Risk stratification for radioactive iodine refractoriness using molecular alterations in distant metastatic differentiated thyroid cancer

Objective: Patients with radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC) are often diagnosed with delay and constrained to limited treatment options. The correlation between RAI refractoriness and the underlying genetic characteristics has not been extensively studied.Methods: Adult patients with distant metastatic DTC were enrolled and assigned to undergo next-generation sequencing of a customized 26-gene panel(Thyro Lead). Patients were classified into RAIR-DTC or non-RAIR groups to determine the differences in clinicopathological and molecular characteristics. Molecular risk stratification(MRS) was constructed based on the association between molecular alterations identified and RAI refractoriness, and the results were classified as high, intermediate or low MRS.Results: A total of 220 patients with distant metastases were included, 63.2% of whom were identified as RAIRDTC. Genetic alterations were identified in 90% of all the patients, with BRAF(59.7% vs. 17.3%), TERT promoter(43.9% vs. 7.4%), and TP53 mutations(11.5% vs. 3.7%) being more prevalent in the RAIR-DTC group than in the non-RAIR group, except for RET fusions(15.8% vs. 39.5%), which had the opposite pattern. BRAF and TERT promoter are independent predictors of RAIR-DTC, accounting for 67.6% of patients with RAIR-DTC. MRS was strongly associated with RAI refractoriness(P<0.001), with an odds ratio(OR) of high to low MRS of 7.52 [95%confidence interval(95% CI), 3.96-14.28;P<0.001] and an OR of intermediate to low MRS of 3.20(95% CI,1.01-10.14;P=0.041).Conclusions: Molecular alterations were associated with RAI refractoriness, with BRAF and TERT promoter mutations being the predominant contributors, followed by TP53 and DICER1 mutations. MRS might serve as a valuable tool for both prognosticating clinical outcomes and directing precision-based therapeutic interventions.

Role of TSH Inhibition Therapy in the Postoperative Management of Patients with Differentiated Thyroid Cancer

Objective:To investigate the effect of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer.Methods:Seventy patients diagnosed with differentiated thyroid cancer were selected for the study.TSH inhibition therapy was administered to the research group,while thyroxine replacement therapy was provided to the control group during the postoperative management phase.This allowed for a comparative analysis between the two groups.Results:In comparison with the control group,the research group exhibited significant decreases in serum TSH,T3,and T4 levels after treatment,while FT4 and FT3 levels significantly increased(P<0.05).Additionally,significant decreases in Tg,VEGF,TSGF,CD44V6,and sIL-2R levels were observed in the research group after treatment(P<0.05).No significant differences were found in pre-treatment thyroid function between the two groups(P>0.05).Conclusion:The application of TSH inhibition therapy in the postoperative management of patients with differentiated thyroid cancer demonstrates promising outcomes.

Characteristics of Persistent or Recurrent Differentiated Thyroid Cancer

Introduction: The differentiated thyroid cancer has generally an excellent prognosis after the treatment. The aim of this study is to describe the characteristics of persistent or recurrent differentiated thyroid cancers. Patients/ Methods: It is about a descriptive and retrospective study conducted from 392 patients followed for differentiated thyroid cancer. The data concerning the persistent or recurrent differentiated thyroid cancer have been collected from 1986 to 2015 in endocrinology service in Ibn Rochd CHU. Results: In total, twenty-four patients have shown the relapse or the persistency of their tumor, corresponding to the prevalence of 6.12 percent. The papillary carcinoma was dominant in 79 percent of cases and the follicular carcinoma in 21 percent of cases. The metastases were cerebral (two cases), lung (3 cases), bones (3 cases, Figure 1), and lymph nodes (9 cases). In our series, eighteen cases of persistent differentiated thyroid cancer have been found against six cases of recurrent differentiated thyroid cancer. Two cases of death at least three years of followed in our series and concerned the two cases of cerebral metastasis. Conclusion: The persistent or recurrent differentiated thyroid cancer rate is low in our series. The discovery of the relapse t is late.

