背景与目的:尽管儿童及青少年甲状腺癌的发病率远低于成人,但仍呈现逐年升高的趋势,甲状腺癌已成为儿童及青少年中较为常见的恶性肿瘤之一.与成人相比,儿童及青少年甲状腺癌具有一些不同的临床特征,进一步了解这些特征,将更有助于加精准诊疗.因此,本研究通过回顾性分析探讨儿童及青少年甲状腺癌的临床病理特点与预后情况,以期为临床治疗决策提供参考.方法:收集湖南师范大学附属第一医院/湖南省人民医院2014年9月—2021年6月间68例因甲状腺疾病行手术治疗的儿童及青少年患者(年龄≤20岁)资料,将其中获随访的甲状腺癌患者纳入研究.另随机抽取22例成人甲状腺癌患者作为对照,比较两组甲状腺癌人群临床病理特征的异同.结果:68例儿童及青少年患者中病理确诊为甲状腺癌的24例(35.29％),其中22例获随访3～72个月.22例患者中,女19例,男3例(6.33∶1);年龄3～20岁,平均(16.73±4.52)岁;病程10d至5年,平均为9.5个月;主要因触及颈部无痛性肿块就诊;术前甲状腺超声TI-RADS4类及以上结节占比高(19/22,86.36％);3例行患侧甲状腺腺叶切除术,1例行患侧甲状腺腺叶切除+对侧腺叶次全切除术,2例行患侧甲状腺腺叶切除+对侧腺叶近全切除术,余均行甲状腺全切术;21例行中央区淋巴结清扫,其中13例患者还行侧颈区淋巴结清扫,1例未行淋巴结清扫.术后病理示,甲状腺乳头状癌(PTC)18例(81.82％),甲状腺微小乳头状癌(PTMC)3例(13.64％),甲状腺髓样癌(MTC)1例(4.54％).术后出现单侧喉返神经损伤者3例,喉头水肿者1例,甲状旁腺功能低下者2例,1例患者行左侧侧颈区淋巴结清扫术后出现乳糜漏.1例MTC患者术后3年余复发,再次双侧颈部淋巴结扩大清扫术,并行靶向药物治疗;余在访患者均未发现复发或转移征象.儿童及青少年甲状腺癌的性别分布与成人基本一致;儿童及青少年甲状腺癌与成人甲状腺癌病理类型均以PTC居多(95.45％vs.100.00％),但前者PTMC的比例明显低于后者(13.36％vs.50.00％,P＜0.05);此外,儿童及青少年患者颈部淋巴结转移占77.27％(17/22),且其双侧淋巴结转移比例明显高于成人患者(50.00％vs.9.09％,P＜0.05).结论:儿童及青少年的甲状腺疾病中,甲状腺癌占比较高,发病性别与病理类型与成人相似,但确诊时肿瘤体积往往较成人更大,且更易出现双侧颈部淋巴结转移,但经手术等规范化治疗后,整体预后较好.

Abstract Background: Fibronectin 1 (FN1), an important extracellular matrix glycoprotein encoded by FN1 gene. Thyroid carcinoma (TC) and breast carcinoma (BC) have always been a threat to women's physical and mental health. However, the relationship between FN1 expression, tumor immunity, and prognosis in TC, BC remains unclear. Methods: FN1 expression and its influence on tumor prognosis were analyzed by the ONCOMINE, Tumor Immune Estimation Resource (TIMER) and Kaplan-Meier plotter. The relationship between FN1 expression and tumor immunity was analyzed by TIMER and Gene Expression Profiling Interactive Analysis (GEPIA). Results: FN1 expression was significantly higher in several human cancers, including TC, BC than in corresponding normal tissues. FN1 expression in TC, BC tissues correlated with prognosis. High FN1 expression associated with poorer relapse-free survival (RFS) in TC patients and poorer post progression survival (PPS), RFS, distant metastasis-free survival (DMFS) in BC patients, particularly at higher T stage and N stage. FN1 showed strong correlation with B cells, CD8+T cells, CD4+T cells, macrophages, neutrophils, and dendritic cells. Conclusion: These findings demonstrate that FN1 is a potential prognostic biomarker that determines cancer progression and correlated with tumor immune cells infiltration in TC and BC.

Background: Tumor metastasis to lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) is a main cause of disease recurrence in patients with papillary thyroid carcinoma (PTC), which may increase the risk of recurrence and secondary surgery, and the disruption of normal anatomical relationships during secondary surgery increases the risk of laryngeal nerve injury and hypoparathyroidism. However, controversy remains as to whether the dissection of LN-prRLN is required in cN(0) PTC patients. The purpose of this study is to explore the factors associated with LN-prRLN metastasis in patients with cN(0) PTC and the need for LN-prRLN node dissection in patients with cN(0) PTC who undergo right central compartment dissection. Methods: The clinical data of 290 patients with cN0 PTC who received radical thyroid cancer surgery from December 2019 to March 2022 at our center were retrospectively analyzed. All the patients underwent thyroid lobectomy and right central lymph node dissection (CLND), along with other treatments. SPSS 26.0 statistical software was used for the analysis. The measurement data were compared using the rank-sum test, and the count data were compared using the chi-square test. Results: LN-prRLN metastasis was detected in 65 (22.4%) of the 290 cN0 PTC patients. The metastasis sites included level VIa (51.72%), the left central compartment (22.76%), and the prelaryngeal compartment (8.97%). The univariate analysis revealed that tumor multifocality, a tumor diameter >1 cm, capsular invasion, LN metastasis in the left central compartment, and level VIa positivity were influencing factors of LN-prRLN metastasis in PTC patients. The logistic regression analysis showed that a tumor diameter >1 cm (OR =2.897, 95% CI: 1.630-5.147, P<0.001), LN metastasis in the left central compartment (OR =3.724, 95% CI: 2.039-6.801, P<0.001), and level VIa (OR =3.405, 95% CI: 1.846-6.281, P<0.001) positivity were independent risk factors of LN-prRLN metastasis in PTC patients. Conclusions: The high-risk factors of LN-prRLN metastasis in cN(0) PTC patients include a large tumor (a diameter >1 cm), lymph node metastasis in the left central compartment, and lymph node metastasis in level VIa. For patients with cN(0) PTC undergoing right CLND, with high-risk factors of LN-prRLN metastasis, LN-prRLN dissection is recommended.