Objective
To investigate the trends in the clinicopathological characteristics of thyroid cancer patients undergoing surgery from 1994 to 2013.
Methods
A retrospective analysis was conducted on the clinical data of inpatients with thyroid nodular diasease undergoing thyroidectomy with pathology results from January 1994 to December 2013. The trends in the pathogenic constituent of thyroid nodule and the clinicopathological characteristics of 3 399 patients with thyroid cancer were analyzed.
Results
(1)Over the past 20 years, the proportion of patients diagnosed as thyroid cancer was gradually increased, especially those with papillary thyroid cancer(PTC). Whereas the proportions of benign nodule and other rare thyroid cancer were gradually decreased(P<0.01). (2)The average age of patients with thyroid cancer was(44.30±11.72)years, with the peak incidence at 30~59 years. The incidence of thyroid cancer was increasing in both males and females, especially more evident in the absolute increase in women(P<0.05). (3)Among 3 399 patients with thyroid cancer, 56.20%(1 910/3 399)underwent subtotal lobectomy. 20.74%(705/3 399)underwent total/near total thyroidectomy, showing an increase trend(P<0.01). Ultrasound-guided aspiration biopsy for thyroid nodule were performed in 48.87%(1 661/3 399)patients before operation. The proportion of aspiration biopsy was gradually increased since 2004.(4)An increase in thyroid cancer of tumor sizes less than 2.0 cm was observed, especially those size≤1.0 cm(P<0.01). 83.96%(2 854/3 399)patients revealed TNM Ⅰ~Ⅱstage, and the proportion of patients with TNM Ⅲ~Ⅳ stage was gradually decreased since 2006(P<0.01).
Conclusion
Over the past 20 years, the proportion of thyroid cancer, especially papillary thyroid microcarcinoma reveals an ascending tendency. The percentages of patients undertaking total/near total thyroidectomy and ultrasound-guided aspiration biopsy before operation are on the rising. (Chin J Endocrinol Metab, 2017, 33: 291-295)
Key words:
Thyroid cancer; Clinical characteristics; Pathology; Tendency
Abstract We aimed to investigate the association between excess body mass index (BMI) and papillary thyroid cancer (PTC) in an operative population, and the impact of higher BMI on clinicopathological aggressiveness of PTC. Charts of 10,844 consecutive patients with thyroid nodules undergoing partial or total thyroidectomy between 1993 and 2015 were reviewed. Patients diagnosed with PTC were stratified in 4 groups: BMI < 18.5 (underweight), 18.5 ≤ BMI < 24 (normal-weight), 24 ≤ BMI < 28 (overweight) and BMI ≥ 28(obese). The impacts of high BMI on prevalence and clinicopathological parameters of PTC were retrospectively analyzed in both univariate and multivariate binary logistic regression analysis. For every 5-unit increase in body mass, the odds of risk-adjusted malignance increased by 36.6%. The individuals who were obese and overweight were associated with high risk of thyroid cancer [odds ratio (OR)= 1.982, P < .001; OR= 1.377, P < .001; respectively] compared to normal weight patients, and this positive association was found in both genders. Obesity was independent predictors for tumors larger than 1 cm (OR = 1.562, P < .001) and multifocality (OR = 1.616, P < .001). However, there was no difference in cervical lymph node (LN) metastasis among BMI groups. Crude analysis showed BMI was associated with advanced tumor-node-metastasis (TNM) stage (relative risk, approximately 1.23 per 5 BMI units, P < .001), but this association disappeared after adjusting for confounding factors. Obesity was significantly associated with the risk of PTC in a large, operative population. Higher BMI was significantly associated with larger tumor size and multifocal tumor.
