Familial Nonmedullary Thyroid Carcinoma: A Retrospective Analysis of 117 Families / 中华医学杂志(英文版)

<p><b>Background</b>The first and most important step in characterizing familial nonmedullary thyroid carcinoma (NMTC) is to distinguish the true familial patients, which is the prerequisite for all accurate analyses. This study aimed to investigate whether patients from families with ≥3 first-degree relatives affected with NMTC have different characteristics than patients from families with only two affected members, and to compare these patients with those with sporadic disease.</p><p><b>Methods:</b>We analyzed the clinicopathological features and prognosis of 209 familial and 1120 sporadic cases of NMTC. Familial patients were further divided into two subgroups: families with two affected members and families with ≥3 affected members.</p><p><b>Results:</b>The familial group had a significantly higher risk of bilateral growth, multifocality, extrathyroidal extension, and lateral lymph node metastasis than the sporadic group (P < 0.05). These main features were also different between the group with ≥3 affected members and the sporadic group. The only difference between the two affected members' group and the sporadic group was incidence of multifocality (P < 0.05). The probability of disease recurrence in patients from families with ≥3 affected members was significantly higher than that in sporadic cases (14.46% vs. 5.27%; P = 0.001), while the probability in patients from families with two affected members was similar to that in sporadic patients (6.35% vs. 5.27%; P = 0.610). The Kaplan-Meier survival analysis showed a statistically significant difference in disease-free survival between the two subgroups (85.54% vs. 93.65%; P = 0.045).</p><p><b>Conclusions:</b>Patients from families with ≥3 members affected by NMTC have more aggressive features and a worse prognosis than those from families with only two affected members. Patients from families with ≥3 affected first-degree relatives may be considered to have true familial NMTC.</p>

Minimally invasive endoscopy-assisted neck dissection to treat lateral cervical metastasis of thyroid papillary carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>Traditional open surgery for lateral neck dissection for patients with papillary thyroid carcinoma (PTC) leaves an unsightly scar. It is necessary to apply small incision to complete lateral neck dissection with endoscopy-technique for PTC and to evaluate its feasibility and safety.</p><p><b>METHODS</b>Between March 2010 and May 2011, 6 cases of PTC with no definite lymph node metastasis at level II-IV and 12 cases of PTC at T1-T4 with definite lymph node metastasis at level II-V received minimally invasive endoscopy-assisted lateral neck dissection. After accomplishing thyroidectomy and central compartment dissection, ipsilateral level II-IV,VI orII-VI dissection via small neck incision was performed.</p><p><b>RESULTS</b>This procedure was carried out successfully in all 18 patients. The incision was 5 cm every patient. Postoperative pT1 was 5 cases, pT2 5 cases, pT3 6 cases, pT4 2 cases, pN0 5 cases, N1b 13 cases. Mean operative time for lateral neck dissection was 3.6 hours (ranging 2.5-5.0 hours). No significant blood loss or complications occurred. Thirteen patients showed lymph node metastases in both central or lateral neck. The mean number of harvested nodes was 33.1 (ranging 16-61). No residual or recurrent disease was found in 2-3 years follow-up time.</p><p><b>CONCLUSION</b>Minimally invasive video-assisted comprehensive neck dissection for metastatic papillary thyroid carcinoma is feasible and safe with excellent cosmetic results.</p>

