the capsule was not correlated to the CLNM. The joint model, which included age, gender, tumor volume, and capsular invasion, were analyzed using the ROC curve. The cut-off point for the prediction of CLNM was defined as a value of 0.208. The area under the ROC curve was 0.687, the sensitivity was 65.4%, and the specificity was 63.3%. CONCLUSIONS: Gender, age, maximum diameter, mean diameter, tumor volume, and capsular invasion were independently associated with the CLNM. When there was no capsular invasion, the distance between the tumor and capsule was not correlated to the CLNM, suggesting that considering whether the tumor is close to the capsule may not be necessary for low-risk PTMC.

Parathyroid Hormone Reduction Predicts Transient Hypocalcemia after Total Thyroidectomy: A Single-Center Prospective Study.

OBJECTIVE: We performed this study to investigate the risk factors for postoperative hypocalcemia after total thyroidectomy with central lymph node dissection (CLND). Study Design. This was a single-center prospective study based on 176 consecutive patients who underwent total thyroidectomy for papillary thyroid carcinoma. Setting. Patients were recruited between January 2016 and June 2018. Subjects and Methods. Patients who underwent bilateral (n = 155, bilateral group) and ipsilateral CLND (n = 21) after total thyroidectomy were included. The preoperative and postoperative parathyroid hormone (PTH) and calcium levels were detected. The risk factors for transient hypocalcemia were identified using logistic regression analysis and receiver operating characteristic (ROC) curve analysis. RESULTS: Fifty-one (28.98%) patients developed transient hypocalcemia, and 2 patients (1.14%) developed permanent hypoparathyroidism. There was no difference in the gender ratio or the morbidity of hypocalcemia between the patients who underwent bilateral and ipsilateral CLND. On postoperative day 1, PTH decrease was a risk factor for transient hypocalcemia in the whole cohort (ß = 0.043, OR = 1.044, 95% CI 1.023-1.065, p < 0.001), bilateral group (ß = 0.042, OR = 1.043, 95% CI 1.022-1.064, p < 0.001), and female patients (ß = 0.049, OR = 1.050, 95% CI 1.026-1.075, p < 0.001). Tumor diameter was a risk factor for transient hypocalcemia in female patients (ß = 0.499, OR = 1.647, 95% CI 1.003-2.704, p=0.049). The ROC curve analysis illustrated that 65.58%, 71.00%, and 71.00% PTH level reduction had high accuracy in predicting transient hypocalcemia in the whole cohort, bilateral group, and female patients, respectively (AUC = 0.986, 0.987, and 0.987). CONCLUSION: Asymptomatic female patients with bilateral CLND and a 71.00% PTH level reduction were at a high risk of transient hypocalcemia.

MiR-345-5p inhibits tumorigenesis of papillary thyroid carcinoma by targeting SETD7.

INTRODUCTION: This study aimed to explore the effects of miR-345-5p on papillary thyroid carcinoma (PTC) and uncover the possible mechanisms. MATERIAL AND METHODS: MiR-345-5p and SETD7 mRNA levels were analyzed by quantitative real-time PCR and SETD7 protein level was measured by Western blot. The viability, colony formation ability and apoptosis of PTC cells were measured with CCK-8, soft agar colony formation and flow cytometry assay, respectively. Luciferase reporter assay was used to identify miR-345-5p's target. RESULTS: Compared to neighboring normal tissues, there was lower miR-345-5p expression and higher SETD7 expression in PTC tissues. Moreover, Spearman's correlation analysis indicated that there was a negative correlation between miR-345-5p and SETD7 expression in PTC tissues. MiR-345-5p mimics inhibited the viability and colony formation of TPC1 and B-CPAP cells and promoted apoptosis, whereas anti-miR-345-5p promoted PTC cell proliferation and inhibited apoptosis. SETD7 was confirmed to be a direct target of miR-345-5p through target scan analysis and luciferase reporter assay. Additionally, overexpression of SETD7 promoted the viability and colony formation of TPC1 and B-CPAP cells and inhibited apoptosis, whereas downregulation of SETD7 by shRNAs had opposite effects on PTC cells. Furthermore, overexpression of SETD7 attenuated the miR-345-5p induced anti-tumor effects on PTC cells. CONCLUSIONS: MiR-345-5p exhibited suppressive effects on PTC via targeting SETD7.

SRY­related HMG box­2 role in anaplastic thyroid cancer aggressiveness is related to the fibronectin 1 and PI3K/AKT pathway.

