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Background: The status of lymph node metastasis (LNM) is crucial for evaluating prognosis in patients with medullary thyroid cancer (MTC). However, only the compartment of LNM was reflected in the eighth edition (8th) of the American Joint Committee on Cancer (AJCC) N-staging system. Therefore, a more accurate N-staging system is required for MTC. Methods: Two large cohorts were included in this analysis and consisted of 1374 MTC patients from the Surveillance, Epidemiology, and End Results (SEER) database and 164 MTC patients from the Fudan University Shanghai Cancer Center (FUSCC) database. Using metastatic lymph node number (MLNN) and metastatic lymph node ratio (MLNR), a novel N-staging system that predicts the survival of MTC was derived and measured by concordance index (C-index). Results: The cutoff values were 0 and 12 for MLNN and 0.6 (MLNN≤12) and 0.75 (MLNN≥13) for MLNR. Based on the values of MLNN and MLNR, we proposed the following novel N-staging system for MTC: N0, MLNN=0; N1, 1≤MLNN≤12 and MLNR 12 and MLNR 12 and MLNR ≥0.75. Multivariate Cox analysis indicated that the novel N-staging system was an independent prognostic factor for cancerspecific survival. The C-index was higher for the novel N-staging system than for the 8th AJCC N-staging system (SEER cohort: 0.783 vs. 0.756; FUSCC cohort: 0.716 vs. 0.670). Conclusion: With some improvements, the novel N-staging system for MTC suggested from this research may be assessed for potential adoption in the next edition of the AJCC N-staging system. Funding Statement: This work was supported by National Natural Science Foundation of China (81772852), the Science and Technology Commission of Shanghai Municipality (16ZR1406600). Declaration of Interests: The authors report no conflicts of interest in this work. Ethics Approval Statement: This study was approved by the Ethics Committee of FUSCC.

Introduction To investigate whether the positive lymph node number (PLNN) and positive lymph node ratio (PLNR) could predict the prognosis of patients with major salivary gland cancer (MSGC) and to identify the optimal cutoff points for these variables that stratify patients according to their risk of survival. Methods We used the Surveillance, Epidemiology, and End Results (SEER) database to identify all patients with MSGC between 1988 and 2014. A logistic regression analysis was carried out to evaluate the risk factors for lymph node metastasis (LNM) in MSGC. The X-tile program was used to identify the cutoff values for the PLNN and PLNR in MSGC patients with LNM. Cox proportional hazards regression models were performed to identify the predictors of cancer-specific survival (CSS). Results In the SEER database, 8668 eligible patients were identified and 3046 of them had LNM. The logistic regression analysis indicated that older age, male sex, larger tumor size, higher grade, tumor extension and high-risk pathology were associated with LNM. The X-tile program showed that a PLNN>4 and a PLNR>0.15 were prognostic indicators of CSS. A multivariable analysis indicated that, after the factors that might potentially affect the prognosis were adjusted for, the PLNN and PLNR were still associated with CSS. Conclusions Our Results demonstrated that the PLNN and PLNR were independent prognostic indicators for MSGC patients with lymph node metastasis.

6084 Background: Surgery is the primary treatment for locally advanced thyroid cancer. However, some locally advanced patients are not candidates for R0/1 resection. There is limited evidence of neoadjuvant treatment in locally advanced thyroid cancer. Surufatinib targets multiple kinases (VEGFR1-3, FGFR1 and CSF-1R) involved in tumor angiogenesis and tumor immune evasion. It is efficient, tolerable and safe for patients with radioiodine-refractory differentiated thyroid cancer to receive surufatinib. In addition, surufatinib plus toripalimab (an anti-PD-1 antibody) showed encouraging antitumor activity and an acceptable safety profile in advanced solid tumors. This study aimed to evaluate the efficacy and safety of surufatinib plus toripalimab in locally advanced thyroid cancer in the neoadjuvant setting. Methods: In this single-arm phase II study, patients with pathologically confirmed diagnosis of unresectable or borderline resectable differentiated thyroid cancer were eligible and received a combination of 250 mg surufatinib (oral, qd) with 240 mg toripalimab (IV, q3w). Treatment was continued until satisfied for curative surgery, disease progression, withdrawal of consent, unacceptable toxicity or investigator decision. Primary endpoint was objective response rate (ORR) by RECIST 1.1. Secondary endpoints included R0/1 resection rate, disease control rate (DCR), time to remission (TTR), adverse events (AEs), etc. Results: This study is ongoing. 10/10 patients were enrolled. 6 patients received ≥4 cycles of surufatinib plus toripalimab treatment and were also evaluated for efficacy. The ORR was 66.7% with 4 partial response (PR) and 2 stable disease (SD). 4 PR and 1 SD patients received R0 resections after neoadjuvant treatment. The safety was consistent with previously reported. No grade ≥3 AEs were observed. Specific AEs data are still being counted. Conclusions: Surufatinib in combination with toripalimab as neoadjuvant therapy for locally advanced thyroid cancer was feasible and majority of patients achieved R0 resection. AEs were mainly grade 1-2, and this combination was well-tolerated. The combination of these two agents should be further investigated for neoadjuvant treatment of locally advanced thyroid cancer based on good results. Clinical trial information: NCT04524884.