Clinical analysis of 318 cases of oropharyngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features, treatment outcomes and prognosis of patients with oropharyngeal squamous cell carcinoma (OSCC).</p><p><b>METHODS</b>Retrospective review of 318 consecutive cases with OSCC treated from January 1999 to December 2011. Survival rates and prognostic factors were calculated using the Kaplan-Meier method and multivariate Cox model survival analysis respectively. There were 281 males and 37 females, with a median age of 56 years. Of the 318 cases, 163 carcinomas were from tonsil, 108 from tongue base and 47 from soft palate-uvula. The presenting symptoms were pharyngalgia (128 cases, 40.3%), neck masses (71 cases, 22.3%), foreign body sensation in the pharynx (63 cases, 19.8%) and dental ulcer (44 cases, 13.8%). The median time from onset of the first symptoms until diagnosis of OSCC was 3 months. Of the 318 OSCC, 75 were with high grade, 110 with intermediate grade and 133 with low grade, including 10 patients at stageI, 39 at stage II, 68 at stage III and 201 at stage IV.</p><p><b>RESULTS</b>The rates of lymph node metastasis, distant metastasis and second primary carcinoma were 72.3%, 13.2% and 7.9%, respectively. Of 318 patients, 117 received radiotherapy alone, 66 underwent surgery plus postoperative radiotherapy, 59 underwent preoperative radiotherapy plus surgery, 33 received concomitant chemotherapy and radiotherapy, 20 received concomitant molecular targeted therapy and radiotherapy, 16 underwent surgery alone and 7 received induction chemotherapy plus radiotherapy. The 3-, 5-year overall survival (OS) rates were 58.4%, 50.7%, respectively, and the median overall survival time was 60.1 months. Ages (P = 0.034), gender(P = 0.024), smoking and alcohol consumptions(P = 0.008), doses of radiotherapy(P = 0.046) and clinic stages(P = 0.001) were independent factors for OS.</p><p><b>CONCLUSIONS</b>OSCC is poor in prognosis, with a high incidence of cervical lymph node metastasis. Radiotherapy and salvage surgery are the main treatments for OSCC.</p>

Primary squamous cell carcinoma of the thyroid: retrospective analysis of 28 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathological features, treatment outcomes and prognosis of patients with squamous cell carcinoma of the thyroid (SCCT).</p><p><b>METHODS</b>Retrospective review of SCCT cases in our hospital from January 1999 to May 2012. Demographic data and clinical charts, including presenting symptoms, histologic grade of tumor, treatment, and outcome of 28 consecutive patients were obtained. Survival rates and prognostic factors were calculated with SPSS 13.0 software using the Kaplan-Meier method and multivariate Cox model survival analysis.</p><p><b>RESULTS</b>SCCT accounted for only 0.36% of all types of thyroid malignancy. There were 15 males and 13 females, and the median age was 63 years. The presenting symptoms were neck masses (26/28) and hoarse voice (18/28). The 28 SCCTs included 15 high grade tumors, eight intermediate grade tumors and five low grade tumors. According to the UICC 2002 staging criteria, 16 patients were stage IVa, and 12 were stage IVb. Of the 28 patients, 19 underwent surgery plus postoperative radiotherapy, seven underwent surgery alone, and two received radiotherapy alone. The rates of lymph node metastasis and distant metastasis were 60.7% and 25.0%, respectively. The 1-year, 2-year and 5-year overall survival (OS) rate were 50.4%, 25.8% and 19.3%, respectively, and the median overall survival time was 12.2 months. Kaplan-Meier univariate survival analyses indicated that the sizes of the tumors, esophageal invasions and treatment policies are prognostic factors, and multivariate Cox model survival analyses confirmed that the sizes of the tumors and treatment policies were independent factors for OS. Multivariate survival analyses confirmed that the sizes of the tumors and treatment policies were independent factors for OS.</p><p><b>CONCLUSIONS</b>SCCT is a rare malignant tumor with strong invasive ability, high malignancy and poor prognosis. Combined modality therapy was strongly recommended, and surgical resection plus postoperative radiotherapy may be the main treatment protocol for patients with SCCT.</p>

Significance of selective neck dissection in patients with cN0 thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the significance of selective neck dissection in patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis.</p><p><b>METHODS</b>Sixty three patients with cN0 thyroid carcinoma who have a high-risk of lateral neck lymph node metastasis were prospectively studied at the Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between August 2006 and June 2011. The patients with cN0 thyroid carcinoma easy to occur neck lymph node metastasis include: The maximum diameter of primary tumor is ≥ 2 cm; The primary tumor invaded the thyroid capsule; Lymph node metastasis in level VI is found; Lymph node enlargement in level III or/and IV were detected preoperatively by ultrasonography, but not considered as metastasis. The surgical procedure is that the selective neck dissection in level III and IV is performed depending on the collar incision of thyroid surgery. The lymph node chosen from the specimen has a frozen section. If lymph node metastasis is found in the frozen section, a functional neck dissection should be performed through prolonging the collar incision.</p><p><b>RESULTS</b>All cases were pathologically confirmed as thyroid papillary carcinoma. The occult metastasis rate of lateral neck lymph nodes was 39.7%. According to the univariate analysis, the patients with thyroid capsule invasion and lymph node metastasis in level VI were more likely to have lateral neck lymph node metastasis, and the occult metastasis rate was 46.9% and 54.3%, respectively (P = 0.028, P = 0.008), and there were statistically no significant difference in the primary tumor size and the preoperative neck lymph node status by ultrasonography with occult metastasis of lateral neck lymph nodes (P = 0.803 and P = 0.072). According to the multivariate analysis, there was a significant correlation only between the lymph node metastasis in level VI and occult metastasis of lateral neck lymph nodes (P = 0.017), but there was no significant correlation with the thyroid capsule invasion, primary tumor size and neck lymph node status by preoperative ultrasonography in prediction of occult metastasis of lateral neck lymph nodes (all P > 0.05).</p><p><b>CONCLUSIONS</b>Selective neck dissection is feasible for the patients with cN0 thyroid carcinoma who have a high-risk lateral neck lymph node metastasis and the lateral occult metastatic lymph node can be promptly found and removed. We suggest that the selective neck dissection for level III and IV should be routinely performed in cN0 thyroid carcinoma patients with thyroid capsule invasion and lymph node metastasis in level VI.</p>

