Radiation-induced osteosarcoma of the maxilla and mandible after radiotherapy for nasopharyngeal carcinoma

Background

The increasing incidence of radiation-induced osteosarcoma of the maxilla and mandible (RIOSM) has become a significant problem that can limit long-term survival. The purpose of this study was to analyze the association of clinicopathologic characteristics with treatment outcomes and prognostic factors of patients who developed RIOSM after undergoing radiotherapy for nasopharyngeal carcinoma (NPC).

Methods

We reviewed the medical records of 53,760 NPC patients admitted to Sun Yat-sen University Cancer Center during the period August 1964 to August 2012. Of these patients, 47 who developed RISOM and met inclusion criteria were included in this study. Two of these 47 patients refused treatment and were then excluded.

Results

For all patients treated for NPC at Sun Yat-sen University Cancer Center during the study period, the total incidence of RIOSM after radiotherapy was 0.084% (47/53,760). Two patients (4.4%) had metastases at the diagnosis of RIOSM. Thirty-nine of the 45 (86.7%) patients underwent surgery for RIOSM; most patients (24/39; 61.5%) who underwent resection had gross clear margins, with 15 patients (38.5%) having either a gross or microscopic positive margin. All patients died. The 1-, 2-, and 3-year overall survival (OS) rates for the entire cohort of 45 patients were 53.3%, 35.6% and 13.5%, respectively. The independent prognostic factors associated with high OS rate were tumor size and treatment type.

Conclusions

RISOM after radiotherapy for NPC is aggressive and often eludes early detection and timely intervention. Surgery combined with postoperative chemotherapy might be an effective treatment to improve patient survival.

Circulating B7-H4 in serum predicts prognosis in patients with hepatocellular carcinoma

B7-H4 is member of the B7 family that negatively regulates the immune response, which are important for fine-tuning of the tumor microenvironment. Dysregulation of B7-H4 expression has been associated with tumor progression. However, expression level of B7-H4 in hepatocellular carcinoma (HCC) tissues is still a controversial topic. In addition, whether serum B7-H4 expression of HCC patients has any clinical value is unknown. We compared serum levels of B7-H4 in patients with HCC and healthy controls by using the ELISA method. Association between serum B7-H4 expression level and clinical parameters of HCC was further investigated. Log-rank test and Kaplan-Meier method were employed to evaluate the overall survival rate of HCC patients. Univariate and multivariate analysis of prognostic factors were performed with the Cox regression model. Our results showed that HCC patients had significantly higher serum B7-H4 level as compared with healthy controls (P < 0.001). In addition, serum B7-H4 expression was correlated with HCC clinical parameters including serum AFP expression and TNM stage. HCC patients in the higher serum B7-H4 expression group had a poorer 5-year overall survival rate (P = 0.028). Moreover, serum B7-H4 expression was shown to be an independent prognostic factor for HCC (P = 0.034). The findings from this study suggest that serum B7-H4 is an independent prognostic indicator for HCC and may be a promising biomarker for early diagnosis as well as disease prognosis of HCC.

Submandibular salivary gland transfer for the prevention of radiation-induced xerostomia in patients with nasopharyngeal carcinoma: 5-Year outcomes

BACKGROUND

Our aim in this study was to investigate the value of the submandibular salivary gland transfer procedure in prevention of radiation-induced xerostomia in patients with nasopharyngeal carcinoma (NPC).

METHODS

In all, there were 70 patients, consisting of a test group (36 patients) and a control group (34 patients) in a nonrandomized fashion. In the test group, the submandibular salivary gland was transferred to submental space before radiotherapy (XRT) and shielded. Salivary gland functions were evaluated by the amount of saliva and a quality of life questionnaire before and after XRT and 3 and 60 months after XRT.

RESULTS

At 5 years, the trapping and excretion functions of salivary gland were significantly better in the test group (p = .000 and p = .000). The mean weight of saliva after XRT was heavier (1.65 g vs 0.73 g, p = .000), and the incidence of xerostomia was lower in the test group, with no difference in 5-year survival and neck nodal recurrence between the 2 groups.

CONCLUSIONS

Salivary gland transfer procedure prevents XRT-induced xerostomia and improves quality of life of patients with NPC.

Laryngeal framework reconstruction using titanium mesh in glottic cancer after frontolateral vertical partial laryngectomy

OBJECTIVES

To investigate the feasibility and efficacy of laryngeal framework reconstruction using titanium mesh in patients with glottic cancer after frontolateral vertical partial laryngectomy.

STUDY DESIGN

Prospective study.

METHODS

Defect of laryngeal framework, caused by frontolateral vertical partial laryngectomy in nine patients with T2 or T3 squamous cell carcinoma of glottic, were reconstructed with titanium mesh from 2007 to 2009. Computed tomography (CT) and fiberscopic examinations were performed at two weeks and three months postoperatively.

RESULTS

No aspiration and laryngeal stenosis was observed in the nine patients. CT scanning showed that titanium mesh was fastened well without displacement and deformity and that there was no laryngeal stenosis. Fiberscopic inspection showed that the larynx lumen was maintained well without stricture, shrinkage, and necrosis. No titanium mesh was exposed to the larynx lumen.

CONCLUSIONS

Titanium mesh was a good alternative for reconstruction of the laryngeal framework. It provided adequate structural support to maintain airway patency.

[Re-operation extent of primary lesion of thyroid cancer]

BACKGROUND AND OBJECTIVE

Many thyroid cancer patients need to receive second operation because of tumor residue. This study was to explore the resection extent of primary lesion in re-operation of thyroid carcinoma.

METHODS

Clinical data of 55 thyroid carcinoma patients who received re-operation were reviewed. The patients, including seven men and 48 women, were aged of 18-56. All patients received ipsilateral residual lobectomy, isthmectomy, ipsilateral anterior cervical muscle and level VI lymph node dissection. The optimal extent for radical re-resection of primary lesion was explored.

RESULTS

Tumor residue was proved by pathology in 29 patients, with a rate of 52.73%. Of the 29 patients, eight had primary lesion residue, seven had level VI lymph node residue, and 14 had both. Tumor cells were connected with muscle in four patients. Forty-five metastatic lymph nodes were found.

CONCLUSION

Ipsilateral residual lobectomy, isthmectomy, ipsilateral anterior cervical muscle and level VI lymph node dissection is the basic re-resection extent of primary lesion for thyroid carcinoma patients.

[Detection and clinical significance of lymphatic microvessel density in supraglottic laryngeal carcinoma]

BACKGROUND AND OBJECTIVE

Lymphatic microvessels may play an important role in tumor metastasis. This study detected lymphatic microvessel density (LVD) in supraglottic laryngeal carcinoma to find its correlation to clinicopathologic characteristics, and to assess its prognostic significance in supraglottic laryngeal carcinoma.

METHODS

Clinical data of 51 supraglottic laryngeal carcinoma patients who underwent primary lesion resection were reviewed. Immunohistochemical staining was performed with podoplanin monoclonal antibody to recognize lymphatic microvessels. The correlations of LVD to clinicopathologic characteristics and prognosis were analyzed.

RESULTS

The mean LVD was 3.25+/-2.37, with a median of 3, in the 51 specimens of supraglottic laryngeal carcinoma. LVD was significantly higher in the patients with cervical lymph node metastasis than in those without (P=0.009). The overall 5-year survival rate was 54.9%. The 5-year survival rate was significantly lower in the patients with poorly differentiated tumor, stages T3-4 disease, lymph node metastasis, stages III-IV disease and high LVD than in their counterparts. Cox regression analysis revealed that LVD, T classification, and differentiation were independent factors for survival.

CONCLUSION

LVD is related to lymph nodes status, and is an independent factor for prognosis of supraglottic laryngeal carcinoma.

[Survival and prognostic analysis of 221 patients with advanced laryngeal squamous cell carcinoma treated by surgery]

BACKGROUND AND OBJECTIVE

The prognosis of advanced squamous cell carcinoma of the larynx is poor Prognostic factors of this disease vary in different studies. This study was to analyze the most important factors affecting the prognosis of the patients with advanced (stage III and IV) squamous cell carcinoma (SCC) of the larynx.

METHODS

Clinical data of 221 patients with advanced SCC of the larynx were retrospectively analyzed. Survival analysis was performed by the life table method; comparison among/between groups was performed using the log-rank test; and multivariate analysis was carried out using the Cox proportional hazard model.

RESULTS

The two- and five-year overall survival rates of the 221 patients were 76.9% and 51.1%; while the 2-and 5-year disease free survival rates were 60.0% and 43.0%. Patients in stage III had better prognosis than those in stage IV. Post-operative radiotherapy improved the survival rate in patients with positive surgical margins. There was no difference in the survival rate between patients underwent partial laryngectomy and those underwent total laryngectomy. Multivariate analyses indicated that age, anatomic type, post-surgical stage, surgical margin and radiotherapy influenced the disease free survival (p<0.05), whereas, age, post-surgical stage and surgical margin affected the overall survival (p<0.05).

CONCLUSIONS

The prognosis of patients with advanced SCC of the larynx receiving surgery is poor. Age, post-surgical stage and surgical margin are the most important factors affecting the overall survival.

[Survival analysis of 229 patients with advanced squamous cell carcinoma of the oral tongue]

BACKGROUND & OBJECTIVE

Patients with advanced squamous cell carcinoma (SCC) of the oral tongue have poor prognosis. This study was to analyze the most important factors affecting the prognosis of the patients with advanced (stage III and IV) SCC of the oral tongue.

METHODS

Complete clinical and follow-up data of 229 patients with pathologically confirmed advanced SCC of the oral tongue, initially treated at Sun Yat-sen University Cancer Center were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier analysis, comparison among groups was analyzed using log-rank test, and multivariate analysis was conducted using the Cox proportional hazard model. Independent risk factors were deducted. The risk function was established and evaluated.

