Changes in Clinical Presentation, Management and Outcome in 1348 Patients with Differentiated Thyroid Carcinoma: Experience in a Single Institute in Hong Kong, 1960–2000

The clinical features, management and outcome of 1348 patients diagnosed with differentiated thyroid carcinoma in Queen Elizabeth Hospital, Hong Kong, were analysed according to the period of diagnosis: A (before 1980), B (1981-1990) and C (1991-2000). As time advanced, ratio of papillary carcinoma (PTC) to follicular carcinoma (FTC) increased (A:B:C = 1.6: 3.1: 7.2). The mean size of the primary tumour decreased (A:B:C = 3.5 cm: 2.8 cm: 2.5 cm), with a greater percentage of microcarcinoma of 1 cm or less (A:B:C = 5.1%: 16.1%: 21.7%). At presentation, the incidence of lymph-node metastasis decreased (A:B:C = 32.7%: 31.6%: 24.8%) and that of distant metastasis decreased (A:B:C = 9%: 6.1%: 5.3%). Bilateral surgical resection was more commonly used (A:B:C = 62.8%: 89.1%: 94.8%) than lobectomy (A:B:C = 26.3%: 2.8%: 1.8%). Radiation treatment, radioactive iodine (131I; RAI) and external radiotherapy (EXT), was more commonly used (A:B:C = 53.2%: 74.7%: 85.1%). RAI was used in 84.3% (A:B:C = 50%: 71.2%: 84.3%) and EXT in 14.5% of patients in the past decade (A:B:C = 10.9%: 8.7%: 14.5%). The proportion of patients who adopted a bilateral surgery and RAI treatment increased gradually with time (A:B:C = 33%: 68%: 83.8%). The 5-year cause-specific survival (A:B:C = 90.2%: 93.7%: 95.7%), locoregional failure-free survival (A:B:C = 72.6%: 82.9%: 91.6%) and distant metastasis failure-free survival (A:B:C = 84.5%: 89.1%: 92.6%) were improved. However, the period of diagnosis was not found to be an important explanatory variable (i.e. P > 0.05) in Cox regression after adjusting for other factors, indicating that the improvement was probably related to the temporal trend of other factors: presentation at earlier stage, increased ratio of PTC:FTC and more aggressive management by bilateral surgery and radiation therapy.

Baseline BMD and bone loss at distal radius measured by peripheral quantitative computed tomography in peri- and postmenopausal Hong Kong Chinese women

The current study was designed to investigate the rate of bone loss in distal radius and its association with baseline volumetric bone mineral density (BMD) and years since menopause (YSM) in peri- and postmenopausal women using precise and multislice peripheral quantitative computed tomography (pQCT; Densiscan 2000). Two hundred and five healthy Hong Kong Chinese perimenopausal ( n = 26) and postmenopausal ( n = 179) women within 10 years of the onset of menopause were recruited. Anthropometric parameters and menstrual status were also measured. The linear regression model derived from the baseline volumetric BMD revealed a significant and slightly better correlation with YSM than age, with a YSM-related annual decline of 2.56%, 1.82% and 0.65% in trabecular BMD (tBMD), integral BMD (iBMD) and cortical BMD (cBMD), respectively. Follow-up measurements after a time interval of 12 months showed that the rate of bone loss was higher than the annual decline in BMD calculated from the baseline BMD, with decreases of 2.89%, 2.16% 0.91% in tBMD, iBMD and cBMD, respectively. Baseline BMD was associated with age or YSM ( r ranges from -0.283 to -0.502; p<0.001 in all cases), but no relationship was found between annual rate of bone loss and age or YSM. The rate of bone loss did not correlate with baseline volumetric BMD values or YSM after dividing the subjects into fast bone losers (with annual tBMD loss > or =3%), normal bone losers (with annual tBMD loss > or = 1% but <3%) or slow bone losers (with annual tBMD loss <1%). The rate of bone loss was greater in both trabecular and cortical bone of postmenopausal women within the first 3 menopausal years but was only significant in the iBMD as compared with perimenopausal and postmenopausal women over 7 years after onset of menopause. The percentage distribution of slow and fast bone losers was not found to be associated with YSM. As a total of only 4 fracture cases were documented, the study could not provide conclusive information on whether perimenopausal and early postmenopausal baseline volumetric BMD or rate of bone loss determines the development of osteoporosis or fracture occurrence.

