Objective To investigate the expressions of Twist transcription factor and E-cadherin in anaplastic thyroid carcinoma and their correlation with the prognosis. Methods The clinicopathological data of 20 patients with anaplastic thyroid carcinoma in Shanxi Provincial Cancer Hospital from May 2016 to April 2018 were retrospectively analyzed. The expressions of Twist protein and E-cadherin protein in anaplastic thyroid carcinoma tissues and corresponding paracancerous tissues were detected by using immunohistochemistry. The relationship between the expressions of the two proteins and the clinicopathological features of the patients was analyzed, and the correlation among the expressions of the two proteins as well as the clinicopathological factors and the prognosis of the patients was analyzed. Results The positive expression rate of Twist protein in anaplastic thyroid carcinoma tissues was 65％ (13/20), while it was 20％ (4/20) in paracancerous tissues, and the difference was statistically significant (P= 0.004). The positive expression rate of E-cadherin in anaplastic thyroid carcinoma tissues was 60％(12/20), while it was 100％(20/20) in paracancerous tissues, and the difference was statistically significant (P = 0.001). There was a negative correlation between the expression of Twist protein and E-cadherin protein in anaplastic thyroid carcinoma (r=-0.685, P=0.001). The expression of Twist protein in anaplastic thyroid carcinoma was correlated with lymph node metastasis and TNM stage (both P< 0.05), while it had no correlation with gender, age and tumor diameter (all P> 0.05). The expression of E-cadherin protein in anaplastic thyroid carcinoma had no correlation with clinicopathological factors (all P> 0.05). The results of Kaplan-Meier survival analysis showed that lymphnode metastasis (P< 0.01), TNM stage (P = 0.002) and the expression of Twist protein (P = 0.017) were prognostic factors in patients with anaplastic thyroid carcinoma. Conclusions The expression of Twist transcription factor is upregulated in anaplastic thyroid carcinoma, and the expression of E-cadherin is downregulated. The expression of Twist protein is correlated with the prognosis of the patients. The epithelial-mesenchymal transition may be involved in the progress of anaplastic thyroid carcinoma.

Objective:To compare the clinical effects of endoscopic thyroidectomy with different approaches on patients with thyroid cancer.Methods:A prospective study was conducted on 96 patients with thyroid cancer who underwent complete endoscopic thyroidectomy (CET) by the same experienced surgical team in the Head and Neck Surgery Department of Shanxi Cancer Hospital from Jan. 2020 to Jan. 2023. The patients were randomly divided into a trans-subclavian approach group of 48 cases and a transoral vestibular access group of 48 cases using a random number table method. The trans-subclavian approach group underwent CET via the subclavian approach, while the transoral vestibular access group underwent CET via the oral vestibular approach. The surgical and postoperative rehabilitation conditions, complications, and cosmetic satisfaction scores were compared between the two groups. The immune indicators (T lymphocyte subsets (CD3 +, CD4 +), CD4 +/CD8 +), serum soluble interleukin 2 receptor (SIL-2R), tissue kallikrein 11 (KLK11), midkine (MK) levels were measured before surgery. At 1 d, 3 d, and 7 d postoperatively, neck function was assessed using the visual analog scale (VAS), neck injury index, and dysphagia index. Results:The operation time of the transoral vestibular access group and the Trans-subclavian approach group were (117.58±10.87) min and (101.84±11.35) min, respectively ( P<0.001), and the hospitalization time was (4.31±0.86) d and (5.12±0.91) d, respectively ( P<0.001). The drainage volume was (65.13±12.49) mL and (78.65±15.32) mL, respectively ( P<0.001). At 1, 3, and 7 days after surgery, the CD3 + levels in the transoral vestibular access group and the trans-subclavian approach group were (41.53±3.86) % and (38.29±3.51) %, respectively ( P<0.001), (46.21±4.35) % and (42.81±4.06) %, respectively ( P=0.001), and (48.23±4.47) % and (45.10±4.23) %, respectively ( P<0.001). The CD4 + levels were (33.27±3.90) % and (30.18±3.45) %, respectively ( P<0.001), (36.28±4.15) % and (33.46±3.87) %, respectively ( P=0.001), and (38.69±4.22) % and (35.17±4.10) %, respectively ( P<0.001). The CD4 +/CD8 + levels were (1.31±0.22) and (1.16±0.21), respectively ( P=0.001), (1.40±0.23) and (1.20±0.22), respectively ( P<0.001), and (1.58±0.24) and (1.45±0.25), respectively ( P=0.011). There was no significant difference in the levels of serum SIL-2R, KLK11, MK, VAS scores, cervical injury index, or swallowing dysfunction index between the transoral vestibular access group and the trans-subclavian approach group on postoperative day 1, 3, and 7 ( P>0.05). The incidence of complications in the transoral vestibular access group and the trans-subclavian approach group was 8.33% (4/48) and 22.92% (11/48), respectively ( P=0.049), and the cosmetic satisfaction rate was 95.83% (46/48) and 81.25% (39/48), respectively ( P=0.025) . Conclusions:Both the transoral vestibular approach and the subclavian approach for CET treatment of thyroid cancer can cause damage to cervical function. The former can reduce immune function damage, help with early postoperative recovery, and improve safety and patient satisfaction with cosmetic appearance, but it can prolong the operation time.