RESULTS

The mean survival time of the 229 patients was 80.33 months, with the two-and five-year survival rates of 50.66% and 37.99%, respectively. Univariate analysis showed that age, tongue base invasion, cervical lymphatic metastasis, stage, surgical treatment, recurrence and residual tumor were risk factors affecting prognosis (P<0.05). Multivariate analysis indicated that tumour invasion across the midline, cervical lymphatic metastases, surgical treatment, recurrence and residual tumor were independent factors for prognosis. Moreover, the risk function effectively predicted the prognosis.

CONCLUSIONS

The prognosis of patients with advanced SCC of the oral tongue is poor. Tumour invasion across the midline, cervical lymphatic metastasis, surgical treatment, recurrence, and residual tumor are independent factors affecting the prognosis.

[Clinical features and diagnosis of head and neck rhabdomyosarcoma: a report of 24 cases]

BACKGROUND & OBJECTIVE

Rhabdomyosarcoma is a rare malignant tumor. This study aimed to summarize the clinical features of head and neck rhabdomyosarcoma.

METHODS

Clinical data of 24 patients with head and neck rhabdomyosarcom, treated in Cancer Center of Sun Yat-sun University from 1989 to 2005, were analyzed.

RESULTS

Of the 24 patients, 15 (62.5%) were younger than 25; 12 (50.0%) with tumors originated from nasosinus. All patients presented with localized mass: 14 (58.3%) had large masses (>/=4 cm) at their first visit; 13 (54.2%) had clinical lymph node metastasis (cN+), and 12 (50.0%) of them were confirmed by pathology (pN+); 2 (8.3%) had distant metastasis. Of the 24 patients, 3 were at stage I, 3 at stage II, 16 at stage III and 2 at stage IV. Bone erosion was indicated by CT in 16 (66.7%) patients. Fourteen patients received immunohistochemical examination: 10 (71.4%) were HHF-35-positive, 6 (42.8%) were Desmin-positive, 9 (64.3%) were Myolobin-positive, 9 (64.3%) were Vemintin-positive. Thirteen patients were treated with multi-disciplinary treatment. The 3-year survival rate was 42.8% for those having chemotherapy as part of the treatment.

CONCLUSIONS

Head and neck rhabdomyosarcoma is usually seen in adolescents and mostly developed in the nasosinus. It usually manifests as a localized mass and has a high frequency of lymphatic metastasis and distant metastasis. Chemotherapy-dominant multidisciplinary treatment is recommended for this disease.

[Treatment of advanced maxillary sinus squamous carcinoma: an analysis of 92 cases]

BACKGROUND & OBJECTIVE

There is no satisfactory treatment for advanced maxillary sinus squamous carcinoma. The treatment strategy is controversial. This study aimed to explore a rational treatment for advanced maxillary sinus squamous carcinoma.

METHODS

Clinical data of 92 patients with stage T3-T4 maxillary sinus squamous cell carcinoma, treated in Cancer Center of Sun Yat-sen University from Jan.1978 to Dec.2001, were reviewed. Of the 92 patients, 21 received radiotherapy alone, 8 received surgery alone, 63 received multimodality therapy (51 received surgery combined with radiotherapy, and 12 received chemoradiotherapy).

RESULTS

The 3-and 5-year survival rates were significantly lower in radiotherapy group and surgery group than in multimodality therapy group (19.0% and 25.0% vs. 46.0%, P<0.05; 9.5% and 12.5% vs. 33.3%, P<0.05). In multimodality therapy group, the 3-and 5-year survival rates were 33.3% and 23.8% for the patients who received radiotherapy followed by surgery, 52.9% and 47.1% for the patients who received surgery follow by radiotherapy, 53.8% and 30.8% for the patients who received pre-and postoperative radiotherapy, and 50.0% and 33.3% for the patients who received chemoradiotherapy. There were no significant differences in survival rate between these four subgroups (P>0.05).

CONCLUSIONS

The efficacy of multimodality therapy is better than that of single therapy strategy for advanced maxillary sinus squamous carcinoma. The best treatment pattern for advanced maxillary sinus squamous carcinoma needs further research.

[Treatment and prognosis of gingival carcinoma: a report of 116 cases]

BACKGROUND & OBJECTIVE

The treatment and prognosis of gingival carcinoma, a common oral carcinoma, have seldom been reported. This study was to explore appropriate therapies and analyze prognostic factors of gingival carcinoma.

METHODS

Clinical data of 116 gingival carcinoma patients, treated at Cancer Center of Sun Yat-sen University from 1992 to 2003, were analyzed. Survival analyses were performed for patients who received surgery, radiotherapy, or surgery combined with chemotherapy or/and radiotherapy. The patients had been followed up for more than 3 years.

RESULTS

One hundred patients received radical therapy. The overall 3-and 5-year survival rates were 52.7% and 41.8%. The 5-year survival rates were 50.3% in surgery alone group and 49.0% in combined treatment group, without significant difference. The 5-year survival rate of radiotherapy alone group was only 20.0%. For advanced gingival carcinoma, the recurrence rate was much lower in combined treatment group than in surgery alone group. Clinical stage and surgical margin status were predictors of survival.

CONCLUSIONS

Surgery alone is appropriate for gingival carcinoma patients at an early stage; surgery combined with chemotherapy or/and radiotherapy is an adequate treatment for patients at advanced stages. Clinical stage and surgical margin status are important prognostic factors.

[Surgical treatment and long-term efficacy on stage T1-3N0 differentiated thyroid carcinoma]

BACKGROUND & OBJECTIVE

Whether to choose total thyroidectomy or lobectomy for the primary lesion of differentiated thyroid carcinoma (DTC) limited in one lobe is controversial. This study was to investigate the patterns of surgical treatment for stage T1-3N0 DTC, and observe the long-term efficacy.

METHODS

Clinical data of 153 DTC patients, first treated at Cancer Center of Sun Yat-sen University from 1985 to 2000, were reviewed. The postoperative pathologic stage of these patients was T1-3N0. The multiple centricity of primary lesions, patterns of surgical treatment, and prognosis were analyzed.

RESULTS

Of the 153 DTC patients, 21 had cancer multifocality: 12 had multiple cancer foci in one lobe and 9 had cancer multifocality in both lobes. Ninety-two patients received unilateral lobectomy plus isthmectomy; 44 patients received ipsilateral subtotal lobectomy plus isthmectomy. Among the 9 patients who had cancer multifocality in both lobes, 7 received unilateral lobectomy plus isthmectomy with contralateral subtotal lobectmoy and 2 received bilateral subtotal lobectomy. Eight patients, whose primary lesions were at isthmus, underwent isthmectomy plus bilateral partial lobectomy. Regional lymph node metastasis appeared in 7 patients after initial operation: 6 in the neck and 1 in the upper mediastinum. Five patients had distant metastasis after operation. The 5-, 10-and 15-year survival rates of these 153 patients were 98.7%, 96.1% and 86.9%, respectively. Age, pathologic type, tumor size and distant metastasis affected the survival (P<0.05). The patients whose age was less than 45 years, tumor size was less than 4 cm, pathologic type was papillary or mixed carcinoma, and who had no distant metastasis had relatively good prognosis. Age and distant metastasis were independent prognostic factors.

CONCLUSIONS

It is feasible to perform unilateral lobectomy or subtotal lobectomy plus isthmectomy for patients with stage T1-3N0 DTC. The long-term outcomes of stage T1-3N0 DTC patients are relatively well. Age, pathologic type, tumor size and distant metastasis affect prognosis.

[Concurrent chemoradiotherapy versus radiotherapy alone for locoregionally advanced nasopharyngeal carcinoma: a meta-analysis]

OBJECTIVE

To determine the value of concurrent chemoradiotherapy in patients with locoregionally advanced nasopharyngeal carcinoma from the mainland of China.

METHODS

Data were extracted from randomized trials comparing chemotherapy plus radiotherapy with radiotherapy alone in locally advanced nasopharyngeal carcinoma. Actuarial rates of survival and distant metastases were calculated. The followed electronic databases were searched the Chinese Biomedicine database, Pubmed, Medline, Embase and Cochrane library; Data were extracted by tow reviewers and Review manager 4.1 software was applied for statistical analysis.

RESULTS

Eighteen trials with 1993 patients were include according to the including criterion. The 3-year overall survival rate of the chemoradiotherapy group and the radiotherapy group were 68.47% and 56.38% respectively, and the 5-year overall survival rate of the two groups above were 51.91% and 41.09% respectively, while the distant metastases rate of the chemoradiotherapy group and the radiotherapy group were 26.19% and 38.71% respectively. The result demonstrated that chemoradiotherapy increased overall survival by 12% at 3 years, and 11% at 5 years after treatment. After chemoradiotherapy, the rate of distant metastasis was reduce by 12%.

CONCLUSIONS

In patients with locoregionally advanced nasopharyngeal carcinoma, chemoradiotherapy significantly improves overall survival at 3 years, and 5 years compared with radiotherapy alone.

[Childhood thyroid carcinoma: clinical analyses of 22 cases]

BACKGROUND & OBJECTIVE

Thyroid carcinoma is rarely occurred in children. Clinicopathologic characteristics, therapy and prognosis of childhood thyroid carcinoma patients are different from those of adult patients, and the treatment of this disease is controversial. This study was to explore the clinicopathologic characteristics, diagnosis and therapy of thyroid carcinoma in children.

METHODS

Clinical data of 22 children under the age of 14, diagnosed as thyroid carcinoma between Jan. 1980 and Dec. 2000, were reviewed.

