Analysis Of Clinical Features Of 427 Patients With Thyroid Carcinoma And Gene Mutations Of Aggressive Thyroid Carcinoma

ObjectiveThis study retrospectively analyzed the gender,age,clinical history,clinical manifestations,ultrasound features and postoperative pathological features of 427 patients with thyroid carcinoma,and researched the gene mutations of aggressive thyroid carcinoma.MethodsPatients with postoperative pathological diagnosis of non-papillary thyroid carcinoma from January 2015 to October 2019 in Xiangya Hospital of Central South University,together with thyroid cancer patients counted in four third-class Hospitals in HengYang City during the same period were included in this clinical study.Clinical features of 361 cases of papillary thyroid carcinoma(PTC),23 cases of thyroid follicular carcinoma(FTC),30 cases of medullary thyroid carcinoma(MTC),13 cases of aggressive thyroid carcinoma were analyzed through statistical methods,then we explored the overall situation of the gender composition,the average age of onset,clinical history,clinical manifestations,ultrasound features,and pathological features of different pathological types of thyroid cancer.Aggressive thyroid carcinoma includes anaplastic thyroid carcinoma(ATC)and poorly differentiated thyroid carcinoma(PDTC).Upon extracting the DNA from formalin fixed paraffin-embedded tumor pathological tissues(4 cases of PTC,3 cases of ATC,1 case of PDTC),we carried out whole-exome sequencing to analyze their gene mutations.Results1.Regardless of male or female,the onset of thyroid carcinoma peaked at 46~55 years of age,and gradually decreased after the age of 55.Young and middle-aged people were the peak incidence of thyroid carcinoma.The gender composition of different pathological types of thyroid carcinoma were not all the same(P<0.05),and the proportion of women with thyroid cancer was higher than that of men in addition to MTC.Secondly,the average age of the onset of different pathological types of thyroid cancer were not exactly equal(P<0.05).The average age of the onset of aggressive thyroid cancer was higher than that of the other three types of thyroid cancers.2.Thyroid carcinoma of different pathological types had different composition in family history,hoarseness,dysphagia,dyspnea,local lumps pain and enlarged cervical lymph nodes(P<0.05).MTC had familial genetic characteristics.Both ATC and PDTC were prone to be accompanied by hoarseness,difficulty swallowing and breathing,and the duration of onset was obviously shorter than other types of thyroid cancer.3.Thyroid carcinoma of different pathological types had different composition in the echogenicity of nodules,the maximum diameter of nodules,the calcification of nodules,the blood flow in nodules,and the enlarged lymph nodes in the neck(P<0.05).The nodules of ATC and PDTC on ultrasound images were relatively large,the diameter of more than half of the nodules were ? 4cm.4.Thyroid carcinoma of different pathological types had different composition in the maximum diameter of tumor lesion,cervical lymph node metastasis,vascular(Vasculature)invasion,and gland outside invasion(P<0.05).Nearly half(47.4%)of PTC were microscopic cancers,while more than half(61.5%)of the lesions of ATC and PDTC had a maximum diameter of ? 4cm.And FTC,ATC and PDTC were more prone to be accompanied by vascular(Vasculature)invasion,ATC and PDTC were more prone to be accompanied by gland outside invasion.5.The SESN2 mutation was found in all aggressive thyroid cancers(3 cases of ATC and 1 case of PDTC).This mutation may affect the expression of SESN2 through AMPK/mTORC1 signaling pathway,causing abnormal autophagy process in cells or affecting their antioxidant stress damage ability,which may lead the occurrence of ATC and PDTC.The BRAF mutation had high mutation frequency in PTC,accounted for 75%(3/4).Conclusion1.Young and middle-aged people are the peak incidence of thyroid carcinoma.The proportion of women with thyroid cancer is higher than that of men in addition to MTC,and there is gender differences.2.The aggressive thyroid carcinoma with strong aggressiveness tends to occur at an older age,and it is prone to invade surrounding adjacent tissues and cause corresponding clinical symptoms.The size of the lesions is related to the pathological classification of thyroid carcinoma,and the lesions of aggressive thyroid cancer is relatively larger.3.The SESN2 mutation may affect the expression of SESN2 through AMPK/mTORC1 signaling pathway leading the occurrence of aggressive thyroid carcinoma.