Impact of Thyroglobulin on Survival and Prognosis of Differentiated Thyroid Cancer

Proper assessment of risk factors contributes to the principle management of differentiated thyroid carcinoma post operatively. Aim of the study: to investigate the effect of Thyroglobulin (Tg) levels on prognosis together with other risk factors for Differentiated Thyroid Cancer (DTC). Patients and methods: Medical records of all patients with DTC presented to Clinical Oncology and Nuclear Medicine Department referred from Diabetes & Endocrine unit (Internal Medicine Hospital) and Surgery Department Mansoura University from 2011-2016 were retrospectively reviewed. Patients with distant metastasis or who lost follow-up were excluded. So data of 220 patients were analyzed. Data collected included pre-surgical assessment, also surgical interference either total or near total thyroidectomy with or without lymph node neck dissection were reviewed. Different prognostic factors that affect progression free survival (PFS) include age, umorsize, ymph node status, ex, multifocality, capsular infiltration, vascular invasion and Tg level were evaluated through multivariate analysis. Results: Most of the patients included were <45 years (69.1%). Incidence of the disease was higher in female (80%) with papillary type predominance (80.9%). About 59.5% of cases presented with tumor size ≤ 2 cm and multifocality was reported in 13.6%. While 30% had lymph node metastasis, 11% had vascular invasion. Capsular infiltration was observed in 15% and most of them showed Tg level ≤ 10 ng/ml (68.2%). About 70% received ablative radioiodine. The 5-year Progression Free Survival (PFS) was 85%. On multivariate analysis of variable prognostic factors on PFS, we found that tumor size, age, lymph node status, capsular infiltration, Tg level and vascular invasion significantly affected PFS (P = 0.01, 0.005, 0.004, 0.005, 0.02, 0.003) respectively. While sex, pathological type and multifocality were not (P = 0.9, 0.4, 0.6) respectively. Conclusion: Postoperative Tg level is a statistically significant prognostic factor together with other risk factors.

Differentiated Thyroid Cancer with Thyroglobulin Elevation and Negative Iodine Scintigraphy (TENIS Syndrome)

Background and Objectives: Following the initial management, some patients with differentiated thyroid cancer (DTC) develop a state of high thyroglobulin (Tg) and Negative Iodine Scintigraphy. The predisposing factors and outcome of this condition are unclear. In this study, our objectives were to analyze the characteristics of patients with high Tg level and negative Iodine scintigraphy and to determine the predictive factors for development of high Tg and negative scintigraphy. Patients and Methods: Retrospective study of 34 patients undergoing treatment for DTC, followed in the Nuclear Medicine department of the University Hospital—Sahloul Sousse between 1990 and 2006 and having a high Tg and negative Iodine scintigraphy. Fourteen patients had Tg between 2 and 10 ng/ml, 16 had Tg between 11 and 100 ng/ml and 4 patients had Tg more than 100 ng/ml. Results: There were 25 women and 9 men. The mean age was 51.65 years. In 94.1% of cases, the tumor was papillary carcinoma. Follicular tumors accounted for only 5.9%. The mean nodule size was3.26 cm. Capsular invasion was seen in 47.1% cases. The locoregional invasion was found in 35.3%. The lymph node extension was found in 84.8% of patients having lymph node surgery. Lymph node involvement was observed in 92.8% of patients with papillary cancer but it was found in 7.2% of patients with follicular cancers. Lymph node invasion was unilateral in 28.6% (N1a) and bilateral, contralateral or mediastinal in 71.4% (N1b). Initial level of Tg was as follows: 7 patients had Tg between 2 and 10 ng/ml, 14 patients had Tg between 11 and 100 ng/ml and 12 had Tg more than 100 ng/ml. The mean number of radioactive Iodine cure was 11.08 for patients with Tg more than 100 ng/ml with a significant difference (P = 0.001). Conclusion: Among epidemiological, pathological and clinical characteristics, lymph node invasion is the most frequent parameter found in patients with a DTC with high Tg level and negative Iodine scintigraphy.