RESULTS

According to UICC clinical and histopathologic classification(2002), 19 cases were classified as stageI (2 cases of T1-4N0M0 and 17 cases of T1-4N1M0) and 3 cases as stage II (T1-4N1-4M1). Of the 22 patients, 8 (36.4%) had papillary carcinoma, 8 (36.4%) had follicular carcinoma, 5(22.7%) had mixed papillary-follicular carcinoma, and 1 (4.5%) had medullary carcinoma. All patients had received operation and postoperative thyroxin therapy. Unilateral and bilateral neck dissection had been performed in 12 and 7 patients, respectively; 19 patients had cervical lymph node metastasis. The follow-up period was 6 to 26 years (median, 14.83 years). The 5-and 10-year survival rates were 100% and 95.5%, respectively.

CONCLUSIONS

Childhood thyroid carcinomas are mostly differentiated carcinomas, with high frequency of cervical lymph node metastases. The optimal treatment for thyroid carcinoma in children may improve the quality of life and decrease the incidence of complications.

[Application of helix water jet to parotid surgery]

BACKGROUND & OBJECTIVE

Dissecting the facial nerves safely is an important guarantee for the accomplishment of parotidectomy and reduction of postoperative complications. This study was to explore the application of helix water jet to parotidectomy.

METHODS

Clinical data of 43 patients with parotid tumors, who received operation with helix water jet from Feb. 2004 to Feb. 2005 at Cancer Center of Sun Yat-Sen University, were analyzed. Meanwhile, traditional techniques in parotidectomy was performed in 36 patients (control group). Duration of operation, postoperative drainage volume, postoperative hospitalization, and occurrence of postoperative complications, such as facial nerve dysfunction and salivary fistula, of the 2 groups were compared.

RESULTS

The postoperative drainage volume was significantly lower in water jet group than in control group [(9.89+/-3.74) mL vs. (12.15+/-2.11) mL, P<0.05]. There were no significant differences in duration of operation [(90.28+/-25.30) min vs. (76.32+/-20.74) min, P>0.05], postoperative hospitalization [(6.39+/-1.38) days vs. (6.45+/-1.05) days, P>0.05] between the two groups. Of the 43 patients in water jet group, 6 (14.0%) had grade II facial nerve dysfunction and 1 (2.3%) had grade III facial nerve dysfunction; of the 36 patients in control group, 5 (13.9%) had grade II facial nerve dysfunction, 2 (5.6%) had grade III facial nerve dysfunction, 1 (2.8%) had grade IV facial nerve dysfunction and 1 (2.8%) had salivary fistula. There was no permanent facial nerve dysfunction occurred in both groups. There was no significant difference in the occurrence of complications between the two groups. Nine patients who retained nervus auricularis magnus suffered from slight numbness symptom of auricular lobule.

CONCLUSION

Use of helix water jet in parotid surgery is safe and confers some advantages over conventional methods of parotid dissection.

[Clinical study of 36 cases with adenoid cystic carcinoma of the maxillary sinus]

OBJECTIVE

To study the clinical characters, management and the prognosis of patients with adenoid cystic carcinoma of the maxillary sinus.

METHODS

The clinical data were analyzed retrospectively for 36 patients with adenoid cystic carcinoma of the maxillary sinus to evaluate the treatment results of different modalities. The contribution of every factors influencing on survival were also analyzed. Survival analysis was performed by life table method, comparison among/between groups was performed using log-rank test, and multivariate analysis was carried out using Cox proportional hazard model.

RESULTS

The 5-year survival rate was 58.33% in all patients, while they were only 75.0% and 42.9% in stage III and stage IV lesions respectively. The 5-year survival rate of 66.7% was obtained in patients who received surgery combined with radiotherapy,71.4% and 12.5% respectively in those treated by surgery and by radiotherapy alone. Multivariate analysis indicated that stage, treatment modality, and the tumour residues in the primary treatment were the predict factors for the prognosis.

CONCLUSIONS

Advanced adenoid cystic carcinoma should be treated by combined surgery and radiotherapy. Stage, treatment approach and short-term therapeutic response are the most important factors affecting the prognosis of the patients with adenoid cystic carcinoma of the maxillary sinus.

[Treatment and prognosis of stage IV glottic laryngeal cancer]

BACKGROUND & OBJECTIVE

The prognosis of stage IV glottic cancer is poor. This study was to explore the impacts of different treatment modalities, cervical lymph node status and surgical margin on the prognosis of stage IV glottic cancer.

METHODS

Clinical data of 88 patients with stage IV glottic cancer were reviewed. The correlations of different treatment modalities, cervical lymph node status, and surgical margin to the prognosis of stage IV glottic cancer were analyzed.

RESULTS

The overall 3-and 5-year survival rates of the 88 patients were 71.6% and 63.0%. There was no significant difference in survival rate among the patients received operation, operation plus postoperative radiotherapy, chemoradiotherapy, and operation plus chemotherapy (P=0.729). The overall survival rate was significant lower in patients with lymph node metastasis than in those without lymph node metastasis (P=0.015); for stage cN0 patients, there was no significant difference between the patients with and without occult lymph node metastasis (P=0.474). There was no significant difference between the patients with positive surgical margin and those with negative surgical margin (P=0.016).

CONCLUSIONS

N stage is the important prognostic factor for stage IV glottic cancer. The prognosis of patients with lymph node metastasis is poor. The survival rate of the patients with positive surgical margin is lower than that of those with negative surgical margin.

[Correlation of cervical lymphatic metastasis to prognosis of glottic carcinoma: a report of 333 cases]

BACKGROUND & OBJECTIVE

Cervical lymph node metastasis rate of glottic carcinoma is low. How to deal with cervical adenopathy remains controversial. This study was to explore the factors relate to cervical lymphatic metastasis of glottic carcinoma.

METHODS

Clinical data of 333 patients with glottic carcinoma, treated at Cancer Center of Sun Yat-sen University from Jan. 1, 1992 to Dec. 31, 2000, were reviewed. Distribution of cervical adenopathy, prognosis, and neck management were analyzed.

RESULTS

The overall lymphatic metastasis rate was 9.61% (32/333); the occult lymphatic metastasis rate was 6.24% (20/321). Most metastatic lymph nodes located at ipsilateral levels II, III and IV (28/32). The pathologic grade had no correlation to the overall lymphatic metastasis rate (P=0.092), and occult lymphatic metastasis rate (P=0.067). The overall lymphatic metastasis rate (P=0.002) and occult lymphatic metastasis rate (P=0.015) rose up following with increased T stage. Neck selective radiotherapy for the patients at stage cN0 had no significant impact on occult lymph node metastasis rate (P=0.363). The 3-and 5-year survival rates were significantly lower in cN+ patients than in cN0 patients (56.25% vs. 88.70%, 46.67% vs. 85.37%, P<0.001), significantly lower in the cN+ patients with occult lymph node metastasis than in the cN+ patients without lymph node metastasis (68.18% vs. 89.00%, 63.31% vs. 85.55%, P=0.005), and significantly lower in naive cN+ patients than in the naive cN0 patients with occult lymph node metastasis (41.67% vs. 68.18%, 16.67% vs. 63.31%, P=0.004).

CONCLUSIONS

Most metastatic lymph nodes of glottic carcinoma locate at ipsilateral levels II, III and IV, especially at level II. Cervical lymphatic metastasis affects the prognosis of glottic carcinoma.

[Postoperative recurrence-related factors of 125 patients with cT1-2N0 squamous cell carcinoma of the oral tongue]

BACKGROUND & OBJECTIVE

The treatment pattern for cT1-2N0 squamous cell carcinoma (SCC) of the oral tongue is controversial; the postoperative recurrence rate of the disease is high and the salvage effect is poor. This study was to explore the postoperative recurrence-related factors of cT1-2N0 SCC of the oral tongue, to analyze their effects on the survival, and to seek more reasonable therapeutic modality.

METHODS

Clinical data of 125 patients with cT1-2N0 SCC of the oral tongue, treated in Cancer Center of Sun Yat-sen University from Jan. 1992 to Dec. 2000, were reviewed. Of the 125 patients, 58 were at stage T1, 67 were at stage T2; 17 (13.6%) were treated with local operation alone, 53 (42.4%) were treated with both local operation and selective neck dissection, and 55 (44.0%) were treated with operation and chemotherapy and/or radiotherapy. The correlations of disease duration, tumor growth pattern, clinical TNM stage, pathologic grade, occult cervical lymphatic metastasis, tumor invasion depth, treatment methods and neck management to tumor recurrence and prognosis were analyzed.

RESULTS

Forty-one (32.8%) patients had recurrence; the overall 5-year survival rate was 62.59%. The 5-year survival rate was significantly lower in recurrent group than in non-recurrent group (38.74% vs. 74.69%, log-rank=19.27, P<0.001). Disease duration (Chi(2) test, P=0.002), tumor growth pattern (Chi(2) test, P<0.001), neck management (Chi(2) test, P<0.001) and occult cervical lymphatic metastasis (Cox regression, P=0.001) were significantly related to the recurrence of cT1-2N0 SCC of the oral tongue. Tumor invasion depth (Cox regression, P=0.005) and the site of recurrent tumor (Cox regression, P<0.001) were significantly related to the prognosis of cT1-2N0 SCC of the oral tongue.

CONCLUSION

Disease duration, tumor growth pattern, neck management, and occult cervical lymphatic metastasis are main recurrent factors of cT1-2N0 SCC of the oral tongue; tumor invasion depth and the site of recurrent tumor are important prognostic factors.

[Sentinel lymph node radiolocalization in squamous cell carcinoma of the oral tongue]

BACKGROUND & OBJECTIVE

At present, there is no clinical examination that can accurately assess the lymph node metastasis status of oral tongue carcinoma with clinically negative neck lymph node (cN0) before operation. Therefore, the treatment of cN0 neck is still controversial. Sentinel lymph node (SLN) biopsy may be the evidence for individual treatment of cN0 neck. This study was to explore the feasibility of SLN radiolocalization, and to investigate the clinical value of SLN detection in squamous cell carcinoma of the oral tongue.