Human papillomavirus infection in oropharyngeal squamous cell carcinoma and prognosis: a preliminary analysis of 66 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the relationship between the prognosis of patients with oropharyngeal squamous cell carcinoma (OSCC) and human papillomavirus (HPV) infection in OSCC.</p><p><b>METHODS</b>Sixty-six patients with oropharyngeal carcinoma who met the enrollment criteria during the period from January 1999 to December 2009 were retrospectively reviewed. The presence or absence of HPV oncogenic types in OSCC specimen was determined by multiplex polymerase chain reaction (PCR). Overall survival (OS) and disease specific survival (DSS) for HPV-positive and HPV-negative patients were estimated by Kaplan-Meier analysis. Cox regression model was used for multivariate analysis.</p><p><b>RESULTS</b>HPV-DNA was detected in 11(16.7%) of all specimens. Among them, 7 were positive for HPV-16, 1 for HPV-16/11, 1 for HPV-35, 1 for HPV-58/52, and 1 for HPV-33/52/54. With the follow-up of 3-78 months (a median of 24.5 months), patients with HPV-positive tumors had significantly better overall survival (χ2=5.792, P=0.016) and disease specific survival (χ2=4.721, P=0.030), the 3-year OS and DSS were 90.0% vs 52.4% and 90.0% vs 56.4%, respectively. Multivariate analysis by Cox regression model showed that HPV infection and nodal status were both independent prognostic factors for patients with OSCC (P<0.05).</p><p><b>CONCLUSIONS</b>Patients with HPV-positive OSCC have significantly better prognosis than patients with HPV-negative tumors. HPV infection is an independent prognostic factor.</p>

Association of antigen processing machinery and HLA class I defects with clinicopathological outcome in laryngeal squamous cell carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the role of antigen-processing machinery (APM) component defects in HLA class I antigen down-regulation in laryngeal squamous cell carcinoma (SCC) and to assess the clinical significance of these defects.</p><p><b>METHODS</b>Fifty-one formalin-fixed, paraffin-embedded SCC specimens were examined for the expressions of APM component transporter associated with antigen processing (TAP1) and low molecular weight polypeptide (LMP-7) and HLA class I antigen by immunohistochemistry.</p><p><b>RESULTS</b>HLA class I antigens, TAP-1 and LMP-7 expressions were down-regulated in 56.9% (29/51), 39.2% (20/51) and 45.1% (23/51) of the tested specimens respectively, whereas HLA class I antigens, TAP-1 and LMP-7 expressions lost in 21.6% (11/51), 33.3% (17/51) and 27.5% (14/51) of the tested specimens respectively. TAP-1 and LMP-7 expressions were significantly correlated with HLA class I antigen expression (r=0.460, P<0.05 and r=0.685, P<0.05, respectively). HLA class I antigens down-regulation was significantly correlated with T stage (χ2=8.61, P<0.05). Both TAP-1 and LMP-7 down-regulations were significantly correlated with T stage (χ2 values were 9.72 and 8.97 respectively, P<0.05) and TNM stage (χ2 values were 9.18 and 7.70 respectively, P<0.05). TAP-1, LMP-7 and HLA class I antigen down-regulations were significantly associated with reduced patients' overall survival (P<0.05) and disease-free survival (P<0.05). Multivariate analysis showed lymph node metastasis, recurrence and HLA class I antigen down-regulation were unfavorable prognostic factors (P<0.05).</p><p><b>CONCLUSIONS</b>Down-regulated expressions of HLA class I antigen and APM component TAP-1 and LMP-7 occur frequently in laryngeal squamous cell carcinoma, by which cancer cells could avoid immune surveillance, while HLA class I antigen down-regulation is a major contributing factor to tumour progression and mortality.</p>