Background tRNA-derived small noncoding RNAs (sncRNAs) are mainly categorized into tRNA halves (tiRNAs) and fragments (tRFs). Biological functions of tiRNAs in human solid tumor are attracting more and more attention, but researches concerning the mechanisms in tiRNAs-mediated tumorigenesis are rarely. The direct regulatory relationship between tiRNAs and splicing-related proteins remain elusive. Methods Papillary thyroid carcinoma (PTC) associated tRNA fragments were screened by tRNA fragments deep sequencing and validated by qRT-PCR and Northern Blot in PTC tissues. The biological function of tRNA fragments were assessed by cell counting kit, transwells and subcutaneous transplantation tumor of nude mice. For mechanistic study, tRNA fragments pull-down, RNA immunoprecipitation, Western Blot, Immunofluorescence, Immunohistochemical staining were performed. Results Herein, we have identified a 33 nt tiRNA-Gly significantly increases in papillary thyroid cancer (PTC) based on tRFs & tiRNAs sequencing. The ectopic expression of tiRNA-Gly promotes cell proliferation and migration, whereas down-regulation of tiRNA-Gly exhibits reverse effects. Mechanistic investigations reveal tiRNA-Gly directly bind the UHM domain of a splicing-related RNA-binding protein RBM17. The interaction with tiRNA-Gly could translocate RBM17 from cytoplasm into nucleus. In addition, tiRNA-Gly increases RBM17 protein expression via inhibiting its degradation in a ubiquitin/proteasome-dependent way. Moreover, RBM17 level in tiRNA-Gly high-expressing human PTC tissues is upregulated. In vivo mouse model shows that suppression of tiRNA-Gly decreases RBM17 expression. Importantly, tiRNA-Gly can induce exon 16 splicing of MAP4K4 mRNA leading to phosphorylation of downstream signaling pathway, which is RBM17 dependent. Conclusions Our study firstly illustrates tiRNA-Gly can directly bind to RBM17 and display oncogenic effect via RBM17-mediated alternative splicing. This fully novel model broadens our understanding of molecular mechanism in which tRNA fragment in tumor cells directly bind RNA binding protein and play a role in alternative splicing.

// Kai Qian 1, 2 , Kai Guo 1, 2 , Xiaoke Zheng 1, 2 , Tuanqi Sun 1, 2 , Duanshu Li 1, 2 , Yi Wu 1, 2 , Qinghai Ji 1, 2 and Zhuoying Wang 1, 2 1 Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China 2 Department of Oncology, Fudan University Shanghai Medical College, Shanghai 200032, China Correspondence to: Zhuoying Wang, email: zhuoyingwang@hotmail.com Keywords: screening criteria, active surveillance, papillary thyroid microcarcinoma, prognostic indicators, retrospective study Received: March 14, 2017 Accepted: June 30, 2017 Published: July 22, 2017 ABSTRACT Screening out patients who do not require immediate surgery is a growing trend in the field of thyroid research. In this study, we retrospectively compared the application of two surveillance selection criteria in 1001 patients who had undergone surgical treatment of papillary thyroid microcarcinoma (PTMC): low-risk PTMC characteristics defined by Kuma Hospital and CATO consensus on PTMC management of active surveillance. Treatment outcomes were compared between groups. We then analyzed the prognostic indicators of patients who could be managed by surveillance. A total of 724 patients met Kuma screening criteria and 135 met CATO screening criteria. The Kuma low-risk group had a lower incidence of multifocal lesions and CLNM than Kuma high-risk group. We also found more obvious differences in multifocal lesions, CLNM and extrathyroidal extension when evaluating the CATO low-risk criteria in the same manner. On the other hand, patients in the CATO low-risk group had a lower disease progression rate and longer disease-free survival than those in CATO high-risk group. There was no significant difference in prognosis between the Kuma low-risk group and Kuma high-risk group. Our logistic regression analysis showed that a preoperative ultrasound size of >5 mm, male sex, younger age, and malignant lesions without concurrent benign nodules could be predictors of CLNM. In conclusion, patients classified in CATO low-risk criteria had lower proportion of clinicopathological risk factors than the ones in Kuma low-risk criteria. We also found more risk factors may not be suitable for surveillance, such as tumors without concurrent benign nodules.