METHODS

Twenty-one oral tongue squamous cell carcinoma patients with cN0 necks were recruited, among which 1 had received primary dissection before. 99mTc-SC, as the tracer, was injected into the submucosa around primary tumor before operation. Lymphoscintigraphy was performed immediately in 5 cases. The gamma probe was used to identify SLNs for all cases before and during operation. All patients received supraomohyoid neck lymph node dissection. The pathologic results were considered as golden standard to evaluate the effectiveness of SLN radiolocalization. SLNs that had been reported as negative by routine pathologic examination were examined by immunohistochemistry.

RESULTS

The detection rate of SLNs was 100%. Among the 21 patients, the pathologic results of SLNs for 21 patients accorded with the pathologic results of neck lymph node dissection; the accuracy rate was 95%. In 1 patient, the pathologic result of SLNs was negative, but that of neck lymph node dissection was positive. Micrometastases were found in 3 of 41 detected lymph nodes by immunohistochemstry.

CONCLUSIONS

SLN radiolocalization in squamous cell carcinoma of the oral tongue is feasible. SLN biopsy can well predict the cervical lymph node metastasis status of oral tongue carcinoma, but further investigation is necessary to determine its clinical value.

[Treatments and outcomes of 10 cases of subglottic cancer and literature review]

BACKGROUND & OBJECTIVE

Subglottic cancer is rare. The subglottic region of the larynx is occult, which leads to misdiagnosis or missed diagnosis of subglottic cancer. It is usually advanced when initially presented. There is no large amount case-control study on subglottic cancer, and management of this tumor is still controversial. This study was to analyze the clinical features, treatments, and outcomes of subglottic cancer.

METHODS

Clinical records of 10 subglottic cancer patients, treated in Cancer Center of Sun Yat-sen University from Jan. 1981 to Oct. 2005, were reviewed.

RESULTS

Of the 10 patients, 4 had intralaryngeal invasion of more than half circle, 4 had extralaryngeal invasion, and 1 had lymph node metastasis. The patients were followed up for 1-15 years; 1 was lost. The overall 5-year survival rate was 55.5% (5/9). Excepted for the 2 patients denied treatment, the 5-year survival rate of the 7 treated patients was 71.4%, the 5-year disease-free survival rate was 42.9%. The 5-year disease-free survival was 0/2 for the patients received radiotherapy alone, 1/2 for those received operation alone, and 2/3 for those received both treatments.

CONCLUSIONS

Subglottic cancer is usually advanced when diagnosed, and tends to extend within the larynx and infiltrate other organs. The prognosis is poor. Total laryngectomy is still the main operation for subglottic cancer, and operation combined with radiotherapy is better than single treatment.

Therapeutic targeting of the endothelin a receptor in human nasopharyngeal carcinoma

The endothelin A receptor (ET(A)R) autocrine pathway is overexpressed in many malignancies, including nasopharyngeal carcinoma (NPC). In this tumor, ET(A)R expression is an independent determinant of survival and a robust independent predictor of distant metastasis. To evaluate whether ET(A)R represents a new target in NPC treatment, we tested the therapeutic role of ET(A)R in NPC. Cell proliferation was inhibited by the ET(A)R-selective antagonist ABT-627 in two ET(A)R-positive NPC cells in a dose-dependent manner. Proliferation of ET(A)R-negative NPC cells was not decreased. ET(A)R blockade also resulted in sensitization to cisplatin and 5-fluorouracil-induced apoptosis. In nude mice, ABT-627 inhibited the growth of NPC cell xenografts. Combined treatment of ABT-627 with the cytotoxic drug cisplatin or 5-fluorouracil produced additive antitumor effects. The antitumor activity of ABT-627 was demonstrated finally on an experimental lung metastasis by a reduction in the number of tumors. These results support the rationale of combining ABT-627 with current standard chemotherapy to further improve the therapeutic ratio in the treatment of NPC.

[Treatment and prognosis of anaplastic thyroid carcinoma]

OBJECTIVE

To investigate the treatment model and the factors that influence survival of the patients with anaplastic thyroid carcinoma (ATC).

METHODS

The clinical data of all patients with ATC in our hospital from May. 1970 to May. 2005 were analyzed retrospectively with regard to mortality and survival rate (Kaplan-Meier). Multivariate analysis was performed by the Cox proportional hazard model.

RESULTS

Fifty cases together were analyzed. The overall 1-year, 3-year, 5-year survival rate were 39.4%, 29.6% and 20.7% respectively. The median survival time was 6 months. Univariate analysis showed the patients with their age < 55 years old, without distant metastasis, white blood cell count < 10.0 x 10(9)/L at presentation, without receiving chemotherapy, receiving radiotherapy with the dose no less than 40 Gy, receiving multiple modality therapy had a better prognosis. White blood cell count at presentation, the model of therapy were the risk factors independently influencing prognosis by multivariate analysis.

CONCLUSIONS

White blood cell count at presentation, receiving surgery and postoperative radiotherapy or not were the risk factors independently influencing prognosis. The prognosis of anaplastic thyroid carcinoma was worse; the patients with ATC maybe get a better prognosis by receiving surgery and postoperative radiotherapy.

[Primary investigation of dose-effect relationship of 153Sm-EDTMP in treating multiple bone metastases]

BACKGROUND & OBJECTIVE

Dose calculation of radionuclide internal irradiation is a hot topic and difficulty of nuclear medical researches. This study was to calculate the focus absorption dose of 153Sm-EDTMP with the Monte Carlo EGS4 method for treatment of bone metastases from nasopharyngeal carcinoma or breast cancer, and investigate the relationship between the focus absorption dose and painkilling effect of 153Sm-EDTMP.

METHODS

Four patients with multiple bone metastases from nasopharyngeal or breast carcinoma and suffered from grade IV bone pain were treated with radionuclide internal irradiation of 153Sm-EDTMP. The absorption dose and dose distribution of bone metastases and other targeted organs were calculated with MC EGS4 program based on the time-order SPECT/CT scanning and the measurement of the radioactivity in the urine accumulation. The release of bone pain and the improvement of life quality were observed.

RESULTS

Bone pain of the patients was significantly alleviated to grade II for 3-4 weeks after internal 153Sm-EDTMP irradiation. The 3-dimensional absorption dose distribution image of bone metastases and targeted organs showed that the dose distribution in bone metastases was not asymmetrical. After injection of 0.65x37 MBq/kg 153Sm-EDTMP, the highest absorption dose in bone lesions was about 4.9-5.9 Gy, and the dose in the lesion margin was about 2.0 Gy. Use the highest dose as reference dose point, the relative absorption dose values of bone marrow, bone cortex, and soft tissue near lesions were 0.48-1.1 Gy, 0.51-0.85 Gy, and 0.01-0.14 Gy, respectively.

CONCLUSIONS

The absorption dose of bone metastases is significantly lower than treatment dose of 30 Gy after single irradiation of 153Sm-EDTMP. The painkilling effect is limited and in accordance with clinical observation.

[Correlation of cervical lymphatic metastasis to prognosis of T3-T4 glottic cancer]

BACKGROUND & OBJECTIVE

The cervical lymphatic metastasis rate of glottic cancer is low, and has seldom been reported. This study was to explore the factors related to cervical lymphatic metastasis of T3-T4 glottic cancer, and analyze its correlation to prognosis.

METHODS

Clinical data of 83 patients with T3-T4 glottic cancer, treated in Cancer Center of Sun Yat-sen University from 1992 to 2000, were reviewed retrospectively. The lymphatic metastasis rate, distribution of metastatic lymph nodes, influence factors of neck recurrence of cN0 glottic cancer, and correlation of cervical lymphatic metastasis to prognosis of T3-T4 glottic cancer were analyzed.

RESULTS

Overall lymphatic metastasis rate was 20.5%. The neck recurrence rate of cN0 patients was 14.3%. Most metastatic lymph nodes located at the ipsilateral levels II, III, and IV, while only 1 located at the contralateral level II. For cN0 patients, there was no difference in the neck recurrence rate between observation group and prophylactic cervical radiation group (P=0.772). Histopathologic differentiation affected the neck recurrence of cN0 patients (P=0.028); while T stage did not relate to the neck recurrence (P=0.217). The prognosis of cN+ patients was poorer than that of cN0 patients (P<0.001). The neck recurrence of CN0 patients did not affect the prognosis (P=0.460).

CONCLUSION

Most metastatic lymph nodes of T3-T4 glottic cancer locate at the ipsilateral levels II, III, and IV. Poor differentiation is significantly correlated to high risk of neck recurrence among cN0 patients. However, the recurrence does not affect the prognosis. Close observation should be done to the cervix of cN0 patients; while neck dissection should be done to cN+ patients.

[In vitro preservation of laryngeal allograft for larynx transplantation]

BACKGROUND & OBJECTIVE

As a complex organ, laryngeal allograft cannot endure more than 3 hours during preservative time in vitro. This study was to explore the best preservation method and time limit of laryngeal allograft.

METHODS

During transplantation experiment of the larynx, HCA solution and UW's solution was used to perfuse laryngeal allograft on original position separately. The sequential morphologic changes of the allograft after cold preservation were observed to compare the effects of the 2 solutions.

RESULTS

After preservation in HCA solution for 20 h, ultrastructure changes, including mitochondrial edema or collapse and chromatin agglutination, appeared in mucosa, capillary and intrinsic laryngeal muscle cells of the laryngeal allograft; nuclear pyknosis was observed after 22 h and followed by apoptosis. While ischemic and necrosis changes of the laryngeal allograft appeared after preservation in UW's solution for 24 h.

CONCLUSIONS

UW's solution can preserve laryngeal allograft for 24 h in vitro, and has better effect than HCA solution.

