The incidence of thyroid cancer (TC) is increasing annually worldwide, with a growing burden. This study aims to analyze temporal trends in the burden of TC by age and sex in China and globally from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates, and to predict future trends. We obtained data on TC in China and globally from 1990 to 2021 from the Global Burden of Disease (GBD) database. Using the Joinpoint regression model, we calculated and analyzed the trends in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). Specifically, we estimated the annual percent change (APC), the average annual percent change (AAPC), and the corresponding 95% confidence intervals (95% CI) for each metric. Additionally, we conducted a decomposition analysis to investigate the impact of aging, population growth, and epidemiological factors on the incidence and mortality rates of TC. Furthermore, the autoregressive integrated moving average (ARIMA) model was employed to predict the burden of TC from 2022 to 2036. From 1990 to 2021, the ASIR for TC in China increased from 1.249 (95% uncertainty interval [UI]: 1.009–1.473) per 100,000 to 2.473 (95% UI: 1.993–3.088) per 100,000. Conversely, the ASMR decreased from 0.473 (95% UI: 0.403–0.550) per 100,000 to 0.387 (95% UI: 0.307–0.472) per 100,000. Both males and females demonstrated an upward trajectory in ASIR. However, while the ASMR for females decreased, that for males showed an overall increase despite a decline in the last decade. The age of peak onset for TC ranged from 30 to 79 years, whereas the age of peak mortality was between 50 and 89 years. The analysis using the AAPC indicates that the growth in the ASIR (AAPC = 2.242, 95% CI: 2.112–2.371) and ASPR (AAPC = 2.975, 95% CI: 2.833–3.117) in China exceeds the global rate. Furthermore, the reduction in ASMR (AAPC = -0.651, 95% CI: -0.824 - -0.479) and ASDR (AAPC = -0.590, 95% CI: -0.787 - -0.392) in China is also more pronounced than globally. Decomposition analysis indicates that the increasing TC burden in China is primarily driven by population aging, whereas globally, population growth plays a more significant role. Projections based on predictive models suggest that from 2021 to 2036, the ASIR for both China and the global population is expected to continue rising, while the ASMR is anticipated to decline further. The incidence rates of TC in China and globally have shown a continuous upward trend, which is expected to persist over the next 15 years. Additionally, although the number of male TC cases is relatively lower compared to females, the overall ASMR and ASDR for males have shown an upward trend, despite a slight decline in recent years. This highlights the need to enhance prevention, diagnosis, and treatment measures, and to develop differentiated screening and treatment strategies based on age and sex.

Background: The incidence and recurrence rate of papillary thyroid carcinoma (PTC) are high. Thus, it is critical to accurately identify patients at high risk of recurrence. Pyroptosis is a type of programmed cell death closely related to the progression and prognosis of cancer. However, the role of pyroptosis in PTC remains unclear. Methods: Transcriptome data for PTC patients were obtained from The Cancer Genome Atlas database. The expression level of pyroptosis-related genes (PRGs) in PTC and normal tissues was identified. Based on these differentially expressed genes, a risk score model of disease-free survival (DFS) was established using least absolute shrinkage and selection operator Cox regression. In-cluster and quantitative real-time PCR validations were carried out. A nomogram, in combination with clinical factors, was also established. In addition, its relationship with immune characteristics and tumor gene mutations is discussed. Results: A risk score model with four PRGs, including CASP6, CASP9, IL-18, and NOD1, was established. The samples were divided into high- and low-risk clusters, according to the risk score, revealing significant differences in DFS between the two clusters. A nomogram was established combining age, lymph node metastasis and extrathyroidal extension. The area under the curve (AUC) of predicting one-, five-, and 10-year DFS in PTC patients was 0.745, 0.801, and 0.803, respectively. The low-risk cluster showed higher levels of immune infiltration and immune checkpoint gene expression, while the high-risk cluster demonstrated a higher tumor mutation burden. Conclusion: A predictive DFS model was established, based on PRGs, which may aid in identifying patients at high risk of recurrence. The present study helps to better understand the role of pyroptosis in the progression and prognosis of PTC.

