Wen Zeng

TERT promoter Mutation and Its Association with Clinicopathological Features and Prognosis of Papillary Thyroid Cancer: A Meta-analysis.

We performed a meta-analysis to elucidate the associations of the clinicopathological characteristics and prognostic factors of papillary thyroid cancer (PTC) with TERT promoter mutations. A literature search was performed of the PubMed and EMBASE databases using Medical Subject Headings and keywords. Individual study-specific odds ratios (ORs) and confidence intervals (CIs) were calculated. The average prevalence rate of TERT promoter mutations was 10.1%. TERT promoter mutations occurred more frequently in patients with larger tumors (p = 0.003). TERT promoter mutations were associated with advanced stage (OR = 3.11, 95% CI = 2.22–4.36), lymph node metastasis (OR = 1.82, 95% CI = 1.12–2.96), distant metastasis (OR = 4.18, 95% CI = 1.61–10.81), BRAF mutation positivity (OR = 2.71, 95% CI = 1.45–3.24), recurrence (OR = 3.91, 95% CI = 1.83–8.34), and mortality (OR = 8.13, 95% CI = 3.77–17.53). The associations of TERT promoter mutations with extrathyroidal invasion (OR = 1.98, 95% CI = 0.96–4.07), unifocality (OR = 1.36, 95% CI = 0.90–2.07), and vascular invasion (OR = 1.45, 95% CI = 0.92–2.30) were not significant. TERT promoter mutations are closely associated with aggressive clinicopathological characteristics and poorer prognosis in PTC.

A comparison of the clinicopathological features and prognoses of the classical and the tall cell variant of papillary thyroid cancer: a meta-analysis

Papillary thyroid cancer (PTC) accounts for 80–90% of all thyroid malignancies. The tall cell variant (TCV) is a rare aggressive histotype of PTC. We performed a meta-analysis to compare the clinicopathological characteristics and prognostic factors of TCV with those of classical papillary thyroid carcinoma (cPTC). A literature search was performed using the PubMed and EMBASE databases using Medical Subject Headings and keywords. Twenty studies that included 1871 patients with TCV and 75323 patients with cPTC were included in our meta-analysis. Odds ratios and confidence intervals were calculated for each study. Patients with TCV were associated with multifocality, higher TNM stage, extrathyroidal extension, vascular invasion, lymph node metastasis, distant metastasis, BRAF mutation, disease-specific survival, and overall survival. We found that TCV cases were associated with more aggressive clinicopathological characteristics and poorer prognoses than cPTC cases were. Our results suggest that TCV is a high-risk PTC that warrants aggressive treatment and follow-up strategies.

Diagnostic accuracy of ultrasonographic features for lymph node metastasis in papillary thyroid microcarcinoma: a single-center retrospective study

BackgroundWhether sonography is an appropriate imaging modality for cervical lymph nodes in patients with papillary thyroid microcarcinoma (PTMC) remains unclear. Hence, this study aimed to evaluate the diagnostic value of ultrasonography (US) features for lymph node metastasis in PTMC.MethodsSeven hundred twelve patients with PTMC who underwent conventional ultrasonography examinations of the cervical lymph nodes were included. All included cases underwent total thyroidectomy plus prophylactic central lymph node dissection. The included lymph nodes were marked superficially, and the corresponding lymph nodes were completely removed and sent for pathological examination. The US features of lymph nodes with and without metastasis were compared, and the odds ratios of the suspicious US features were determined with univariate and multivariate analyses.ResultsRound shape, loss of an echogenic fatty hilum, cystic change, calcification, and abnormal vascularity were significantly more common in metastatic than nonmetastatic lymph nodes, whereas the boundary and echo did not significantly differ. Multivariate logistic regression analysis showed that round shape, loss of echogenic fatty hilum, cystic change, calcification, and abnormal vascularity were independent predictive factors for the assessment of metastatic lymph nodes. Round shape had the highest sensitivity of all variables, while loss of an echogenic fatty hilum had the highest specificity and accuracy. The area under the receiver operating characteristic curve, which was calculated to verify the relationship between the various US features and metastatic lymph nodes, was 0.793.ConclusionsOur study found that the US features of round shape, cystic change, calcification, loss of echogenic fatty hilum, and abnormal vascularity were useful sonographic criteria for differentiating between cervical lymph nodes with and without metastasis.

Total tumour diameter is superior to unifocal diameter as a predictor of papillary thyroid microcarcinoma prognosis

The current American Joint Committee (AJCC) on Cancer TNM classification does not describe the treatment of multifocal papillary thyroid microcarcinomas (PTMCs) with a total tumour diameter (TTD) >1 cm. Herein, we investigated this PTMC subgroup in terms of extrathyroidal extension (ETE), local infiltration, central lymph node metastasis (LNM), and prognosis. Consecutive patients (n = 1102) were identified and the proportions of LNM, ETE, and local infiltration were similar between PTCs with a unifocal tumour diameter >1 cm and ≤2 cm and PTMCs with a multifocal TTD >1 cm and ≤2 cm. The proportions of LNM, ETE, and local infiltration were also similar between PTMCs with a unifocal diameter ≤1 cm vs. multifocal TTD ≤1 cm. However, when comparing PTMCs with a unifocal diameter ≤1 cm vs. multifocal TTD >1 cm, significant differences were observed. In the Kaplan-Meier analysis, significant differences were observed between PTMCs with a unifocal diameter ≤1 cm vs. multifocal TTD >1 cm and multifocal TTD ≤1 cm vs. multifocal TTD >1 cm. Accordingly, TTD may represent a more accurate criterion for tumour size of PTCs and should be considered in the revised AJCC staging system.

