A retrospective analysis of prognostic factors predictive of lymph-node metastasis and recurrence in thyroid papillary microcarcinoma.

AIM: The literature is inconclusive concerning the prognostic factors and therapeutic management of papillary thyroid microcarcinoma (PTMC). Herein we report on our extensive experience with PTMC in relation to clinicopathological characteristics and prognostic factors. METHODS: In all, 248 patients that were diagnosed and treated for PTMC between 2007 and 2012 were retrospectively analyzed. Demographic and tumor characteristics at presentation, and recurrence during follow-up were noted. RESULTS: Total thyroidectomy and radioactive iodine (RAI) ablation treatment were performed in all patients. Bilateral involvement, vascular and capsular invasion, extra-thyroidal extension, and lymph node metastasis occurred significantly more frequently in patients with tumor size>5 mm (P<0.05). Multivariate statistical analysis showed that a clinically suspected diagnosis (OR:0.095; P=0.043) and elevated thyroglobulin (TG) level (OR: 1.083; P=0.011; cut-off value≥7.98 ngmL(-1)) were significant and independent risk factors for lymph node metastasis, with a sensitivity of 57% and specificity of 83%. After a median follow-up of 2 years (range:0.3-11 years), 10 (4%) of the 248 patients had recurrent disease. According to multivariate analysis, lymph node metastasis (OR: 51.4; P=0.003) was the only independent predictor of recurrence. CONCLUSION: Our findings revealed that serum TG level and a clinically suspected diagnosis were risk factors for lymph node metastasis, while nodal metastasis was a predictor of recurrence.

Early onset proteinuria after renal transplantation: a marker for allograft dysfunction.

The objective of this study was to determine whether early proteinuria after renal transplantation affected long-term allograft survival. The 130 patients included 105 men and 25 women of overall mean age, 29.6 +/- 9.6 years. There were 105 living related and, 25 cadaveric donor transplants. Proteinuria was defined as a level in of more than 300 mg/d. Donor and recipient age at transplantation, duration of pretransplant dialysis, donor type (living related or cadaveric), the presence of delayed graft function or acute rejection, panel-reactive antibodies, the number of human leukocyte antigen mismatches, and the systolic blood pressure level were retrospectively recorded for the study subjects. Cox regression analysis was used to determine the effects of proteinuria on allograft survival. Patients with proteinuria demonstrated significantly lower graft survival rates than did those without proteinuria (54.17% vs 82.62%, respectively; P<.002). Proteinuria at the third month after transplantation (P<.004, odds ratio [OR]=3.26, confidence interval [CI]=1.46 to 7.29), donor age (P<.001, OR=1.06, CI=1.02 to 109), and panel-reactive antibodies (P<.041, OR=1.06, CI=1.00 to 1.12) were significantly associated with decreased allograft survival. Early proteinuria after renal transplantation was indicative of a high risk for allograft dysfunction. A reduction of proteinuria may be associated with improved graft survival.

Relationship of posttransplantation erythrocytosis to hypercalcemia in renal transplant recipients.

Experimental studies have demonstrated that calcium is an essential molecule in modulation of erythropoiesis. The aim of this study was to investigate the role of serum calcium levels on the development of posttransplantation erythrocytosis (PTE) among renal transplant recipients. We enrolled 155 patients (36 females/119 males; mean age, 34.9 +/- 9.7 years) with normal graft function who underwent renal transplantation between 1999 and 2002. All of the demographic features and various laboratory parameters were retrospectively analyzed as possible factors associated with erythrocytosis. PTE appeared in 43 (27.7%) patients during the follow-up period. Sixty-three (40.6%) patients developed hypercalcemia (corrected serum calcium level > or =10.2 mg/dL). Serum calcium levels tended to increase in patients with PTE, but significantly decreased in patients without PTE (10.6 +/- 0.6 vs 9.8 +/- 0.5 mg/dL; P < .0001). Similarly, hypercalcemia was more common among patients with PTE compared with patients without PTE (74.4% vs 27.7%; P < .0001). Hypercalcemic patients had a significantly higher frequency of PTE than normocalcemic patients (50.7% vs 11.9%; P < .0001). There were no differences in other laboratory and demographic data between the patients with and without PTE (P > .05). These findings suggest that hypercalcemia may lead to increased PTE in renal transplant recipients.

Influence of cyclosporine and tacrolimus on serum uric acid levels in stable kidney transplant recipients.

Although hyperuricemia is a well-known adverse effect of cyclosporine (CsA) treatment, there are contradictory data regarding the effect of tacrolimus on uric acid levels. The aim of this study was to examine the influences of CsA and tacrolimus-based treatment regimens on serum uric acid levels in 155 renal transplant recipients with normal allograft function who underwent renal transplantation between 1999 and 2002. Serum uric acid levels were recorded at 1, 6, 12, 18, and 24 months follow-up. The patients were treated with CsA-based (n = 73), tacrolimus-based (n = 47), or conversion from CsA-based to tacrolimus-based (n = 35) immunosuppressive regimens. Serum uric acid levels for patients in the CsA and tacrolimus groups were 6.3 +/- 1.6 versus 7.9 +/- 1.9 mg/dL and 6.5 +/- 1.8 versus 8.0 +/- 1.8 mg/dL at the study outset and 24 months, respectively. Both of the treatment regimens showed progressively increasing serum uric acid levels (P < .001). Serum uric acid levels of patients with treatment conversion from CsA to tacrolimus were 8.6 +/- 2.8 mg/dL before conversion and 8.1 +/- 1.9 mg/dL after conversion. There was no alteration in serum uric acid levels after the change of treatment (P > .05). These findings indicate that, compared with CsA, tacrolimus offers no advantage for serum uric acid levels in renal transplant recipients.