Effects of sorafenib and liposome doxorubicin on human poorly differentiated thyroid carcinoma xenografts in nude mice / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of sorafenib and liposome doxorubicin on poorly differentiated thyroid carcinoma (PDTC) xenografts in nude mice.</p><p><b>METHODS</b>Sorafenib and liposome doxorubicin were applied to PDTC xenografts in nude mice. The mice were randomized into seven groups: blank control (A), vehicle control (B), single liposome doxorubicin (C), single sorafenib group (D), liposome doxorubicin combined with low dose sorafenib group (E), combined group with medium dosage of sorafenib (F), combined group with high-dose of sorafenib(G). The volume, weight and growth inhibition rate of tumours were measured to evaluate the therapeutic effects of drugs.</p><p><b>RESULTS</b>Sorafenib and liposome doxorubicin showed significant antitumor activity in the PDTC xenografts. The mean tumor volumes of seven groups were (1274.13 ± 393.76) mm(3), (1060.00 ± 469.05) mm(3), (726.76 ± 488.22) mm(3), (451.54 ± 97.75) mm(3), (518.37 ± 164.44) mm(3), (310.51 ± 210.53) mm(3), and (228.44 ± 129.21) mm(3), respectively. The mean tumor weights of the seven groups were (1.13 ± 0.42)g, (0.91 ± 0.39)g, (0.78 ± 0.45)g, (0.55 ± 0.17) g, (0.52 ± 0.19) g, (0.34 ± 0.21) g, and (0.19 ± 0.09) g separately. The tumor inhibition rates of group C to G were 30.8%, 40.8%, 42.3%, 62.9%, 72.6% separately.</p><p><b>CONCLUSIONS</b>Sorafenib and liposome doxorubicin, no matter for single agent or in combination, showed significant antitumor activity in the PDTC PDTC xenografts in vivo. The tumour-inhibited effect of single sorafenib is better than that of single liposome doxorubicin. Liposome doxorubicin combined with medium dosage of sorafenib had a better therapeutic effect and less side effects.</p>

Clinical analysis of surgical complications after preoperative concurrent chemoradiotherapy of pyriform sinus cancer / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the surgery complications and laryngeal function sparing rate after preoperative concurrent chemoradiotherapy and preoperative radiotherapy of pyriform sinus cancer.</p><p><b>METHODS</b>Forty-six patients with squamous cell carcinoma of pyriform sinus from March 2002 to March 2009 were retrospectively analyzed. Concurrent chemotherapy with radiotherapy (CRT + S group) was conducted in twenty-three patients. Cisplatin (50 mg/weekly) was mostly applied. Twenty-three patients were treated with radiation only (RT + S group). Surgery was conducted after a break-time of 21 - 44 days (median, 31 d) and 17 - 40 days (median, 28 d), respectively.</p><p><b>RESULTS</b>The complication rate of CRT + S group and RT + S group were 30.4% and 39.1% respectively, no significant differences was found (χ(2) = 0.099, P < 0.05). The one-year laryngeal function sparing rate of the two groups were 52.2% and 17.4% respectively, with significant differences (χ(2) = 6.133, P < 0.05). The one-year local regional control rate and disease free survival rate for the CRT + S group were 89.9%, 71.1%, and for RT + S group were 56.3%, 47.1%, P level were 0.018 and 0.037, respectively. There was significant differences in one year local regional control rate and disease free survival rate between the two groups.</p><p><b>CONCLUSION</b>The addition of concurrent chemotherapy to preoperative radiotherapy in patients with pyriform sinus cancer does not increase the incidence of surgery complications. Chemotherapy improves the remission rate and appears to increase the laryngeal function sparing rate. Preoperative concurrent chemoradiotherapy can improve the local and regional control, and certainly, more investigations will be needed.</p>

