最新刊期
卷 32 ， 期 5 ， 2022
- 摘要：The incidence rate of thyroid cancer increases with age. Although the incidence rate of thyroid cancer in children is far lower than in adults, thyroid cancer has become the fifth most common cancer among children aged 0-14 and the most common cancer among adolescents worldwide. Unlike thyroid cancer in adults, the increase in the incidence of thyroid cancer in children is more likely to be caused by genetic or environmental factors. Moreover, thyroid cancer in children tends to be late stage, and the recurrence rate is much higher than in adults. However, the relationship between molecular pathological characteristics and metastasis of thyroid cancer in children still needs to be further clarified. This review focused on the genetic changes of metastatic thyroid cancer in children in order to provide the reference for researchers and clinicians to better understand basic research, prevention and treatment of thyroid cancer in children.关键词：Childhood thyroid carcinoma;Metastasis;Molecular pathology;Prognosis35|2684|0更新时间：2025-12-31
Specialists' Commentary
- 摘要：Background and purpose: The molecular characteristics of differentiated thyroid cancer (DTC) in children and adolescents and its role in clinical practice remain unclear. This study intended to explore the genetic characteristics and its relationship with clinical characteristics and efficacy of 131I therapy in locally advanced or metastatic pediatric and adolescent DTC patients. Methods: A thyroid cancer-related gene panel (ThyroLead®) was used to test the primary tumors from children and adolescents with DTC treated in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from December 2020 to July 2021. The samples were sequenced, the clinicopathological characteristics and 131I treatment history were retrospectively collected, and the relationship between their genetic characteristics and clinicopathological characteristics and the efficacy of 131I therapy was analyzed. Results: All the 39 children present locally advanced or metastatic disease. All the children with accessible data had lymph node metastasis, 91.4% (32/35) of whom had lateral lymph node metastasis, and 61.5% (24/39) patients had distant metastasis. Thyroid cancer-related gene variants were detected in 61.5% (24/39) of the patients, among which RET fusion (38.5%, 15/39) and BRAF V600E point mutation (12.8%, 5/39) were the most common. No statistically significant differences were found in clinical characteristics between the mutation group and the non-mutation group (P>0.05). Most of the children (91.7%, 22/24) with distant metastases remained structural incomplete response (SIR) status after 131I treatment. Nine patients were considered radioactive iodine-refractory (RAIR) status, and 8 of them had thyroid cancer driver mutations, among which NCOA4/RET accounted for 62.5% (5/8). Among cases with RET genetic variations, NCOA4/RET fusion-positive patients tended to present more distant metastasis than those with other forms of RET fusion (33.3% vs 88.9%, P=0.089). Conclusion: Compared with point mutations, fusion gene mutations, especially RET fusions, are more common in locally advanced or metastatic pediatric and adolescent DTC patients. NCOA4/RET fusion-positive tumor has more aggressive behaviors and are more likely to become RAIR.关键词：Pediatric and adolescent thyroid cancer;Locally advanced;Metastases;Genetic alterations;RET fusions;Radioactive iodine-refractory612|2815|0更新时间：2025-12-31
- 摘要：Background and purpose: Thyroid cancer is one of the fastest increasing malignancies worldwide, and its incidence in children and adolescents has also been increasing over the years. Meta-analysis were performed to investigate the correlation between gene alteration patterns and distant metastasis of differentiated thyroid carcinoma (DTC) in children and adolescents. Methods: Databases were used to search studies on the association between gene alteration patterns and distant metastasis of DTC in children and adolescents, and STATA 14.0 software was used to analyze the gene alterations related to distant metastasis. Results: Twenty studies involving 1 273 patients were included, and the analysis showed that negative BRAF V600E mutation and positive RET gene fusion were risk factors for distant metastasis in DTC in children and adolescents, while NTRK gene fusion was not significantly associated with distant metastasis. Conclusion: Our research identified several genetic alterations associated with distant metastasis in DTC in children and adolescents, which could be guidance for prognosis assessment and treatment planning.关键词：Differentiated thyroid cancer;Children and adolescents;Distant metastasis;gene mutation283|2906|0更新时间：2025-12-31