Anaplastic thyroid cancer (ATC) is a rare thyroid tumor associated with high mortality rates; thus, the identification of novel molecular targets and the development of therapeutic strategies are urgently required. The present study aimed to investigate the role of SRY­related HMG box­2 (SOX2) in ATC cells and explore whether the underlying mechanism was associated with fibronectin 1 (FN1). The proliferative, migratory and invasive ability of ATC cell lines was investigated using Cell Counting Kit­8, colony formation, wound­healing and Transwell assays, respectively; SOX2 expression in FRO cells was knocked down using small interfering RNA and SOX2 overexpression in FRO cells was achieved using cDNA constructs; and reverse transcription­quantitative PCR and western blotting were used to identify the mechanism of action underlying the SOX­2 mediated increased in cell aggressive phenotypes. Increased protein expression levels of SOX2 protein were observed in ATC tissue, and FRO and 8505c ATC cell lines. SOX2 overexpression increased the cell viability, and proliferative, migratory and invasive abilities of FRO cell lines. SOX2 overexpression increased FN1, p65, phosphorylated PI3K and AKT expression levels, whereas the knockdown of SOX2 promoted the opposite effects. In conclusion, the present study suggested a possible model of SOX2­mediated gene regulation in ATC cells, in which the overexpression of SOX2 promoted FN1 expression via the PI3K/AKT signaling pathway to induce the aggressive phenotype of ATC. These findings may provide crucial molecular insights into ATC pathogenesis and may demonstrate potential to develop into novel therapeutic interventions for patients with ATC.

miR-206 inhibits thyroid cancer proliferation and invasion by targeting RAP1B.

Thyroid cancer (TC) is one of the primary tumors arisen from endocrine system. The purpose of this study was to investigate the underlying mechanism by which RAP1B (Ras-related protein Rap-1b) modulates microRNA (miR)-206 related effects on TC cells. Expression of miR-206 and RAP1B was analyzed in cells and tissues. miR-206 mimics or inhibitors and RAP1B vector were used in functional experiments to investigate the effects of miR-206 and RAP1B on cell activities including proliferation, migration, and invasion. Luciferase assay was performed to explore the association between miR-206 and RAP1B. The influence of miR-206 on tumorigenesis of TC cells was investigated using an ex vivo model. Our results demonstrated the reduce of miR-206 in TC tissues and cell lines in which RAP1B was increased. Overexpression of miR-206 significantly inhibited the functional capacities of TPC-1 cells including proliferation, invasion, and migration, most likely, through reducing the expression of RAP1B. Xenograft experiment showed that increased miR-206 could effectively inhibit the tumorigenesis of TC cells. Our study showed that miR-206 negatively regulated cell activities of proliferation, invasion, and migration in TC via suppressing RAP1B expression, suggesting that miR-206 exerts a vital role in TC.

High PD-L1 expression is associated with a favorable prognosis in patients with esophageal squamous cell carcinoma undergoing postoperative adjuvant radiotherapy.

Previous results on the prognostic value of programmed death-ligand (PD-L)1 expression in patients with esophageal squamous cell carcinoma (ESCC) remain limited and conflicting. The present study aimed to determine whether PD-L1 expression status predicts prognosis in patients with ESCC, particularly in those undergoing different postoperative treatments. Immunohistochemical staining for PD-L1 was performed on surgical specimens that were obtained from 246 patients with ESCC, who underwent surgical treatment but did not undergo preoperative chemotherapy, radiotherapy, targeted therapy or immune therapy. The association of PD-L1 expression with the clinicopathological factors and the association of PD-L1 expression with survival of patients with ESCC, including subgroups of patients undergoing different postoperative treatments (surgery alone, surgery with adjuvant chemotherapy, surgery with adjuvant radiotherapy and surgery with adjuvant chemo-radiotherapy groups), were statistically analyzed. Positive PD-L1 expression was significantly associated with advanced tumor-node metastasis stage (P=0.022). Median overall survival (OS) time was compared between patients with positive PD-L1 expression and those with negative PD-L1 expression in the overall patient population. In patients who were treated with postoperative adjuvant radiotherapy, the prognosis was significantly improved in patients who were PD-L1-positive compared with those who were PD-L1-negative (P=0.046). In patients treated with adjuvant chemotherapy, median OS was poorer in patients with positive PD-L1 expression compared with those with negative PD-L1 expression. However, the difference was not significant. Multivariate Cox regression analysis demonstrated that PD-L1 expression status was not an independent prognostic factor in patients with ESCC. High PD-L1 expression was associated with a favorable prognosis in patients with ESCC undergoing postoperative adjuvant radiotherapy, and it was concluded that patients with positive PD-L1 expression might benefit from postoperative adjuvant radiotherapy.