Surgical treatment and prognosis analysis on medullary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, the surgical treatments and the prognostic factors of medullary thyroid carcinoma.</p><p><b>METHODS</b>Eighty-two cases of medullary thyroid carcinoma undergoing surgeries between January 1999 and December 2004 were reviewed. There were 39 males and 43 females. Age ranged from 16 to 77 years old, with a median of 46 years old. The calcitonin, chromogranin A and neuron-specific enolase were analysed by immunohistochemistry in samples, and calcitonin was detected in 24 cases. Of them, 28 cases underwent lobectomy with isthmectomy, 24 for remained lobe dissection, 16 for total thyroidectomy, and 14 only for neck and upper mediastinal lymph node dissection. Of the 82 cases, 68 cases underwent trachea esophageal ditch dissection, 53 for unilateral neck dissection, 11 for bilateral neck dissection, 13 for upper mediastinal lymph node dissection through trans-cervical approach, and 5 for mediastinal lymph node dissection through inverted T-shaped incision.</p><p><b>RESULTS</b>Immunohistochemical examination revealed that the expression rates of calcitonin, chromogranin A and neuron-specific enolase were 95.8%, 88.9% and 80.0% respectively. Total metastasis rate of neck lymph nodes was 68.8%, and the rates in level II, III, IV, V and VI were 27.3%, 47.7%, 59.1%, 11.4% and 52.3% respectively. The overall five-year survival rate was 87.8%. The recurrent rate of contralateral lobes was 5.8% and local recurrent rate was 7.3% respectively. Univariate analysis showed that gender, age and TNM stage were significant prognostic factors. Multivariate analysis revealed that distant metastasis was an independent prognostic factor.</p><p><b>CONCLUSIONS</b>Standard radical surgery of the primary and metastatic lesion is key to the treatment of medullary thyroid carcinoma. Lobectomy with isthmectomy should be applied to sporadic medullary thyroid carcinoma, with regular postoperative follow-up, and total thyroidectomy to familial or bilateral medullary thyroid carcinoma. Therefore, detecting the calcitonin is very important for medullary thyroid carcinoma patients' prognosis.</p>

Application of internal mammary artery perforator flap for tracheostoma and anterior cervical defect / 中华整形外科杂志

<p><b>UNLABELLED</b>OBJECTIVE To investigate the application of pedicled internal mammary artery perforator (IMAP) flap for tracheostoma and anterior cervical defect.</p><p><b>METHODS</b>From April to December 2009, 4 IMAP flaps, based on the second internal mammary artery perforator, were used for two cases of tracheostoma and two cases of anterior cervical skin defect. The flap size was (4-7) cm x (10-13) cm.</p><p><b>RESULTS</b>3 of 4 flaps survived completely. Partial necrosis happened in one flap. The defects at donor sites were closed directly.</p><p><b>CONCLUSIONS</b>The IMAP flap is a new method for head and neck defect. It is very suitable for tracheostoma and cervical skin defect, with less morbidity at donor site.</p>

Microvascular free flap reconstructive options in patients with different types of maxillectomy defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of the distinct free flaps in reconstruction of different types of maxillectomy defects.</p><p><b>METHODS</b>A retrospective reviews was performed of in 66 consecutive cases of reconstructions with free flaps for maxillary tumor ablation defects from October 1997 to June 2010. There were 43 patients who had recurrences after previous operations and 46 patients had accepted radiation therapy before. According to the classification of Brown's maxilla defect:10 cases were in class I, 13 in class II, 23 in class III and 20 in class IV. The reconstructive free flaps included 26 fibula flaps, 10 radial forearm flaps, 7 latissimus dorsi flaps, 7 rectus abdominis flaps, 7 anterolateral thigh perforator flaps, 5 deep inferior epigastric artery perforators, 2 latissimus dorsi/rib flaps and 2 iliac crest flaps. Postoperative features and functions were assessed in 29 patients.</p><p><b>RESULTS</b>The overall free flap success rate was 93.9% (62/66). Three rectus abdominis flaps and one fibula flap failed. There were 29 patients who received postoperative function assessment. Sixty-two percent of the patients restored to taking regular diets, 24 (82.8%) patients had normal language communication ability, and 25 (86.2%) patients were satisfied with their feature.</p><p><b>CONCLUSIONS</b>Radial forearm flap was recommended to reconstruct the class 1 defect, fibula flap to class 2 or class 3 and preformatted flap to class 4.</p>