[Evaluation of CT, MRI and PET-CT in detecting retropharyngeal lymph node metastasis in nasopharyngeal carcinoma]

BACKGROUND & OBJECTIVE

At present, the detection of retropharyngeal lymph node (RLN) metastasis in nasopharyngeal carcinoma (NPC) mainly depends on imaging, but the diagnosis criteria are controversial. Recently, the 18F-fluoro-2-deoxy-D-glucose positron emission tomography ((18)FDG-PET-CT) has been widely applied in diagnosing cancer. This study was to evaluate CT, MRI, and (18)FDG-PET-CT in detecting RLN metastasis of NPC, and explore the imaging diagnosis criteria.

METHODS

From Dec. 2003 to Aug. 2005, 53 consecutive patients with NPC treated in Cancer Center of Sun Yat-sen University were enrolled. Contrast enhanced CT, MRI, and (18)FDG-PET-CT were performed on bilateral RLNs of the patients within 10 days before treatment. The diagnosis criteria of RLN metastasis for CT and MRI included single node with maximum diameter of > or =4 mm, and the presence of central necrosis or ringed enhancement; the criteria for (18)FDG-PET-CT included abnormal accumulation of irradiation in the RLN with the standard uptake value (SUV) of > or =2.5. Considering the response of RLN to clinical treatment, the differences of CT, MRI, and PET-CT in detecting RLN metastasis were compared.

RESULTS

Among the 106 intropharyngeal spaces of the 53 patients, the positive rate of RLN metastasis was significantly higher detected by CT and MRI than by PET-CT (39.6% and 45.3% vs. 20.8%, P<0.01), but the difference between CT and MRI was not significant (P>0.05). CT detected 27 cases of RLN metastasis with the maximum diameter of 0.4-0.9 cm, MRI detected 31 cases, and PET-CT only detected 5 cases. Especially, MRI detected 7 cases of RLN metastasis with the maximum diameter of < or =0.5 cm, CT detected 4 cases, but PET-CT detected none. CT detected 12 cases of RLN metastasis with the maximum diameter of > or =1.0 cm, MRI detected 14 cases, and PET-CT detected 13 cases. All patients were followed-up after treatment. One case of RLN metastasis with necrosis and the maximum diameter of 1.0 cm, and 1 case with the maximum diameter of 1.5 cm were eliminated within 6 months after treatment; the rest were eliminated within 3 months.

CONCLUSIONS

In detecting RLN metastasis in NPC, MRI has no obvious advantage over CT, while PET-CT is markedly inferior to CT and MRI, especially in detecting the cases with the maximum diameter of <1.0 cm. Furthermore, the metastatic RLNs with necrosis or the maximum diameter of < or =5 mm can't be detected by PET-CT. Setting the maximum diameter of > or =4 mm as a diagnosis criterion of RLN metastasis for CT or MRI is reasonable and feasible.

[Effect of survivin shRNA on chemosensitivity of human ovarian cancer cell line OVCAR3 to paclitaxel]

BACKGROUND & OBJECTIVE

Drug resistance is a major obstacle to the successful chemotherapy of ovarian cancer. Recent studies have shown overexpression of Survivin in ovarian cancer tissues and cell lines, which may play an important role in the drug resistance of ovarian cancer. This study was to explore the effects of Survivin short hairpin RNA (shRNA) on Survivin expression, apoptosis, and chemosensitivity of human ovarian cancer cell line OVCAR3.

METHODS

OVCAR3 cells were transfected with Survivin shRNA. Untransfected, lip-transfected, and mU6-transfected cells were set as controls. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the expression of Survivin mRNA. Flow cytometry was applied to examine the expression of Survivin protein and cell apoptosis. MTT assay was used to examine the effect of Survivin shRNA on chemosensitivity of OVCAR3 cells.

RESULTS

The mRNA and protein levels of Survivin were obviously lower in Survivin shRNA-transfected OVCAR3 cells than in untransfected cells, lip-transfected cells, and mU6-transfected cells 24 h after transfection. The apoptotic rates of OVCAR3 cells 12 h, 24 h, 36 h, 48 h after Survivin shRNA transfection were 20.7%, 31.9%, 39.0%, and 46.7%, respectively, that showed a time-dependent manner. The 50% inhibitory concentrations (IC50) of paclitaxel were (0.305+/-0.032) micromol/L for untransfected cells, (0.157+/-0.031) micromol/L for lip-transfected cells, (0.175+/-0.010) micromol/L for mU6-transfected cells, and (0.019+/-0.001) micromol/L for Survivin shRNA-transfected cells; and the IC50 of cisplatin were (9.410+/-0.796) micromol/L, (6.675+/-1.739) micromol/L, (6.930+/-1.273) micromol/L, and (7.862+/-0.081) micromol/L, respectively. Survivin shRNA increased the sensitivity of OVCAR3 cells to paclitaxel by 16 folds (P<0.01), but had no significant effect on the sensitivity to cisplatin (P>0.05).

CONCLUSION

Sequence-specific shRNA targeting Survivin can suppress the expression of Survivin gene effectively in OVCAR3 cells, and sensitize OVCAR3 cells to paclitaxel, but has no significant effect on the sensitivity to cisplatin.

[Neck relapse-related factors of cN0 stage supraglottic cancer]

BACKGROUND & OBJECTIVE

The occult lymph node metastasis rate of supraglottic cancer is high, and the treatment of occult lymph node metastasis is important. This study was to explore the related factors, treatment, and prognosis of occult lymph node metastasis of supraglottic cancer.

METHODS

Clinical data of 104 patients with cN0 supraglottic cancer, treated in Cancer Center of Sun Yat-sen University from 1992 to 1999, were retrospectively reviewed. The occult lymph node metastasis rate, distribution of metastatic lymph nodes, related factors, and treatment of the neck were analyzed.

RESULTS

The occult lymph node metastasis rates were 23.1% (24/104) in the whole group, and 23.9% (11/46) in stage T2 patients, 30.8% (8/26) in stage T3, 18.5% (5/17) in stage T4. The metastatic lymph nodes mainly located at lateral levels II-III(22/24). The prognosis of the patients with occult lymph node metastasis was poor (log-rank=10.66, P=0.001). Positive margin increased occult lymph node metastasis rate (Chi(2)=10.015, P=0.002), while pathologic differentiation (Chi(2)=3.349, P=0.175), T stage (Chi(2)=2.701, P=0.440), and treatment of primary lesion (Chi(2)=1.093, P=0.296) had no effects on it. Selective neck dissection reduced occult lymph node metastasis rate (Chi(2)=4.070,P=0.044).

CONCLUSIONS

The occult metastatic lymph nodes of cN0 supraglottic cancer mainly locate at lateral levels II-III. The prognosis of the patients with occult lymph node metastasis is poor. Positive margin increases occult lymph node metastasis rate. For patients at stage T1N0, observation is enough; for patients at stage T2-4N0, lateral neck dissection (levels II-IV) is effective.

[Expression and clinical significance of VEGF-C and Flt-4 in tongue squamous cell carcinoma]

BACKGROUND & OBJECTIVE

Vascular endothelial growth factor-C (VEGF-C) could induce lymphangiogenesis in or around solid tumor, and is closely related with lymphatic metastasis. This study was to investigate the expression and clinical significance of VEGF-C and its receptor fms-like tyrosine kinase-4 (Flt-4) in tongue squamous cell carcinoma (TSCC).

METHODS

The expression of VEGF-C and Flt-4 in 99 specimens of TSCC and 17 specimens of benign tongue epithelial lesions was detected by LSAB immunohistochemistry. The correlations of expression of VEGF-C and Flt-4 to the clinicopathologic features and prognosis of TSCC were analyzed.

RESULTS

The positive rates of VEGF-C and Flt-4 were significantly higher in TSCC than in benign tongue epithelial lesion (35.35% vs. 5.88%, and 40.40% vs. 5.88%, P<0.05). The positive rate of VEGF-C was significantly higher in TSCC with cervical lymph node metastasis than in TSCC without metastasis (43.75% vs. 20%, P<0.05), and significantly lower in stage I-II TSCC than in stage III-IV TSCC (18.52% vs. 41.67%, P<0.05). The cumulative 5-year survival rates of the patients with positive expression of either VEGF-C or Flt-4 were significantly lower than those of the patients with negative expression of either VEGF-C or Flt-4 (45.08% vs. 68.25%, and 38.03% vs. 75.46%, P<0.05).

CONCLUSIONS

The positive rates of VEGF-C and Flt-4 are significantly higher in TSCC than in benign tongue epithelial lesions. The expression of VEGF-C is correlated with cervical lymph node metastasis and clinical stage. The prognosis of TSCC patients with high expression of VEGF-C and Flt-4 is poor.

An analysis of outcomes for hypopharyngeal squamous cell carcinoma treated with different methods

AIM: To analyze the outcomes of hypop-haryngeal squamous cell carcinoma treated with different methods and to explore a more effective therapy for it.

METHODS: This retrospective study concerns 187 hypopharyngeal squamous cell carcinomas and their characteristics. The survival rate, recurrence rate and influence of laryngeal preservation on the survival were compared among different therapies.

