{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:43:56Z","timestamp":1777959836199,"version":"3.51.4"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T00:00:00Z","timestamp":1666828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the clinicopathological characteristics of papillary thyroid cancer (PTC) and identify risk factors for postoperative recurrence of PTC with recurrent laryngeal nerve (RLN) involvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In total, 171 patients (112 women and 59 men, age: 18\u201380 years, and 65 patients aged \u2265 55) with T4a PTC with RLN involvement, treated at Beijing Tongren Hospital, Capital Medical University, from January 2006 to December 2020, were retrospectively examined. Clinicopathological characteristics, including voice analysis results, and survival outcomes were assessed. The Mann\u2013Whitney U and Kruskal\u2013Wallis H tests were used to analyze differences in acoustic parameters. The Kaplan\u2013Meier method was used to calculate the overall survival (OS) and recurrence-free (RFS) rates. Univariate and multivariate Cox regression analyses were performed of the clinical data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The postoperative follow-up period ranged from 12 to 196 months (mean: 66.18 months). Of the 171 patients, 16 had recurrence and 8 died of thyroid-related diseases. The 5-year OS rate was 95.22%. The 5-year RFS rate was 89.38%. Jitter and shimmer were higher and maximum phonation time was shorter in patients with preoperative vocal cord paralysis (VCP) than in those without RLN involvement, and in 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 \u2265 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 \u2265 55 years (OR 4.52, 95% confidence interval: 1.44\u201314.19, P = 0.010) was an independent risk factor for recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>PTC patients with RLN invasion can achieve good outcomes. Preoperative voice analysis may offer insights into RLN function. Age of onset \u2265 55 years is an independent risk factor for postoperative recurrence in T4a PTC patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2022.1041538","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T04:42:08Z","timestamp":1666845728000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Preoperative voice analysis and survival outcomes in papillary thyroid cancer with recurrent laryngeal nerve invasion"],"prefix":"10.3389","volume":"13","author":[{"given":"Jiaming","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lizhen","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongzhi","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qian","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shizhi","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yansong","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng","family":"Lian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xixi","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ru","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jugao","family":"Fang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jncc.2022.02.002","article-title":"Cancer incidence and mortality in China, 2016","volume":"2","author":"Zheng","year":"2022","journal-title":"J Natl Cancer Center"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1002\/hed.2880160211","article-title":"Locally invasive papillary thyroid carcinoma: 1940-1990","volume":"16","author":"McCaffrey","year":"1994","journal-title":"Head Neck"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/lary.27360","article-title":"International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data","volume":"128","author":"Wu","year":"2018","journal-title":"Laryngoscope"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/hed.10058","article-title":"Results of the treatment of locally invasive thyroid carcinoma","volume":"24","author":"Kowalski","year":"2002","journal-title":"Head Neck"},{"key":"B5","doi-asserted-by":"publisher","first-page":"55","DOI":"10.3322\/caac.21439","article-title":"Differentiated and anaplastic thyroid carcinoma: Major changes in the American joint committee on cancer eighth edition cancer staging manual","volume":"68","author":"Perrier","year":"2018","journal-title":"CA Cancer J Clin"},{"key":"B6","doi-asserted-by":"publisher","first-page":"26(1)","DOI":"10.1089\/thy.2015.0020","article-title":"American Thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer","volume":"2016","author":"Haugen","year":"2015","journal-title":"Thyroid"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/hed.23619","article-title":"Management of invasive well-differentiated thyroid cancer: an American head and neck society consensus statement. 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