Relationship of prognostic factors in stomach cancer with helicobacter pylori: a retrospective study

Background and study aims: The prognostic value of H. pylori, which infects more than half of the human population living in the world and plays a role in gastric cancer pathogenesis, is controversial. Our aim is to investigate the relationship between H. pylori and prognostic factors in gastric cancer. Patients and methods: The data of 110 patients (38 females and 72 males) that underwent surgeries due to gastric cancer between 2014 and 2017 were retrospectively analyzed. The relationships between survival (disease-free and overall) and factors such as p53, HER2/neu, Ki-67, neutrophil and platelet lymphocyte ratio (NLR / PLR), histopathological and demographic characteristics were examined. In addition, the results of H. pylori positive and negative groups were compared. Results: Sixty-one (55%) patients were H. pylori negative and 49 (45%) were positive. In multivariate analysis, TNM stage, lymph node capsule invasion and NLR were determined as independent prognostic factors in both disease-free and overall survival. Age>62 and PLR>14.3 were determined as independent predictive factors of poor prognosis in overall survival. In univariate analysis, tumor diameter of >4.3 cm, lymphovascular and perineural invasion, and diffuse p53 expression were determined as predictive factors of poor prognosis in disease-free and overall survival. The effectiveness of these markers in prognosis was not different between H. pylori negative and positive groups. Conclusion: While age, tumor diameter, TNM stage, lymph node capsule invasion, perineural and lymphovascular invasion, diffuse p53, PLR, and NLR were determined as prognostic factors in gastric cancer, these factors were not affected by the presence of H. pylori.

Risk Factors for Large-Volume Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Meta-Analysis

Background We defined large-volume lymph node metastasis (L-VLNM) as more than five lymph node metastases (LNMs) or any lymph node with a diameter of 2 mm or greater in any case of papillary thyroid cancer (PTC). This study investigated risk factors for the development of L-VLNM in PTC with meta-analysis.Methods Articles published until July 2021 on clinicopathological factors of L-VLNM in PTC were searched in electronic databases (PubMed, Web of Science (WOS), Embase, Cochrane, Wanfang Data and Chinese National Knowledge Infrastructure (CNKI)) to identify studies based on predefined criteria. Statistical analysis was performed using STATA 14.0. The outcomes were clinical and pathologic factors for L-VLNM, and the individual and pooled odds ratios (ORs) with 95% confidence intervals (CIs) of each outcome were analysed by fixed-/random-effects models. Egger’s test was used to assess publication bias in the publications. This study is registered with PROSPERO (CRD 42020213831).Results Twelve studies included 10806 patients in total. Meta-analysis revealed that an increased risk of L-VLNM was associated with male sex (OR=2.20, 95% CI=1.63–2.97, P<0.001), age<45 years (OR=2.34, 95% CI=1.36–4.02, P<0.001), tumour diameter>1 cm (OR=3.99, 95% CI=3.45–4.62, P<0.001), extrathyroidal extension (OR=2.42, 95% CI=1.90–2.82, P<0.001), capsule invasion (OR=3.62, 95% CI=1.44–9.06, P<0.001) and multifocality (OR=2.02, 95% CI=1.47–2.77, P<0.001). Hashimoto’s thyroiditis (HT; OR=0.82, 95% CI=0.60–1.11, P=0.03) was not associated with L-VLNM.Conclusions Male sex, age <45 years, tumour diameter >1 cm, extrathyroidal extension, capsule invasion and multifocality were risk factors for L-VLNM, HT was not a risk factor.

Predictive Factor of Large‐Volume Central Lymph Node Metastasis in Clinical N0 Papillary Thyroid Carcinoma Patients Underwent Total Thyroidectomy

Large‐volume central lymph node metastasis (large-volume CLNM) is associated with high recurrence rate in papillary thyroid carcinoma (PTC) patients. However, sensitivity in investigating large-volume CLNM on preoperative ultrasonography (US) is not high. The aim of this study is to investigate the clinical factors associated with large-volume CLNM in clinical N0 PTC patients. We reviewed 976 PTC patients undergoing total thyroidectomy with central lymph node dissection during 2017 to 2019. The rate of large-volume LNM was 4.1% (40 of 967 patients). Multivariate analysis showed that male gender and young age (age&lt;45 years old) were independent risk factors for large-volume CLNM with odds ratios [(OR), 95% confidence interval (CI)] of 2.034 (1.015-4.073) and 2.997 (1.306–6.876), respectively. In papillary thyroid microcarcinoma (PTMC), capsule invasion was associated with large-volume CLNM with OR (95% CI) of 2.845 (1.110–7.288). In conventional papillary thyroid cancer (CPTC), tumor diameter (&gt;2cm) was associated with large-volume CLNM, with OR (95% CI) 3.757 (1.061–13.310), by multivariate analysis. In ROC curve analysis on the diameter of the CPTC tumor, the Area Under Curve (AUC) =0.682(p=0.013), the best cut-off point was selected as 2.0cm. In conclusion, male gender and young age were predictors for large-volume CLNM of cN0 PTC. cN0 PTMC patient with capsule invasion and cN0 CPTC patient with tumor diameter &gt;2cm were correlated with large-volume CLNM. Total thyroidectomy with central lymph node dissection may be a favorable primary treatment option for those patients.

