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OBJECTIVE@#Primary mucosal melanoma of nasal and oral cavity is a rare tumor with a poor prognosis. This study aims to summarize the clinical features and survival status and then to evaluate the prognostic factors.@*METHOD@#Clinical data of 66 patients with mucosal melanoma in nasal and oral cavity treated from Jan. 1980 to Jan. 2005, were retrospectively reviewed. All patients received the surgery. The following parameters: gender, age, primary location, tumor size, presence of ulcer, presence of pigment aggravation, lymph node metastasis, treatment mode and initially treatment outcome were investigated to evaluate their potential impact on survival. Kaplan-Meier method and Log-rank test were used for survival analysis. Cox proportional hazards regression was used for multivariate analysis.@*RESULT@#The primary locations were nasal cavity (34 cases), oral cavity (23 cases) and paranasal sinuses (9 cases). All patients received surgery. Thirty-seven patients received post-operative adjuvant treatments. Of which, 12 received adjuvant chemotherapy. 8 received adjuvant immunotherapy, 5 received adjuvant chemotherapy and immunotherapy, 8 received adjuvant radiotherapy and 4 received adjuvant radiotherapy and chemotherapy. Local recurrence, lymph node metastasis or distant metastasis appeared in 15 patients at 6 months after the primary treatment. The distant metastasis rate was 15.2% (10/66). The average survival time was 77.9 months, the median survival time was 33.7 months. The 3-year and 5-year overall survival rates were 41.4% and 31.1% respectively. Multivariate analysis showed that tumor size, lymph node metastasis and initially treatment outcome were significant prognostic factors for overall survival.@*CONCLUSION@#The prognosis of mucosal melanoma in nasal and oral cavity is poor. Tumor size, lymph node metastasis, initially treatment outcome are independent prognostic factors for overall survival. The effect of post-operative adjuvant treatments is not clear, and further studies are needed.
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Adolescent , Adult , Aged , Child , Female , Humans , Middle Aged , Young Adult , Melanoma , Diagnosis , Epidemiology , Mouth Mucosa , Mouth Neoplasms , Diagnosis , Epidemiology , Nose Neoplasms , Diagnosis , Epidemiology , Prognosis , Retrospective Studies , Survival AnalysisABSTRACT
Objective To investigate the treatment and prognosis of patients with papillary thyroid microcarcinoma. Methods The clinical and following-up data of 124 patients with papillary thyroid microcarcinoma treated at the Department of Head and Neck Surgery of Cancer Centre, SUN Yat-sen University from Jan 1990 to Dec 1999 were analyzed retrospectively for mortality and survival rate ( KaplanMeier). A multivariate analysis was performed in these patients by Cox proportional hazard model. Results The overall 10-year and 15-year survival rate of all 124 patients with papillary thyroid microcarcinoma were 94.9% and 92.5% respectively. The univariate analysis showed the prognostic factors significantly influencing the survival of patients included age (being worse for those of 35 years and older) at presentation, and the status of distant metastasis ( all P ＜ 0. 05 ) , while gender, incidentally found at surgery, the size of primary tumor, the status of neck lymph node metastasis, recurrence after a primary resection, and the extent of surgical resection did not significantly effect the prognosis. Multivariate analysis showed the age more than 35 years at presentation was an independent risk factor indicating worse prognosis (P = 0. 045 ). Conclusioas The prognosis of patients with papillary thyroid microcarcinoma is satisfactory, but that is poor for those patients 35 years old and up at presentation and with distant metastasis.
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Objective To evaluate radical resection for thyroid carcinoma in patients without lateral neck lymph node metastasis.Methods Clinical data of 132 thyroid carcinoma patients without lateral neck lymph node metastasis undergoing radical thyroidectomy were retrospectively analyzed.Results There were 35 male and 97 female patients.Age ranged from 18 to 62 years,median age was 34.2 years.All patients underwent ipsilateral lobectomy plus isthmectomy and Ⅵ level dissection.The rate of recurrent laryngeal nerve injury was 4.5% (6/132).Taking into account of tumor invaded nerve,the rate of dissection procedure caused injury was 1.6% (2/128).Conclusion Combination of ipsilateral lobectomy plus isthmectomy and Ⅵ level dissection constitutes radical thyroidectomy in papillocarcinoma of the thyroid gland without lateral neck lymph node metastasis,recurrent laryngeal nerve exposure is the key for this en bloc resection.