Combination gemcitabine and cisplatin chemotherapy for metastatic or recurrent nasopharyngeal carcinoma: report of a phase II study

BACKGROUND

To evaluate the efficacy and toxicity of combination gemcitabine plus cisplatin (GC) chemotherapy in metastatic or recurrent nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS

Forty-four patients of Chinese ethnicity with metastatic or recurrent NPC received ambulatory GC chemotherapy every 28 days (gemcitabine 1000 mg/m(2) days 1, 8 and 15; cisplatin 50 mg/m(2) days 1 and 8). There were 40 male and four female patients with a mean age of 47.4 years. More than half (54.5%) of the patients had received either prior platinum-based chemotherapy and/or radiotherapy to target lesions.

RESULTS

There were nine complete responses and 23 partial responses in the 44 patients, achieving an overall response rate of 73% (78% for the 41 assessable patients). The mean duration of response was 5.3 months. Improved subjective symptom-control scores were found in 78% of patients with pre-existing symptoms, while 64% of patients experienced improved general well-being scores. Toxicity was mainly hematological: grade III/IV anemia, granulocytopenia and thrombocytopenia were found in 11, 37 and 16% of cycles, respectively. With a median follow-up of 17.2 months, 62% survived 1 year while 36% were alive and progression free.

CONCLUSIONS

Gemcitabine plus cisplatin chemotherapy offers a satisfactory overall response rate, subjective patient improvement and safety profile for metastatic and recurrent NPC.

Peripheral volumetric bone mineral density in pre- and postmenopausal Chinese women in Hong Kong

The aim of this cross-sectional study was to use a newly available precise and multislice pQCT (Densiscan 2000) for establishing reference data of volumetric bone mineral density (vBMD) of the distal radius. vBMD of the nondominant wrist was measured in 118 healthy Hong Kong Chinese women aged 41-60. Anthropometric parameters, menstrual status, and handgrip strength were also measured. Results showed that there was a significant age-related decline in trabecular BMD (tBMD), integral BMD (iBMD), and cortical BMD (cBMD), with correlation coefficients ranging from -0.401 to -0.547 (P < 0.001). The annual decline of vBMD was 2.22%, 1.79%, and 0.88% in tBMD, iBMD, and cBMD, respectively. When subjects were divided into premenopausal and postmenopausal groups, we found an age-related decline in tBMD and iBMD, but not in cBMD in both groups. The vBMD values interpreted in mg/cm3 in premenopausal women were 238.4 +/- 57.2 in tBMD, 604.6 +/- 82.9 in iBMD, 1415.5 +/- 129.9 in cBMD, and declined significantly (all P < 0.001) to 193.7 +/-54.7 in tBMD, 500.0 +/- 90.3 in iBMD, and 1306.7 +/- 153.5 in cBMD in the postmenopausal women. On average, 16.7% of the subjects showed their vBMDs to be below-1 SD and only 1.7% of them lower than -2 SD. Linear regression showed that the annual decline of vBMD was faster in postmenopausal women with 2.42% in tBMD, 1.90% in iBMD, and 0.88% in cBMD compared with 1.91% in tBMD, 0.98% in iBMD, and 0.55% in cBMD in the premenopausal women. After adjustment for age, only the iBMD with dominant trabecular elements showed a significantly accelerated decrease after the onset of menopause (P = 0.008). Weak or no association was found among vBMDs with anthropometric parameters, years since menopause, or handgrip strength. In conclusion, we found a significant age-related decline of vBMDs in Hong Kong Chinese women aged 41-60 years, characterized by the early reduction of metabolically active trabecular bone after entering the fourth decade of life, with an accelerated decline after the onset of menopause.