| Part 1: Analysis of the correlation between ultrasonographic manifestations of papillary thyroid carcinoma and cervical lymph node metastasis objective : The clinical data of pathologically confirmed PTC patients and the ultraso nographic characteristics of cancer nodules were selected to analyze the correlation bet ween them and cervical lymph node metastasis,so as to explore the risk signs of late nt lymph node metastasis,and provide reliable basis for clinical selection of surgical methods and surgical ranges.Methods : 208 nodules in 176 cases that met the inclusion and exclusion criteria were collected and divided into non-metastatic group(143 nodules in 121 cases)and metastatic group(65nodules in 55 cases)according to the presence or absence of cervical lymph node metastasis using postoperative pathological diagnosis as the gold standard.The clinical data(gender,age)and ultrasonographic characteristics of cancer nodules(including the number of lesions,echo,microcalcification,maximum diameter,aspect ratio,margin,boundary,whether in contact with the capsule,blood flow)were statistically analyzed.Chi-square test was used for univariate analysis to obtain the predictive signs with statistically significant differences(P<0.05),and then binary logistic regression multivariate analysis was used to screen the sonographic characteristics with statistically significant lymph node metastasis(P<0.05)and analyze their correlation with cervical lymph node metastasis of PTC.Results : Univariate chi-square test showed that the incidence of cervical lymph node metastasis in males was 47.8%(22/46),higher than 25.4%(33/130)in females,and the difference was statistically significant(χ2=7.965,P<0.05).There were significant differences in the incidence of cervical lymph node metastasis among the maximum diameter of nodules(χ2=17.724,P<0.05),irregular margin(51/133 38.3% χ2=8.645,P<0.05),contact with capsule(22/67 32.8% χ2=120.846,P<0.05),microcalcification(55/140 39.3% χ2=8.867 P <0.05)and blood flow(χ2=22.120,P<0.05).Age,number of cancerous nodules,echogenicity,aspect ratio,and border were not statistically different in the incidence of cervical lymph node metastasis(P>0.05).Binary logistic regression analysis showed that male gender(P 0.001 OR 4.158 95%CI 1.831-9.441),regular margin(P 0.002 OR 0.267 95%CI0.117-0.609),microcalcification(P 0.004 OR 3.866 95%CI 1.536-9.732),and blood flow(grade 0-II)were associated with cervical lymph node metastasis of PTC(P<0.05),of which regular margin and blood flow(grade 0-II)were negatively correlated with cervical lymph node metastasis of PTC;gender and microcalcification were independent predictors of cervical lymph node metastasis of PTC.There was no significant difference in the incidence of cervical lymph node metastasis between the maximum diameter of cancerous nodules and the relationship with capsule(P > 0.05).Conclusion : The sex(male)and ultrasonographic features of PTC patients,including irregular margin of cancerous nodules,microcalcifications,and blood flow(grade 0–II),are correlated with lymph node metastasis.In ultrasonography,for PTC nodules with the above features,combined with comprehensive analysis of other signs,the possibility of early occult lymph node metastasis should be considered.Part 2: To investigate the role of extracellular matrix-associated genes in lymph node metastasis of papillary thyroid carcinoma based on transcriptome sequencing technologyobjective: Through transcriptome sequencing,differentially expressed genes of cervical lymph node metastasis of papillary thyroid carcinoma were screened,and extracellular matrix-related genes associated with cervical lymph node metastasis of PTC were mined to provide a basis for predicting cervical lymph node metastasis of PTC at the molecular level.Methods: Eleven PTC cancer tissues with cervical lymph node metastasis and 11 normal tissues were collected.RNA was extracted for transcriptome sequencing.Differential genes enriched in extracellular matrix-receptor interaction signaling pathway were selected by gene ontology(GO)annotation analysis and gene encyclopedia(KEGG)pathway enrichment analysis.Protein interaction network(PPI)was constructed.Differential analysis and progression-free survival(RFS)analysis were performed on GEPIA website.Results: A total of 1029 differential genes were screened by taking P < 0.05 and log2 Fold Change>2,of which 499 were up-regulated and 530 were down-regulated.The differentially expressed genes FN1,LAMB3,ITGA2,COL1A1,COMP,IBSP,RELN,and CD36 are all enriched in ECM-receptor interaction signaling pathways,which encode proteins that interact with each other.Differential analysis of GEPIA website showed that FN1,LAMB3,ITGA2,COL1A1,COMP,RELN,and CD36 were differentially expressed in thyroid cancer tissues and normal tissues.FN1,ITGA2,RELN,and CD36 were significantly associated with progression-free survival in thyroid cancer patients(P<0.05).Conclusion: High expression of extracellular matrix-associated genes FN1,ITGA2,and low expression of RELN,CD36 may play an important role in cervical lymph node metastasis of PTC and can be further studied as potential biological markers. |