It has been suggested that anti-thyroglobulin antibody (TgAb) are more common among papillary thyroid cancer (PTC). This study investigated the correlation between TgAb expression level and PTC in Chinese patients between 2011-2015 in a retrospective study. Thyroid goiter patients who have undergone thyroidectomy and received a confirmed pathological diagnosis were enrolled into this retrospective study. Demographic data, clinical characteristics and preoperative thyroglobulin antibody (TgAb) were collected from each patient. Based on the TgAb test, patients were divided into a TgAb negative (TgAb-) group (<60 IU/mL) and a TgAb positive (TgAb+) group (≥60 IU/mL), Among 4046 patients, 671 patients were TgAb+ while 3375 patients were TgAb-. In the TgAb+ group, there were 535 (79.7%) patients with PTC. In the TgAb- group, there were 2154 (63.8%) patients with PTC. The malignancy rate was significantly higher in TgAb+ patients than in TgAb- patients. TgAb+ patients were divided into four groups based on the TgAb titer by quartile stratification. The prevalence of PTC did not increase with TgAb titer. No significant difference in TgAb expression was noted in patients with different clinicopathologies, including TNM stage, lymph node metastasis and multifocal carcinoma. Regression analysis suggested a higher risk of PTC malignancy among TgAb+ patients. Preoperative TgAb expression levels ≥60 IU/mL might be associated with a higher risk of PTC. However, there was not a titer-dependent association between elevated TgAb titer and PTC malignancy.
Objective
To investigate the influence of Chinese guidelines for thyroid nodules and differentiated thyroid cancers on the diagnosis and treatment of thyroid nodule patients undergoing thyroid surgery in the PLA General Hospital.
Methods
A retrospective analysis was conducted on data of 2 243 thyroid nodule inpatients who were undergoing thyroid surgery and with their pathology results in 2011(before the guideline change, 1 013 patients)and in 2013(after the guideline change, 1 230 patients). The data of the changes of the baseline characteristics, diagnosis, constituent of thyroid nodule, distribution of benign thyroid nodule size were compared between 2011 and 2013. The differences of surgical managements of thyroid cancer were also studied.
Results
(1)A higher proportion of female patients was showed in 2013 group(75.61% vs 69.20%, P<0.01). The age of patients in 2013 group was significantly younger than that of 2011 group [(45.74±11.77 vs 47.43±11.87)years old, P<0.01]. (2)Thyroid stimulating hormone and ultrasound-guided aspiration biopsy were used more often after the guideline change(83.00% vs 65.55%, 47.95% vs 19.50% respectively, both P<0.01). And the proportion of benign nodules decreased gradually in the post-guideline period(32.20% vs 49.95%, P<0.01). The sizes of benign and malignant nodules were both showed a descending tendency [(2.487±0.861 vs 2.800±0.720)cm, (1.027±0.795 vs 1.186±0.964)cm respectively, both P<0.01]. (3)After the change of guidelines, the percentage of the options of total/near-total thyroidectomy, hemithyroidectomy with isthmusectomy, and central lymph node dissection for thyroid cancer were increased(respectively 31.29% vs 15.38%, 16.91% vs 7.69%, and 64.15% vs 50.50%, all P<0.01).
Conclusion
After Chinese guideline was introduced in 2012, the surgical management of thyroid nodules in our hospital had been followed more closely to the recommendations of the guidelines. (Chin J Endocrinol Metab, 2016, 32: 749-753)
Key words:
Thyroid nodule; Guidelines; Diagnosis; Therapy
Silibinin is a mixture of two flavonoid lignan silibinins A and B from the seeds of milk thistle (Silybum marianum L.). Using ultra-performance liquid chromatography/quadrupole time-of-flight-MS (UPLC/Q-TOF-MS), a total of 18 metabolites were identified in rat and human urine samples after oral administration of silibinin capsule. Furthermore, nine glucuronides and/or sulfated metabolites and two prototype compounds were simultaneously quantified in rat urine after oral administration of silibinin capsule at 50 and 100 mg/kg. Over a 72-h period, 27.6% and 23.3% of silibinin were excreted in the form of metabolites (n = 11) in urine, among which five major metabolites, including silibinin A-7-O-β-glucuronide (SA-7G), silibinin B-7-O-β-glucuronide (SB-7G), silibinin A-5-O-β-glucuronide (SA-5G), silibinin B-5-O-β-glucuronide (SB-5G) and silibinin A-20-O-glucuronide (SA-20G), accounted for 20.5% and 15.5% of the dosages, respectively, when administered at doses of 50 and 100 mg/kg. These results suggested that glucuronidation at the C7-, C5- and C20-hydroxyls was the primary metabolic pathway of silibinin diastereoisomers in vivo. The present results provide helpful information about the in vivo metabolism and clinical usage of silibinin capsule.
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