Association Between Metabolic Syndrome and Clinicopathological Features of Differentiated Thyroid Cancer

Purpose: Metabolic syndrome (MetS) is a risk factor for differentiated thyroid cancer (DTC). Whether MetS impacts the aggressiveness of DTC is still unclear. We carried out this study to clarify this issue.Methods: We evaluated 455 consecutive DTC patients treated with surgery. The patients were divided into three groups based on their number of MetS components: patients without any MetS components, patients with one to two MetS components, and patients with three to five MetS components. The clinical features and histological aggressiveness of DTC at the time of diagnosis were evaluated.Results: A total of 455 patients were included in this study. Eighty-five patients had three or more metabolic components and were diagnosed as having MetS. Those patients with one or two metabolic components had higher risks for bilaterality (OR = 1.90, 95% CI:1.04–3.46) and capsule invasion (OR = 1.68, 95% CI: 1.05–2.70). MetS was a risk factor for larger tumors (OR = 2.25, 95% CI: 1.25–4.06), more lymph node metastasis (OR=3.14, 95% CI: 1.68-5.87), multifocal tumor (OR = 2.38, 95% CI: 1.30–4.35), bilateral disease (OR = 3.39, 95% CI: 1.67–6.90), capsule invasion (OR = 2.26, 95% CI: 1.15–4.45), and extrathyroid invasion (OR = 4.44, 95% CI: 1.67–11.81) after correction for age, sex, and the thyroid-stimulating hormone level (TSH).Conclusions: In our hospital-based cohort study, MetS was associated with the aggressiveness of DTC. This association was still significant after being adjusted for age, sex, and TSH.

DIAGNOSTIC AND MANAGEMENT OF PATIENT WITH ADRENOCORTICAL CARCINOMA

Endogenous Cushing’s syndrome is a rare case, and about 8% is due to adrenocortical carcinoma. We report a case of a 31-year-old womanwith complaints of weight gain, round face, brown lines, menstrual disorders, and limb weakness. On physical examination, there werehypertension, moon face, central obesity, and stroke. On laboratory examination, there were morning serum cortisol levels were 46.87 andACTH levels 5. On CT scan. It was found that the right adrenal gland solid mass enhancement was +/- 6.6x4.9x7.3 cm, with suspicion ofadrenal carcinoma. On histopathological examination, adrenocortical carcinoma was obtained, and capsule invasion was obtained. Patients underwent surgery to remove the tumor, radiotherapy and chemotherapy. The patient was alive and had no residual mass at the surgical bed.

Fine-needle Aspiration Washout Precipitation Specimens: An Acceptable Supplement to Genetic Mutation Detection of Thyroid Nodules

Objectives: Thyroid nodules are common in adults, but only some of them are malignant. Ultrasound-guided fine-needle aspiration (FNA) is widely applied as a reliable and minimally invasive technique for evaluating thyroid nodules. However, the scarcity of FNA biopsy specimens poses a challenge to molecular diagnosis. This study aimed to evaluate the feasibility of FNA washout precipitation specimens as an effective supplement to the thyroid genetic test. Methods: A total of 115 patients with thyroid nodules were enrolled in our study. The BRAF V600E mutation status was detected in all FNA washout precipitation specimens and biopsy formalin-fixed paraffin-embedded (FFPE) specimens using an amplification refractory mutation system PCR (ARMS-PCR). All patients underwent cytological diagnoses; 79 patients also underwent surgery for histopathological analysis. Results: All the 115 samples were successfully analyzed using both FNA washout precipitation and biopsy FFPE specimens. The results showed that the BRAF V600E status detected in 96 FNA washout precipitation specimens were consistent with that in FNA biopsy FFPE specimens, including 41 BRAF V600E positive and 55 BRAF V600E negative, achieving a concordance rate of 84.4% (kappa = 0.689). Furthermore, the BRAF V600E mutation status using FNA washout precipitation specimens provided a 100.0% positive predictive value for diagnosing papillary thyroid carcinoma in patients with The Bethesda system for reporting thyroid cytopathology (TBSRTC) V. Besides, the BRAF V600E mutation status was positive in 90.9% (10/11) FNA washout precipitation specimens from patients with capsule invasion, achieving a higher overall sensitivity of 100.0%, compared with 57.1% of FNA washout precipitation specimens from patients without capsule invasion. Conclusion: These results suggested that FNA washout precipitation specimens might be a valuable supplementary sample type for detecting the BRAF V600E mutation in patients with thyroid nodules, especially with thyroid capsule invasion.