[Management and prognostic factors for 119 patients with follicular thyroid carcinoma].

OBJECTIVE: To explore the optimal management and analyze the prognostic factors for follicular thyroid carcinoma. METHODS: The clinicopathological data of 119 patients with well-differentiated follicular thyroid carcinoma treated in our hospital from 1970 to 2008 were retrospectively reviewed. The overall survival (OS) rate was estimated by Kaplan-Meier method. Log rank and Cox regression analyses were used to identify the prognostic factors. RESULTS: The 5- and 10-year OS rates were 81.1% and 66.7%, respectively. The 3- , 5- and 10-year cumulative distant metastasis rates were 27.4%, 29.6% and 35.9%, respectively. The age of ≥ 45 years old was one of the most important factors affecting survival rate (P < 0.05) and an independent factor for distant matastasis. CONCLUSIONS: Follicular thyroid carcinoma has some special features such as diffuse growth and vascular tumors thrombosis and with a relatively poor prognosis. The key measure to improve local control and prognosis is radical resection. Some aggressive management such as total thyroidectomy combined with (13)1I therapy and regular follow-up should be performed to improve the survival rate and to control postoperative distant metastasis for patients ≥ 45 years old.

[Clinical analysis of squamous cell carcinoma of the subglottis].

OBJECTIVE: To investigate the clinical characteristics, pattern of lymph node metastasis, optimal management and relative prognostic factors of subglottic squamous cell carcinoma. METHODS: A retrospective review was conducted in 36 cases with subglottic squamous cell carcinoma from 1970 to 2005. TNM staging showed 6 patients with stage I, 9 stage II, 8 stage III and 13 stage IV (AJCC 2010). Eight of these 36 cases were treated with radiotherapy alone, 18 with surgery alone and 10 with surgery plus perioperative radiotherapy. The overall 5-year survival rate was estimated by the Kaplan-Meier method according to different clinical stages and treatments. Log-Rank analysis was used to identify the prognostic factors. RESULTS: The overall 5-year survival rate was 58.2%, and 5-year survival rates were 66.7%, 66.7%, 62.5% and 30.8% for patients with stage I, II, III and IV, respectively, and the rates were 43.8%, 66.7% and 51.9% for radiotherapy alone, surgery alone, surgery plus perioperative radiotherapy, respectively. The 5-year survival rate of patients with stage I-III was significantly higher than that of patients with stage IV (χ(2) = 3.955, P < 0.05). Pathologically confirmed positive rate of cervical lymph node was 25.0% (9/36), and the positive cervical lymph nodes were mainly distributed in level VI, followed by level II. The 5-year survival rate of patients with negative cervical lymph node was significantly higher than that of patients with positive cervical lymph node (χ(2) = 6.466, P < 0.05). CONCLUSIONS: The prognosis of subglottic squamous cell carcinoma was relatively poor. Total laryngectomy was the the main therapeutic management, and only part of the early cases could be treated with radiotherapy alone or partial laryngectomy. For locally advanced cases, the typical neck dissection including level II-IV and VI should be performed.

[Salvage surgery after failure of partial laryngectomy for laryngeal carcinoma].

OBJECTIVE: To study surgical managements, outcomes and the factors affecting prognosis of the primary recurrence following partial laryngectomy for laryngeal carcinoma. METHODS: The clinical data of 77 patients with salvage surgery for primary recurrence following partial laryngectomy for laryngeal carcinoma were analyzed retrospectively. Fifty-one patients underwent salvage total laryngectomy and other 26 patients with salvage partial laryngectomy. Of them, 19 patients without previous radiotherapy received a combined therapy of surgery and radiotherapy. Survival rates were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression. RESULTS: After salvage surgery, the 3-and 5-year cumulative overall survival rates were 59.1% and 52.7% respectively, and both the 3- and 5-year local recurrence rates were 30.7%. Most patients (48.4%) died of the failure at the primary sites. Multivariate analysis revealed the advanced T stage at initial presentation and the extra-laryngeal invasion of recurrent tumor were adverse prognostic factors for survival rate and also the advanced T stage at initial presentation influenced local recurrence rate. CONCLUSIONS: Salvage surgery for the primary recurrence following conservation treatment for laryngeal carcinoma can achieve promising results. Salvage total laryngectomy is the main therapeutic management in most recurrent patients. Salvage partial laryngectomy can achieve sound results in the patients selected carefully.

[Adenoid cystic carcinoma of maxillary sinus: diagnosis, treatment and prognostic factors].

OBJECTIVE: To study the clinical characters, the outcomes of treatments and the factors affecting long-term treatment results of adenoid cystic carcinoma (ACC) of the maxillary sinus. METHODS: The clinical data of 80 patients with ACC of the maxillary sinus treated initially were analyzed retrospectively. Survival rate, local recurrence and distant metastasis were analyzed using Kaplan-Meier method. Prognosis factors were analyzed by Log-rank test and Cox regression. RESULTS: The 5-, 10- and 15-year cumulative overall survival rates were 65.2%, 37.1%, 26.3% respectively and 5-, 10-, and 15-year disease-free survival rates 50.7%, 30.7% and 24.5% respectively. The 5-, 10- and 15-year cumulative local control rates were 68.5%, 47.3% and 47.3% respectively and the cumulative distant metastasis rate were 32.8%, 48.8% and 48.8% respectively. Prognostic factors affecting survival included T stage, pathologic grade and the modes of treatment (P < 0.05). Patients with combined therapy composed of surgery and radiation had a better local control, compared with surgery or radiation alone (χ(2) = 18.33, P < 0.01), and surgery combined with postoperative radiation was prior to preoperative radiation combined with surgery (χ(2) = 6.64, P < 0.05). Patients treated with surgery combined with preoperative radiation, either with doses of ≥ 60 Gy or with negative margins, had a better local control, compared with doses < 60 Gy and with positive margins (χ(2) = 5.06, P < 0.05). The most of patients (62.8%) died of local recurrence. CONCLUSIONS: The most of failure was due to recurrence. Combined therapy composed of surgery and radiation improves the local control and survival in patients with ACC of the maxillary sinus, compared with surgery or radiation alone. Surgery combined with postoperative radiation provides the best overall survival and local control and should be the first choice of treatments.