- 摘要：Background and Purpose: The incidence rate of thyroid cancer in children and adolescents is increasing year by year, and there is a high rate of metastasis and recurrence. The application of diagnostic criteria for thyroid nodules based on adult characteristics in children has a high rate of missed diagnosis rate, misdiagnosis rate and unnecessary biopsy. This study aimed to establish a graded diagnostic model of thyroid nodules in children and adolescents, and to compare its diagnostic efficacy with American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS). Methods: One Hundred and forty-four patients with thyroid nodules aged 0-18 years in Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2000 to October 2017 were included as the training set, and 41 patients with thyroid nodules aged 0-18 years in China-Japan Friendship Hospital and Civil Aviation General Hospital from November 2015 to January 2022 were included as the testing set. Taking pathological diagnosis as the gold standard, the statistically significant ultrasonic characteristics were analyzed by multivariate binary logistic regression. The ultrasonic grading diagnostic model was established and brought into the testing set to compare its diagnostic efficiency with ACR TI-RADS. Results: There was significant difference in solidity, hypoechoic, taller-than-wide shape, irregular edge and microcalcification between the two groups (P<0.05). Logistic regression analysis showed that hypoechoic, solidity, irregular margin and calcification were independent predictors for the diagnosis of thyroid cancer in children and adolescents. When the ultrasonic grade was established based on the above independent predictors, this graded model had higher diagnostic accuracy in the testing set compared with ACR TI-RADS (92.7% vs 82.9%). Conclusion: The graded diagnostic model based on solidity, hypoechoic, irregular margin and microcalcification can be used in the diagnosis of thyroid nodules in children and adolescents. Compared with ACR TI-RADS, it has higher diagnostic accuracy.关键词：Thyroid cancer;Children;Adolescents;Ultrasound;Graded diagnotic model32|2626|0更新时间：2025-12-31
- 摘要：Background and purpose: Previous studies have found different clinicopathological characteristics and prognosis between differentiated thyroid carcinoma (DTC) in children and adolescents who are ≤18 years old and in adult. However, there are few studies comparing the characteristics within DTC in children and adolescents itself. In this study, the clinicopathological characteristics of DTC in children and adolescents and the response to the initial 131I treatment were investigated in different age groups. Methods: One hundred and fifty-six cases of DTC in children and adolescents admitted to West China Hospital, Sichuan University from July 2006 to January 2022 were retrospectively analyzed. The cohorts were segregated into three age categories: prepubertal (0 year<age≤10 years), peri-pubertal (10 years<age≤14 years) and pubertal (14 years<age≤18 years). Clinicopathological characteristics, initial recurrence risk, dynamic risk assessment after initial 131I treatment and the percentage change of stimulated thyroglobulin (sTg) were compared among three age groups. Results: There was no statistically significant difference among three age groups in gender, maximum diameter of primary tumor, extrathyroidal invasion, T stage, N stage and positive metastasis proportion of dissected lymph node (P>0.05). The proportion of distant metastasis in 0-10 years, 10-14 years and 14-18 years were 63.2%, 42.1% and 20.2%, respectively (χ2=16.839, P=0.000). High-risk recurrence patients accounted for 88.9%, 60.5%, 46.4% in three age groups, respectively (χ2=12.447, P=0.009). Dynamic risk assessment after initial 131I treatment was obviously different among three age groups (χ2=21.744, P=0.001). The excellent response (ER) rate in three groups was 10.5%, 25.0% and 38.1%, respectively. The structural incomplete response (SIR) rate was 68.4%, 52.8% and 25.8%, respectively. The biochemical incomplete response (BIR) rate was 21.1%, 13.9% and 14.4%, respectively. Sixty-three patients with TgAb less than 40 U/mL received the second 131I treatment, and the median ΔsTg% in three group was 41.31%, 38.02% and 60.38% (H=4.642, P=0.098), respectively. Conclusion: Patients aged 0-10 years had the highest proportion of distant metastasis and high-risk recurrence and lowest ER rate after initial 131I treatment among DTC in children and adolescents. More effort is needed to study the carcinogenesis mechanism and treatment strategies of DTC in prepubertal children with DTC.