[Prognostic factors of medullary thyroid carcinoma].

OBJECTIVE: To investigate prognostic factors of medullary thyroid carcinoma. METHODS: By using univariate analysis and multivariate analysis, the prognostic factors were investigated in 102 patients with medullary thyroid carcinoma treated at this hospital. RESULTS: Overall survival rates of 5-year, 10-year and 15-year were 87.4%, 74.6% and 54.2% respectively by Kaplan-Meier method analysis. In univariate analysis, gender, age, bilateral thyroid lobe tumors, tumor size > 4 cm, invasion of thyroid capsule, distant metastasis, and non-radical tumor resection were significant poor prognostic factors. In multivariate analysis, tumor size > 4 cm (chi(2) = 7.43, P = 0.0035), distant metastasis (chi(2) = 23.50, P = 0.0000), and non-radical tumor resection (chi(2) = 25.90, P = 0.0000) remained as independent prognostic factors. CONCLUSIONS: Tumor size > 4 cm, distant metastasis, and non-radical tumor resection are the independent predictors of patients survival. Early diagnosis and early therapy can improve significantly the prognosis of medullary thyroid carcinoma.

[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.

[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.

[Expression and significance of E-cadherin in adenoid cystic carcinoma of the salivary glands].

BACKGROUND & OBJECTIVE: There are many researches on the relationship between E-cadherin and cancers, but the results from different studies are various. Recent studies showed that E-cadherin might have complex functions in tumor metastasis. This study was to explore the expression of E-cadherin in adenoid cystic carcinoma of the salivary glands and its correlations to nerve invasion, regional recurrence, distant metastasis and prognosis of this disease. METHODS: The expression of E-cadherin in 55 specimens of adenoid cystic carcinoma of the salivary glands and 20 specimens of normal salivary gland tissue was detected by immunohistochemistry. Patients' survival was analyzed by Kaplan-Meier method. The differences between the 2 groups were compared by log-rank test and Chi2 test. RESULTS: The 5-and 10-year cumulative survival rates of the 55 patients were 78.2% and 51.4%. The positive rate of E-cadherin was significantly higher in normal salivary gland tissues than in adenoid cystic carcinoma tissues (90.0% vs.63.6%, P<0.05). The positive rate of E-cadherin was significantly lower in the group with nerve invasion, regional recurrence and distant metastasis than in the group without (50.0% vs. 71.4%, P=0.012; 52.4% vs. 70.6%, P=0.046; 47.8% vs. 75.0%, P=0.013). CONCLUSION: E-cadherin expression is down-regulated in adenoid cystic carcinoma of the salivary glands, which is correlated to nerve invasion, regional recurrence and distant metastasis.

[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.