Background: Thyroid cancer is the most common endocrine malignant disease in children and adolescents. There is a trend of more conservative strategies including lobectomy and less radioactive iodine therapy (RAI) in multifocal papillary thyroid cancer (PTC) for its good survival outcome. The aim of our study was to define long-time outcome of a large cohort of multifocal PTC patients less than 20 years old treated at our institution. Methods: Data were collected from 276 cases who were initially diagnosis of PTC under the age of 20 from January 2006 to December 2015 at Fudan University Shanghai Cancer Center. All patients received total/near total thyroidectomy or lobectomy. Therapeutic central-compartment (level VI) and lateral neck lymph node dissection performed for patients with clinically involved neck nodes. RAI therapy used in selected patients. No patients received chemotherapy or kinase inhibitor therapy. Thyroid-stimulating hormone (TSH) suppression therapy was performed in all patients for at least 5 years. Results: Ninety among 276 were multifocal PTC patients and included in this study. The median follow-up time was 54.28 months, ranging from 6.10 to 141.27 months. Fifteen patients had tumor recurrence during the follow-up. On Kaplan-Meier survival curves, lymphovascular invasion and extrathyroidal extension was associated with a decline in recurrence-free survival. However, there was no difference in recurrence-free survival curves in patients no matter which treatment they had received, either lobectomy or total thyroidectomy, RAI or not. Conclusions: More conservative strategies including lobectomy and less RAI in multifocal PTC among children and adolescents are safe and effective.

In recent decades, the incidence rate of papillary thyroid carcinoma (PTC) has been rapidly increasing. However, the molecular mechanism of the physiological and pathological processes of PTC is still largely unknown. Phospholysine phosphohistidine inorganic pyrophosphate phosphatase (LHPP) is a tumor suppressor and exerts anti-tumor effect in several human cancers, while the role and underlying mechanism of LHPP in PTC remain vague. In this study, we firstly evaluated the roles of LHPP in PTC and explored its underlying mechanism. Using clinical tissue samples, we detected the level of LHPP in PTC tissues and in matched adjacent normal tissues. Lower level of LHPP was found in PTC tissues than in matched adjacent normal tissues. Similar LHPP expression pattern was found in PTC cell lines when compared with that in normal human thyroid follicular epithelial cells. Then, we over-expressed LHPP in three PTC cell lines and results showed that ectopic LHPP expression consistently reduced cell viability, proliferation, and migration and triggered cell autophagy. Furthermore, over-expression of LHPP inhibited the activation of the AKT/mTOR pathway and promoted the AMPK signaling pathway. In addition, the activation of AKT/mTOR and inhibition of AMPK signaling pathways restored the role of ectopic LHPP expression in PTC cell lines, indicating that LHPP exerts its anti-tumor activity through regulating the AKT/AMPK/mTOR pathway. Ultimately, we illustrated that ectopic LHPP expression inhibited PTC tumor growth in vivo. In conclusion, we revealed that LHPP has an anti-tumor effect in PTC and indicated that LHPP might serve as an effective diagnostic and therapeutic target for PTC.

