| Part ?:Preliminary study of super-selective lymph node dissection in regional lateral cervical lymph node metastasis of papillary thyroid carcinomaBackgroundPapillary thyroid carcinoma(PTC)usually has a good prognosis,but often has a high rate of cervical lymph node metastasis clinically,and cervical lymph node metastasis can be found in about 30%-80%patients at the first diagnosis.Although cervical lymph node dissection has been widely carried out into clinical practice,the specific range of lateral cervical lymph node dissection for PTCs has always been controversial,which has brought a lot of confusion to clinical treatment.Therefore,the management of lateral cervical lymph nodes in PTC patients needs to be standardized.In this study,we analyzed the feasibility and safety of super-selective cervical lymph node dissection in patients with regional lymph node metastasis(cN1b stage).And explored the value of applying super-selective cervical lymph node dissection in PTC patients with clinically suspicious lateral lymph node metastasis(LNM).MethodsWe retrospectively analyzed the clinical data of 232 cN1b PTC patients who underwent surgery from September 2013 to May 2018 in the department of Head and Neck Surgical Oncology,National Cancer Center,among which 90 cases receive super-selective neck dissection(level ? and ?)and 142 cases underwent selective neck dissection(level ?-?).The LNM of two groups were statistically analyzed.ResultsPostoperative pathological results showed that 113 cases(75%)and 178 cases(77%)had LNM in the central compartment and lateral neck,respectively.LNM rates of level ?-?were 20%,63%and 56%,respectively.8 patients of super-selective neck dissection and 5 of selective neck dissection had lymphatic fistulas,which has no significant differences(P=0.083).No patients in super-selective neck dissection group had shoulder movement disorder,9 patients in the selective lymph node dissection group had impairment of shoulder mobility after surgery,the difference was statistically significant(P=0.015).In the super-selective neck dissection group,2 patients had long-term post-operative incision discomfort,and 5 cases had obvious cicatrix after surgery.Among the patients with selective neck dissection,23 cases experienced long-term incision discomfort after surgery,and 26 patients had apparent scar tissue,the differences are statistically significant(P values<0.05).There was no recurrence during the follow-up.ConclusionSuper-selective neck dissection is a feasible,safe and effective treatment for cN1b PTC patients.It can improve the quality of post-operative life and avoid the over treatment for patients.Part ?:The expression and clinical significance of co-stimulatory molecule B7-H3 in papillary thyroid carcinomaBackgroundB7-H3(CD276)is an important immune checkpoint member of the B7-CD28 families with a lot of clinical trials in full swing,which is regarded as a very promising target after PD-L1.Although it has shown great potential in clinical transformation,nothing is known about the expression details of B7-H3 in papillary thyroid carcinoma(PTC).Therefore,we intend to carry on a large-scale analysis of B7-H3 expression with regard to immune features,lymph node metastases(LNM),and recurrence in PTC patients for the first time.MethodsTotally,1210 samples were collected in this study,including 867 public available samples from TCGA and 4 GEO datasets for B7-H3-related transcriptome analyses,and 343 post-operative,whole-tumor sections from patients with PTC in our institute for B7-H3 specific immunohistochemistry(IHC)staining.The statistical analysis and graphical work were mainly accomplished through R language.ResultsB7-H3 positive was found in 61.5%PTC patients(211/343)and the expression of B7-H3 in PTC was prominently higher than para-tumor tissues no matter from mRNA level or protein level(P<0.001),which may act as a novel diagnosis biomarker for PTC.The significant up-regulation of B7-H3 in PTC may be caused by the different patterns of CNVs and CpG DNA methylation.Functional enrichment analysis confirmed that high B7-H3 expression was tightly associated with distinct immune features and angiogenesis.High protein level of B7-H3 expression was found associated with tumor size(P=0,022),extrathyroidal extension(ETE)(P=0.003),and lymph node metastasis(LNM)(P<0.001).More importantly,multivariate analysis confirmed B7-H3 was an independent predictor of relapse-free survival(P<0.05).In subgroup analysis,positive B7-H3 staining was associated with worse RFS in primary tumor size?2cm(P=0.003),LNM(P=0.003),multifocal(P=0.003),and ETE(P=0.003).Besides,circos plots indicated that B7-H3 was tightly associated with other immune checkpoints in B7-CD28 family.ConclusionsThis is the first and the most comprehensive study to elucidate the expression profile of B7-H3 in PTC.Our observations suggest that B7-H3 is a novel independent biomarker for predicting LNM and recurrence of PTC patients,which may serve as a potential indicator to improve risk-adapted therapeutic strategies and a novel possible target for immunotherapy against patients who undergo an aggressive course. |
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