Changes in percentage of lymphocyte subsets after ^(131)I treatment in patients with differentiated thyroid cancer

To monitor the extent and the duration of lymphocyte subset changes in patients with thyroid carcinoma undergoing therapeutic 131I administration, the percentage of lymphocyte subsets were serially analyzed before and after 131I treatment. In patients who received 1850 MBq of 131I for ablation of thyroid remnants, only for NK cells and B cells showed a significant reduction. In patients received 3700 MBq of 131I for treatment of local lymph node me-tastases, NK cells, B cells and CD4+ were found decreased. In patients received 7400 MBq of 131I for treatment of distant metastases, NK cells, B cells and CD4+ and CD8+ were all affected. However, there is no significant reduc-tion compared to the baseline in the percentage of all lymphocyte subsets three months after 131I treatment. The re-sults show that the sensitivity of lymphocytes to 131I internal radiation depends upon lymphocyte phenotype and 131I activity. The immunosuppression effects are temporary and reversible.

ANALYSIS OF EFFICACY IN TREATMENT OF LOW-RISK WELL-DIFFERENTIATED THYROID CANCER WITHOUT CERVICAL LYMPH NODE INVOLVEMENT: 42 CASES REPORT

Objective To assess the more appropriate surgical treatment for low-risk group differentiated thyroid cancer. Methods A total of 42 low-risk patients with DTC, according to the AMES system (male, n = 6; female, n = 36) , were chosen for total thyroidectomy or subtotal thyroidectomy with center compartment lympha-dectomy. Results Nineteen patients had cervical lymph node involvement. Two patients had recurrent nerve injured. One patient had hypoparathyroidism. There were no mortality or local lymph recurrent up to present. Conclusion Total thyroidectomy or subtotal thyroidectomy with prophylactic center compartment lymphadectomy is an appropriate approach for the treatment of low-risk group differentiated thyroed cancer, to prevent recurrent and improve life quality.

New approaches for patients with advanced radioiodine-refractory thyroid cancer

The cumulative evidence over the past decades has shown that the incidence of differentiated thyroid carcinoma(DTC)has exponentially increased.Approximately 10%of patients with DTC exhibit recurrent or metastatic disease,and about two-thirds of the latter will be defined as refractory to radioactive iodine(RAIR)treatment.Since this condition implies 10-year survival rates less than 10% after detection,using available treatments,such as systemic and targeted therapies,have become increasingly relevant.The initiation of these treatments aims to reach stabilization,tumor volume reduction,and/or symptom improvement and it should be decided by highly specialized endocrinologists/oncologists on the basis of patient’s features.Considering that despite enlarged progression-free survival was proven,multikinase inhibitors remain non-curative,their benefits last for a limited time and the side effects potentially cause harm and quality of life reduction.In this context,molecular testing of cancer cells provides a promising spectrum of targeted therapies that offer increased compatibility with individual patient needs by improving efficacy,progression free survival,overall survival and adverse events profile.This review article aims to provide a summary of the current therapeutic strategies in advanced RAIR-DTC,including approved target therapies as well as those for off-label use,RAI resensitization agents,and immunotherapy.

Analysis of the incidence and influencing factors of hyponatremia before ^(131)I treatment of differentiated thyroid carcinoma