RESULTS: The overall 5-year survival rate was 44.9%. The 5-year survival rates of stageⅠ, Ⅱ, Ⅲ and Ⅳ were 100%, 81.8%, 47.6%, and 30.2%, respectively, and the former two were significantly higher than the latter two (χ² = 22.878, P = 0.000 1). The overall 5-year survival rate for synthetic therapy, surgery and radiotherapy alone was 60.8%, 38.7%, and 22.0%, respectively, and the survival rates of patients at stage Ⅲ and Ⅳ were 75.5% and 45.3% for synthetic therapy, 33.3% and 17.6% in surgery alone, 16.7% and 7.7% in radiotherapy alone. The survival rates of stage Ⅲ and stage Ⅳ in patient received synthetic therapy were markedly higher than those in patient received surgery or radiotherapy (all P < 0.05). The overall recurrence rate was 44.9%. The 5-year recurrence rates of stage Ⅱ, Ⅲ and Ⅳ were 31.8%, 47.6% and 49.0%, respectively, and there was a significant difference between stage Ⅲ, Ⅳ and stage Ⅰ, Ⅱ(48.4% vs 25%, χ² = 5.816, P = 0.016). Significant differences were shown in the recurrence rate of stage Ⅲ, Ⅳ between synthetic therapy (26.7%) and surgery (60.9%) or radiotherapy (80%)(all P < 0.01). The recurrence rates of highly, moderately and lowly differentiated carcinoma were 34.2%, 50% and 56.1%, respectively, and there was significant differences between highly and moderately or lowly differentiated carcinoma (χ²= 4.977, P = 0.026). The 5-year survival rate was not significantly different between patients with laryngeal preservation and without laryngeal preservation at stage Ⅲ or Ⅳ (all P > 0.05).

CONCLUSION: Synthetic therapy is superior to surgery or radiotherapy alone in the treatment of hypopharyngeal squamous cell carcinoma. Laryngeal preservation can be achieved in some of patients at stage Ⅲ or Ⅳ.

[Treatment and prognosis of stage T3 glottic laryngeal cancer--a report of 65 cases]

BACKGROUND & OBJECTIVE

Clinical treatment of stage T3 glottic laryngeal cancer still remains controversial. This study was to explore the influences of different treatment modalities, lymph node metastasis, and positive margin on prognosis of stage T3 glottic cancer.

METHODS

Records of 65 stage T3 glottic cancer patients, treated in Cancer Center of Sun Yat-sen University from Jan. 1, 1990 to Dec. 30, 1998, were retrospectively analyzed. The influences of different treatments, lymph node metastasis, and positive margin on survival of the patients were analyzed.

RESULTS

The 3- and 5-year overall survival rates were 75.47% and 65.07%. No significant difference was found among surgery alone, radiotherapy alone, and surgery plus adjuvant radiotherapy groups (P=0.914), between partial laryngectomy and total laryngectomy groups (P=0.710), and between positive margin and negative margin groups (P=0.176). The lymph node metastasis rate was 18.5%, and the occult lymph node metastasis rate was 10.8%. Lymph node metastasis was a poor prognostic factor (P<0.001).

CONCLUSIONS

The influences of different treatments on survival of stage T3 glottic cancer patients are similar, and the effects of partial laryngectomy and total laryngectomy are also similar. Lymph node metastasis affects prognosis, and wait-and-see is recommended to cN0 patients. The survival of patients with positive margin after postoperative radiotherapy is similar to that of patients with negative margin.

[Treatment and prognosis of stage III-IV laryngeal squamous cell carcinoma]

BACKGROUND & OBJECTIVE

Laryngeal squamous cell carcinoma (LSCC) is a common malignancy of the head and neck. Stage I-II LSCC patients have a favorable prognosis after operation or radiotherapy, but the curative effect and prognosis of stage III-IV LSCC are not satisfying, and its treatment is also controversial. This study was to summarize our experience in treating stage III-IV LSCC patients, evaluate the treatment results, and seek more reasonable therapeutic modality.

METHODS

Records of 202 stage III-IV LSCC patients, treated in Cancer Center of Sun Yat-sen University from Jan. 1, 1991 to Jan. 1, 2000, were retrospectively analyzed. Of the 202 patients, 64 received surgery alone, 83 received surgery and preoperative or postoperative radiotherapy, 41 received radiotherapy, and 14 received chemotherapy. The overall survival rate was estimated using life table method by SPSS10.0 software. Survival curves were compared with Wilcoxon method; relapse statuses were compared with Chi(2) test.

RESULTS

The 5- and 10-year overall survival rates of the 202 patients was (42.12+/-3.62)% and (33.20+/-4.32)%, and the median survival time was 48.5 months. The 5-year survival rates were 61.07% in glottic carcinoma group and 26.07% in supraglottic carcinoma group, and were 53.41% in surgery alone group, 51.04% in surgery plus radiotherapy group, 18.33% in radiotherapy group and 7.14% in chemotherapy group. There was no significant difference between surgery alone group and surgery plus radiotherapy group (P>0.05). Of the 147 patients received surgery, the 5-year survival rates were 56.15% for the 31 patients received partial laryngectomy and 52.08% for the 116 patients received total laryngectomy. Eleven patients had tumor relapsed after total laryngectomy within 5 years.

CONCLUSIONS

Surgery, especially total laryngectomy, is the major treatment modality for stage III-IV LSCC. Partial laryngectomy may be performed with strict selection. Postoperative radiotherapy may be preformed on the patients with suspect of tumor residue or positive margin.

Elevated plasma big ET-1 is associated with distant failure in patients with advanced-stage nasopharyngeal carcinoma

BACKGROUND

Endothelin-1 (ET-1) is a potent vasoactive peptide and a hypoxia-inducible angiogenic growth factor associated with the development and spread of solid tumors. The clinical significance of plasma big ET-1 in patients with advanced-stage nasopharyngeal carcinoma (NPC) is not known.

METHODS

Pretreatment plasma big ET-1 levels were measured in 62 patients with advanced-stage NPC using a sandwich enzyme-linked immunoassay and compared with the levels from a control group (n = 19 participants).

RESULTS

The median pretreatment plasma big ET-1 level in patients with advanced-stage NPC was 4.6 pg/mL (range, 1.9-15.2 pg/mL) and was significantly elevated compared with median plasma big ET-1 levels in healthy controls, 2.6 pg/mL (1.6-4.5 pg/mL) (P < .001). Using the upper limit (4.5 pg/mL) of control subjects as the cut-off value, plasma big ET-1 was < or = 4.5 pg/mL in 29 (46.8%) patients and > 4.5 pg/mL in 33 (53.2%) patients. A pretreatment plasma big ET-1 level > 4.5 pg/mL was associated with a significantly poorer 2-year distant metastasis-free survival rate (56.7% vs. 81.1%, P = .031). Multivariate analysis showed that N classification (hazard ratio [HR], 2.416; 95% confidence interval [CI], 1.071-5.447; P = .034) and pretreatment plasma big ET-1 level (HR, 3.151; 95% CI, 1.099-9.028, P = .033) were independent significant prognostic factors for posttreatment distant failure in patients with advanced-stage NPC.

CONCLUSIONS

Pretreatment plasma big ET-1 levels may be useful in predicting posttreatment distant failure in patients with advanced-stage NPC.

[Establishment of a modified larynx transplantation model with inbred F344 rat]

BACKGROUND & OBJECTIVE

As a non-vital organ, transplantation of larynx lags behind that of the other organs, but it is supposed that if induction of immunologic tolerance of the host to the allograft comes true, larynx transplantation would be an optimal approach for management of advanced laryngeal cancer as well as functional reconstruction of the larynx. This study was designed to establish a modified rat model of larynx transplantation to improve survival rate of the recipients and vitality of the allografts, and provide an optimal rat model for further research on immunology and induction of immunologic tolerance in larynx transplantation.

METHODS

A Strome's model of larynx transplantation was repeated with inbred F344 rats (40 rats in Stroma model A and 40 rats in Stroma model B). A modified model of larynx transplantation was developed (40 rats), in which both superior thyroid arteries and ascending pharyngeal arteries were preserved, combining with the hyoid, base of the tongue, hypopharynx, larynx, thyroid, part of the cervical trachea and cervical esophagus as an allograft complexity. The blood supply of the allograft was reconstructed through end-to-end anastomosis of the donors' carotid arteries with the recipients' carotid artery and anterior jugular vein. The recipients were injected with 15 ml of 5% glucose normal saline (GNS) through contralateral external jugular vein intraoperatively, and injected subcutaneously with 5 ml of 5% GNS daily for 3-5 days postoperatively. Morphology of the allografts and patency of the arteries and veins were observed under microscope 7 days after operation, and vitality of the allogafts was assessed pathologically. Survival of the recipients and vitality of the allografts in Strome model and modified model were compared.

RESULTS

Survival rates of the recipient rats were 70% in Strome model A, 85% in Strome model B, and 95% in modified model; the survival rates of the allografts were 30% in Strome model A, 40% in Strome model B, and 80% in modified model, respectively.

CONCLUSIONS

Compare with Strome models, the modified model of larynx transplantation reduces mortality of the recipients through enhancing perioperative care, improves vitality of the allografts through including both ascending pharyngeal arteries and superior thyroid arteries in the allograft complexity, which increases blood supply of the allografts and reduces micro-circulation resistance, therefore, reduces the micro-circulation malfunction of the allografts.

[Expression of S100-labeled dendritic cells in glottic squamous cell carcinoma and its correlation to prognosis]

BACKGROUND & OBJECTIVE

Dendritic cells (DCs) are the most important antigen-presenting cells, and can synthesize and secrete S100 protein. This study was designed to investigate the expression of S100-labeled DCs in glottic squamous cell carcinoma, and analyze its correlation to the prognosis.

METHODS

The expression of S100-labeled DCs in peritumoral tissues of 111 specimens of gllotic squamous cell carcinoma was detected by immunohistochemistry; 17 specimens of normal tissues were used as control. The correlation of S100-labeled DCs expression to prognosis of the 111 patients was evaluated.

RESULTS

The positive rates of S100-labeled DCs were 51.35% (57/111) in peritumoral tissues of gllotic squamous cell carcinoma, and 0 in normal tissues. The 5-year survival rate was significantly higher in S100-positive group than in S100-negative group (72.31% vs. 53.91%, P=0.030).

CONCLUSIONS

The glottic squamous cell carcinoma patients with obvious infiltration of S100-labeled DCs may achieve good prognosis.