Reconstruction of hypopharyngeal circumferential and cervical esophageal defects with free jejunal interposition in 112 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the results of reconstruction of hypopharyngeal circumferential and cervical esophageal defects with free jejunal transfer.</p><p><b>METHODS</b>Retrospective review of 112 patients who underwent pharyngoesophageal reconstruction with free jejunal interposition. Analysis was confined to the patients with advanced hypopharyngeal, esophageal or recurrent laryngeal squamous cell cancer. Kaplan-Meier method was used to identify the accumulative survival rate.</p><p><b>RESULTS</b>The free jejunal success rate was 94.6% (106/112). The pharyngocutaneous fistula rate and anastomoses narrow rate were 8.9% (10/112) and 12.5% (12/96) respectively. The perioperative mortality rate was 1.8% (2/112). Except 1 case of dead, 6 cases with flap failure and 2 cases with laryngeal preservation, other 103 cases had resumed oral feeding.</p><p><b>CONCLUSIONS</b>The success rate of free jejunal transplantation is high and free jejunal interposition is an ideal reconstruction method for patients who have hypopharyngeal circumferential and cervical esophageal defects after tumor resection.</p>

Adenoid cystic carcinoma of maxillary sinus: diagnosis, treatment and prognostic factors / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the clinical characters, the outcomes of treatments and the factors affecting long-term treatment results of adenoid cystic carcinoma (ACC) of the maxillary sinus.</p><p><b>METHODS</b>The clinical data of 80 patients with ACC of the maxillary sinus treated initially were analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression.</p><p><b>RESULTS</b>The 5-, 10- and 15-year cumulative overall survival rates were 65.2%, 37.1%, 26.3% respectively and 5-, 10-, and 15-year disease-free survival rates 50.7%, 30.7% and 24.5% respectively. The 5-, 10- and 15-year cumulative local control rates were 68.5%, 47.3% and 47.3% respectively and the cumulative distant metastasis rate were 32.8%, 48.8% and 48.8% respectively. Prognostic factors affecting survival included T stage, pathologic grade and the modes of treatment (P < 0.05). Patients with combined therapy composed of surgery and radiation had a better local control, compared with surgery or radiation alone (χ(2) = 18.33, P < 0.01), and surgery combined with postoperative radiation was prior to preoperative radiation combined with surgery (χ(2) = 6.64, P < 0.05). Patients treated with surgery combined with preoperative radiation, either with doses of ≥ 60 Gy or with negative margins, had a better local control, compared with doses < 60 Gy and with positive margins (χ(2) = 5.06, P < 0.05). The most of patients (62.8%) died of local recurrence.</p><p><b>CONCLUSIONS</b>The most of failure was due to recurrence. Combined therapy composed of surgery and radiation improves the local control and survival in patients with ACC of the maxillary sinus, compared with surgery or radiation alone. Surgery combined with postoperative radiation provides the best overall survival and local control and should be the first choice of treatments.</p>

Salvage surgery after failure of partial laryngectomy for laryngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study surgical managements, outcomes and the factors affecting prognosis of the primary recurrence following partial laryngectomy for laryngeal carcinoma.</p><p><b>METHODS</b>The clinical data of 77 patients with salvage surgery for primary recurrence following partial laryngectomy for laryngeal carcinoma were analyzed retrospectively. Fifty-one patients underwent salvage total laryngectomy and other 26 patients with salvage partial laryngectomy. Of them, 19 patients without previous radiotherapy received a combined therapy of surgery and radiotherapy. Survival rates were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression.</p><p><b>RESULTS</b>After salvage surgery, the 3-and 5-year cumulative overall survival rates were 59.1% and 52.7% respectively, and both the 3- and 5-year local recurrence rates were 30.7%. Most patients (48.4%) died of the failure at the primary sites. Multivariate analysis revealed the advanced T stage at initial presentation and the extra-laryngeal invasion of recurrent tumor were adverse prognostic factors for survival rate and also the advanced T stage at initial presentation influenced local recurrence rate.</p><p><b>CONCLUSIONS</b>Salvage surgery for the primary recurrence following conservation treatment for laryngeal carcinoma can achieve promising results. Salvage total laryngectomy is the main therapeutic management in most recurrent patients. Salvage partial laryngectomy can achieve sound results in the patients selected carefully.</p>