Objective: To investigate risk factors of lateral cervical lymph node metastasis (LLNM) in patients with medullary thyroid carcinoma (MTC). Methods: Published studies regarding clinicopathological factors of LLNM in MTC were searched in PubMed, Web of Science, Embase, Cochrane library, Wanfang date and CNKI. Statistical analysis was performed using Stata 14.0 software. The mean and standard deviation from the sample size, range, median, and interquartile range was estimated. Odds ratio (OR) or standard mean difference (SMD) with 95% confidence interval (CI) of related factors were analyzed by fixed/random-effects models. Egger’s test and Begg’s test were applied to assess the publication bias of the literature. This study was registered with PROSPERO (CRD42021254955). Results: Fifteen studies involving 1424 patients were included in the analysis, among whom 543 cases had LLNM (38.13%). Meta-analysis revealed that an increased risk of LLNM was associated with male gender (OR=1.64, 95%CI: 1.29–2.09, Z=4.06, P<0.01), tumor diameter≥1cm (OR=5.09, 95%CI: 2.43–10.67, Z=4.31, P<0.01), multifocality (OR=2.55, 95%CI: 1.79–3.61, Z=5.22, P<0.01), capsule invasion (OR=7.80, 95%CI: 4.84–12.55, Z=8.46, P<0.01), extracapsular extension (OR=9.46, 95%CI : 5.66–15.81, Z=8.58, P<0.01), cervical central lymph node metastasis (OR=23.58, 95%CI : 9.44–58.87, Z=6.77, P<0.01), elevated preoperative calcitonin (SMD=1.17,95%CI: 0.67–1.67, Z=4.56, P<0.01), spiculated margin on ultrasonography (OR=4.32, 95%CI: 2.43–7.68, Z=4.99, P<0.01), irregular shape on ultrasonography (OR=6.81, 95%CI : 3.64–12.73, Z=6.01, P<0.01); while age ≥ 45 years (OR=1.22, 95%CI: 0.65–2.29, Z=0.62, P>0.05), elevated preoperative carcinoembryonic antigen (SMD=0.95, 95%CI : –0.48–2.38, Z=1.30, P>0.05) and calcification on ultrasonography (OR=1.28, 95%CI: 0.75–2.18, Z=0.92, P>0.05) were not associated with LLNM. Conclusion: Male gender, tumor diameter≥1 cm, multifocality, capsule invasion, extracapsular extension, central lymph node metastasis, elevated preoperative calcitonin, spiculated margin and irregular shape on ultrasonography are risk factors for LLNM in MTC, when these clinical and ultrasonic features are present, lateral neck lymph node dissection is recommended.

The burden of thyroid cancer (TC) among young people aged 10–24 years has not been systematically studied to date. This study aims to analyze the burden of TC among young people aged 10–24 years globally, regionally, and nationally from 1990 to 2021. We collected data on the incidence, mortality, and disability-adjusted life years (DALYs) rates for TC among young people aged 10–24 years from 1990 to 2021 using the Global Burden of Disease (GBD) 2021. Joinpoint regression analysis, frontier analysis, and health inequality analysis were employed to examine the variations and changes in TC burden among young people aged 10–24 years across different countries and regions. From 1990 to 2021, the global burden of TC among young people has increased from 2.726 per 100,000 people [95% Uncertainty Interval (UI) 2.38–3.181] to 2.956 per 100,000 people (95% UI: 2.339–3.922), with an Average Annual Percent Change (AAPC) of 0.258 (95% Confidence Interval (CI): 0.138—0.378). The highest incidence rates were observed in Saudi Arabia, Taiwan (China), and Vietnam, while the highest mortality rates were in India, China, and Bangladesh. Frontier analysis revealed that the largest disparities in effective differences were found in the Netherlands, Germany, Canada, the United States of America, and Guinea-Bissau. The Slope Index of Inequality (SII) for DALYs increased slightly from -0.15 in 1990 to -1.3 in 2021. Over the past three decades, the burden of TC has increased globally among young people, particularly in poorer countries and regions. This study highlights the importance of formulating public health policies tailored to the specific circumstances of different countries and regions aimed at reducing the TC burden among young people.

Background: Large number lymph node metastases (LNLNMs) in papillary thyroid carcinoma (PTC) significantly increase recurrence risk, yet preoperative prediction remains challenging. This study aimed to develop a predictive model integrating blood inflammatory markers and clinical features to identify patients with high-risk LNLNM. Methods: A retrospective cohort of 731 patients with PTC who underwent thyroid surgery at Hangzhou First People’s Hospital between September 2021 and October 2022 was included. These patients were divided into a model group (n=513) and a validation group (n=218) at a 7:3 ratio. Analyzed variables included age, gender, absolute values of neutrophils (N), monocytes (M), platelets (Plt), and lymphocytes (L), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammatory index (SII), and tumor diameter and multifocality. Independent risk factors for LNLNM were identified through univariate and multivariate logistic regression analyses, and a risk prediction model was subsequently constructed. Model performance was assessed via receiver operating characteristic (ROC) curves, the Hosmer-Lemeshow (HL) test, calibration curves, and decision curve analysis (DCA). Results: Age, tumor diameter, Plt, and NLR were identified as independent risk factors for LNLNM in patients with PTC. A predictive model was developed to evaluate the risk of LNLNM, with an area under the curve (AUC) of 0.827 (95% CI: 0.784–0.870; P<0.001) and the specificity and sensitivity were both 75.8%. The AUC of the validation group was 0.824 (95% CI: 0.757–0.890; P<0.001), with a specificity of 79.5% and a sensitivity of 76.9%. Furthermore, the model demonstrated good calibration in the HL test and favorable diagnostic value in calibration curve analysis and DCA. Conclusions: Age, tumor diameter, Plt count, and NLR count are high-risk factors for LNLNM in patients with PTC, and the predictive model established in combination with the above factors could effectively predict the occurrence of LNLNMs in PTC. This study provides support for surgeons in accurately predicting the possibility of LNLNMs and developing personalized treatment plans before surgery.