Multifocality is associated with central neck lymph node metastases in papillary thyroid microcarcinoma.

BACKGROUND: This study aimed to assess the predictive factor of multifocality to identify patients at high risk of central lymph node metastasis (CLNM). PATIENTS AND METHODS: Papillary thyroid microcarcinoma patients who underwent total or hemi-thyroidectomy with effective unilateral or bilateral central lymph node dissection were enrolled. RESULTS: Multifocality, age, sex, tumor size, extrathyroidal extension, and nodular goiter were significantly associated with CLNM. Multifocality was an independent predictor for CLNM in multivariate analysis. Compared with unifocal disease, the odds ratio for CLNM was 1.447 for patients with ≥2 tumor foci (P<0.001) and 2.978 for patients with ≥3 tumor foci (P<0.001). The significant association is at ≥3 foci diseases. CONCLUSION: Multifocality with ≥3 tumor foci was an independent predictive factor for CLNM in papillary thyroid microcarcinoma. Multifocality should be assessed when selecting patients for prophylactic central neck lymph node dissection, and we speculate that patients with multifocality should undergo more radical treatment.

Clinical characteristics and treatment of thyroid cancer in children and adolescents: a retrospective analysis of 83 patients.

OBJECTIVE: To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. METHODS: We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients ≤12 years of age (27 cases) and those >12 years of age (56 cases). All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians. RESULTS: Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node metastasis than the older group (92.59% vs. 71.43%, P=0.028). The incidence rate in females in the older group was higher than that in the younger group (80.36% vs. 59.26%, P=0.041). There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups. CONCLUSIONS: The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those >12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.

Application of a cervical low incision in the functional neck dissection of thyroid papillary carcinoma.

The present study aimed to discuss the advantage of the application of a cervical low incision for functional neck dissection in patients with thyroid papillary carcinoma. The study was a retrospective analysis of 87 thyroid papillary carcinoma patients; cervical low incision in the functional neck dissection was applied for 47 cases and the classic 'L' incision was applied for 40 cases. The different integrity, surgical time, blood loss and the aesthetic property of the incision were compared between the cervical low incision and the classic 'L' incision for lateral neck dissection of thyroid cancer. The postoperative pathological diagnosis was that the average total amount and the region II lymph nodes of the unilateral neck dissection were 33 and 10 for the cervical low incision group, and 32 and 11 for the classic 'L' incision group, respectively (P>0.05). The average unilateral neck dissection times were 87 and 58 min for the cervical low incision group and the classic 'L' incision group, respectively (P<0.05). The blood loss of the cervical low incision group was 67 ml, while the loss for the classic 'L' incision group was 61 ml (P>0.05). The postoperative incision of the cervical low incision group was smaller and more concealing. Additionally, the cosmetic deformities were milder for an inconspicuous cervical scar, and the sensation was improved for the patients in comparison with the classic 'L' incision group. These results suggest that the application of cervical low incision for functional neck dissection in thyroid papillary carcinoma patients aids in reducing postoperative complications, without increasing recurrence rates. Therefore, the classic 'L' incision can be replaced by the cervical low incision.

Comparison of Conventional Open Thyroidectomy and Endoscopic Thyroidectomy via Breast Approach for Papillary Thyroid Carcinoma.

Purpose. The aim of this study was to evaluate the feasibility of endoscopic thyroidectomy via breast approach for papillary thyroid carcinoma (PTC). Methods. Between March 2008 and March 2013, 34 patients with PTC received endoscopic thyroidectomy (endo group) and 30 patients received conventional open thyroidectomy (open group). Patients in two groups underwent ipsilateral central compartment node dissection. The two groups were compared in terms of patient characteristics, perioperative clinical results, and postoperative complication. Results. The rates of lymph node metastasis in endo group and open group were 23.5% (8/34) and 13.3% (4/30), respectively, without statistically significant difference (P = 0.351). The mean number of lymph nodes dissected was 2.4 ± 2.9 in endoscopic group and 2.2 ± 1.9 in open group (P = 0.774). During the follow-up period, there was no recurrence or metastatic patients in two groups. All patients received the excellent cosmetic results in endo group, while 25 patients were satisfied with the cosmetic result and 5 were unsatisfied in the open group. Conclusions. The efficacy of endoscopic thyroidectomy via breast approach could be comparable to conventional open thyroidectomy in selected patients with PTC.

