Ming-Jie Jiang

Although lacking high-quality clinical evidence, the use of thermal ablation for papillary thyroid carcinoma (PTC) is increasing. Emerging evidence suggest

Background: Although recent guidelines recommend parathyroid autotransplantation for inadvertent excision of ischaemic glands, its benefit for the recovery of parathyroid function after total thyroidectomy remains uncertain. Methods: This retrospective study analysed patients with normal parathyroid hormone (PTH) concentrations who underwent primary total thyroidectomy at Sun Yat-sen University Cancer Center between September 2013 and November 2024. Postoperative hypoparathyroidism and PTH trajectories were compared across three groups: autotransplantation, inadvertent parathyroid resection, and all glands preserved in situ. Long-term recovery was modelled using generalized additive mixed models (GAMM). Results: Of 7539 eligible patients, 441 (5.8%) underwent autotransplantation and 814 (10.8%) had inadvertent parathyroid resection. Higher proportions of parathyroid autotransplantation or inadvertent resection were observed among patients undergoing central neck dissection, particularly bilateral procedures. Postoperative (POD) 1 hypoparathyroidism (PTH < 15 pg/ml) occurred in 64.9% and 62.4% of patients in the autotransplantation and inadvertent resection groups, respectively, compared with 50.7% of patients with in situ gland preservation. At 1 month, hypoparathyroidism was present in 17.1% and 22.5% of patients in the autotransplantation and inadvertent resection groups, respectively, compared with 11.9% of patients with in situ gland preservation. Among patients with POD1 hypoparathyroidism, the recovery of parathyroid function at 1 month was similar in the autotransplantation and in situ preservation groups (∼72% and ∼74%, respectively), but lower in the group with inadvertent resection (∼62%). GAMMs showed poorest long-term recovery after inadvertent resection, whereas recovery in the autotransplantation group approached in situ preservation without clear superiority. Conclusions: Parathyroid autotransplantation improved long-term recovery compared with inadvertent resection but did not outperform in situ preservation. These findings support autotransplantation for inadvertently resected parathyroid glands, but not for devascularized glands.

Background Locally advanced head and neck squamous cell carcinoma (LA HNSCC) remains a disease with a challenging prognosis. Concurrent chemoradiotherapy has long been the standard of care, yet efforts to enhance outcomes through the addition of induction or adjuvant therapies have largely failed. Recently, immune checkpoint inhibitors, particularly PD-1 inhibitors, have demonstrated efficacy in managing HNSCC, becoming a first-line treatment for recurrent/metastatic cases. This study aims to evaluate whether adding PD-1 inhibitors to induction chemotherapy can improve long-term outcomes in newly diagnosed LA HNSCC patients. Patients and methods This retrospective analysis included 204 newly diagnosed LA HNSCC patients treated between February 2012 and February 2023. Patients were divided into two cohorts: TPI group (n=115), who received induction chemotherapy including PD-1 inhibitors, and TP group (n=89), who received induction chemotherapy alone. The primary outcome was overall survival (OS), while secondary outcomes included progression-free survival (PFS) and objective response rate (ORR). Baseline characteristics were balanced using overlap propensity score weighting. Survival analyses were conducted using the Kaplan-Meier method, and subgroup analyses employed Cox proportional hazards models. Results With a median follow-up of 29.23 months, baseline characteristics were balanced after weighting. The addition of PD-1 inhibitors significantly improved OS (HR: 0.11, 95% CI: 0.03–0.37, pp=0.024). Furthermore, the TPI group showed a significant improvement in the best radiological responses (p=0.02). Subgroup analyses identified specific factors associated with enhanced PFS and OS. Conclusions The addition of PD-1 inhibitors to induction chemotherapy significantly improves overall survival in patients with LA HNSCC, underscoring the potential for further clinical trials to refine and optimize treatment strategies.

