Prognostic value of thyroidectomy and tracheostomy in anaplastic thyroid carcinoma

@#<p><strong>OBJECTIVE:</strong> To determine the prognostic value of surgical interventions done among patients with anaplastic thyroid carcinoma (ATC)</p><p><strong>METHODS:</strong> A five-year retrospective chart review of 25 patients was done and baseline characteristics determined. Patients discharged alive as of the time of last chart entry were followed up by phone interview or personal visit. Overall survival was the main outcome measure which was plotted as Kaplan-Meier estimates and compared via log-rank test. The incidence of complications surrounding tracheostomy and thyroidectomy were also noted.</p><p><strong>Methods: </strong></p><p><strong>Design:</strong> Ambispective Cohort Study</p><p><strong>Setting:</strong> Tertiary National University Hospital</p><p><strong>Participants:</strong> All private and public (charity) patients seen at the wards or clinics diagnosed with ATC via fine needle cytology or tissue histopathology.</p><p><strong>RESULTS:</strong> All patients presented with either stage IV-B or stage IV-C disease. A significant difference in survival curves was noted when comparing between the two stages (p<.05). Subgroup analysis per stage revealed no significant difference in overall survival when comparing patients who did not undergo surgery, those who underwent tracheostomy or those who underwent thyroidectomy for both IV-B (p=.244) or IV-C (p=.165) disease. The incidence of complications for tracheostomy was 60%, the most common being mucus plugging. For thyroidectomy, the incidence of complications was 80% with hypocalcemia being the most common.</p><p><strong>CONCLUSION:</strong> The current available data fails to demonstrate any significant survival advantage of tracheostomy or thyroidectomy when performed among similarly staged patients.</p>

Histopathologically positive regional neck node metastasis among patients with laryngeal squamous cell carcinoma

Objective@#To determine the patterns of regional neck node metastasis in laryngeal squamous cell carcinoma in Filipinos according to subsite and clinical stage, and to determine possible factors associated with level V involvement.@*Methods@# Design: Retrospective Case Series. Setting: Tertiary National University Hospital. Participants: A chart review was conducted for patients diagnosed with laryngeal squamous cell carcinoma who underwent laryngectomy with neck dissection from January 2011 to April 2015. Medical information obtained included demographics, clinical parameters, and histopathologic reports of nodal involvement. The rate and location of positive neck nodes was recorded according to clinical stage and primary subsite. Fisher exact test was used to determine significant risk factors for level V cervical lymph node involvement.@*Results@#Of 56 patients included, most were male with an average age of 61 years. Most patients had cancer originating from the glottic subsite, with the majority being staged III and IVA according to the TNM classification. Histopathologically positive neck nodes were centered at levels II to IV. No significant association was seen between level V involvement and the studied clinicopathologic factors (age, sex, tumor differentiation, subsite involvement, involvement of other neck node levels). @*Conclusion@#Cervical neck node levels II, III, and IV are the most commonly involved in neck dissection, with many being positive for nodal metastasis for these levels. Level V nodes may be removed when clinically positive, but elective neck dissection may exclude this level. The current practice of neck dissection appears to be appropriate in terms of selecting the most likely locations of metastatic spread. Further study is recommended, with a greater population and standardized levels of neck dissection.

Risk factors for recurrent papillary thyroid carcinoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To identify risk factors associated with disease recurrence among Filipinos with papillary thyroid carcinoma (PTC).<br /><strong>METHODS:</strong><br /><strong>Design:</strong> Retrospective Cohort Study<br /><strong>Setting:</strong> Tertiary National University Hospital<br /><strong>Participants:</strong> 76 patients diagnosed with papillary thyroid carcinoma, classified as low and low-to-intermediate risk (2015 ATA classification) that underwent total thyroidectomy with or without neck dissection from 2010-2014 and were followed up from 10 months to 5 years. Log rank and Cox regression analyses were used to determine significant risk factors for recurrence.<br /><strong>RESULTS:</strong> 29 (38.15%) had recurrence. On univariate analysis, age, tumor size, multifocality, extrathyroidal extension, presence of lateral neck nodes and RAI therapy were statistically associated with recurrence. However, on multivariate analysis, no clinicopathologic factor was statistically associated with recurrence.<br /><strong>CONCLUSION:</strong> Age of >45 years, female sex, tumor size of >2 cm, multifocality, presence of microscopic extrathyroidal extension and lymph node metastasis might contribute to the recurrence of papillary thyroid cancer while post-operative radioactive ablation may have some protective effect. However, this study suggests that other factors must be included in the model to better understand the relationship between these factors and recurrence.</p>

Thyroid gland involvement in advanced laryngeal squamous cell carcinoma

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aims to determine the prevalence and pattern of thyroid gland involvement in advanced laryngeal squamous cell carcinoma and to identify factors associated with its development.<br /><strong>METHOD:</strong> Records of 118 patients who underwent laryngectomy with thyroidectomy for advanced laryngeal squamous cell carcinoma in a tertiary government hospital from January 2010 to August 2015 were reviewed. Demographic, clinical and histopathology data were obtained. The relationship of the laterality of primary tumor bulk and lobe involvement was analyzed using Fischer's exact test. The association between thyroid gland invasion and other factors was analyzed using logistic regression.<br /><strong>RESULTS:</strong> Thyroid gland involvement was found in 11% of the patients via direct spread in 92.3%. Single lobe involvement accounted for 61.5% of cases. There is a tendency for laryngeal squamous cell carcinoma to invade the thyroid lobe ipsilateral to the primary tumor bulk. Extralaryngeal spread, tracheostomal involvement, and tracheal extension were associated with thyroid gland involvement.<br /><strong>CONCLUSION:</strong> Thyroid gland involvement in advanced laryngeal squamous cell carcinoma is rare; hence, indications for performing thyroidectomy in relation to the presence of thyroid gland involvement should be established to avoid unnecessary surgeries.</p>

Pattern of nodal metastasis in papillary thyroid carcinoma among Filipinos

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> The objective of the study is to describe the pattern of nodal metastasis in papillary thyroid carcinoma (PTC) among Filipinos and to determine the possible clinicopathologic factors associated with level V involvement.<br /><strong>METHODS:</strong> This study included patients >18 years old with PTC with clinically positive neck node (cN1b) who underwent total thyroidectomy with lateral neck dissection (levels II-IV) or posterolateral neck dissection (II-V) from 2011-2016 at the Department of Otorhinolaryngology-Head and Neck Surgery, Philippine General Hospital. Histopathology reports were reviewed for the presence of nodal metastasis per level, tumor size, tumor location, gross extrathyroidal involvement and subtype. Univariate analysis utilized Pearson Chi-square test or the Fischer exact test. Multivariate analysis utilized logistic regression.<br /><strong>RESULTS:</strong> Lymph node involvement in the lateral neck was highest in level III (87.04%), followed by level IV (81.48%), IIa (66.67%), V (60.00%) and IIb (42.59%). No clinicopathologic factor was found to be associated with level V involvement.<br /><strong>CONCLUSION:</strong> The pattern of lymph node metastasis among Filipinos is similar but higher than that reported in the literature. Level V involvement is high and thus, this study suggests including level II-V in the neck dissection among Filipinos with cN1b papillary thyroid carcinoma.</p>