[Expression and clinical significance of CD1a+ dendritic cells in glottic squamous cell carcinoma]

BACKGROUND & OBJECTIVE

Dendritic cells (DCs) are the most important antigen-presenting cells. CD1a, a marker of immature DCs, plays a role in tumorigenesis. This study was designed to explore the correlation of CD1a(+) DCs to pathologic degree, T stage, local recurrence, and prognosis of glottic squamous cell carcinoma.

METHODS

Clinical and follow-up data of 111 patients with glottic squamous cell carcinoma were analyzed retrospectively. The expression of CD1a(+) DCs in the 111 specimens of glottic squamous cell carcinoma and 17 specimens of non-tumor tissue was detected by immunohistochemistry. Correlations of CD1a(+) DCs to pathologic degree, T stage, local recurrence, and prognosis of glottic squamous cell carcinoma were analyzed.

RESULTS

Positive rates of CD1a(+) DCs were 59.46% in glottic squamous cell carcinoma tissues, and 0 in non-tumor tissues; it was significantly higher in well-differentiated group than in moderately-and poorly-differentiated group [71.43% (55/77) vs. 28.57% (11/34), P<0.05], higher in T1-T2 group than in T3-T4 group [67.16% (45/67) vs. 47.73% (21/44), P<0.05], and higher in non-recurrence group than in local recurrence group [65.06% (54/83) vs. 42.86% (12/28), P<0.05].

CONCLUSIONS

The lower pathologic degree and higher T stage of glottic squamous cell carcinoma, the lower expression of CD1a(+) DCs. The positive rate of CD1a(+) DCs is low in recurrent glottic tumor. High expression of CD1a(+) DCs may indicate better prognosis of glottic squamous cell carcinoma.

[Recurrence risk factors of platinum-sensitive epithelial ovarian cancer]

BACKGROUND & OBJECTIVE

The prognosis of platinum-sensitive ovarian cancer patients was better than that of chemoresistant ones. However, platinum-sensitive ovarian cancer patients still have a high recurrence rate, which affects their prognosis. This study was designed to analyze clinical features and recurrence risk factors of platinum-sensitive epithelial ovarian cancer.

METHODS

Factors that might relate to recurrence of 90 platinum-sensitive epithelial ovarian cancer patients, admitted in Cancer Center of Sun Yat-sen University from 1993 to 1999, with complete remission of more than 6 months, were assessed. Univariate analysis was performed using Chi(2) test; while multivariate analysis was carried out using Cox proportional hazard model.

RESULTS

Among the 90 patients, 36(40.0%) relapsed with the median recurrence-free interval of 20 months. Pelvic cavity (18/36, 50.0%) was the most frequently involved. The 3-and 5-year survival rates of all patients were 79.6% and 69.5%; while those of the recurrent ones were 62.3% and 39.6%. Univariate analysis showed that the early FIGO stage group, mucinous type group, and no neoadjuvant chemotherapy group had lower recurrence rates than advanced FIGO stage group, non-mucinous type group, and neoadjuvant chemotherapy group, respectively (P=0.001, P=0.002, and P=0.025). Cox multivariate analysis showed that only FIGO stage was the independent risk factor of recurrence of ovarian cancer (risk ratio=1.771, P=0.003). There was no significant difference in recurrence rate between CBP and other postoperative chemotherapy regimen groups. More cycles of chemotherapy could not reduce the recurrence rate.

CONCLUSION

Since FIGO stage is an independent recurrence risk factor of platinum-sensitive epithelial ovarian cancer patients, early diagnosis is the key point to decrease the recurrence rate.

[Extramedullary plasmacytoma in the head and neck: a report of 10 cases and literature review]

BACKGROUND & OBJECTIVE

Extramedullary plasmacytoma (EMP), a rare tumor, often appears in the head and neck region. About 80% of EMPs occur in the submucosa of the upper aerodigestive tract. On both clinical presentation and pathologic examination, these tumors may be confused with some common tumors in the head and neck. This study was to evaluate clinical feature, diagnosis, and treatment of EMP in the head and neck.

METHODS

Clinical data of 10 consecutive patients with pathologically confirmed EMP in the head and neck, treated in our hospital from Jan. 1977 to Dec. 2003, were reviewed. Of the 10 patients, 2 underwent surgery alone, 2 underwent surgery plus adjuvant radiotherapy,4 received radical radiotherapy, 1 received radical radiotherapy plus adjuvant chemotherapy, and 1 gave up treatment.

RESULTS

The patients mainly manifested as local masses and relevant symptoms. Of the 3 patients received immunohistochemical staining to detect IgG, 1 was lambda type, and 2 were kappa type. Six patients received Bence-Jones protein detection, and 4 patients received serum myeloma protein detection; all of them showed negative results. Bone marrow biopsy was made in 4 patients, skeletal survey was made in 4 patients; all results were normal. By the end of follow-up (Mar. 2003), 6 patients were still alive (5 patients survived for more than 1 year, 3 of the 5 patients survived disease-freely for more than 15 years); 1 died of local recurrence 2 years after diagnosis; 1 died of multiple myeloma; 1 died of heart disease before treatment; 1 lost follow-up.

CONCLUSIONS

The diagnosis of EMP mainly depends on clinical manifestation and pathologic results. Radiotherapy and surgery are the main treatments for EMP in the head and neck.

[Correlation of endothelin A receptor expression to prognosis of nasopharyngeal carcinoma]

BACKGROUND & OBJECTIVE

Endothelin A receptor (ET(A)R) activation contributes to tumor growth and metastasis, including cell proliferation, cell death, angiogenesis, and metastatic spread. In this study, we evaluated correlation of ET(A)R expression to clinical features of nasopharyngeal carcinoma (NPC), and explored its correlation to prognosis.

METHODS

Expression of ET(A)R in 153 specimens of NPC was detected by SABC immunohistochemistry.

RESULTS

Positive rate of ET(A)R was 73.9% in the 153 NPC specimens. No correlation was found between ET(A)R expression and gender, age, T stage, N stage, and TNM stage of the patients. The 3-year overall survival rate, relapse-free survival rate, and distant metastasis-free survival rate were significantly higher in ET(A)R-negative patients than in ET(AR-positive patients (87.5% vs. 73.2%, P = 0.029; 80.0% vs. 57.3%, P = 0.009; and 89.9% vs. 70.4%, P = 0.012), except for local relapse-free survival rate (86.9% vs. 80.2%, P = 0.228). Cox multivariate analysis showed that ET(A)R expression, gender, age, T stage, and N stage were independent prognostic factors, which affected overall survival, relapse-free survival, and distant metastasis.

CONCLUSION

ET(A)R expression is an important distant metastasis-related risk factor for patients with NPC; its overexpression indicates poor prognosis.

[Primary effect of submandibular salivary gland transfer in preventing radiation-induced xerostomia of nasopharyngeal carcinoma]

BACKGROUND & OBJECTIVE

Xerostomia, an ubiquitous sequelae in nasopharyngeal carcinoma (NPC) patients after radiotherapy, seriously affects life quality of the patients. This study was to investigate clinical value of submandibular salivary gland transfer in preventing radiation-induced xerostomia of NPC patients.

METHODS

A total of 70 eligible patients with NPC were recruited, and divided into test group (36 patients) and control group (34 patients). In test group, the submandibular glands were transferred to the submental spaces before conventional radiotherapy. The submental spaces were shielded during radiotherapy. Oral cavity mucous membrane reaction during radiotherapy, submandibular gland function and salivary fluid before and after radiotherapy, and questionnaire of xerostomia 3 months after radiotherapy were compared between test group and control group.

RESULTS

Acute oral cavity mucous membrane reaction was severer in control group than in test group; the incidence of stage III reaction was significantly higher in control group than in test group ( 8/34 vs. 3/36, P = 0.007). Three months after radiotherapy, trapping and excretion functions of the transferred submandibular glands were significantly better than those of the untransferred submandibular glands in test group (P = 0.001 and P = 0.000); trapping and excretion functions of the submandibular glands were significantly better in test group than in control group (P = 0.004 and P = 0.000). The mean weight of salivary fluid after radiotherapy was heavier in test group than in control group (1.41 g vs. 0.71 g). Incidence of moderate to severe degree of xerostomia was significantly higher in test group than in control group (76.5% vs. 13.9%, P = 0.000).

CONCLUSION

Submandibular gland transfer may be used to prevent radiation-induced xerostomia of NPC patients, and may improve life quality of the patients.

Overexpression of MMP-2 in laryngeal squamous cell carcinoma: a potential indicator for poor prognosis

OBJECTIVES

To investigate the expression and clinical significance of gelatinases (MMP-2 and MMP-9) in patients with laryngeal squamous cell carcinoma (LSCC).

STUDY DESIGN AND SETTING

In a retrospective study of 72 consecutive patients with LSCC hospitalized in a single cancer center, immunohistochemistry was used to examine the expression of MMP-2 and MMP-9 in surgical samples. The results were compared to clinicopathological features and prognosis.

RESULTS

The positive expression of MMP-2 and MMP-9 in patients with LSCC was 50% (36/72) and 73.6% (53/72), respectively. According to the expression scale, there were 36 patients of -, 26 patients of +, 7 patients of ++, and 3 patients of +++ expression of MMP-2; 19 patients of -, 26 patients of +, 16 patients of ++, and 11 patients of +++ expression of MMP-9. There was no significant relationship found between the expression of MMP-2 or MMP-9 and clinicopathological features of LSCC, such as histological grade, primary site, T stage, N stage, and clinical stage. The 5-year overall survival (OS) and disease-free survival (DFS) rate calculated by Kaplan-Meier method in patients with negative and positive expression of MMP-9 and MMP-2 was 73.68%, 50.94%, 73.68%, and 49.06% in MMP-9 and 72.22%, 41.67%, 72.22%, and 38.89% in MMP-2, respectively. Significant 5-year survival difference was found between patients with negative and positive expression of MMP-2 (log rank = 6.74, P = 0.0094). There was significant lower survival rate in patients with higher positive expression of MMP-2 (log rank = 11.77, P = 0.0028). In glottic laryngeal cancer, positive expression of MMP-2 could predict poor survival and was more likely to present primary recurrence.