// Shuwen Yang 1, 2, 3, * , Qinghai Ji 1, 2, 3, * , Bin Chang 2, 4 , Yan Wang 2, 3 , Yongxue Zhu 1, 2 , Duanshu Li 1, 2 , Caiping Huang 1, 2 , Yulong Wang 1, 2 , Guohua Sun 1, 2 , Ling Zhang 1, 2 , Qing Guan 1, 2 , Jun Xiang 1, 2 , Wenjun Wei 1, 2 , Zhongwu Lu 1, 2 , Tian Liao 1, 3 , Jiao Meng 3 , Ziliang Wang 3 , Ben Ma 1, 2, 3 , Li Zhou 1, 2, 3 , Yu Wang 1, 2, 3 , Gong Yang 2, 3, 5 1 Department of Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China 3 Cancer Research Institute, Fudan University Shanghai Cancer Center, Shanghai 200032, China 4 Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai 200032, China 5 Central Laboratory, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai 200240, China * Co-First authors Correspondence to: Yu Wang, email: neck130@hotmail.com Gong Yang, email: yanggong@fudan.edu.cn Keywords: STC2, pAKT, Snail, HNSCC, metastasis Received: May 23, 2016 Accepted: October 14, 2016 Published: November 15, 2016 ABSTRACT The mammalian peptide hormone stanniocalcin 2 (STC2) plays an oncogenic role in many human cancers. However, the exact function of STC2 in human head and neck squamous cell carcinoma (HNSCC) is unclear. We aimed to examine the function and clinical significance of STC2 in HNSCC. Using in vitro and in vivo assays, we show that overexpression of STC2 suppressed cell apoptosis, promoted cell proliferation, migration, invasion, and cell cycle arrest at the G1/S transition. By contrast, silencing of STC2 inhibited these activities. We further show that STC2 upregulated the phosphorylation of AKT and enhanced HNSCC metastasis via Snail-mediated increase of vimentin and decrease of E-cadherin. These responses were blocked by silencing of STC2/Snail expression or inhibition of pAKT activity. Furthermore, clinical data indicate that high STC2 expression was associated with high levels of pAKT and Snail in tumor samples from HNSCC patients with regional lymph node metastasis (P < 0.01). Thus, we conclude that STC2 controls HNSCC metastasis via the PI3K/AKT/Snail signaling axis and that targeted therapy against STC2 may be a novel strategy to effectively treat patients with metastatic HNSCC.

// Fen Xue 1 , Duanshu Li 2 , Chaosu Hu 1 , Zhuoying Wang 2 , Xiayun He 1 and Yi Wu 2 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China 2 Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China Correspondence to: Xiayun He, email: // Yi Wu, email: // Keywords : unresectable poorly differentiated thyroid carcinoma; intensity modulated radiotherapy; chemotherapy; locoregional control; distant metastases Received : July 10, 2016 Accepted : October 13, 2016 Published : October 20, 2016 Abstract Poorly differentiated thyroid carcinoma (PDTC) is a rare and aggressive malignancy with high rates of invasion and distant metastasis. This study was to explore the ability of intensity-modulated radiotherapy (IMRT) combined with chemotherapy to manage unresectable PDTC. Between February 2011 and April 2012, 5 patients with unresectable PDTC were treated by IMRT at our institution and were included in this analysis. The median radiotherapy dose to the gross tumor volume (GTV) was 66 Gy/33 fractions/6.4 weeks. All patients received chemotherapy, and one patient with tumor compression symptoms had a tracheotomy before treatment. The mean survival time of the 5 patients was 41.6 months. The direct causes of death were distant metastases (40%) and progression of the locoregional disease (20%). In conclusion, IMRT combined with chemotherapy for unresectable PDTC might be beneficial to improve locoregional control. Further new therapies are needed to control metastases.

Background Schwannomas of the vagus nerve and cervical sympathetic nerve are rare; hence, only limited information exists regarding their diagnosis and clinical management. Methods We conducted a retrospective review of the clinical features, imaging studies, and treatment results of patients with schwannoma of the vagus nerve and schwannoma of the sympathetic nerve. Results Of 91 patients, 91% (n = 83) were preoperatively diagnosed with schwannoma tumors. Using the hyoid bone as an anatomic landmark, the location of the schwannoma of the vagus nerve in the carotid space was significantly different to the location of schwannoma of the sympathetic nerve (p = .003). Although 52 of the 76 patients followed up (68%) had postoperative nerve weaknesses, 13 patients (50%) and 14 patients (53.8%), respectively, fully recovered from schwannoma of the vagus nerve and schwannoma of the sympathetic nerve. Conclusion In the carotid space, schwannomas of the vagus nerve are usually located below the hyoid bone, whereas schwannomas of the sympathetic nerve more commonly arise from the suprahyoid compartment. Accurate preoperative diagnosis and the intracapsular enucleation surgical approach decreased the incidence of postoperative morbidity. © 2016 Wiley Periodicals, Head Neck, 2016