BACKGROUND Hyponatremia is a common clinical electrolyte disorder.However,the association between hyponatremia and acute hypothyroidism is unclear.Acute hypothyroidism is usually seen in patients who undergo preparation for radioactive iodine therapy.AIM To analyze the incidence and influencing factors of hyponatremia in a condition of iatrogenic acute hypothyroidism in patients with differentiated thyroid cancer(DTC)before ^(131)I treatment.METHODS The study group consisted of 903 DTC patients who received ^(131)I treatment.The clinical data before and after surgery,as well as on the day of ^(131)I treatment were analyzed.According to the blood sodium level before ^(131)I treatment,patients were divided into the non-hyponatremia group and hyponatremia group.Correlations between serum sodium levels before ^(131)I treatment and baseline data were analyzed.Univariate analysis and binary logistic regression were performed to identify the influencing factors of hyponatremia.RESULTS A total of 903 patients with DTC,including 283(31.3%)males and 620(68.7%)females,with an average age of 43.8±12.7 years,were included in this study.The serum sodium levels before surgery and ^(131)I treatment were 141.3±2.3 and 140.5±2.1 mmol/L,respectively(P=0.001).However,the serum sodium levels in males and females before ^(131)I treatment were lower than those before surgery.Patients aged more than 60 years and less than 60 years also showed decreased serum sodium levels before ^(131)I treatment.In addition,the estimated glomerular filtration rate(eGFR)in males and females decreased before ^(131)I treatment compared with those before surgery(P=0.001).Moreover,eGFR in patients over 60 years and under 60 years decreased before ^(131)I treatment,when compared with that before surgery.There were no significant differences in serum potassium,calcium,albumin,hemoglobin,and blood glucose in patients before surgery and ^(131)I treatment(P>0.05).Among the 903 patients,23(2.5%)were diagnosed with hyponatremia before ^(131)I treatment,including 21 cases(91.3%)of mild hyponatremia and 2 cases(8.7%)of moderate hyponatremia.Clinical data showed that patients with mild hyponatremia had no specific clinical manifestations,while moderate hyponatremia cases were mainly characterized by fatigue and dizziness,which were similar to neurological symptoms caused by hypothyroidism and were difficult to distinguish.Correlation analysis showed a correlation between serum sodium before ^(131)I treatment and the preoperative level(r=0.395,P=0.001).There was no significant correlation between blood sodium and thyroid-stimulating hormone(TSH)levels and urine iodine before ^(131)I treatment(r=0.045,P=0.174;r=0.013,P=0.697).Univariate analysis showed that there were significant differences in age,sex,history of diuretic use,distant metastasis,preoperative blood sodium,blood urea nitrogen(BUN),eGFR,TSH and urinary iodine between the two groups(all P<0.05).Logistic regression analysis showed that factors such as history of diuretic use,distant metastases,preoperative sodium and BUN were all influencing factors of hyponatremia.The Hosmer and Lemeshow test(c2=2.841,P=0.944)suggested a high fit of the model.Omnibus tests of model coefficients indicated the overall significance of the model in this fitted model(P<0.05).Preoperative serum sodium was a significant factor associated with pre-^(131)I therapy hyponatremia(OR=0.763;95%CI:0.627-0.928;P=0.007).CONCLUSION The incidence of hyponatremia induced by ^(131)I treatment preparation was not high.Preparation for radioactive iodine therapy was not a risk factor for the development of hyponatremia in thyroid cancer patients.

Correlation between sodium-iodide symporter expression and circulating tumor cell positivity in differentiated thyroid carcinoma

Objective We investigated the correlation between the expression of the sodium-iodide symporter(NIS) and the detection of circulating tumor cells(CTCs) in differentiated thyroid carcinoma(DTC).Methods NIS expression in differentiated thyroid and the positive rate of CTCs in the peripheral blood were determined by immunohistochemistry S-P and flow cytometry from the records of 172 cases of differentiated thyroid carcinoma.Results Seventy-six cases(44.2%) expressed NIS in the differentiated thyroid and 63 cases(36.6%) were positive for CTCs in the peripheral blood. There was a significant difference between N0 and N1 in the expression of NIS(χ~2 = 6.015, P = 0.014) and the positive rate of CTCs(χ~2 = 14.035, P = 0.001). N0 and N1 also differed significantly in the expression of NIS(r =-0.383,-0.610, P = 0.002, < 0.001). The differences in the NIS expression, but not in the positive rate of CTCs, were significant among the different pathological subtypes(χ~2 = 7.897, P = 0.005; χ~2 = 1.455, P = 0.228, respectively). There was a significant negative correlation between the highly differentiated type and intermediate differentiation type both in the expression of NIS and positive rate of CTCs(r =-0.591,-0.443, P < 0.001, P = 0.002). Conclusion There was a significant negative correlation between the expression of tissue NIS and positive rate of CTCs in the peripheral blood in DTC. The malignancy level and lymph node metastasis in differentiated thyroid carcinoma were negatively correlated with NIS expression and positively correlated with the positive rate of CTC.