Potential role for carbon nanoparticles identification and preservation in situ of parathyroid glands during total thyroidectomy and central compartment node dissection.

OBJECTIVE: To determine the potential role of intraoperative carbon nanoparticles (CN) injections for identification and preservation of parathyroid glands, thereby reducing the postoperative hypocalcaemia. METHODS: 100 patients with thyroid cancer who underwent total thyroidectomy and central compartment node dissection (CCND) were randomly assigned to receive intraoperative injection of (CN) or not for identifying and preserving normal parathyroid glands. RESULTS: There was no significantly difference for preoperative and postoperative parathyroid hormone (PTH) levels between the CN and control group (P>0.05). The levels of albumin-adjusted serum calcium (AASC) before surgery and at day 1 and 1 month after surgery did not reach the significant difference between the two groups (P>0.05). However, the patients in CN group had the higher level of AASC at day 3 after surgery than those in control group (P=0.044). Transient postoperative hypoparathyroidism occurred in 24 (48%) patients in CN group and 28 (56%) in control groups, respectively (P=0.423). The incidence of transient postoperative hypocalcemia was 20% (10/50) in CN group and 24% (12/50) in control groups, respectively (P=0.629). CONCLUSIONS: Carbon nanoparticles can make the thyroid gland and the central lymph node black-stained, but no-stained for parathyroid glands. After rapidly identifying parathyroid and distinguishing it from thyroid and lymph nodes by carbon nanoparticles, complete lymph node dissection and preservation of parathyroid glands become feasible during total thyroidectomy with neck lymph node dissection. After identification, strict adherence to capsular dissection remains essential for safe preservation in situ of the parathyroid glands and their blood supply.

Value of intraoperative parathyroid hormone monitoring in papillary thyroid cancer surgery: can it be used to guide the choice of operation methods?

BACKGROUND: To assess the diagnostic value of decreased parathyroid hormone (PTH) in hypoparathyroidism after unilateral operation. METHODS: A study was conducted on patients with PTC undergoing total or near-total thyroidectomy plus central neck dissection (CND). RESULTS: Postoperative hypocalcemia was found in 42 patients (51.2%). For patients undergoing bilateral CND, those whose tumor invasion proceeded beyond the thyroid capsule have a higher rate of postoperative hypoparathyroidism (P<0.05). PTH level of hypoparathyroidism patients was lower than that of non-hypoparathyroidism patients from surgery to 6 months later (P<0.05). When unilateral thyroidectomy and central region dissection were completed, PTH level decreased by 47.06% in hypoparathyroidism patients, which was significantly higher than non-hypoparathyroidism patients (28.35%) (P<0.001). PTH level (AUC 0.806) and its decreasing degree (AUC 0.736) played predicting roles in assessing postoperative hypoparathyroidism (P<0.001). CONCLUSIONS: For PTC surgery, PTH level and its decreasing degree played predicting roles in assessing postoperative hypoparathyroidism.

Chemoradiotherapy is superior to radiotherapy alone after surgery in advanced squamous cell carcinoma of the head and neck: a systematic review and meta-analysis.

BACKGROUND: To conduct a comprehensive review whether chemotherapy to radiotherapy after surgical resection could improve the loco regional control and survival compared with postoperative radiotherapy alone. METHODS: A comprehensive search of PubMed for relevant studies comparing patients with advanced squamous cell carcinoma of the head and neck undergoing chemoradiotherapy or radiotherapy alone after resection was conducted. RESULTS: The meta-analysis demonstrated significant benefits from adding chemotherapy to radiotherapy in local-regional control, disease-free survival and overall survival (p < 0.00001). The adverse effects include hematological and non-hematological toxicities. Although the acute and late toxicities occurred more frequently and severely in chemoradiation combined treatment, there was no significant difference compared with radiotherapy alone, but the estimated pooled RR of mucositis or dysphagia was 1.69 (p < 0.00001) in favor of radiotherapy regimens. CONCLUSIONS: Postoperative chemotherapy adding to radiotherapy is superior to radiotherapy alone. Patients with chemoradiotherapy after surgical resection can achieve the higher LRC, longer DFS and OS.