［Abstract］　Objective　To study the application value of postoperative calcitonin-to-preoperative calcitonin ratio(CR) as a predictive marker for structural recurrence in sporadic medullary thyroid cancer(MTC). Methods　The clinical data of the MTC patients treated in Sun Yat-sen University Cancer Center were retrospectively analyzed. Kaplan-Meier method and Cox regression analysis were used to investigate the impact of CR on recurrence-free survival(RFS) and a nomogram based on CR was constructed. Results　The optimal cut-off value of CR for predicting disease recurrence was 0.124. The RFS of the patients in the CR≥0.124 group was significantly lower than that of the patients in the CR<0.124 group(P<0.001). The results of multivariate Cox regression analysis showed that CR, age, tumor diameter and the number of lymph node metastasis were the independent influence factors of structural recurrence in MTC, among which CR was the strongest independent predictor［HR(95%CI): 5.09(2.34-11.06), P<0.001］. The consistency index(c-index) of the nomogram model for predicting RFS was 0.837(95%CI: 0.763-0.911). Moreover, the calibration curves showed that the nomogram based on CR had relatively good calibration and predictive value. Conclusion　CR is a strong prognostic marker to predict structural recurrence in patients with sporadic MTC. Under the condition of CR combined with the nomogram, the risk of postoperative structural recurrence in patients with sporadic MTC can be accurately calculated to provide individualized treatment.]]> 2023/8/31 17:39:32 JIAO Zan, JIANG Ming-jie, WU Tong, et al. 5true ［Abstract］　Objective　To analyze the clinicopathological features of diffuse sclerosing variant of papillary thyroid carcinoma in adults and adolescents. Methods　The clinical data of 4 739 patients with papillary thyroid carcinoma who were admitted to the Department of Head and Neck Surgery of Tianjin Medical University Cancer Hospital from May 2013 to December 2015 were retrospectively analyzed. Among these patients, 36 cases suffered from diffuse sclerosing variant of papillary thyroid carcinoma. The data of the adults and adolescents with diffuse sclerosing variant of papillary thyroid carcinoma were analyzed. Results　The incidence rate of bilateral diffuse sclerosing variant of papillary thyroid carcinoma in the adolescent patients, and their diffuse lesion rate, extra-thyroidal invasion rate, central lymph node metastasis rate and lateral cervical lymph node metastasis rate were higher than those in the adults patients, but the differences were not significant(P>0.05). There was only significant difference in the recurrence rate of cervical lymph nodes between the two groups(P<0.05). Conclusion　Most patients with diffuse sclerosing variant of papillary thyroid carcinoma are young patients, and diffuse sclerosing variant of papillary thyroid carcinoma is more likely to occur bilaterally in adolescents, with a higher rate of extra-thyroidal invasion and a rate of lymph node metastasis, and is more likely to recur in the adolescent patients than in the adult patients.]]> 2023/8/31 17:39:32 ZHANG Wei, LI Da-peng, CHENG Wen-yuan, et al. 4true ［Abstract］　Objective　To evaluate the relationship between telomerase reverse transcriptase promoter(TERTp) mutation and cervical lymph node metastasis in patients with papillary thyroid carcinoma(PTC) by meta-analysis. Methods　Case-control or cohort studies of TERTp mutations in PTC patients were electronically searched from PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Internet(CNKI) and Wanfang databases up to July 2023. Two reviewers independently screened the literature, from which the data were extracted and assessed the risk of bias of the included studies. Review Manager 5.4 and STATA 17.0 were used for meta-analysis. Results　A total of 369 papers were retrieved, and 33 studies were finally included, including 12 683 patients.The meta-analysis showed that the PTC patients carrying TERTp mutations had a higher risk of cervical lymph node metastasis than those without TERTp mutations. Conclusion　TERTp mutation increases the risk of cervical lymph node metastasis in PTC patients and is an important reference factor in predicting lymph node metastasis in the PTC patients.]]