Stem cell biology in thyroid cancer: Insights for novel therapies

Currently, thyroid cancer is one of the most common endocrine cancer in the United States. A recent involvement of sub-population of stem cells, cancer stem cells, has been proposed in different histological types of thyroid cancer. Because of their ability of self-renewal and differentiation into various specialized cells in the body, these putative cells drive tumor genesis, metastatic activity and are responsible to provide chemo- and radioresistant nature to the cancer cells in the thyroid gland. Our Review was conducted from previously published literature to provide latest apprises to investigate the role of embryonic, somatic and cancer stem cells, and discusses the hypothesis of epithelial-mesenchymal transition. Different methods for their identification and isolation through stemness markers using various in vivo and in vitro methods such as flow cytometry, thyrosphere formation assay, aldehyde dehydrogenase activity and ATP-binding cassette sub-family G member 2 efflux-pump mediated Hoechst 33342 dye exclusion have been discussed. The review also outlines various setbacks that still remain to target these tumor initiating cells. Future perspectives of therapeutic strategies and their potential to treat advanced stages of thyroid cancer are also disclosed in this review.

Optimal Threshold of Stimulated Serum Thyroglobulin Level for ^(18)F-FDG PET/CT imaging in Patients with Thyroid Cancer

This study was to explore the optimal threshold of thyroid-stimulating hormone(TSH)-stimulated serum thyroglobulin(s-Tg) for patients who were to receive18F-fluorodeoxyglucose(18F-FDG) PET/CT scan owing to clinical suspicion of differentiated thyroid cancer(DTC) recurrence but negative post-therapeutic 131I whole-body scan(131I-WBS). A total of 60 qualified patients underwent PET/CT scanning from October 2010 to July 2014. The receiver operating characteristic(ROC) curve analyses showed that s-Tg levels over 49 μg/L led to the highest diagnostic accuracy of PET/CT to detect recurrence, with a sensitivity of 89.5% and a specificity of 90.9%. Besides, bivariate correlation analysis showed positive correlation between s-Tg levels and the maximum standardized uptake values(SUVmax) of18F-FDG in patients with positive PET/CT scanning, suggesting a significant influence of TSH both on Tg release and uptake of18F-FDG. So, positive PET/CT imaging is expected when patients have negative 131I-WBS but s-Tg levels over 49 μg/L.

Role of prophylactic central neck lymph node dissection for papillary thyroid carcinoma in the era of de-escalation

Thyroid cancer is the most common endocrine malignancy.While there has been no appreciable increase in the observed mortality of well-differentiated thyroid cancer,there has been an overall rise in its incidence worldwide over the last few decades.Patients with papillary thyroid carcinoma(PTC)and clinical evidence of central(cN1)and/or lateral lymph node metastases require total thyroidectomy plus central and/or lateral neck dissection as the initial surgical treatment.Nodal status in PTC patients plays a crucial role in the prognostic evaluation of the recurrence risk.The 2015 guidelines of the American Thyroid Association(ATA)have more accurately determined the indications for therapeutic central and lateral lymph node dissection.However,prophylactic central neck lymph node dissection(pCND)in negative lymph node(cN0)PTC patients is controversial,as the 2009 ATA guidelines recommended that CND“should be considered”routinely in patients who underwent total thyroidectomy for PTC.Although the current guidelines show clear indications for therapeutic CND,the role of pCND in cN0 patients with PTC is still debated.In small solitary papillary carcinoma(T1,T2),pCND is not recommended unless there are high-risk prediction factors for recurrence and diffuse nodal spread(extrathyroid extension,mutation in the BRAF gene).pCND can be considered in cN0 disease with advanced primary tumors(T3 or T4)or clinical lateral neck disease(cN1b)or for staging and treatment planning purposes.The role of the preoperative evaluation is fundamental to minimizing the possible detrimental effect of overtreatment of the types of patients who are associated with low disease-related morbidity and mortality.On the other hand,it determines the choice of appropriate treatment and determines if close monitoring of patients at a higher risk is needed.Thus,pCND is currently recommended for T3 and T4 tumors but not for T1 and T2 tumors without high-risk prediction factors of recurrence.