Reevaluating the prognostic significance of male gender for papillary thyroid carcinoma and microcarcinoma: a SEER database analysis

The prognostic significance of gender remains controversial for papillary thyroid carcinoma (PTC). In this study, we investigated the associations between gender and prognosis in a large cohort of patients with PTC or PTMC that was diagnosed in 2010–2013 and recorded in the Surveillance, Epidemiology, and End Results cancer registry. The mean ± standard deviation duration of survival for all patients with PTC during the study period was 21.47 ± 14.04 months. In Kaplan-Meier analyses of the entire cohort of PTC patients, survival curves for all-cause death and cancer-specific death declined more sharply for men than for women. Similar results were observed in analyses of patients with PTCs > 1 cm and PTMC. After adjusting for potential confounders, hazard rates indicated significantly elevated all-cause mortality for men in analyses of all PTCs, PTCs > 1 cm, and PTMCs. However, in a confounder-adjusted analysis of patients with PTMC, the hazard rate did not indicate significantly higher mortality for men than for women. Our study demonstrated that male gender is an independent poor prognostic factor for all PTCs and for PTCs > 1 cm. However, gender is not an independent prognostic factor for cause-specific survival in PTMC.

Do patients with oxyphilic cell papillary thyroid carcinoma have a poor prognosis? Analysis of the surveillance, epidemiology, and end results database 2004-2013 with propensity score matching

The prognosis of oxyphilic cell papillary thyroid carcinoma (OCPTC) remains unclear. The aim of this study was to investigate the prognosis of OCPTC and provide a new perspective on treatment guidelines for these patients. We investigated a large cohort of DTC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013. Patient mortality was examined by Kaplan-Meier analyses with log-rank tests and Cox proportional hazards regression analyses. In the study cohort, the rate of cancer-specific mortality per 1000 person-years for OCPTC was lower than that for classic papillary thyroid cancer (CPTC) and follicular thyroid cancer (FTC). According to the multivariate Cox regression model, the cancer-specific and all-cause mortality rates of OCPTC were similar to that of CPTC and FTC. The cancer-specific survival rate in patients with OCPTC was higher than that in patients with FTC, but similar to patients with CPTC, after matching for influential factors using propensity score matching analysis. The unanticipated prognosis provided new implications for the treatment of patients with OCPTC.

Unanticipated prognosis of differential thyroid cancer patients with T0 stage: analysis of the SEER database 2004-2013

The prognosis of T0 stage differentiated thyroid cancer (DTC) remains unclear. This study aimed to investigate the prognosis of T0 stage DTC patients to provide a new perspective on treatment guidelines for these patients. We investigated a large cohort of DTC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013. Patient survival curves were examined by Kaplan-Meier analyses with log-rank tests and Cox proportional hazards regression analyses. In the study cohort, the rate of cancer-specific mortality per 1000 person-years for T0 was higher than T1–T3, but lower than T4. The all-cause mortality for T0 patients was higher than all other stages (T1–T4). Multivariate Cox regression modeling showed that T0 had a significant risk for cancer-specific mortality when compared to T1 and T4, but not T2 or T3, after adjustment for other risk factors. For all-cause mortality, T0 showed a significant risk for all-cause mortality when compared to T4, but not T1–T3 stage patients. Similar results were obtained after matching for influential factors using propensity scored matching analysis. The unanticipated prognosis of T0 stage DTC patients was found to be not better than of other stage DTC patients, providing new implications for the treatment of T0 stage DTC patients.

High Expression of Yes-activated Protein-1 in Papillary Thyroid Carcinoma Correlates With Poor Prognosis

Context: The Hippo signal transduction pathway is highly conserved in mammals. It plays a critical role in tissue and organ size by regulating the balance between cell proliferation and apoptosis. However, there have been few reports concerning Yes-activated protein-1 (YAP-1) elevation in papillary thyroid cancer (PTC). Objective: The objective of this study was to determine whether YAP-1 expression is a biomarker and high-risk clinicopathologic prognosticator in PTC. Design: A large series of patients of PTC with a long follow-up were investigated for YAP-1 expression. Setting: Our study was carried out in the laboratory of breast and thyroid and Department of pathology. Patients or Other Participants: Immunohistochemical staining was performed on 240 patient-derived PTC specimens to analyze the correlation of YAP-1 expression with clinicopathologic features and prognosis in patients with PTC. Intervention: The 240 PTC patients were immunohistochemically assessed for YAP-1 expression. Outcome Measures: Kaplan-Meier analysis was conducted to assess recurrence-free survival (RFS). Univariate and multivariate analyses were conducted to determine prognosticators of RFS. Results: YAP-1 expression was observed in 62.1% of PTC tumors. There were significant positive correlations between YAP-1 expression and tumor size, lymph node metastases, extrathyroidal extension, and tissue infiltration. YAP-1 expression was significantly associated with RFS. Univariate analysis revealed that YAP-1 expression significantly affects RFS. YAP-1 and extrathyroidal extension were significant independent prognosticators for RFS. Conclusions: YAP-1 expression was significantly correlated with high-risk clinicopathologic features and inferior RFS in patients with PTC.