> 2023/8/31 17:39:32 HOU Shao-dong, YAN Cun-ye, YIN Su-peng, et al. 3true ［Abstract］　Objective　To observe the effect of preoperative application of carbon nanoparticles suspension injection on central lymph node dissection in patients with cN₀ papillary thyroid carcinoma who underwent radical surgery and to evaluate its role in protecting parathyroid function. Methods　A total of 104 patients with stage cN₀ papillary thyroid carcinoma who were admitted to the Department of Head and Neck Surgery of Guangxi Medical University Cancer Hospital from September 2021 to June 2023 were selected and randomly divided into observation group and control group, with 52 cases in each group. The observation group was injected with 0.2 ml carbon nanoparticles suspension injection around the primary tumor 1 day before surgery, while the control group was not injected with carbon nanoparticles suspension injection. The patients in both groups underwent unilateral thyroidectomy+central lymph node dissection. According to different surgical approaches, the observation group was further divided into open surgery observation group(26 cases) and endoscopic surgery observation group(26 cases), and the control group was also divided into open surgery control group(26 cases) and endoscopic surgery control group(26 cases). The operation time, intraoperative blood loss, hospital stay, the number of lymph nodes detected, the number of positive lymph nodes and the rate of mis-dissected parathyroid glands were compared between the two observation groups and between the two control groups. Results　There were 14 cases(13.46%) of the 104 patients with mis-dissected parathyroid glands after thyroidectomy. The rate of mis-dissected parathyroid glands in the observation group was lower than that in the control group(P<0.05). The number of lymph nodes detected and the number of positive lymph nodes in the observation group were higher than those in the control group(P<0.05). There were no significant differences in operation time, intraoperative blood loss and hospital stay between the observation group and the control group(P>0.05). In the subgroup analysis, the rate of mis-dissected parathyroid glands in the endoscopic surgery observation group was lower than that in the endoscopic surgery control group, and the difference was statistically significant(P<0.05). Conclusion　The preoperative application of carbon nanoparticles suspension injection can increase the number of lymph nodes detected and reduce the rate of mis-dissected parathyroid glands in the radical surgery of stage cN₀ papillary thyroid cancer, and has a significant protective effect on parathyroid function in radical surgery of transaxillary endoscopic thyroidectomy for thyroid carcinoma.]]> 2023/8/31 17:39:32 ZHAO Peng, BAO Yu-ling, LUO Yong-biao, et al. 2true ［Abstract］　Objective　To compare the clinical efficacy and postoperative complications between gasless transaxillary endoscopic surgery and traditional open surgery in treatment of unilateral papillary thyroid carcinoma. Methods　The clinical data of 160 patients undergoing a radical operation to remove unilateral papillary thyroid carcinoma in the Department of Breast and Thyroid Surgery of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2021 to December 2022 were retrospectively analyzed. According to different operation procedures, the patients were divided into 80 cases receiving the gasless transaxillary approach endoscopic surgery(endoscopic group) and 80 cases receiving the traditional open surgery(open group). The general clinical data, operation-related indicators, levels of parathyroid hormone and serum calcium before and 1 day after operation, incidence of postoperative complications and postoperative aesthetic satisfaction of the patients were compared between the two groups. Results　There were no significant differences in the intraoperative blood loss, length of hospital stay, number of central lymph nodes dissected and levels of serum parathyroid hormone and serum calcium between the open group and the endoscopic group(P>0.05). The endoscopic group had longer surgical time, greater volume of postoperative drainage and higher postoperative aesthetic satisfaction rate than the open group, and the differences were statistically significant(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion　The incision for endoscopic thyroidectomy through the gasless transaxillary approach is concealed and aesthetically pleasing. Although the surgical time of this approach is longer, the number of lymph nodes dissected by the approach is comparable to that dissected by the approach of the open group, and the aesthetic satisfaction rate of the patients receiving gasless transaxillary approach is higher, so the gasless transaxillary approach is worthy of clinical promotion.]]> 2023/8/31 17:39:32 LI Meng-yang, LIU Ri-qiang, LI Ze-lun, et al. 1true