Screening and bioinformatics analysis of thyroid cancer-related hub genes

Objective:To identify the thyroid cancer-related hub genes and pathways by bioinformatics initially in order to lay the foundation for further study.Methods:The expression profile chips and data of thyroid cancer were screened and downloaded from the gene expression omnibus(GEO).The GEO2R was applied to identify the differential expressed genes between thyroid cancer tissues and normal thyroid tissues.And the Metascape online website was used for pathway and function enrichment.With the usage of STRING and Cytoscape,the protein-protein interaction network was constructed,and the plug-in app cytoHubba in Cytoscape was applied to screen hub genes.Kaplan-Meier Plotter was implemented to conduct survival analysis of hub genes for further screening and discussion.Results:A total of 304 differential expressed genes were screened,and were mainly enriched in the biological processes of extracellular matrix,cell-substrate adhesion,response to wounding,muscle structure development and hormone metabolic process etc.by Metascape.Protein-protein interaction network visualized 284 nodes;the top ten scores of Maximal Clique Centrality algorithm were taken as the criteria to screen out the hub genes with high connectivity in the gene expression network.The KM plotter analysis confirmed that 5 of 9 hub genes were correlated with the prognosis of thyroid cancer patients.Conclusion:FN1,SPP1,TIMP1,VCAN,COL1A1,COL1A2,MMP1,DCN,COMP and FMOD may play a significant role in the development of thyroid cancer.Genes which have prognostic significance in survival analyses were found to be relevant to the composition and regulation of extracellular matrix.

Genetic factors for differentiated thyroid cancer in French Polynesia:new candidate loci

Background:Populations of French Polynesia(FP),where France performed atmospheric tests between 1966 and 1974,experience a high incidence of differentiated thyroid cancer(DTC).However,up to now,no sufficiently large study of DTC genetic factors in this population has been performed to reach definitive conclusion.This research aimed to analyze the genetic factors of DTC risk among the native FP populations.Methods:We analyzed more than 300000 single nucleotide polymorphisms(SNPs)genotyped in 283 DTC cases and 418 matched controls born in FP,most being younger than 15 years old at the time of the first nuclear tests.We analyzed the genetic profile of our cohort to identify population subgroups.We then completed a genome-wide analysis study on the whole population.Results:We identified a specific genetic structure in the FP population reflecting admixture from Asian and European populations.We identified three regions associated with increased DTC risk at 6q24.3,10p12.2,and 17q21.32.The lead SNPs at these loci showed respective p-values of 1.66×10^(−7),2.39×10^(−7),and 7.19×10^(−7) and corresponding odds ratios of 2.02,1.89,and 2.37.Conclusion:Our study results suggest a role of the loci 6q24.3,10p12.2 and 17q21.32 in DTC risk.However,a whole genome sequencing approach would be better suited to characterize these factors than genotyping with microarray chip designed for the Caucasian population.Moreover,the functional impact of these three new loci needs to be further explored and validated.