Functional reconstruction after total or near total glossectomy / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the functional outcomes of patients who underwent total or near total glossectomy with pectoralis major myocutaneous flap (PMMF) or free flap (FF) reconstruction.</p><p><b>METHODS</b>Retrospective study of 38 consecutive patients undergoing total or near total glossectomy with PMMF or FF reconstruction. The outcomes of decannulation, feeding and speech function recovery were compared.</p><p><b>RESULTS</b>Near total glossectomy was performed in 33 patients and total glossectomy was performed in 5 patients. Twenty five patients underwent reconstruction with PMMF including 2 salvage reconstructions after free flaps failure. All PMMFs survived except one complete necrosis. The success rate of PMMF was 96.0% (24/25). Fifteen patients underwent reconstruction with FF. Two flaps developed complete necrosis and the success rate of FF was 86.7% (13/15). The difference in the rates between the two groups was not significant (P=0.545). In the PMMF and FF groups, the renewal of oral feeding were 65.2% (15/23) and 100% (13/13), P<0.05, and the tracheostomy decannulation were 52.2% (12/23) and 100% (12/12), P<0.05, respectively. Postoperative feeding function recovery was better in FF group than that in PMMF group (P=0.011). Single factor analysis showed that using FF and maintaining the continuity of the mandible were related to successful rate of renewal of oral feeding. Multivariate Logistic regression analysis showed that the continuity of the mandible was the only independent predictor for renewal of oral feeding. There was no significant difference in the postoperative speech functions between the two groups.</p><p><b>CONCLUSIONS</b>The continuity of the mandible is the major factor to restore the functional outcomes in feeding after total or near total glossectomy. Compared with PMMF, using FF is more beneficial to retain or rebuild the continuity of the mandible.</p>

Cervical lymph node metastasis in clinical N0 papillary thyroid carcinoma / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study the patterns of cervical lymph nodes metastasis and the surgical managements of cervical lymph nodes in clinical N0 (cN0) papillary thyroid carcinoma.</p><p><b>METHODS</b>Fifty-one consecutive patients with papillary carcinomas without clinical evidence of cervical lymph node involvement were included in the study between August 2007 and September 2010, in which 53 sides underwent neck lymph node dissection. Preoperative lymphoscintigraphy intra-operative hand-held gamma probe detecting and blue dye technique were used to detect the sentinel lymph node (SLN). SLNs were sent to frozen-section and the results were compared with specimen of routine selective neck dissection. All the pathologic specimens were reviewed by pathologists, counting the numbers of pathologic positive nodes and mapping the localization of positive nodes in level II, III, IV, V and VI respectively. The following criteria were used to study the predictive value of lateral neck compartment lymph node metastasis: age, multifocality of the tumor, extracapsular spread (ECS), tumor size, and the number of central compartment metastasis nodes. Univariate analysis with the χ2 test was used to analyze the statistical correlation between lateral neck compartment lymph node metastasis and the other clinical factors. Multiple logistic regression analysis was used to identify the multivariate correlates of lateral neck compartment metastasis.</p><p><b>RESULTS</b>The occult lymph node metastasis and lateral neck metastasis rates were 77.4% and 58.5% respectively, central compartment metastasis ≥3 nodes was the only independent predictive factor for the metastasis in lateral neck. Twelve sides were pN0 and other 41 sides were pN+ in all 53 side specimens. Of 41 sides with pN+, 17 sides (41.5%) involved single site and 24 sides (58.5%) involved multi-sites. The distribution of metastasis lymph nodes:level VI 62.3%, level III 52.8%, level IV 30.2%, level II 18.9%, and level V 0%.</p><p><b>CONCLUSIONS</b>Cervical occult lymph node metastasis in cN0 papillary thyroid carcinoma mainly localizes in level VI, level III, level IV and level II.Selective neck dissection including level VI, III, IV, II is enough for papillary carcinoma without clinical evidence of cervical lymph node involvement.</p>

