Clinical prognosis of patients with CN0 papillary thyroid carcinoma without prophylactic neck dissection / 肿瘤

Objective: To determine the incidence of lateral lymph node (LN) metastasis in patients with CN0 papillary thyroid carcinoma who did not undergo prophylactic neck dissection after initial surgery. Methods: Three hundred and eighty patients diagnosed as CN0 papillary thyroid carcinoma were admitted in our hospital from Nov. 1991 to Nov. 2001. They did not receive prophylactic ipsilateral neck dissection. Their clinical data were analyzed retrospectively. Results: LN metastasis in ipsilateral cervical area was present in 8 of 380 patients who were given second lateral elective neck dissection. Fifty six patients with lateral cervical lymphadenectasis diagnosed with preoperative CT scan had negative lateral cervical LN metastasis during follow-up period. The size of the lesions, the age of the patients, the status of central compartment LN metastasis were not risk factors for lateral cervical LN metastasis during follow-up period. Conclusion: Prophylactic neck dissection is not recommended for patients with CN0 papillary thyroid carcinoma close observation is necessary. Preoperative CT scan could decrease the LN metastasis rate in lateral cervical area postoperatively.

Long-term impact of initial surgical and medical therapy on young patients with papillary thyroid cancer and bilateral cervical metastases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There are few reviews on the clinical features and prognosis of young patients with papillary thyroid cancer and bilateral cervical metastases. We have investigated the long-term impact of initial surgical and medical therapy on such patients.</p><p><b>METHODS</b>A retrospective study was performed on 24 young patients (11 females and 13 males) with papillary thyroid cancer and bilateral cervical lymph node metastases, ranging in age from 11 to 20 years (mean age, 16.6 years), who were treated in our institution from 1 January 1970 to 31 December 1985.</p><p><b>RESULTS</b>All the patients in this group were followed up for 20 years. The survival of the patients at 20 years was 91.7%. The recurrence of local tumor and distant metastases was 20.8% and 12.5%, respectively. Based on analysis of the clinical data, we determined that the completeness of the surgical excision had a significant correlation with tumor recurrence.</p><p><b>CONCLUSION</b>These young patients with papillary thyroid cancer and cervical metastases have a good prognosis after suitable treatment.</p>

Predictive factors for level VI lymph node metastasis in papillary thyroid microcarcinoma / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the predictive factors for level VI lymph node (LN) metastasis in thyroid papillary microcarcinoma (PTMC).</p><p><b>METHODS</b>From November 2005 to January 2007, 86 patients with PTMC with a lateral cN0 were treated by thyroidectomy and elective level VI LN dissection without comprehensive lateral neck dissection. The data from the cases were analyzed retrospectively to determine the predictive factors for level VI LN metastasis.</p><p><b>RESULTS</b>Forty cases (46.5%) of the patients were found with level VI LN metastasis. Tumor size (> or = 5 mm), thyroid capsular invasion or extracapsular invasion, enlarged level VI LN size (> or = 4 mm) were found significantly related to level VI LN metastasis on univariate analysis (P < 0.05). Tumor size (> or = 5 mm) and thyroid capsular invasion or extracapsular invasion were found to be independent predictive factors for level VI LN metastasis on multivariate analysis (P < 0.05).</p><p><b>CONCLUSIONS</b>Thyroid capsular invasion or extracapsular invasion, tumor size (> or = 5 mm) were significantly associated with level VI LN metastasis in patients with PTMC. Elective neck dissection in level VI should be considered particularly in patients with thyroid capsular invasion or extracapsular invasion and a tumor greater than 5 mm.</p>

Surgical management of papillary thyroid carcinoma with endotracheal infiltration / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the diagnosis and treatment of papillary thyroid carcinoma with endotracheal infiltration.</p><p><b>METHODS</b>Clinical data of 12 patients treated from January 1999 to December 2006 were retrospectively analyzed. Six patients received tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction (group A). Six patients received tracheal sleeve resection-end to end anastomosis (group B).</p><p><b>RESULTS</b>Ten patients had the symptoms which indicated the tracheal invasion. Endotracheal focuses were detected in the region from 2 cm to 4 cm under glottis by endoscopy and positive rate of smear biopsy was 33%. Positive rate of CT scan was 92%. Mean diameter of carcinoma focus was 3.8 cm (from 3 cm to 7 cm), and mean number of tracheal ring resected was 4. For group A, even 7 rings were resected, and the longest longitude and latitude was 7 cm and 3 cm, respectively. For group B, the greatest number of rings resected was 4. Incidence rate of perioperative complication and mortality was 58% and 0%, respectively. Mean duration of follow-up was 49 months. One patient died of local recurrence, 1 patient died of lung metastasis. Two patients with tumor recurrence were also alive. For group A, extubation was successful in all patients.</p><p><b>CONCLUSIONS</b>Comprehensive use of diagnostic methods, especially MRI, will give detailed information for operation. Tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction and tracheal sleeve resection-end to end anastomosis are safe and useful methods to reconstruct the defects caused by tracheal operation.</p>

