Abstract
PurposeThe aim of this study was to find useful metabolites to predict lymph node (LN) metastasis in patients with papillary thyroid cancer (PTC) through a metabolomics approach and investigate the potential role of metabolites as a novel prognostic marker.Materials and methodsFifty-two consecutive patients (median age: 41.5 years, range 15–74 years) were enrolled who underwent total thyroidectomy and central LN dissection with or without lateral LN dissection in Severance Hospital between October 2013 and July 2015. The study specimens were provided by the Severance Hospital Gene Bank, and consisted of PTC from each patient. The specimens were prepared for proton nuclear magnetic resonance (1H-NMR) spectroscopy. Spectral data by 1H-NMR spectroscopy were acquired, processed, and analyzed. Patients were grouped in three ways, according to the presence of LN metastasis, central LN metastasis and lateral LN metastasis. Chi-square test and the student t-test were used to analyze categorical variables and continuous variables, respectively. The Mann-Whitney U test was used for univariate analysis of metabolites. Orthogonal projections to latent structure discriminant analysis (OPLS-DA) was used for multivariate analysis to discriminate metabolic differences between the two groups.ResultsAmong 52 patients, 32 had central LN metastasis and 19 had lateral LN metastasis. No clinical or histopathological characteristic was significantly different for all comparisons. On univariate analysis, no metabolite showed significant difference for all comparisons. On multivariate analysis, OPLS-DA did not discriminate the presence and absence of LN metastasis. Lactate was found to be the most promising metabolite.ConclusionsNo metabolite could discriminate the presence of LN metastasis. However, lactate was found to be the most promising metabolite for discrimination. Further studies with larger sample sizes are needed to elucidate significant metabolites which can indicate the presence of LN metastasis in patients with PTC.
Highlights
The incidence of thyroid cancer has increased worldwide during the last few decades and it is the most common endocrine malignancy [1,2]
No metabolite could discriminate the presence of lymph node (LN) metastasis
Further studies with larger sample sizes are needed to elucidate significant metabolites which can indicate the presence of LN metastasis in patients with Papillary thyroid cancer (PTC)
Summary
The incidence of thyroid cancer has increased worldwide during the last few decades and it is the most common endocrine malignancy [1,2]. Papillary thyroid cancer (PTC) is the most common histologic type, accounting for 85% to 90% of thyroid malignancies [3]. Some patient subsets suffer from more aggressive PTC characterized by recurrent disease, lymph node (LN) or distant metastasis [5]. These patients may need more extensive surgery including total thyroidectomy with therapeutic or prophylactic LN dissection and postoperative radioactive iodine (RAI) ablation [6]. Being able to predict risk is important and would help stratify patients for proper treatment [7]
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