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Objective: To investigate the long-term effect of submandibular salivary gland transfer on xerostomia induced by radiation in patients with nasopharyngeal carcinoma (NPC). Methods: A total of 70 eligible patients with NPC were divided into the test group (36 cases) and the control group (34 cases). In the test group, the submandibular salivary glands were transferred to the submental space before conventional radiotherapy (XRT) and shielded during XRT. Submandibular gland function and salivary fluid before and after radiotherapy, questionnaire of xerostomia at 60 months after XRT, and 5-year survival rate were compared between the two groups. Results: At 5 years after XRT, the trapping and excretion function of submandibular glands were significantly better in the test group (P=0.000 and P=0.000, respectively). The mean weight of saliva after XRT was greater in the test group than in the control group (1.65gvs.0.73g, P=0.000). Incidence of moderate to severe degree of xerostomia was significantly lower in the test group than in the control group (12.9%vs.78.6%, P=0.000). No significant difference was found in 5 year survival rate between the two groups (86.1%vs.82.4%, P＞0.05). Conclusion: Submandibular gland transfer procedure is safe for NPC patients. It can prevent XRT induced xerostomia and improve the quality of life of NPC patients.
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OBJECTIVE To assess the outcomesof three different therapeutic approaches for the treatment of T3N0M0(stage Ⅲ) glottic squamous cell carcinoma. METHODS Sixty-five cases of T3N0M0 glottic squamous cell carcinoma treated with curative intent by three different modalities include vertical hemilaryngectomy(VHL,n=21),total laryngectomy(TL,n=31)and radiotherapy(RT,n=13) were reviewed retrospectively. The survival rate,recurrence rate at the primary lesion site and jugular lymph node, and laryngeal preservation was compared among three methods. RESULTS There was no significant difference in the overall survival rates(Cox proportion hazard model) and recurrence rates at the primary lesion site or jugular lymph node among the three methods. Laryngeal function was preserved in 100% of the cases in the VHL and RT groups after initial treatment. CONCLUSION The three treatment modalities had statistically similar survival and recurrence rates. Patients treated with VHL and RT had a higher rate of laryngeal preservation compared to that of TL, hence VHL or RT is a valid alternative to TL in treating selected patients with T3N0M0 glottic squamous cell carcinoma.
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Purpose:To investigate the curative effect of T3 lesions of supraglottic carcinoma in our hospital and discuss the management of T3 lesions.Methods:33 cases of T3 supraglottic carcinoma hospitalized in Cancer Center of Sun Yat sen University of Medical Sciences from 1982 to 1991 were reviewed. All primary lesions were resected by surgery, including 27 total laryngectomy and 6 horizontal supraglottic laryngectomy. The treatment modality of the neck was as follows: Among 13 clinically positive neck 2 underwent radical neck dissection, 11 underwent selective neck dissection. Among 20 clinically N0 cases 1 underwent elective neck dissection and the rest watchful waiting. In this group 19 cases were treated by definitive surgery, the rest 14 cases managed by surgery plus radiotherapy.Results:The 5 year survival rate in our group was 63.6%(21/33), the 5 year tumor free survival rate was 57.6%(19/33) and the 5 year cumulative survival rate by Kaplan Meier was 63.9%. The 5 year survival rate in partial laryngectomy and total laryngectomy was 80% and 59.9% respectively, no significant difference was shown by Kaplan Meier analysis(Log Rank=0.82, P =0.3646). The 5 year survival rate in definitive surgery and surgery plus radiotherapy was 56.4% and 67.3% respectively. There was also no significant difference by Kaplan Meier analysis (Log Rank=0.61, P =0.4341). 5 cases presented primary relapse and 12 cases neck relapse in our group. The primary and neck control rate was 84.8%(28/33)and 63.6%(21/33)respectively.Conclusions:For T3 subtypes with pre epiglottic space or tongue base infiltration, horizontal supraglottic laryngectomy could abtain better result. One should be careful when applying partial laryngectomy in T3 with cord fixation. Although surgery plus radiotherapy could not significantly influence survival, it could have a tendency to get higher 5 year survival rate than definitive surgery. Radiotherapy and chmotherapy need to be study further.