关键词：Differentiated thyroid carcinoma;Children;Adolescent;Clinicopathological characteristics;131I162|2482|0更新时间：2025-12-31
Specialists' Article
- 摘要：Background and purpose: The prognosis of differentiated thyroid cancer (DTC) patients with suspicious high thyroglobulin (Tg) concentration and without explicit structural lesions varies from each other, hence the clinical treatment decisions including 131I therapy remain controversial. This study aimed to explore the effects of 131I treatment and the therapeutic dose on the clinical outcome of these patients. Methods: The study included 138 DTC patients treated in Department of Nuclear Medicine, Peking Union Medical College Hospital from 2007 to 2021, who had undergone total thyroidectomy and subsequent 131I therapy. All patients were divided into 3 groups as low dose (dose=1.11 GBq), medium dose (1.11 GBq<dose≤3.70 GBq) and high dose (3.70 GBq<dose≤7.40 GBq) according to the dose of 131I therapy. We compared the short-term and end-of period response to therapy among these three groups, and further observed the clinical outcome of patients with biochemical incomplete response (BIR) after initial treatment. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of stimulated Tg (sTg) levels in patients with structural incomplete response (SIR) and distant metastasis. Results: For the short-term response, the rate of excellent response (ER) was 6.7%, 13.5% and 7.0% in low, medium and high dose group, respectively. The short-term response showed no statistically significant difference among three groups (H=1.02, P=0.60). The end-of-period response among the three groups under routine follow-up also showed no significant difference (H=2.94, P=0.23). No significant difference was observed in the clinical outcome of patients with BIR after routine follow-up and second 131I treatment (U=324.5, P=0.15). The diagnostic critical point (DCP) of sTg to predict SIR and distant metastasis was 27.5 and 61.7 ng/mL, respectively. Conclusion: DTC patients with suspicious high Tg concentration has high recurrence risk, taking 27.5 ng/mL as the cut-off of sTg is helpful to identify the patients with high recurrence risk early. 131I treatment is helpful for these patients to achieve ER as soon as possible. However, high-dose 131I did not have greater benefits on the prognosis of these patients. Second 131I treatment showed no further benefit for BIR patients.关键词：Differentiated thyroid cancer;Thyroglobulin;131I therapy;Biochemical incomplete response179|3080|0更新时间：2025-12-31
- 摘要：Background and purpose: The response of human epidermal growth factor receptor 2 (HER2)-positive invasive breast cancer to HER2 targeted neoadjuvant therapy is significant. However, the response is not uniform, and a proportion of patients respond poorly. This study aimed to identify predictors of response in the neoadjuvant treatment and to assess the discordance rate of HER2 status between pre- and post-treatment specimens in HER2-positive breast cancer. Methods: The study group included 110 HER2-positive breast cancer patients treated with neoadjuvant therapy and surgery who were diagnosed from 2019 to 2021 in Shenzhen People’s Hospital. Immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) were used to detect the expression of HER2 in core needle biopsy specimens. Pathological complete response (pCR) and residual cancer burden (RCB) of surgically resected specimens after neoadjuvant therapy were used to assess the therapy response of patients. HER2, estrogen receptor (ER) and progesterone receptor (PR) status were further assessed in the residual invasive carcinoma present after neoadjuvant therapy. Results: One hundred and ten breast cancer patients were divided into IHC diffuse 