分化型甲状腺癌的复发治疗

分化型甲状腺癌预后良好,但仍有5%~20%的患者在初次治疗后出现复发,造成患者身心和经济上的负担,同时也给临床医师对甲状腺癌的诊疗带来困难。与初始治疗方案不同,对复发甲状腺癌的处理应综合考虑风险与获益等因素。手术仍是首选治疗方式,对具有摄碘功能的复发病灶推荐放射性碘治疗,而体积较小的复发病灶可暂行主动监测,热消融治疗应仅限于不适合再次手术治疗的患者。当其他治疗方案无效时,可考虑辅助性外照射治疗或系统治疗。

核医学检查在评估中低危分化型甲状腺癌患者术后淋巴结转移中的价值

目的探讨中低危分化型甲状腺癌患者术后刺激状态下甲状腺吸碘率、甲状腺功能及残留甲状腺131I最大计数评估发生淋巴结转移的临床价值。方法随机选取2016年1月—2018年12月就诊于我院临床资料齐全的中低危分化型甲状腺癌术后并欲行131I治疗的182例分化型甲状腺癌(DTC)患者,收集所有患者甲状腺吸碘率、甲状腺功能、颈部超声、131I全身扫描及颈部SPECT/CT断层显像资料。结合淋巴结术后病理、颈部超声、颈部SPECT/CT断层显像及临床随访来最终确定颈部淋巴结转移情况。分析甲状腺吸碘率、功能、131I最大计数诊断淋巴结转移的相关因素。结果二元Logistic回归分析结果显示,中低危分化型甲状腺癌颈部淋巴结转移与术后刺激状态下吸碘率(P=0.048)、Tg(P=0.048)、131I最大计数(P=0.049)有关,与TSH(P=0.256)、FT3(P=0.516)、FT4(P=0.827)、TgAb(P=0.351)、TPOAb(P=0.389)无关。将吸碘率、Tg、131I最大计数对转移进行ROC处理,三者中吸碘率诊断效能最高,131I最大计数效能最差,吸碘率、Tg的临界值分别为1.5、5.28时对评估淋巴结转移有统计意义,131I最大计数临界值为727,但无统计学意义。通过偏相关分析显示,吸碘率、TSH、FT3、FT4、TgAb均与131I最大计数有关,其中吸碘率、FT3、FT4与131I最大计数呈正相关,TSH、TgAb与131I最大计数呈负相关(P<0.05)。结论吸碘率、Tg、131I最大计数对淋巴结转移有一定评估价值;吸碘率、FT3、FT4值越高,提示131I最大计数越高;TSH、TgAb值越高,对应131I最大计数水平越低。

不同甲状腺切除术在分化型甲状腺癌中的对比分析

目的分析次全甲状腺切除手术和全甲状腺切除手术在分化型甲状腺癌中的干预效果差异。方法选择2017年7月—2020年7月淄博市妇幼保健院收治的76例分化型甲状腺癌患者为研究样本,采取随机数字排列表法将其分成A组与B组,各38例。A组患者予以全甲状腺切除手术干预,B组患者予以次全甲状腺切除手术干预。对比2组患者治疗总有效率、手术过程中出血量、手术时间以及住院时间及并发症发生率。结果A组治疗总有效率为97.37%,高于B组的81.58%(P<0.05)。A组住院时间分别为(6.51±1.03)d,B组为(6.57±1.09)d,差异无统计学意义(P>0.05)。B组患者手术过程中出血量为(93.20±5.11)mL,多于A组的(50.19±3.56)mL,差异有统计学意义(P<0.05)。B组患者手术时间为(112.57±6.98)min,长于A组的(70.96±4.87)min(P<0.05)。A组并发症发生率为36.84%,高于B组的13.16%(P<0.05)。A组术后引流量为(30.34±4.43)mL,少于B组的(43.12±4.86)mL(P<0.05);A组引流管拔出时间为(3.34±0.23)d,短于B组的(4.10±0.29)d(P<0.05)。结论分化型甲状腺癌患者采用全甲状腺切除手术治疗可提升治疗效果,降低术中出血量,缩短手术时间;但是术后并发症较多,因此需要依据患者实际情况合理选择手术方式。