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Synthetical therapy of laryngeal carcinoma will be a tendency in clinical practice.The induction chemotherapy plays an important role in it.The induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer were applied widely and the significant experiences had also been reported widely. The references of induction chemotherapy of laryngeal cancer were summarized in this paper.
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Objective To report our results of a study of 21 patients who underwent reconstruction of complicated head and neck defects following cancer ablation using microvascular anastomotic anterolateral thigh flap To discuss the advantages and disadvantages of using this flap Methods Twenty one consecutive free anterolateral thigh flaps in 21 patients were transferred for reconstruction of head and neck defects following cancer ablation between May 1990 and April 2001 The success rate was 95 percent (20 of 21),with one flap lost due to a twisted perforator The anterolateral thigh flaps were classified into four types according to the perforator derivation and the direction in which it traversed the vastus lateralis muscle Type I is the most common,in which a vertical musculocutaneous perforators from the descending branch of the lateral circumflex femoral artery were found in 61 9 percent of cases (13 of 21) Reconstruction of one layer facial skin defect was carried out in 3 cases,through and through defect in 15 cases,the skin defects of the anterior cervical region and the mucosa defects of the hypopharynx in 3 cases Results Nineteen of 21 flaps survived One flap was totally lost and another was partially lost after surgery The mean follow up was 46 months (range:6 to 120 months) A total of 9 patients were disease free survival Two patients are alive with persistent tumor 5 patients died of local recurrence 4 patient died of regional lymph node metastasis,brain metastasis,second primary cancer and cerebral vascular accident respectively,1 patient was lost to follow up Conclusion The anterolateral thigh flap provides more tissue than the radial forearm flap,no important artery sacrificed and the donor scar is more easily hidden The anterolateral thigh flap can be successfully used to repair a variety of complicated defects of the head and neck
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Objective To investigate the prognostic factors of differentiated thyroid carcinoma (DTC) in patients younger than 45 years. Methods Clinical data of all patients less than 45 years old at presentation with DTC in our hospital from Jan 1985 to Dec 1997 were analyzed retrospectively. Single variable analysis was performed by life-table method. Multivariate analysis was performed by Cox proportional hazard model. Results Two hundred and seventy two cases were analyzed. The overall 10-year survival rate was 93. 0%. The main prognostic factors influencing survival were age at presentation, the status of lymph node metastasis and distant metastasis; distant metastasis was the risk factor independently influencing survival by multivariate analysis. Conclusions Distant metastasis is the factor influencing survival significantly. The prognosis of these patients without distant metastasis is good. Total or near-total thyroidectomy and postoperative 131I therapy may be essential for a better prognosis in patients with distant metastasis.
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Objective:To develop a modified rat laryngeal transplantation model to improve the survival rate of recipients.Methods: Eighty Class Ⅱ isogeneic F344 rats,weighing 250-350 g,were randomly divided into 2 groups(n=40).The control group adopted the Strome model.The allograft used for the experimental group preserved ascending pharyngeal artery,which formed a complex allograft together with tongue base,larynx and pharyngolarynx.End-to-end anastomosis was performed between both allograft common carotid arteries and anterior neck veins.The patency rate and survival rate of the allograft of the 2 groups were compared.Results: The artery,vein patency rate and survival rate were 30%,15%,and 30% in control group,and 75%,65%,and 80% in experimental group,respectively(P