3+ group (n=81), heterogeneous 3+ group (n=20), IHC 2+ and FISH amplified (2+FISH+) group (n=9). The pCR rate of HER2 diffuse 3+ group was 54.3%, which was significantly higher compared with heterogeneous 3+ group (5.0%) and 2+FISH+ group (11.1%), and the difference was statistically significant (P<0.05). RCB categories were higher in heterogeneous 3+ and 2+FISH+ groups. Multivariate analysis showed that HER2 diffuse 3+ was an independent predictor of pCR. Seven cases (11.9%) became HER2-negative, the majority (85.7%) from heterogeneous 3+ and 2+FISH+ groups. Conclusion: HER2 heterogeneity predicts the neoadjuvant therapy response of HER2-positive breast cancer. Evaluation of the heterogeneity of HER2 IHC in biopsy specimens and repeating HER2, ER and PR testing after neoadjuvant treatment should therefore be considered, which will facilitate further management decisions. The patients with HER2 heterogeneity may potentially benefit from the novel antibody-drug conjugate (ADC).关键词：Human epidermal growth factor receptor 2 heterogeneity;Breast cancer;Neoadjuvant therapy682|3267|0更新时间：2025-12-31
- 摘要：Background and purpose: Adjuvant radiotherapy for breast cancer after early breast-conserving surgery has been recommended by the guidelines. However, the feasibility of hypofractionated radiotherapy with simultaneous integrated boost is not available. In this randomized controlled study, the cardiac dosimetry parameters and cardiac ultrasound indexes of the two radiotherapy plans were compared to evaluate the safety of hypofractionated radiotherapy with simultaneous integrated boost plan in terms of cardiotoxicity. Methods: A total of 40 patients with breast cancer who received breast-conserving surgery were selected in Zhongshan Hospital, Fudan University from March 2017 to March 2018. They were randomly divided into two groups, including 20 patients reveiving hypofractionated radiotherapy with simultaneous integrated boost plan (whole breast 4 005 cGy/15 Fx, tumor bed 4 500 cGy/15 Fx) and 20 patients reveiving conventional fractionation with simultaneous integrated boost plan (whole breast 5 000 cGy/25 Fx, tumor bed 6 000 cGy/25 Fx). The cardiac dosimetric parameters and cardiac ultrasound indexes of the two groups were compared. The dosimetric parameters included the average doses (Dmean) of the whole heart, left ventricle, right ventricle, right ventricular free wall, ventricular septum and left anterior descending (LAD) coronary artery, and the relative volume fraction of each structure irradiated by 5-35 Gy (V5 Gy-V35 Gy). The follow-up indexes of echocardiography included aortic root diameter, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness, pulmonary artery systolic pressure, left ventricular ejection fraction, E peak, A peak, E-peak deceleration time (DT), E, A, E/A and S wave peak. In addition, the cosmetic effect on breast after radiotherapy in the two groups was also evaluated. Results: Dmean of the whole heart in the hypofractionated group and the conventional group were (471.86±170.54) and (733.07±79.11) cGy (P<0.05); V20 Gy of the whole heart was (3.63±1.74) and (8.43±0.74)% (P<0.05), and V30 Gy was (1.55±1.15) and (4.48±1.01)% (P<0.05). Dmean of LAD were (1 250.17±600.33) and (1 847.20±933.23) cGy (P>0.05); Dmean of left ventricle were (908.64±865.60) vs (946.93±116.13) cGy (P>0.05). Dmean of right ventricle were (590.37±197.99) vs (905.73±180.82) cGy (P<0.05); Dmean of right ventricular free wall were (939.40±284.23) vs (1 597.30±446.3) cGy (P<0.05); Dmean of ventricular septum were (1 637.49±248.19) vs (988.60±159.77) cGy (P<0.05). After one year of follow-up, the cardiac ultrasound indexes in the hypofractionated group and the conventional group were in the normal range, and there was no significant difference between the two groups (P>0.05). There was no significant difference in cosmetic effect between the two groups (P>0.05). Conclusion: Compared with the conventional fractionation plan, hypofractionated radiotherapy with simultaneous integrated boost significantly reduced the radiation dose of the whole heart and some cardiac substructures, and there were no abnormal cardiac ultrasound indexes during one-year follow-up. The dose fractionation method in this study is safe and feasible. Limiting the whole heart dose alone can not effectively protect LAD, so it is recommended to outline the cardiac substructure and limit the dose alone to better protect the heart.关键词：Early breast cancer;Breast-conserving surgery;Hypofractionated radiotherapy;Simultaneous integrated boost;Cardiac injury16|1311|0更新时间：2025-12-31