Anaplastic thyroid carcinoma (ATC) is one of the most lethal human malignancies, often evolving from differentiated thyroid carcinoma (DTC) through a poorly understood dedifferentiation process. To elucidate this transition, spatial transcriptomic sequencing (spRNAseq) is performed on seven samples containing coexisting regions of ATC, poorly differentiated thyroid carcinoma, and DTC. SpRNAseq revealed that ATC regions were characterized by upregulated genes involved in immune suppression, angiogenesis, and extracellular matrix remodeling. Whole‐exome sequencing and inferCNV analysis confirmed that adjacent DTC regions harbored mutational burdens comparable to those of ATC regions, suggesting early genomic priming for dedifferentiation. Trajectory analysis delineated a stepwise reprogramming process and identified four gene modules associated with the loss of thyroid differentiation, among which PDCD4 and TYMP emerged as key regulators. Notably, TYMP⁺ tumor‐associated macrophages (TAMs) were highly enriched in ATC regions and contribute to an immunosuppressive microenvironment. Mechanistic experiments demonstrated that loss of PDCD4 led to eIF4A‐dependent overexpression of immunosuppressive effectors, promoting the high infiltration of TYMP⁺TAMs in ATC. These findings support that coexisting DTC regions with ATC‐like genomic alterations undergo sequential transcriptomic reprogramming and immune microenvironment remodeling to evolve into a full ATC pathological phenotype, in which PDCD4 loss–induced TAMs formation plays a critical role.

Background: Anaplastic thyroid carcinoma (ATC) is a rare, aggressive solid tumor with poor prognosis. Traditional treatment such as surgery, radiotherapy, and chemotherapy has limited therapeutic effects. In recent years, immunotherapy is changing the treatment pattern of them. We systematically summarize the research status and application of immunotherapy in ATC to provide clinicians and relevant researchers with a comprehensive perspective. Method: A comprehensive search of the PubMed and Embase databases identified 18 studies investigating the application of immunotherapy in ATC. These included ten cohort studies and eight case reports. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) and Joanna Briggs Institute checklist (JBI). Subsequently, a single-proportion meta-analysis and meta-regression were performed to evaluate the efficacy of immunotherapy in ATC. Results: The favorable response rate to immunotherapy in ATC patients (33–100%) varies across cohorts, indicating substantial heterogeneity. The combination of immunotherapy with targeted therapy, as well as the use of neoadjuvant treatment, has led to improved outcomes for ATC. Single-proportion meta-analysis suggests that immunotherapy may provide clinical benefits for a subset of ATC patients (approximately one-third to one-half), but its effectiveness in controlling disease progression remains limited. Meta-regression further indicates that ATC patients with PD-L1 expression or BRAF ^V600E mutations tend to have better treatment responses. Among the 8 case reports, two patients achieved complete remission after immunotherapy, and four patients died of disease progression after immunotherapy. Mild adverse effects are common, but interstitial pneumonia is associated with poor prognosis in immunotherapy. Conclusion: Immunotherapy for ATC has demonstrated safety and efficacy in several studies, especially in patients with PD-L1 expression or BRAF ^V600E mutations. However, immune-related side effects should be carefully managed, particularly to prevent interstitial pneumonia.

Background Predicting the likelihood of papillary thyroid carcinoma (PTC) recurrence is crucial for improving patient outcomes. The association between the BRAF V600E (BRAF) mutation and PTC recurrence remains controversial. Our goal was to determine prognostic features of PTC patients and construct models for predicting recurrence risk according to BRAF mutation status. Methods A total of 811 PTC patients whose clinical information and survival data were available were included in this study. Independent prognostic variables of PTC identified by screening via LASSO-Cox regression analysis were then used to construct nomograms. The performance of the predictive models was assessed according to the C-index, ROC curve, validation curve, and decision curve analyses. Kaplan–Meier curves were used to analyze differences between patients grouped according to prognostic factors and relapse risk. Results Multivariate Cox regression analysis demonstrated that extrathyroidal extension (ETE), vascular tumor thrombus, and lymph node yield (LNY) were correlated with recurrence-free survival (RFS) in the BRAF mutation-negative group, while extranodal extension (ENE), number of metastatic lymph node (NMLN), pathological stage, and vascular tumor thrombus were correlated with RFS in the BRAF mutation-positive group. The mutation-stratified predictive models demonstrated better performance than the model without stratification, as indicated by the greater C-index values (0.880 vs. 0.859 vs. 0.753), AUC values (1-year AUC: 0.946 vs. 0.947 vs. 0.758; 3-year AUC: 0.889 vs. 0.871 vs. 0.760; 5-year AUC: 0.845 vs. 0.793 vs. 0.758), and net clinical benefit. The calibration curves at 1 year, 3 years, and 5 years showed good consistency. The bootstrap internal validation had good AUC values exceeding 0.8 and showed a well-fitting calibration curve. Significant differences in RFS were observed between the low-risk and high-risk groups (P < 0.001). Conclusion Stratifying patients based on their BRAF mutation status can facilitate the development of better and more targeted postoperative management strategies. Nomograms for BRAF mutation positive and negative patients were developed to precisely and consistently predict recurrence risk in PTC patients.

