ABSTRACT
Objective:To investigate the risk factors of lymph node metastasis in the cervical region VI (central region) in patients with papillary thyroid microcarcinoma (PTMC) of cN0 stage, and then to determine whether to perform prophylactic central lymph node dissection.Methods:The clinical data of 500 patients with PTMC who underwent surgery from Jan. 2013 to Dec. 2015 in Ningbo First Hospital were retrospectively analyzed. Due to the pathological results, all patients were divided into two groups: central lymph node metastasis (CLNM) positive group and CLNM negative group. SPSS18.0 was used for analyzing.Results:Of the 500 cases of PTMC of cN0 stage, 142 cases had lymph node metastasis. Gender, the maximum tumor diameter, tumor invasion outside the gland, boundary, calcification in tumor, single or multiple lesions, aspect ratio and blood flow were risk factors for CLNM in patients with PTMC of cN0 stage. Multivariate analysis identified that male ( P=0.014) , tumor size ≥0.5 cm ( P=0.03) , tumor invasion outside the gland ( P=0.003) , unclear boundary ( P=0.032) , calcification ( P=0.009) , aspect ratio ≥1 ( P=0.001) were independent predictors factors for CLNM of PTMC. Conclusion:Male, unclear boundary, tumor size ≥0.5cm, tumor invasion outside the gland, calcification, aspect ratio ≥1 are the risk factors of CLNM in patients with cN0 PTMC. Prophylactic central lymph node dissection should be performed for patients without lymph node metastasis but with one risk factor or more.
ABSTRACT
Objective To study the clinical efficacy and adverse reactions of the preoperative neo-adjuvant chemotherapy with oxaliplatin plus fluorouracil and calcium folinate (FOLFOX) in the treatment of advanced gastric carcinoma that was difficult to undergo radical operation. Methods We enrolled 16 patients with advanced gastric carcinomas that were unable to undergo radical operation admitted to our hospital from April 2008 to October 2009. The neo-adjuvant chemotherapy regimen was oxaliplatin 130 mg/m~2 for first one, fluorouracil 500 mg/m~2 and calcium folinate 200 mg/m~2 from first day to fifth day,and one treatment course was three weeks and the patients underwent two courses.The changes of the primary lesion and the adverse reactions of the patients were observed. Results Carcinomas of 13 patients were degraded after the treatment, of which, 11 patients underwent radical resections after 4-6 weeks after operation.There were two cases of complete remission (CR) , 10 cases of partial remission (PR), three cases of stable disease(SD) and one case of progress disease(PD) , and the total effective rate was 75.0% (12/16). Adverse reactions included bone marrow suppression, diarrhea, nausea and vomiting and paresthesia, which were relieved after appropriate symptomatic treatment. Conclusions Neoadjuvant chemotherapy with FOLFOX can improve the resection rate of the advanced gastric carcinoma that is unable to undergo radical resection, and the patients' tolerability to this regimen is favorable.Thus, the regimen is worthy of generalizing.