Purpose To evaluate the value of fluorine-18 2-deoxy-2-d-glucose positron emission tomography/computed tomography ([ 18 F]FDG-PET/CT) in the detection of metastatic medullary thyroid cancer. Methods From November 2006 to November 2012, 50 medullary thyroid cancer patients (median age 48.7years, range 18–76) who had a total thyroidectomy operation underwent whole-body [ 18 F]FDG-PET/CT scans. The diagnostic accuracy of [ 18 F]FDG-PET/CT was determined through both lesion-based and patient-based analyses. Further pathological tests were performed on all identified lesions or clinically followed for a minimum period of 6months. Results One hundred forty-four suspicious lesions were identified by organ-based analysis. Of these lesions, [ 18 F]FDG-PET/CT detected 99 true-positive lesions, sensitivity was 73.3%, and specificity was 66.7%. On the patient-based analysis, the overall sensitivity and specificity were calculated as 65.7% and 92.3%, respectively. Using a cutoff calcitonin value of 1000pg/ml, in patients with calcitonin lower than this value, sensitivity and specificity were 42.9% and 91.0%, respectively. In patients with calcitonin exceeding this value, they raised to 77.3% ( χ 2 =4.392, P χ 2 =0.197, P >.05), respectively. Compared with conventional imaging modality, PET/CT scans detected more lesions in 10 patients (20.4%) and correctly changed the treatment in 8 patients (16.3%). Conclusion [ 18 F]FDG-PET/CT has excellent sensitivity and specificity, especially when the calcitonin value is higher than 1000pg/ml for detecting metastatic medullary thyroid cancer. Compared to conventional morphologic imaging methods, it provides additional information for diagnosis.

To identify genetic markers for laryngeal squamous cell carcinoma (LSCC), we conducted a genome-wide association study (GWAS) on 993 individuals with LSCC (cases) and 1,995 cancer-free controls from Chinese populations. The most promising variants (association P < 1 × 10(-5)) were then replicated in 3 independent sets including 2,398 cases and 2,804 controls, among which we identified 3 new susceptibility loci at 11q12 (rs174549), 6p21 (rs2857595) and 12q24 (rs10492336). The minor alleles of each of these loci showed protective effects, with odds ratios (95% confidence intervals) of 0.73 (0.68-0.78; P = 1.00 × 10(-20)), 0.78 (0.72-0.84; P = 2.43 × 10(-15)) and 0.71 (0.65-0.77; P = 4.48 × 10(-14)), respectively. None of these variants showed an interaction with smoking or drinking. This is the first GWAS to our knowledge solely on LSCC, and the findings might advance understanding of the etiology of LSCC.

Background: To explore whether deep convolutional neural networks (DCNNs) have the potential to improve diagnostic efficiency and increase the level of interobserver agreement in the classification of thyroid nodules in histopathological slides. Methods: A total of 11,715 fragmented images from 806 patients’ original histological images were divided into a training dataset and a test dataset. Inception-ResNet-v2 and VGG-19 were trained using the training dataset and tested using the test dataset to determine the diagnostic efficiencies of different histologic types of thyroid nodules, including normal tissue, adenoma, nodular goiter, papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC). Misdiagnoses were further analyzed. Results: The total 11,715 fragmented images were divided into a training dataset and a test dataset for each pathology type at a ratio of 5:1. Using the test set, VGG-19 yielded a better average diagnostic accuracy than did Inception-ResNet-v2 (97.34% vs . 94.42%, respectively). The VGG-19 model applied to 7 pathology types showed a fragmentation accuracy of 88.33% for normal tissue, 98.57% for ATC, 98.89% for FTC, 100% for MTC, 97.77% for PTC, 100% for nodular goiter and 92.44% for adenoma. It achieved excellent diagnostic efficiencies for all the malignant types. Normal tissue and adenoma were the most challenging histological types to classify. Conclusions: The DCNN models, especially VGG-19, achieved satisfactory accuracies on the task of differentiating thyroid tumors by histopathology. Analysis of the misdiagnosed cases revealed that normal tissue and adenoma were the most challenging histological types for the DCNN to differentiate, while all the malignant classifications achieved excellent diagnostic efficiencies. The results indicate that DCNN models may have potential for facilitating histopathologic thyroid disease diagnosis.

Differentiated thyroid cancer (DTC) is associated with the highest propensity for lymph node metastases, given the significant morbidity associated with sacrificing the spinal accessory nerve, surgeons increasingly looked to minimizing functional deficits while maintaining oncologic outcome. We have detailed the technique of a selective neck dissection with more attention to preserving the cervical sensory nerves since 1999 in Fudan University Shanghai Cancer Center. We found that the radical dissection with preservation of the cutaneous branches including the great auricular nerve, the less occipital nerve and the supraclavicular nerve can maximally decrease the complications of paresthesia and dysesthesia postoperatively in the lower neck, the shoulders and the area around the ear in DTC cases when indications were allowed. As long as the principles of cancer surgery are strictly followed, our approach guarantees radical tumor removal and exhibit more functional preservation.

