AUTHOR=Chen Jiaming , Zhong Qi , Hou Lizhen , Ma Hongzhi , Shi Qian , Feng Ling , He Shizhi , Lin Yansong , Lian Meng , Shen Xixi , Wang Ru , Fang Jugao 

TITLE=Preoperative voice analysis and survival outcomes in papillary thyroid cancer with recurrent laryngeal nerve invasion

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.1041538

DOI=10.3389/fendo.2022.1041538

ISSN=1664-2392

ABSTRACT=Objective: To investigate clinicopathological characteristics of PCT and sought to identify risk factors for postoperative recurrence of PTC with RLN involvement. 
Methods: In total, 171 patients (112 females and 59 males, age: 18–80 years, and 65 patients aged  55) with T4a PTC with RLN involvement, treated at Beijing Tongren Hospital, Capital Medical University, from January 2006 to December 2020, were retrospectively analyzed. Clinicopathological characteristics, including voice analysis results, and survival outcomes were assessed. Mann–Whitney U and Kruskal–Wallis H tests were used to analyze differences in acoustic parameters. The Kaplan–Meier method was used to calculate the overall (OS) and recurrence-free (RFS) rates. Univariate and multivariate Cox regression analyses were performed on the clinical data. 
Results: Postoperative follow-up ranged from 12 to 196 months (mean: 66.18 months). Of the 171 patients, 16 had recurrence and eight died of thyroid-related diseases. The 5-year OS rate was 95.22%. The 5-year RFS rate was 89.38%. Jitter and shimmer was higher and maximum phonation time was shorter in patients with preoperative vocal cord paralysis (VCP) than in those without RLN involvement, and those with RLN involvement but without preoperative VCP. Acoustic parameters were similar in patients with no preoperative VCP and those without RLN involvement. Voice analysis results did not differ between cases with RLN adhesion and RLN invasion. Univariate analysis showed that age at onset  55 years, preoperative RLN palsy, and esophageal invasion were risk factors for postoperative recurrence of PTC with RLN involvement. Multivariate analysis showed that onset age  55 years (OR 4.52, 95% confidence interval: 1.44–14.19, P = 0.010) was an independent risk factor for recurrence. 
Conclusions: PTC patients with RLN invasion can achieve good efficacy. Preoperative voice analysis may offer insights into RLN function. Age of onset ≥ 55 years is an independent risk factor for postoperative recurrence in T4a PTC patients.