Background The prognostic value of nutritional status in anaplastic thyroid carcinoma (ATC) remains unclear. The Prognostic Nutritional Index (PNI) is a reliable indicator of overall nutritional and immune status, and it has emerged as a significant prognostic factor in various malignancies. This study aimed to explore the utility of PNI in ATC. Methods We systematically reviewed ATC patients in our institute from January 2000 to June 2023 and categorized them into high and low PNI groups based on the median PNI value. Kaplan–Meier analysis and Cox regression were employed to assess the impact of PNI on overall survival, while ROC curve analysis evaluated the predictive value of PNI. Mimics software was used for three-dimensional reconstruction of pre- and post-immunotherapy tumor volumes, enabling the assessment of treatment response. Results A total of 77 ATC patients were included in this study. Low baseline PNI was associated with significantly shorter overall survival (1-year survival rate: 5.26% vs 30.77%; median survival time: 5.30 months vs 8.87 months). The 1-year, 2-year, and 3-year AUC values for PNI were 0.82, 0.79, and 0.77, respectively. In the multivariate analysis, both PNI and tumor size emerged as independent prognostic factors for patient overall survival. Among ATC patients receiving 2–3 cycles of immunotherapy, an increase in post-treatment PNI levels was positively correlated with a reduction in tumor volume. Conclusion PNI is an independent predictor of overall survival and holds the potential to serve as a valuable indicator for assessing and predicting immunotherapy efficacy in ATC patients.

Background: Postoperative hypoparathyroidism (hypoPT) is a common complication following thyroid surgery. However, current research findings on the risk factors for post-thyroid surgery hypoPT are not entirely consistent, and the same risk factors may have different impacts on transient and permanent hypoPT. Therefore, there is a need for a comprehensive study to summarize and explore the risk factors for both transient and permanent hypoPT after thyroid surgery. Materials and methods: Two databases (PubMed and Embase) were searched from inception to 2024. The Newcastle–Ottawa Scale was used to rate study quality. Pooled odds ratios were used to calculate the relationship of each risk factor with transient and permanent hypoPT. Subgroup analyses were conducted for hypoPT with different definition-time (6 or 12 months). Publication bias was assessed using Begg’s test and Egger’s test. Results: A total of 19 risk factors from the 93 studies were included in the analysis. Among them, sex and parathyroid autotransplantation were the most frequently reported risk factors. Meta-analysis demonstrated that sex (female vs. male), cN stage, central neck dissection, lateral neck dissection, extent of central neck dissection (bilateral vs. unilateral), surgery [total thyroidectomy (TT) vs. lobectomy], surgery type (TT vs. sub-TT), incidental parathyroidectomy, and pathology (cancer vs. benign) were significantly associated with transient and permanent hypoPT. Preoperative calcium and parathyroid autotransplantation were only identified as risk factors for transient hypoPT, while preoperative PTH was a protective factor. Additionally, node metastasis and parathyroid in specimen were associated with permanent hypoPT. Conclusion: The highest risk of hypoPT occurs in female thyroid cancer patients with lymph node metastasis undergoing TT combined with neck dissection. The key to preventing postoperative hypoPT lies in the selection of surgical approach and intraoperative protection.