Schwannomas of the vagus nerve and cervical sympathetic nerve are rare; hence, only limited information exists regarding their diagnosis and clinical management.We conducted a retrospective review of the clinical features, imaging studies, and treatment results of patients with schwannoma of the vagus nerve and schwannoma of the sympathetic nerve.Of 91 patients, 91% (n = 83) were preoperatively diagnosed with schwannoma tumors. Using the hyoid bone as an anatomic landmark, the location of the schwannoma of the vagus nerve in the carotid space was significantly different to the location of schwannoma of the sympathetic nerve (p = .003). Although 52 of the 76 patients followed up (68%) had postoperative nerve weaknesses, 13 patients (50%) and 14 patients (53.8%), respectively, fully recovered from schwannoma of the vagus nerve and schwannoma of the sympathetic nerve.In the carotid space, schwannomas of the vagus nerve are usually located below the hyoid bone, whereas schwannomas of the sympathetic nerve more commonly arise from the suprahyoid compartment. Accurate preoperative diagnosis and the intracapsular enucleation surgical approach decreased the incidence of postoperative morbidity. © 2016 Wiley Periodicals, Head Neck 39: 42-47, 2017.

Resume But de l’etude Evaluer les caracteristiques epidemiologiques et cliniques des patients ayant un cancer thyroidien dans l’est de la Chine. Population et methodes Evaluation et comparaison des donnees cliniques des patients ayant un cancer thyroidien en 1996 et en 2006 dans le departement de chirurgie de la tete et du cou de l’hopital de l’universite de Fudan, a Shangai, Chine. Resultats Le nombre de patients ayant un cancer thyroidien a augmente de 148 patients en 1996 a 572 patients en 2006 (× 3,9 fois). L’echographie a permis le diagnostic de quatre patients en 1996 (2,7 %) et de 285 patients en 2006 (49,8 %). La sensibilite de l’echographie du cancer de la thyroide etait de 86,7 % en 1996 et 88,2 % en 2006 (p > 0,05). Parmi tous les types anatomopathologiques, le carcinome papillaire thyroidien etait le plus frequent (87,8 % en 1996 et 92,8 % en 2006). L’incidence des microcancers parmi l’ensemble des cancers etait de 35,7 % en 2006 et de 20,3 % en 1996 (p 0,05). Enfin, la proportion de cancers de stade I en 2006 etait superieure a celle observee en 1996. Conclusion Nous avons observe une augmentation de l’incidence des cancers thyroidiens entre 1996 et 2006, qui etait associee a une augmentation de l’incidence des petits cancers (diminution du diametre tumoral, diminution de l’atteinte ganglionnaire et de l’atteinte extrathyroidienne). Nous concluons que l’utilisation de l’echographie thyroidienne a contribuee a l’observation de ces resultats en augmentant la proportion de cancers decouverts a un stade precoce.

Analyze recent clinical features of thyroid cancer in eastern China.Investigation and comparison of clinical data of thyroid cancer patients from 1996 to 2006 from the Department of Head and Neck Surgery in the Cancer Hospital of Fudan University, Shanghai, China.The number of patients with thyroid cancer rose from 148 in the year 1996 to 572 in the year 2006, a 3.9-fold increase. Routine ultrasound survey during physical examination revealed four cases (2.7%) in 1996 and 285 cases (49.8%) in 2006. The sensitivity of the ultrasound survey in thyroid cancer diagnosis was 86.66% in 1996 and 88.20% in 2006 (P0.05). Papillary carcinoma was most prevalent (87.8% in 1996 and 92.8% in 2006). An increasing proportion of small tumors was found. The incidence of microcarcinoma was 35.7% in 2006 in contrast with 20.3% in 1996 (P0.01). Moreover, tumors with diameter from 1 to 2 cm were found in 38.5% patients in 2006 as opposed to 27.0% in 1996 (P0.01). Extrathyroid extension was reported in 46 (31.1%) patients in 1996, but only in 39 (6.8%) in 2006 (P0.01). Central cervical lymph node metastases were found in 98 (66.2%) patients in 1996, contrasting with 301 (52.6%) in 2006 (P0.05). Thirty-seven (25.0%) patients had lateral cervical lymph node metastasis in 1996 compared with 117 (20.5%) in 2006 (P0.05). Last, the proportion of stage I cancers in 2006 was higher than that in 1996.With the increasing incidence of thyroid cancer, cancer was discovered at an earlier stage. This is due to new clinical features of thyroid cancer, such as the decrease in tumor diameter, the lower rate of extrathyroid extension and of cervical lymph node metastasis. Routine ultrasound survey during physical examination has become the most common way to detect thyroid cancer. Increasing usage of diagnostic scrutiny, including the ultrasound survey, has most likely contributed to the increased incidence through detection of small thyroid cancers. Increased use of ultrasound to screen thyroid cancer in early stages should lead to better therapeutic outcome.

