Background and Aims:Medullary thyroid carcinoma(MTC)is an aggressive malignancy that is frequently associated with cervical lymph node metastasis,significantly affecting patient prognosis.However,the risk factors for lateral cervical lymph node metastasis(LLNM)in MTC remain inconclusive.This study aims to identify the risk factors associated with LLNM in MTC patients,in order to inform individualized surgical decision-making.Methods:The clinicopathologic data of 242 patients with MTC who underwent surgical treatment at Tianjin Medical University Cancer Institute and Hospital from 2011 to 2019 were retrospectively collected.The relationships between preoperative tumor markers,including calcitonin and carcinoembryonic antigen(CEA),and LLNM were evaluated.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LLNM.Results:Preoperative calcitonin level was significantly associated with tumor diameter,the number of lymph node metastases,and the extent of lymph node involvement,while preoperative CEA level was significantly associated with tumor diameter(all P<0.05).The area under the ROC curve for preoperative calcitonin in diagnosing LLNM was 0.750(P=0.000),with an optimal cutoff value of 266.00 ng/L(sensitivity 0.854,specificity 0.577).The diagnostic value of preoperative CEA for LLNM was limited.Univariate analysis showed that sex,extracapsular extension,T stage,central lymph node metastasis(CLNM),bilateral lesions,preoperative calcitonin,tumor diameter,and multifocality were significantly associated with LLNM in MTC patients(all P<0.05).Multivariate analysis revealed that CLNM(OR=17.645,95%CI=7.728-40.290)and preoperative calcitonin≥266.00 ng/L(OR=7.832,95%CI=3.132-19.582)were independent risk factors for LLNM.Conclusion:CLNM and elevated preoperative calcitonin level are closely associated with LLNM in patients with MTC.The combination of these two indicators may help identify high-risk patients for LLNM,thereby and promoting individualized and precise treatment strategies for MTC.

Background and Aims:Medullary thyroid carcinoma(MTC)is an aggressive malignancy that is frequently associated with cervical lymph node metastasis,significantly affecting patient prognosis.However,the risk factors for lateral cervical lymph node metastasis(LLNM)in MTC remain inconclusive.This study aims to identify the risk factors associated with LLNM in MTC patients,in order to inform individualized surgical decision-making.Methods:The clinicopathologic data of 242 patients with MTC who underwent surgical treatment at Tianjin Medical University Cancer Institute and Hospital from 2011 to 2019 were retrospectively collected.The relationships between preoperative tumor markers,including calcitonin and carcinoembryonic antigen(CEA),and LLNM were evaluated.Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LLNM.Results:Preoperative calcitonin level was significantly associated with tumor diameter,the number of lymph node metastases,and the extent of lymph node involvement,while preoperative CEA level was significantly associated with tumor diameter(all P<0.05).The area under the ROC curve for preoperative calcitonin in diagnosing LLNM was 0.750(P=0.000),with an optimal cutoff value of 266.00 ng/L(sensitivity 0.854,specificity 0.577).The diagnostic value of preoperative CEA for LLNM was limited.Univariate analysis showed that sex,extracapsular extension,T stage,central lymph node metastasis(CLNM),bilateral lesions,preoperative calcitonin,tumor diameter,and multifocality were significantly associated with LLNM in MTC patients(all P<0.05).Multivariate analysis revealed that CLNM(OR=17.645,95%CI=7.728-40.290)and preoperative calcitonin≥266.00 ng/L(OR=7.832,95%CI=3.132-19.582)were independent risk factors for LLNM.Conclusion:CLNM and elevated preoperative calcitonin level are closely associated with LLNM in patients with MTC.The combination of these two indicators may help identify high-risk patients for LLNM,thereby and promoting individualized and precise treatment strategies for MTC.

As the most common endocrine malignant tumor,the incidence rate of thyroid cancer is increasing year by year.However,the vast majority of subtypes have a good prognosis after traditional surgery,TSH suppression therapy and 131I treatment.With the progressive development of modern medicine,for a few thyroid cancers with poor effects of traditional treatment,molecular diagnosis and targeted therapy have further enriched the therapeutic means of thyroid cancer,in which BRAF mutation is widely present in thyroid cancer,but it often shows primary resistance or poor response to 131I therapy.The factors leading to primary or secondary resistance to targeted drugs with BRAF mutation may include genomic instability,expansion of resistant clones,occurrence of intrinsic mutations,or novel genetic and epigenetic alterations.In this article,we will review the research progress in targeted therapy resistance in BRAF-mutant thyroid cancer.

Objective:To evaluate postoperative calcitonin level as a prognostic marker in long-term follow-up of medullary thyroid carcinoma(MTC).Methods:Clinical data of 146 MTC cases treated at Tianjin Medical University Cancer Institute and Hospital from Jan 2011 to Dec 2019 were reviewed retrospectively. The relationship between postoperative calcitonin and disease-free survival was analyzed. According to the level of calcitonin six months after operation, patients were divided into normal level group and elevated group.Results:The median tumor size in those 146 cases was (1.78±1.22)cm, and 81 cases had lymph node metastasis. After 6 months of follow-up, 89 cases had normal calcitonin, with median tumor size of (1.63±1.20)cm, and 35 cases had lymph node metastasis . After a median follow-up of 56 months, 78 patients had normal calcitonin, 11 patients had biochemical relapse, 3 patients had structural relapse, and no patients died. 57 cases had a higher calcitonin ,median tumor size (1.97±1.22)cm, 46 cases had lymph node metastasis, 5 cases had distant metastasis, 18 cases had structural recurrence, and 7 patients died. Univariate analysis showed that lymph node metastasis, TNM stage, preoperative calcitonin, lymph node dissection and postoperative calcitonin were correlated with long-term disease-free survival (all P < 0.05). Multivariate analysis showed that postoperative calcitonin and TNM stage were an independent prognosis factor for disease-free survival in MTC patients (all P < 0.05). Conclusion:Postoperative calcitonin is a independent prognostic marker for long-term disease-free survival in MTC patients.

Objective:To discuss the causes and effective measures of prevention and treatment of chylous fistula after central lymph node dissection (CLND) of thyroid cancer. Methods:A total of 6 127 patients who underwent CLND of thyroid cancer in the Tianjin Medical University Cancer Institute and Hospital between July 2013 and June 2015 were analyzed;of which, 14 patients acquired the complication of postoperative chylous fistula. The following conservative treatments were initially performed:systemic therapy, local pressure bandaging, normal pressure drainage, 50%glucose injection, or pingyangmycin injection through a drainage tube. Surgical op-eration was then conducted when the efficacy of the treatment was poor. Results:After the conservative treatment of the 14 patients, the drainage volume gradually decreased in 12 patients, and surgery was performed on the remaining two patients. Conclusion:The CLND of thyroid cancer must be carefully conducted to prevent postoperative chylous fistula. An active conservative treatment must be the first option when chylous fistula occurs. Surgery must only be performed if the treatment is invalid.