Whether VI region lymph nodes belong to primary site of the thyroid carcinoma or lateral cervical lymph node metastases / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the evaluation of elective neck dissection (END) for the cN(0) patients with papillary thyroid carcinoma (PTC).</p><p><b>METHODS</b>By analyzing the recurrent and metastatic region (thyroid, group VI lymph nodes, lateral neck region, beyond neck) of 139 PTC patients treated secondly in our hospital, group VI lymph nodal metastasis is divided into recurrence of primary site and distinguished from lateral neck lymph nodes. The clinical value of END for cN(0) PTC patients is also retrospectively analyzed.</p><p><b>RESULTS</b>Thyroidal recurrence accounts for 83% (73/88). Level VI metastasis accounts for 76% (67/88), 17 patients have received END and account for 65% (17/26). Metastasis to lateral neck lymph nodes account for 17% (17/98), among these patients, 5 patients have received END and account for 19% (5/26).</p><p><b>CONCLUSIONS</b>For the patients with cN(0) PTC, ipsilateral thyroid lobectomy plus level VI dissection is recommended and lateral END (level II-V) is not supported. For the patients with cN(0) but UB N(+) and/or CT N(+), lateral END (level II-V) is recommended. The necessity of CT examination in the diagnosis and treatment of thyroid cancer should be emphasized.</p>

Metastatic cystic squamous cell carcinoma in the neck mistaken as primary branchial cleft carcinoma: a report of 4 cases / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To raise the vigilance not to believe easily the diagnosis of a primary branchial cleft carcinoma.</p><p><b>METHODS</b>Four cases of cystic metastatic squamous cell carcinoma in the neck misdiagnosed as branchiogenic carcinoma from 1993 to 2002 in our hospital were analyzed retrospectively.</p><p><b>RESULTS</b>The primary sites of these 4 cases were later discovered, 2 in the aryepiglottic fold, 1 in faucial tonsil and 1 in the skin of the head, respectively. The discovery of the primary sites ranged from the day of initial surgery to 41 months.</p><p><b>CONCLUSION</b>None of the cases reviewed in this study was a branchiogenic carcinoma. Therefore, the diagnosis of a primary branchial cleft carcinoma requires the fulfillment of strict criteria both clinically and pathologically.</p>

Type of surgery for 147 patients with medullary carcinoma of the thyroid / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the optimum type of surgical treatment for thyroid medullary carcinoma.</p><p><b>METHODS</b>From May 1960 to July 2000, 147 patients with thyroid medullary carcinoma were treated with surgical treatment. The results of tumorectomy, subtotal and total thyroidectomy were compared.</p><p><b>RESULTS</b>The overall 5-, 10- and 15-year survival rates were 85.4%, 77.4% and 73.1%. The recurrence rate was lowest in the total thyroidectomy group, medium in the subtotal group and highest in tumor extirpation group (P < 0.05). The overall cervical lymph node metastasis rate was 72.1%. The cervical occult nodal metastasis rate in clinically N0 patients was 42.1% (occult metastasis rates in central and lateral cervical regions were 24.6% and 36.8%). Thirteen patients with persistent postoperative hypercalcitoninemia were observed from 5 months to 6 years without tumor recurrence.</p><p><b>CONCLUSION</b>Total thyroidectomy is the optimal treatment for thyroid medullary carcinoma. Regardless of clinical N0 or N1, central and ipsilateral neck dissection should be considered. Patients with persistent postoperative hypercalcitoninemia should be observed closely.</p>

Twenty-four cases of carcinoma in pleomorphic adenoma in the salivary gland / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the clinical characteristics, treatment and prognosis 24 cases of carcinoma in pleomorphic adenoma in salivary gland.</p><p><b>METHODS</b>The clinical data of 24 patients with carcinoma in pleomorphic adenoma treated in our hospital from September 1974 to July 1995 were analyzed.</p><p><b>RESULTS</b>The overall 5-year survival rate was 66.7%. The five-year survival rates of patients with carcinoma in pleomorphic adenoma in the major and minor salivary glands were 63.6% and 2/2, respectively.</p><p><b>CONCLUSION</b>Operation is the optimal treatment and extensive resection at the initial operation is suggested. For lumps in the submaxillary gland, preventive neck dissection should be considered. Postoperative radiotherapy can not improve the local-control rate.</p>

Expression of chemokine receptor CXCR4 in hypopharyngeal carcinoma and its significance / 中国癌症杂志

Background and purpose:It was reported that chemokine receptor CXCR4 and its ligand stromal cell-derived factor 1(SDF-1)were involved in the proliferation,differentiation,and metastasis of tumor.This study was designed to observe the expression of chemokine receptor CXCR4 in hypopharyngeal squamous cell carcinoma tissue and study the relationship between the expression of chemokine receptor CXCR4 and different clinicopathlogical characteristics,and further to explore the clinical significance.Methods:For the detection of the expression of chemokine receptor CXCR4,43 primary hypopharyngeal squamous cell carcinoma tissues,27 normal hypopharyngeal tissues,34 lymph node metastastatic lesions and 9 normal lymph node lesions were detected by immunohistochemical method using rabbit anti-human CXCR4 polyclonal antibody.Results:The positive expression rates of CXCR4 in 43 hypopharyngeal carcinoma tissues and normal tissues were 95.3% and 22.2%,respectively(P