CXCR4 MFAP2 KLF4在分化型甲状腺癌中的表达及对预后的预测价值研究

目的:研究趋化因子4受体(CXCR4)、微纤维相关蛋白2(MFAP2)、Krüppel样因子4(KLF4)在分化型甲状腺癌(DTC)中的表达及对预后的预测价值。方法:选择我院2019年7月至2020年7月收治的113例DTC患者,术中留取其肿瘤组织及癌旁正常组织。采用蛋白免疫印迹法检测DTC组织及癌旁正常组织中CXCR4、MFAP2、KLF4表达水平,分析CXCR4、MFAP2、KLF4表达水平与DTC临床病理特征的关系。对DTC患者进行3年随访,统计3年总生存情况,比较死亡组与存活组CXCR4、MFAP2、KLF4表达水平,采用ROC曲线分析CXCR4、MFAP2、KLF4对DTC预后的预测价值,采用Cox回归模型进行DTC预后单因素和多因素分析。结果:与癌旁正常组织比较,DTC组织CXCR4、MFAP2蛋白表达量显著升高(P<0.05),KLF4蛋白表达量显著降低(P<0.05)。TNM分期Ⅲ期、发生淋巴结转移、肿瘤低分化者CXCR4、MFAP2蛋白表达量显著高于TNM分期Ⅰ+Ⅱ期、未发生淋巴结转移、肿瘤中高分化者(P<0.05),TNM分期Ⅲ期、发生淋巴结转移、肿瘤低分化者KLF4蛋白表达量显著低于TNM分期Ⅰ+Ⅱ期、未发生淋巴结转移、肿瘤中高分化者(P<0.05)。113例DTC患者随访3年期间失访8例,最终获得随访者105例。死亡组患者CXCR4、MFAP2蛋白表达量显著高于存活组(P<0.05),KLF4蛋白表达量显著低于存活组(P<0.05)。绘制ROC曲线发现,CXCR4、MFAP2、KLF4单独或联合预测DTC预后的AUC(95%CI)分别为0.692(0.562~0.823)、0.729(0.590~0.869)、0.766(0.622~0.910)、0.832(0.690~0.975),联合预测的效能显著优于单项检测(P<0.05)。Cox回归分析显示,淋巴结转移、TNM分期Ⅲ期、肿瘤低分化、CXCR4表达升高、MFAP2表达升高、KLF4表达降低是DTC预后的危险因素(P<0.05)。结论:分化型甲状腺癌患者肿瘤组织中CXCR4、MFAP2呈高表达,KLF4呈低表达,其表达水平与淋巴结转移、肿瘤分化程度、TNM分期及3年总生存率相关,三者联合检测有助于预测分化型甲状腺癌预后。

候床管理系统在提高分化型甲状腺癌患者住院收治率中的作用

目的探讨核医学科分化型甲状腺癌患者候床管理系统构建方法及在提高住院收治率中的作用。方法选择2021年3月—2023年1月广西医科大学第一附属医院核医学科收治的960例分化型甲状腺癌患者为对象,随机数字表法分为2组,各480例。对照组采用常规方法管理,观察组构建候床管理系统。2组均完成3个月干预,比较2组自我管理水平、住院时间、不良反应发生率、住院收治率及满意度。结果观察组干预3个月后自我概念、自护技能、自护意识及健康知识评分高于对照组(P<0.05);观察组干预3个月后住院时间≥7 d病例数和治疗过程中乏力、辐射损伤、放射性炎症、消瘦及恶心呕吐总发生率低于对照组(P<0.05);观察组干预3个月期间住院收治率为64.58%,高于对照组的43.75%;干预方法、服务态度、干预效果及干预形式方面满意度高于对照组(P<0.05)。结论构建核医学科分化型甲状腺癌患者候床管理系统,有助于提高患者自我管理水平,缩短住院时间,降低不良反应发生率,提高住院收治率及满意度。