Cervical residue or recurrence of nasopharyngeal carcinoma (NPC) is traditionally treated with radical neck dissection (RND). Because cervical residue patients with NPC exhibit better prognoses than patients with neck recurrence, selective neck dissection (SND) rather than RND may be the optimal treatment for these patients. This study was designed to evaluate the efficacy of SND for the management of neck residue of NPC.Between January 2008 and July 2013, a total of 69 patients were assigned to undergo either RND or SND in the Department of Head and Neck Surgery at Fudan University Cancer Center. The patients' clinical and pathological characteristics, complications, and treatment outcomes were evaluated and analyzed.Our study consisted of 69 patients, including 51 in the RND group and 18 in the SND group. There was no significant difference in any clinical or pathological characteristic between the two groups. The overall survival (OS), disease-free survival (DFS), and regional-free survival of all the patients were 79.70%, 61.43%, and 83.30%, respectively, at 3 years and 66.81%, 47.43%, and 78.67%, respectively, at 5 years. No statistically significant difference was found in the OS, DFS, or regional-free survival between the RND and SND groups. The total complication rate was much lower in the SND group (11.11%) than in the RND group. The patients in the RND group experienced longer hospitalization and postoperative hospitalization than those in the SND group.SND was demonstrated to be safe and effective for the treatment of neck residue of NPC. The results indicated that patients with neck residue disease who are at stage II to III with a single enlarged lymph node (1 cm) and only one positive pathological lymph node may benefit the most from SND.

High iodine intake might be an important factor in the promotion of thyroid cancer and the incidence of thyroid carcinoma has increased obviously these years especially in area of high iodine intake, though the mechanism of which remains unknown. The aim of present study was to gain more insight into the influence of different iodine concentrations on cell behavior, such as proliferation and migration, and to further investigate its molecular mechanism using two well-differentiated thyroid cancer cell lines. Our study evaluated the effect of different iodine concentrations on cell behavior and investigated relevant molecules involved. The results indicated that iodine in vitro could promote the growth of thyroid cancer cells with the increase of iodine concentration in a specific range. Such effect may be related to signaling pathways as Akt and Erk and cytokine VEGF-A.

Bone metastasis occurs frequently in nasopharyngeal carcinoma (NPC) patients. The aim of this study was to compare the clinical value of 18F-FDG PET/CT with that of 99mTc-MDP planar bone scintigraphy (PBS) for detecting bone metastasis in NPC patients.Thirty-five histologically proven NPC patients were enrolled in this retrospective study. They underwent both 18F-FDG PET/CT and PBS within 7 days in our department. In a lesion-based analysis, the skeletal system, excluding the head, was divided into four regions: the spine, the pelvis, the thorax, and the appendix. Bone metastasis was considered to be present by either biopsy or clinical follow-up for at least 6 months. PET/CT and PBS were compared by McNemar's paired-sample test.A total of 50 lesions were confirmed to be malignant (spine 27, thorax 11, pelvis 8 and appendix 4). Although PET/CT was found to be more sensitive on lesion level than PBS (sensitivity 70.0 versus 42.0%; P=0.044), there were still 14 metastatic (28.0%) lesions that could be detected by PBS while negative in PET/CT imaging. In a patient-based analysis, fifteen (42.9%) of 35 eligible patients were found to have bone metastasis. The sensitivity, specificity and accuracy of PET/CT was 60.0% (9/15), 100% (20/20) and 82.9% (29/35); as for PBS, it was 66.7% (10/15), 85.0% (17/20) and 77.1% (27/35), respectively. There was no statistical difference between PET/CT and PBS (P0.05).PBS, as a conventional imaging, should be used as an important complement for detecting bone metastasis in NPC patients.