Fine-needle aspiration cytology of thyroid nodules: a clinical evaluation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical application of fine needle aspiration (FNA) cytology of thyroid nodules.</p><p><b>METHODS</b>A retrospective review was performed of 474 consecutive cases of FNA cytology of thyroid nodules from October 2005 to January 2011. Two hundred and eighteen patients underwent ultrasound-guided FNA, and 256 patients experienced palpation-guided FNA. Cytologic diagnoses were classified as unsatisfactory, benign, atypical cellular lesion, follicular neoplasm, suspicious for malignancy, and positive for malignancy. The discrepancies between initial cytologic diagnoses and histologic diagnoses were evaluated in 157 surgical specimens.</p><p><b>RESULTS</b>According to the cytological categories, the rates for histologically confirmed malignancy in the 157 patients were as follows: 2/7 of unsatisfactory results, 16.7% (9/54) of benign lesion, 3/9 of atypical cellular lesion, 1/3 of follicular neoplasm, 83.3% (35/42) of suspicious for malignancies, and 97.6% (41/42) of positive for malignancies. The sensitivity, specificity and positive predictive value of thyroid FNA for the diagnosis of malignancy were 85.4%, 86.9% and 90.5%, respectively.</p><p><b>CONCLUSIONS</b>FNA can provide an accurate diagnosis of thyroid malignancy preoperatively. The 6 diagnostic categories were beneficial for either clinical follow-up or surgical management of the patients with thyroid nodules.</p>

Analysis of surgical treatment of papillary thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To present the treatment results and to analyze the causes of recurrence in patients with papillary thyroid carcinoma.</p><p><b>METHODS</b>A retrospective review of 600 patients with papillary thyroid carcinoma treated between 1994 and 1999 was conducted. The primary lesions were originated from the left lobe in 188 cases, the right lobe in 290 cases, the isthmus in 8 cases, and multicentric in 114 cases. From the 600 cases, 584 were well-differentiated and 16 poorly differentiated. TNM stage:385 cases of stage I, 37 cases of stage II, 17 cases of stage III, and 161 cases of stage IV. Three hundred and one patients was N1b stage. All patients received surgical treatment. Among them, 19 cases received radiotherapy, 71 received (131)I-therapy and one case received concomitant radiotherapy and (131)I-therapy.</p><p><b>RESULTS</b>There were 94 recurrent cases. Twenty-seven cases died of recurrence, metastasis and other diseases. The overall 10-year survival rate was 93.2%. The overall 10 year survival rates of stage I, II, III, and IV patients were 99.1%, 94.7%, 93.8%, and 78.5%, respectively (P < 0.01). The 10-year survival rate of lower-age group (< 45 years) was 99.4% and higher-age group (≥ 45 years) 82.1% (P < 0.01). The 10-year survival rate of patients with trachea invasion was 66.5%, significantly lower than the 95.1% in patients without trachea invasion (P < 0.01). The 10-year survival rate of well-differentiated cases was 94.9%, significantly higher than the 38.9% in the poorly differentiated cases (P < 0.01). Multivariate analysis showed that the TNM stage, differentiation degree and the thorough going surgical operation were independent risk factors for the prognosis of papillary thyroid carcinoma.</p><p><b>CONCLUSIONS</b>The TNM stage, differentiation degree and the thorough going surgical operation are independent risk factors for the prognosis of papillary thyroid carcinoma.</p>

Clinical analysis of level V occult metastasis of papillary thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the occurrence and frequency of level V occult metastasis of papillary thyroid carcinoma.</p><p><b>METHODS</b>The clinicopathological data of 475 patients in our hospital from 1980 to 1996 were retrospectively analyzed. Pathological results of 275 cN + patients were analyzed and 200 cases with no lymph node metastasis were followed up to compare the recurrence rate of those two groups. The 275 cN + patients were divided into 3 subgroups according to the risk levels: high risk group 83 cases, moderate risk group 104 cases and low risk group 88 cases.</p><p><b>RESULTS</b>The occurrence rate of level V node occult metastasis in the 275 cases was 17.5%, among them, the results of low risk, moderate and high risk groups were 9.1%, 19.2% and 24.1%, respectively (Chi-Square value 7.041, P < 0.05). These 3 groups were divided according to the number of level II approximately IV positive lymph nodes 1, 2 - 10 and more than 10, and the rate was 0, 4.5% and 24.6%, respectively.</p><p><b>CONCLUSION</b>Careful prudence is needed to decide whether a patient of papillary thyroid carcinoma with clinically negative level V node metastasis should be operated for level V lymph node dissection or not. Patients of low risk group or with less positive lymph nodes could be kept under observation for level V node metastasis.</p>