A Study on the Risk Factors for Recurrence of Recurrent Papillary Thyroid Cancer after Surgery / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is known to have a favorable prognosis and long-term survival due to its biologic characteristics of slow growth and late distant metastasis. However, its characteristic of lymph node metastasis has resulted in a high incidence of neck recurrence and only rare lung metastasis. The objective of this study is to analyze the characteristics of recurrent or persistent thyroid cancer and to evaluate the risk factors for the development of recurrence. METHODS: We retrospectively reviewed 479 consecutive cases of PTC and these patients had undergone surgical operations from January 2004 to December 2006. We assessed age, gender, the tumor characteristics, the operative methods and the recurrence patterns, and the correlations between these factors and recurrence were analyzed. RESULTS: Of the 479 patients with PTC and who were initially treated with surgery at our hospital, 42 patients (8.8%) had recurrent disease. Univariate analysis showed that an age less than 45 years, male gender, extra-thyroidal extension, lymph node metastasis, multifocality, bilaterality and neck node dissection were related to a higher rate of recurrence. Of these, lymph node metastasis and central or lateral neck node dissection were the independent risk factors for recurrent PTC on the multivariate analysis. CONCLUSION: The significant factors influencing locoregional recurrence and distant metastasis were cervical lymph node metastasis and incomplete neck node dissection. In order to reduce the rate of recurrence of PTC, an exact preoperative evaluation of the nodal status and formal neck node dissection are recommended during the initial surgery in patients who have these factors of recurrence.

Analysis of the Clinicopathologic Characteristics of Multifocal Papillary Thyroid Carcinoma / 대한내분비외과학회지

PURPOSE: Papillary thyroid carcinoma (PTC) is the most common malignancy that develops from the thyroid gland and its prognosis is quite excellent. One of the characteristic behaviors of PTC is that it often occurs at multiple foci. The purpose of this study was to investigate the clinicopathologic features and risk factors of multifocal papillary thyroid cancer. METHODS: A retrospective review was carried out on 624 patients with PTC and who underwent surgery from January 2005 to December 2007. Two hundred twenty-nine of them were found to have multiple tumor foci (≥2 foci). The risk factors that included gender, age at diagnosis, tumor size, capsular invasion, extrathyroidal extension (ETE), cervical lymph node (LN) involvement, the TNM classification, local recurrence and distant metastasis were comparatively analyzed between the solitary PTC and multifocal PTC groups. RESULTS: The enrolled patients were 59 male and 565 females. The mean age was 46 years (range: 15~77 years). Age (P=0.025), tumor size (P=0.027), capsular invasion (P<0.001), ETE (P<0.001) and cervical LN metastasis (P=0.002) were the significantly related factors for multifocal papillary thyroid cancer. However, gender was not significantly related with multifocality. CONCLUSION: The results of this study showed that multifocal tumors were significantly associated with age, tumors size, capsular invasion, ETE and cervical LN metastasis in patients with PTC. LN metastasis was mostly influenced by multifocality in the PTC patients. It seems certain that total thyroidectomy and formal central node dissection with postoperative adjuvant therapy are essential treatment for these patients, and closely surveying the nodal status is needed on the follow up of patients with multifocal PTC.

Expression of MUC Gene Proteins in Cholecystitis, Adenoma and Adenocarcinoma of the Gallbladder

PURPOSE: Normal gallbladder mucosa shows unique and diverse patterns of mucin genes, and altered mucin expressions have been noted in the gallbladders with stones, dysplasia or carcinomas. The aim of this study was to characterize the expressions of MUC gene proteins in cholecystitis, adenoma and adenocarcinoma of the gallbladder. Differences of MUCs expressions according to the histopathologic parameters in gallbladder carcinomas were also studied. METHODS: Three tissue microarray blocks were made from 23 cases of cholecystitis, 40 cases of gallbladder adenoma, and 66 cases of gallbladder adenocarcinoma. Immunohistochemical stains for MUC1, MUC2, MUC4, MUC5AC and MUC6 were performed, and staining intensity and patterns were evaluated. RESULTS: MUC1, MUC2, MUC4, MUC5AC and MUC6 were overexpressed in 86 (66.7%), 20 (15.5%), 68 (52.7%), 74 (57.4%) and 47 (36.4%) of gallbladder lesions, respectively. MUC1 and MUC2 overexpression rates were higher in gallbladder carcinoma than in cholecystitis and gallbladder adenoma (P<0.05). MUC6 overexpression rate was higher in gallbladder adenoma than in cholecystitis and gallbladder carcinoma (P<0.05). Overexpression of MUC4 and MUC5AC showed no significant differences in cholecystitis, gallbladder adenoma and gallbladder carcinoma. In gallbladder carcinomas MUC1 overexpression rate was high in cases with deeper tumor invasion (P<0.05). MUC6 overexpression rate decreased in cases with larger tumor (P<0.05), higher histologic grade (P=NS), and deeper invasion (P=NS). MUC2, MUC4 and MUC5AC overexpression rates had no relations to the histopathologic parameters. CONCLUSION: Carcinomatous change of gallbladder may be related to MUC1 and MUC2 overexpressions. MUC1 overexpression seems to be related to aggressive biologic behavior of gallbladder carcinoma. MUC6 overexpression acts as a good prognostic factor.