Carcinoma showing thymus-like differentiation (CASTLE) is a rare disease that is difficult to diagnose. The aim of this study was to assess the effects of combined-modality treatment in CASTLE patients. We retrospectively studied patients identified between January 1, 2000 and December 31, 2009 as having CASTLE and who subsequently underwent surgery and radiotherapy or chemotherapy. Preoperative laboratory findings, ultrasonographic (US) and computed tomographic (CT) features, and fine-needle aspiration biopsy (FNAB) specimens were evaluated. Seven patients with CASTLE were identified (four men, three women). The median age at initial diagnosis was 48 years (range 25–56 years). The five newly diagnosed patients were treated with curative surgery and postoperative radiotherapy, whereas two patients with recurrent disease were treated with salvage surgery plus radiotherapy or chemotherapy. All patients were disease-free at a median follow-up period of 34 months (range 12–61 months). The pattern of immunohistochemical staining was similar to that of thymic carcinoma. Specimens from all seven patients stained positively for CD5, CD117, and cytokeratin but were uniformly negative for thyroglobulin, thyroid transcription factor 1 (TTF-1), and calcitonin. Patients with CASTLE have excellent outcomes after curative resection and postoperative radiotherapy compared with patients with anaplastic thyroid carcinoma. Even patients with local recurrent disease benefited from salvage surgery with subsequent operation and/or radiotherapy. CD5 immunohistochemical staining on FNAB samples may help identify the possible entities that are part of the differential diagnosis.

Background The nonrecurrent inferior laryngeal nerve is an anomaly associated with the absence of the brachiocephalic artery (BCA) and the presence of arteria lusoria. Methods The preoperative CT scans from 290 patients (9 nonrecurrent, 281 recurrent) were retrospectively reviewed. We identified the BCA or the arteria lusoria, and classified the relationship between the right subclavian artery (SCA) and the tracheoesophagus into 2 subtypes. Results The arteria lusoria was identified in 6 nonrecurrent cases. The BCA was identified in 143 recurrent cases. The right SCA was detected on the ventral side of the membranous wall of the trachea in 273 recurrent cases, whereas it was detected on the dorsal side in 8 recurrent cases with enlarged thyroid, and it was detected on the dorsal side in 9 nonrecurrent cases without pressure sign. Conclusions It is possible to predict a nonrecurrent inferior laryngeal nerve by identifying the arteria lusoria or other features on the preoperative CT. © 2010 Wiley Periodicals, Inc. Head Neck, 2011

To investigate the frequency and clinical significance of RET rearrangement in Chinese patients with papillary thyroid carcinoma (PTC) and discuss the role of RET rearrangement in therapeutic decision-making after the performance of level VI lymph node dissection and the 2002 AJCC staging system.RET/PTC-1 and RET/PTC-3 were detected in 126 PTCs using reverse transcription-polymerase chain reaction (RT-PCR) and direct sequencing.RET rearrangement was detected in 18 cases of PTC. The patient group aged20 years had the highest frequency (3/6) of RET rearrangement among the age groups (20 years, 20-40 years andor = 40 years; P=0.03). RET/PTC-1 positive patients were more likely to suffer from Hashimoto's thyroiditis simultaneously (P=0.02) while RET/PTC-3 positive patients had a higher frequency of extrathyroidal extension (P0.01) and advanced T classification (P0.01). RET rearrangement (OR=8.70, 95% CI 1.69-44.81), male (OR=3.88, 95% CI 1.41-10.69), age (OR=0.96, 95% CI 0.93-0.99), multifocality (OR=3.54, 95% CI 1.33-9.41) and advanced T classification (OR=7.32, 95% CI 2.91-18.40) were all identified as risk factors of level II-V lymph node involvement in the multivariate analysis.The frequency of RET rearrangement in Chinese patients is low and age related. RET/PTC-1 and RET/PTC-3 are associated with different clinical pathological characteristics but not with lymph node involvement. The RET/PTC positive patients should receive more attention to lateral neck in the management of PTC.

Background Anaplastic thyroid carcinoma (ATC) is a malignancy with one of the highest fatality rates. We reviewed our recent clinical experience with intensity modulated radiotherapy (IMRT) combined with surgery and chemotherapy for the management of ATC. Methods 13 patients with ATC who were treated by IMRT in our institution between October 2008 and February 2011, have been analyzed. The target volume for IMRT was planned to include Gross tumor volume (GTV): primary tumor plus any N + disease (66 Gy/33 F/6.6 W), with elective irradiation of thyroid bed, bilateral level II through VI and mediastinal lymph nodes to the level of the carina (54-60 Gy). Seven patients received surgical intervention and eleven patients had chemotherapy. Results The median radiotherapy dose to GTV was 60 Gy/30 fractions/6 weeks. The median survival time of the 13 patients was 9 months. The direct causes of death were distant metastases (75%) and progression of the locoregional disease (25%). Ten patients were spared dyspnea and tracheostomy because their primary neck lesion did not progress. Conclusion The results showed that IMRT combined by surgery and chemotherapy for ATC might be beneficial to improve locoregional control. Further new therapies are needed to control metastases.