1.
The Prognostic Value of Tumor Multifocality in Clinical Outcomes of Papillary Thyroid Cancer.
Wang, F, Yu, X, Shen, X, Zhu, G, Huang, Y, Liu, R, Viola, D, Elisei, R, Puxeddu, E, Fugazzola, L, et al
The Journal of clinical endocrinology and metabolism. 2017;(9):3241-3250
-
-
Free full text
-
Abstract
CONTEXT Multifocality is often treated as a risk factor for papillary thyroid cancer (PTC), prompting aggressive treatments, but its prognostic value remains unestablished. OBJECTIVE To investigate the role of tumor multifocality in clinical outcomes of PTC. METHODS Multicenter study of the relationship between multifocality and clinical outcomes of PTC in 2638 patients (623 men and 2015 women) with median [interquartile range (IQR)] age of 46 (35 to 58) years and median (IQR) follow-up time of 58 (26 to 107) months at 11 medical centers in six countries. Surveillance, Epidemiology and End Results (SEER) data were used for validation. RESULTS Disease recurrence in multifocal and unifocal PTC was 198 of 1000 (19.8%) and 221 of 1624 (13.6%) (P < 0.001), with a hazard ratio of 1.55 [95% confidence interval (CI), 1.28 to 1.88], which became insignificant at 1.13 (95% CI, 0.93 to 1.37) on multivariate adjustment. Similar results were obtained in PTC variants: conventional PTC, follicular-variant PTC, tall-cell PTC, and papillary thyroid microcarcinoma. There was no association between multifocality and mortality in any of these PTC settings, whereas there was a strong association between classic risk factors and cancer recurrence or mortality, which remained significant after multivariate adjustment. In 1423 patients with intrathyroidal PTC, disease recurrence was 20 of 455 (4.4%) and 41 of 967 (4.2%) (P = 0.892) and mortality was 0 of 455 (0.0%) and 3 of 967 (0.3%) (P = 0.556) in multifocal and unifocal PTC, respectively. The results were reproduced in 89,680 patients with PTC in the SEER database. CONCLUSIONS Tumor multifocality has no independent risk prognostic value in clinical outcomes of PTC; its indiscriminate use as an independent risk factor, prompting overtreatments of patients, should be avoided.
2.
The role of carbon nanoparticles in identifying lymph nodes and preserving parathyroid in total endoscopic surgery of thyroid carcinoma.
Wang, B, Qiu, NC, Zhang, W, Shan, CX, Jiang, ZG, Liu, S, Qiu, M
Surgical endoscopy. 2015;(10):2914-20
Abstract
AIM: To evaluate the efficacy of carbon nanoparticles (CNs) in identifying lymph nodes and preserving parathyroids in endoscopic total thyroidectomy (ETT) with central neck dissection (CND), and to further explore the role of CNs in recovering postoperative parathyroid function. METHOD Fifty-five patients with papillary thyroid carcinoma were randomized to either CN group (n = 28) or control group (n = 27). The primary outcome measures were pathological results (e.g., amount of incidental removed parathyroids and lymph nodes dissected) and follow-up results [e.g., recovery of serum calcium and parathyroid hormone (PTH) levels]. The secondary end-points were the rates of neuromuscular symptoms, in-hospital postoperative hormonal assay, and lymph node metastases. RESULTS A total of 193 lymph nodes in the CN group and 123 lymph nodes in the control group were detected. The mean number of detected lymph nodes was significantly higher in the CN group than in the control group (P = 0.009). Parathyroids were present in the thyroid or central nodal specimens of five patients, which were all in the control group. The control group had a relatively higher incidence of incidental parathyroidectomy compared to the CN group (P = 0.023). Compared to the CN group, the incidence of paresthesia was higher in the control group even if not statistically significant. During follow-up, the serum calcium levels were higher in the CN group than in the control group; however, there was no statistically significant difference. For the serum PTH levels, the CN group recovered rapidly to the preoperative levels, whereas the control group climbed steadily to the normal range. The serum PTH levels in the CN group were apparently higher than in the control group at 1 week and 1 month postoperatively. CONCLUSION CNs play an important role in protecting parathyroid glands, dissecting lymph nodes thoroughly, and promoting rapid recovery of parathyroid in ETT with CND (ChiCTR-TRC-14005042).