- 摘要：Background and purpose: Laryngeal cancer is a refractory malignant tumor in otolaryngology. Radiotherapy and chemotherapy combined with surgery are often used, however, this treatment method has little improvement on the 5-year survival rate and mortality of patients, and is often accompanied by loss of laryngeal function and drug resistance. This study aimed to explore the effect of sonodynamic therapy (SDT) mediated by nanoacoustic sensitizer T-G-C particles on inhibiting human laryngeal cancer cells, and to provide a new non-invasive treatment for laryngeal cancer. Methods: Based on the synthesized T-G-C nanomaterials, the uptake of nanomaterials by Tu686 cells was evaluated under confocal laser scanning microscope, and the cell survival and apoptosis were evaluated by cell counting kit-8 (CCK-8) and Annexin Ⅴ- fluorescein isothiocyanate (FITC) reagent in the presence of ultrasound. BALB/c nude mouse xenograft model was established. The weight and tumor changes of mice were recorded during the treatment by injecting different types of drugs and ultrasonic irradiation in the tumor area, and the treatment effects were analyzed and compared. The apoptosis and necrosis of tumor cells and the production of reactive oxygen species (ROS) were compared by H-E, TUNEL, Ki-67 and DHE stainings. Results: Nanomaterials and cells incubated for 24 hours had no obvious toxicity, only led to the decline of cell survival rate under ultrasonic stimulation, and the cells showed mainly early apoptosis and late apoptosis. In the animal experiment, only after intratumoral injection of drugs and ultrasound treatment on the 1st, 3rd, 5th and 7th days, the tumor growth of mice in T-G-C+ultrasound group was significantly inhibited, and the tumor inhibition rate is 100%. After 16 d of treatment, obvious red fluorescence could be seen in the tumor area after ultrasound irradiation, which demonstrated that the core of tumor inhibition was the production of ROS. Conclusion: Biocompatible T-G-C nanoparticles stimulate the synergy of SDT and piezoelectric therapy when stimulated by ultrasound, and promote the early and late apoptosis of laryngeal cancer cells through ROS, which provides a combined treatment method for laryngeal cancer and promotes the application of multidisciplinary therapy in department of otolaryngology.关键词：Sonodynamic therapy;Laryngocarcinoma;Nanomaterials;Sonosensitizer;Reactive oxygen species20|1447|0更新时间：2025-12-31
Article
- 摘要：Most melanomas have BRAF V600E/K mutations, making V600 an important target for precision treatment of melanoma, and it can often be blocked by a combination of BRAF inhibitors and MEK inhibitors. The emergence of immune checkpoint inhibitors has also greatly improved the treatment outcome of patients with BRAF V600 mutation-positive advanced melanoma. Clinical trials are also underway to determine the best first-line treatment and the sequence of combination therapies for these patients. This paper reviewed the latest progress in the treatment of BRAF V600 mutation-positive advanced melanoma in the era of precision medicine.关键词：BRAF V600 mutation;Advanced melanoma;Immune checkpoint inhibitors;BRAF inhibitors;MEK inhibitors1064|1422|0更新时间：2025-12-31
Review
- 摘要：Differentiated thyroid cancer in children and adolescents (caDTC) is different from adult DTC, and the DTC guidelines for adult are not fully applicable to children and adolescent patients. Therefore, experts from nuclear medicine, thyroid surgery, endocrinology, ultrasound, pathology and molecular biology formed the thyroid editorial committee to participate in the compilation of consensus on magagement of caDTC. Based on the principles of practicality, locality and treatment accessibility, this expert consensus is composed of the epidemiology, examinations, treatment strategies (surgery, radioactive iodine, targeted therapy and endocrinotherapy) and follow-up. It basically covers the clinical management of caDTC.关键词：Children and adolescents;Differentiated thyroid carcinoma;Nuclear medicine;Management;Consensus2357|1132|0更新时间：2025-12-31
Guideline and Consensus
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