CONCLUSION

The expression of MMP-2 could be used as a potential predictor for poor prognosis in patients with LSCC.

[Surgical management for occult cervical metastasis of oral tongue squamous cell carcinoma]

BACKGROUND & OBJECTIVE

In oral tongue squamous cell carcinoma (SCC), the management for clinically negative (cN0) neck remains controversial. This study was to explore rational neck management for cN0 cases.

METHODS

Clinical data of 187 patients with oral tongue SCC of cN0, who received surgery alone, were retrospectively reviewed. Rules of occult nodal metastasis, factors that impact cervical node metastasis, and prognostic factors were analyzed. Neck recurrences of different treatment groups were compared.

RESULT

Incidence of occult nodal metastasis in all patients was 23.0% (43/187). The most common site of occult nodal metastases was ipsilateral level II. About 83.0% of occult nodal metastases were found in ipsilateral levels I, II, and III. Pathologic grade was an independent influencing factor for occult neck metastases. Occult neck metastasis was an independent prognostic factor for oral tongue SCC. Supraomohyoid neck dissection (SOHND) was an effective therapeutic method for oral tongue SCC of cN0; the neck recurrence rate after SOHND was only 6.7%.

CONCLUSIONS

SOHND is the effective and safe treatment for oral tongue SCC.

[Surgery for the recurrent and persistent lymph node of nasopharyngeal carcinoma after radiotherapy]

OBJECTIVES

To investigate the effect of four types of neck dissections for the recurrent and persistent lymph nodes of NPC after radiotherapy.

METHODS

The clinical data of 88 cases of nasopharyngeal carcinoma with recurrent and persistent lymph nodes after radiotherapy were analyzed retrospectively, the 5-year survival rate, recurrent rate, distant metastatic rate and surgical complications were analyzed. The survival rate and recurrent rate of the radical neck dissection (RND), modified radical neck dissection (MRND), selective neck dissection (SND) and lymph node resection (LNR) were compared. The survival and recurrent rate between those with and without postoperative radiotherapy were investigated as well.

RESULTS

The 5-year survival rate and recurrent rate of whole group were 42.8% and 22.7%, respectively. As for the patients with disease staged II, III, IV, the 5-year survival rates were 56.7%, 36.1% and 32.4%, respectively. The 5-year survival rate of groups of RND, MRND, SND and LMR were 39.8%, 60.0%, 37.9% and 44.1%, respectively, the differences were insignificant (Log Rank = 1.0, P = 0.8011), the recurrent rate of the lymph node among the 4 groups were insignificant either (chi2 = 0.470, P = 0.493). The 5-year survival rates of those with and without postoperative radiotherapy were 39.1% and 45.3%, respectively, the differences were insignificant (Log Rank = 0.06, P = 0.8138), the recurrent rate of the two groups were insignificant (chi2 = 0.593, P = 0.441).

CONCLUSIONS

The four types of neck dissection were effective and safe to control the recurrent and persistent lymph nodes in the neck after radiotherapy, as long as choosing patients rationally and gave postoperative radiotherapy if necessary.

[Neck management in oral tongue squamous cell carcinoma of stage I: a report of 95 cases]

BACKGROUND & OBJECTIVE

Cervical lymph node metastasis and recurrence are the most common causes of treatment failure to patients with oral tongue carcinoma. The neck management for oral tongue carcinoma of early stages remains controversial. This study was to evaluate the effectiveness of elective neck dissection (END) in treating oral tongue squamous cell carcinoma (SCC) of stage I.

METHODS

A retrospective analysis of 95 patients with oral tongue SCC of stage I, undergone surgical treatment from 1988 through 1997, was performed to determine the impact of END on patients' outcomes,such as regional recurrence,and overall survival. Of the 95 patients, 24 (observation group) did not undergo END, while the rest 71 (END group) underwent END.

RESULTS

In observation group, the regional recurrence rate was 25.0% (6/24), and the recurrence-related mortality was 20.8% (5/24). END significantly reduced both the regional recurrence rate and the recurrence-related mortality to 7.0% (5/71) and 4.2% (3/71) respectively (Chi(2) test, P < 0.05). The overall survival rate of END group was also significantly higher than that of observation group (log-rank test, P < 0.05).

CONCLUSION

END may improve the neck control rate of oral tongue SCC of stage I, reduce the recurrence-related mortality, and increase the overall survival rate of patients.

[Management option for cervical metastases in tongue squamous cell carcinoma with clinically N0 neck]

OBJECTIVE

This study was designed to explore the optimal management option for cervical metastases in tongue squamous cell carcinoma (SCC) with clinically N0 neck in order to avoid excessive or inadequate treatment in clinical practice.

METHODS

Clinical data of 327 cases of tongue SCC with cN0 neck were retrospectively analyzed. Neck control rates affected by different pathoclinical parameters were compared. Prognosis analysis and death analysis were also performed.

RESULTS

Overall 3-year survival was 69.7% (228/327), 3-year survival of neck recurrent group and non-recurrent group was 39.1% (25/64) and 77.2% (203/263), and 51.5% (51/99) of the death related to neck failure. Overall neck control rate was 80.4% (263/327); neck control rate of wait and watch group, level I neck dissection, level I + II neck dissection, supraomohyoid neck dissection, radical neck dissection, functional neck dissection, was 67.5% (27/40), 72.7% (24/33), 60.0% (15/25), 84.9% (45/55), 86.8% (131/151), 84.0% (21/25), respectively. Treatment modality and cervical lymph node involvement were independent factors for neck control.

CONCLUSIONS

Neck control is a key for prognosis of tongue SCC with cN0 neck. Supraomohyoid neck dissection is the first choice in management of cervical metastases in tongue SCC with cN0 neck, during which the suspected involved lymph nodes should be sent for frozen section to determine whether comprehensive neck dissection required. Multimodal metastasis and/or capsular spread are the indications for postoperative irradiation.

[Surgical treatment of differentiated thyroid carcinoma and analysis of recurrence-related factors]

BACKGROUND & OBJECTIVE

There are many controversies concerning the treatment to patients with differentiated thyroid carcinoma (DTC), focus on appropriate resection extent of DTC, indications for cervical lymph node dissection, et al. This study was to investigate surgical treatment for DTC, and recurrence-related factors.

METHODS

Records of 581 patients with DTC treated at Cancer Center, Sun Yat-sen University from Jan. 1st, 1985 to Dec. 31st, 1997 were reviewed retrospectively. Various operation patterns for DTC and their treatment effects, and recurrence-related factors were analyzed.

RESULTS

Among 377 patients with DTC who received initial surgery at our hospital, and whose main operation patterns were unilateral lobectomy plus isthmectomy with or without cervical lymph node dissection, 28 (7.43%) recurred, the rate of recurrence in contralateral lobe was 0.80%. Among 195 patients with DTC who received initial surgery in other hospitals, and whose main operation patterns were local mass excision with or without cervical lymph node resection, 143 patients received operation again in our hospital, and 100 of 143 (69.93%) were pathologic positive, positive rate of thyroid was 46.15%, that of cervical lymph node was 48.95%; 47 of 195 patients (24.10%) recurred. Recurrence rate of patients mainly received local mass excision with or without cervical lymph node resection was higher than that of patients mainly received unilateral lobectomy plus isthmectomy with or without cervical lymph node dissection (P >0.05).

CONCLUSIONS

Unilateral lobectomy plus isthmectomy with or without cervical lymph node dissection should be recommended as the first treatment for DTC with primary focus localized in unilateral lobe. The initial operation pattern may influence recurrence of DTC.

[Surgical treatment of well-differentiated thyroid carcinoma invading trachea: a report of 15 cases]

BACKGROUND & OBJECTIVES

At present head and neck surgeons from many countries have different opinions on management of well-differentiated thyroid cancer (WDTC). We will discuss WDTC invading trachea surgical treatment and its clinical significance.

METHODS

Retrospectively reviewed clinical data of 15 cases WDTC invading trachea, According to WDTC invading extent and grade, there were 3 kinds of surgical approaches: 1) end to end anastomosis; 2) tissue flap reconstruction; 3)larynx-tracheal dissociation.

RESULTS

15 cases underwent radical resection and reconstruct the defect of tracheal or larynx-tracheal dissociation. 2 cases received directly suture, 5 cases received sternocleidomastoid muscle flap reconstruction, 2 cases received pectorlis major muscle flap reconstruction, 2 cases received platysma flap reconstruction, 2 cases received free forearm flap with muticore titanium-board reconstruction, 2 cases received larynx-tracheal dissociation with larynx block out and tracheal fistula. 10 cases (10/15, 66.7%) received decannulation postoperation. Patients who were success fully decannulated could recover phonation and maintain airway breath. In the 5 patients who couldn't decannulate, underwent sternocleidomastoid muscle flap reconstruction, 1 underwent free forearm flap with muticore titanium-board reconstruction, 1 underwent pectorlis major muscle flap reconstruction, 2 underwent larynx-tracheal dissociation, but all of them could hardly utter voice by compress tracheostoma and needed permanent tracheostoma due to collapse of trachea. The recurrence rate of our group is 33.33%, 5 years survival rate is 88.89%.

CONCLUSIONS

WDTC with trachea invading easily cause dyspnea or emptysis influencing on 5 years survival rate. We should take more actively surgical approach to resect all the tumor and involved organ, thus improve survival rate and reduce recurrence postoperation.