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Objective@#To analyze the method and effect of reconstruction of the orbital floor defect with preserved orbital contents after advanced maxillary sinus cancer resection.@*Methods@#Thirty-three patients of T3/T4 stage maxillary sinus cancer with orbital invasion who were treated in Shandong Provincial Hospital from January 2010 to October 2016 were retrospectively analyzed, including 20 males and 13 females, aged from 12 to 80 years old. Patients were treated with appropriate surgical methods according to their clinical manifestation, imaging finding, invasion range, preoperative and intraoperative pathology. Surgical approaches such as maxillectomy, expanded maxillectomy and superstructure maxillectomy were used for patients with Medpor orbit floor repairment. Patients were followed up regularly after surgery, and the surgical efficacy was discussed by descriptive statistical method.@*Results@#Of those 33 cases, 19 were squamous cell carcinoma, 8 were adenoid cystic carcinoma, 5 were inverted papilloma malignant transformation, and 1 was myoepithelial carcinoma in our study. After tumor resection and orbital floor repair, the orbital contents and eyeball function of all patients remained intact. During follow-up time ranged from 3 to 8 years, a total of 6 patients relapsed at 3 years and died of ineffective treatment. The survival rate was 81.8% (27/33).@*Conclusion@#Tumor resection and Medpor orbital floor repair in maxillary sinus cancer patients with orbital invasion can preserve the function of the eyeball well, greatly improve the quality of patient′s life.
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Objective To compare two recurrence-risk stratification software (RSS),which could evaluate the recurrence-risk in patients with differentiated thyroid carcinoma (DTC) intelligently.Methods Based on 2009 American Thyroid Association (ATA) guidelines and clinical guidelines for 131I therapy of DTC patients in China (2014),two RSS (RSS1 and RSS2) were designed.From January 2013 to January 2016,1 043 non-metastasis DTC patients (386 males,657 females;average age (46.4±10.5) years) in Peking Union Medical College Hospital were involved to be risk-stratified,and the results were evaluated by ATA response evaluation system.x2 test was used to analyze the data.Results With 2 years' (median) follow-up,the recurrence rates in low,intermediate and high recurrence-risk groups evaluated by RSS1 were 2.8％(1/36),4.7％ (34/725) and 42.9％ (121/282),and those were 0(0/29),3.7％ (26/698) and 41.1％(130/316) evaluated by RSS2.The recurrence rate was lower in low-risk group evaluated by RSS2 than that by RSS1,but there was no significant difference (x2=3.046,P＞0.05).More patients with recurrence were divided into high-risk group evaluated by RSS2,but the recurrence rates of 2 high-risk groups evaluated by RSS1 and RSS2 were not significantly different (x2 =0.082,P＞0.05).Conclusion RSS1 and RSS2 could predict recurrence-risk effectively,and RSS2 could classify more recurrent patients into high-risk group.
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Objective To investigate the efficacy of thyroid ablation with low dose (1 110 MBq) 131 I for non-distant metastases differentiated thyroid carcinoma (DTC) and its probable influence factors.Methods A total of 183 DTC patients (48 males,135 females,average age:(39.75±10.14) years) treated by thyroid ablation with 1 110 MBq 131I from January 2015 to December 2016 were respectively observed.All patients underwent diagnostic whole body scan (Dx-WBS) and the stimulated thyroglobulin (sTg) was measured 6-9 months after thyroid ablation.According to the results,patients were divided into successful ablation group (G1) and unsuccessful group (G2).Clinical and pathological characteristics of 2 groups were compared by two-sample t test,Mann-Whitney u test andx2 test.Logistic regression was used to identify the influence factors for efficacy of 131I ablation,and the cutoff value was determined by receiver operating characteristic (ROC) curve analysis.Results There were 156 patients in G1 and 27 patients in G2.The successful ablation rate was 85.25％(156/183).Comparing with patients in G2,patients in G1 showed higher thyroid stimulating hormone (TSH) before ablation and lower sTg.The TSH level was 137.94(124.21,150.00) and 74.91(55.57,98.18) mU/L respectively (u=6.458,P＜0.05),and sTg was 1.80(0.69,5.20) and 22.30(4.49,32.20) μg/L respectively (u=-6.174,P＜0.05).Logistic regression showed that TSH,sTg and T stage before ablation were independent predictors for efficacy of 131I ablation (odds ratios:0.357-0.944).The optimal cutoff values of TSH and sTg identified by ROC curve analysis were 122.98 mU/L and 13.78 μg/L.Conclusions Low-dose 131I is effective enough for ablation treatment in non-distant metastases DTC patients with low T stage and low sTg(＜ 13.78 μg/L).High TSH (＞ 122.98 mU/L) before ablation may facilitate the efficacy of 131I ablation.
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Objective:To continuously evaluate the response of differentiated thyroid cancer(DTC)after radioiodine therapy,and to an-alyze influencing factors for excellent response. Methods: Data of 237 patients with non-distant metastatic DTC treated in Peking Union Medical College Hospital were retrospectively analyzed,and the changes in response were evaluated(excellent response,ER;biochemical incomplete response,BIR;and structure incomplete response,SIR)2 years after receiving the 131I therapy.The responses of different recurrence-risk stratification and TNM stages were contrasted,and the influencing factors to ER were analyzed by multiple-factor analysis.Results:The percentage of the responses obtained 3 months and 2 years after 131I therapy were(3 months/2 years)as follows:54.9%/73.0%,33.3%/18.1%,11.8%/6.0%,and 0/3.4%.Of the initial IR patients,45.6% were observed to transfer into ER and 28.6% of the BIR patients are confirmed cervical recurrence by pathology.Recurrence-risk stratification and ER rate were negatively correlated(r=0.973,P=0.147);however,TNM stage and response showed no evident correlation.The size of tumor and the number of lymph node metastasis were the main influencing factors in obtaining ER(P=0.008,0.007,respectivtly).Conclusion:The rate of ER in non-metastasis DTC patients increased gradually after receiving 131I therapy.Approximately half of initial IR patients reached ER two years after treatment,and the patients with small diameter of tumor and less lymph node invasion tend to obtain ER.