[Clinical study on prognostic factors in thyroid carcinoma].

We treated 227 patients, 45 men and 182 women, with thyroid carcinoma at our hospital from 1984 to 1998. Of these, 177 had papillary carcinoma and 50 follicular carcinoma. The extent of resection was based on tumor size in papillary carcinoma but not follicular carcinoma, and 70% of carcinoma patients underwent hemithyroidectomy. Neck lymph nodes were resected in 93.2% of papillary carcinoma patients, with D1 neck dissection in 45.7% and D2 or D3 neck dissection in 47.5%. In contrast, 70% of follicular carcinoma patients with lymph node resection had D1 dissection. Locoregional recurrence was noted in 22 patients and distant metastasis in 6 cases. Nonsurvivors numbered 17, 12 papillary and 5 follicular carcinoma patients, died of their primary disease. Almost all deaths were in patients with advanced disease, pT3 in 3, pT4 in 10, N1a in 3 and N1b in 8. The prognostic factors for papillary carcinoma were extracapsular spread, age, and distant metastasis, while the only factor for follicular carcinoma was distant metastasis. The 5-year survival for patients with papillary carcinoma was 93.0% and 10-year survival 88.8%, compared to 5-year survival for 93.5% of follicular carcinoma patients and 10-year survival for 93.5%.

High urinary hydroxyproline excretion in patients with advanced head and neck cancer.

We studied the urinary excretion of hydroxyproline, measured as the hydroxyproline-to-creatinine ratio (HOP/Cr), in sixty-six patients with head and neck disease including, 18 patients with head and neck cancer. Urinary hydroxyproline excretion was determined before treatment by the linear gradient elution method. Although the urinary excretion of hydroxyproline is considered to be useful in monitoring cancer tissue such as prostate carcinomas, no studies have been performed on the urinary excretion of hydroxyproline in patients with head and neck cancer. The HOP/Cr was significantly higher in cancer patients than in the healthy control. The ratio of patients with T3/T4 cancers was higher than in patients with benign tumors (p<0.05), chronic inflammatory diseases (p<0.01) or T1/T2 cancer (p<0.05). The high HOP/Cr with T3/T4 head and neck cancer corresponded to the extent of tumor invasion into the surrounding tissues such as muscles and bone. This suggests that HOP/Cr may be useful as a supplementary parameter for the assessment of tumor invasiveness which is masked in head and neck carcinomas such as skull base or maxillary carcinomas.

Cyclin-D1-gene amplification is a more potent prognostic factor than its protein over-expression in human head-and-neck squamous-cell carcinoma.

To evaluate the prognostic significance of cyclin D1 protein/gene expressions in human head-and-neck squamous-cell carcinoma (HNSCC), we examined amplification of the cyclin-D1 gene (CCND1) by the differential PCR method and over-expression of cyclin-D1 protein by immunohistochemistry in 45 paraffin-embedded sections from HNSCC. Amplification of CCND1 was found in 10 (22%) cases and over-expression of cyclin D1 was found in 24 (53%) cases. CCND1 amplification was also found in 3 (25%) of 12 cases of dysplastic lesions adjacent to HNSCC. The overall 5-year survival of patients with CCND1 amplification or with protein over-production was significantly lower than that of patients without (p < 0.0001 and p < 0.05, respectively). However, with multivariate analysis, only amplification of CCND1 retained an independent prognostic value (p = 0.0018). These suggest that CCND1 amplification occurs at early stages of HNSCC tumorigenesis and is a more useful prognostic factor than over-expression of cyclin D1 in HNSCC.

Investigation of the local provocation test to PPP and IgA nephritis.

We examined 24 cases with pustulosis palmaris et plantaris (PPP) and 13 cases with IgA nephritis. The provocation test was performed in 11 cases with PPP and 7 cases with IgA nephritis. According to Nosaka's criteria, as variables for assessing the provocation test, changes in WBC (white blood cell count), BT (temperature), ESR (erythrocyte sedimentation rate) and skin eruption or urinary findings (hematuria and proteinuria) were estimated. Analysis of the provocation test proved positive in 3 of 11 cases (27%) with PPP and in 5 of 7 cases (71%) with IgA nephritis. Improvement of PPP was found in 12 of 14 cases (86%) with tonsillectomy and in 5 of 10 cases (50%) without tonsillectomy. However, there was no significant relation between prognosis and results of provocation tests. Improvement of IgA nephritis was found in 6 of 10 cases (60%) with tonsillectomy and none of 3 cases (0%)) without tonsillectomy. Furthermore, the cases with positive reaction by the provocation test showed better prognosis than those with negative reaction. Our results suggest that in patients with IgA nephritis, the efficacy of tonsillectomy is better in patients with a positive reaction to the provocation test than in those with a negative reaction. However, this phenomenon was not observed in the patients with PPP. Improvement of symptoms in the patients undergoing tonsillectomy was found in the early time period after surgery as compared with that in the patients with conservative treatment.