小肝癌彩色多普勒血流图像及术中B超诊断

本文报道应用彩色多普勒血流图像（CDFI）及术中B超（IOUS）诊断小肝癌9例，显示小肝癌的肿瘤内外动脉血流图像占88．8％（8／9），动脉阻力指数（ARI）均＞60％（范围68％－89％），网篮征55．5％（5／9）。其它小 占位性病变（血管瘤，炎性假瘤，脂肪瘤，肝囊肿，肝结核），CDFI，ARI＞60及网篮征检出率明显低于小肝癌（P＜0．01）。具有鉴别诊断意义，本组CDFI对小肝癌诊断率为88．8％（8／9），1例漏诊，由IOUS诊断，肿瘤为位于右叶后方上段，＜2.0cm的病例。CDFI具有无创性，操作简便，血流图像检出率高等特点，从而进一步提高超声诊断的特异性。IOUS可进一步辅助CDFI诊断的不足，特别是对AFP阴性，瘤体位于盲区的小肝癌。     

Clinicopathological study of scirrhous hepatocellular carcinoma

BACKGROUND AND AIMS: Scirrhous hepatocellular carcinoma (SHCC) is characterized by diffuse fibrosis of the tumor, however, its clinicopathological features are not fully clarified. This study aimed to clarify the clinicopathological features of SHCC. METHODS: Among 546 consecutively resected HCC without preoperative anticancer therapies, 25 SHCC were selected for the study and compared with 521 cases without scirrhous as the control. RESULTS: SHCC accounted for 4.6% of cases. On diagnostic imagings, SHCC was frequently misdiagnosed as cholangiocarcinoma (CC), combined HCC-CC or metastatic carcinoma. Overall survival rate was significantly higher than the control. The average (+/-SD) tumor size of SHCC was 3.4 +/- 1.8 cm without significant difference to the control. The majority of SHCC (88%) were located close to the liver capsule. SHCC was characterized by stellate fibrosis (84%), no encapsulation (100%), no necrosis and hemorrhage (100%), intratumoral portal tracts (80%), remarkable lymphocyte infiltration (84%), clear cell change (84%), and hyaline bodies (52%). The number of alpha-smooth muscle actin-positive myofibroblast-like cells (activated stellate cells) in the tumor was about three times more than that in the control. Regarding the developmental mechanism of scirrhous change, a close correlation with unique tumor location and activation of stellate cells was suggested. CONCLUSIONS: SHCC presents with characteristic clinicopathological features and the recognition of SHCC is important for both clinicians and pathologists.     

螺旋CT增强三期扫描对原发性小肝癌血供的影像学观察

目的　观察原发性小肝细胞癌(SHCC)的血供特点,提高螺旋CT对SHCC的定性诊断能力。方法　盲法下观察34例经手术病理证实的原发性SHCC患者,术前采用单层动态肝动脉、门静脉及静脉期螺旋CT分别于注入造影剂后2 8～30秒、6 5～70秒及180秒行靶区动态增强扫描,造影剂注射速率为3.0 m/ s,用量90～10 0 ml。结果　共发现37个结节病灶,平扫、动脉期、门静脉期、静脉期的检出率分别为75 .6 %、94 .6 %、97.3%、81.1% ,动脉期和门静脉双期的检出率较平扫和静脉期高(P<0 .0 5 ) ,动脉期与门静脉期、平扫与静脉期检出率无显著性差异(P均>0 .0 5 )。34例中,2 8例肝癌组织为单纯肝动脉供血,其中动脉期强化密度明显高于正常肝脏2 2例,边缘轻度高密度6例;6例为肝动脉和门静脉双重供血,其中4例在三期扫描过程表现为“向心性”强化。结论　原发性SHCC由肝动脉供血者占绝对优势;部分可见肝动脉和门静脉双重供血,并呈现“向心性”强化征象,此征象在与肝脏海绵状血管瘤的鉴别中起重要作用。     

Cytogenetic studies and their prognostic significance in agnogenic myeloid metaplasia: a report on 47 cases

Cytogenetic analysis was performed in 47 newly diagnosed patients with agnogenic myeloid metaplasia (AMM); 32 had a normal karyotype (68%, group I), whereas 15 had clonal abnormalities (32%, group II). The most frequent abnormal findings were a 20q- deletion in six cases (either alone or within complex anomalies), interstitial 13q- deletion in three cases (and monosomy 13 in one case), and acquired trisomy 21 or 21p+ in three cases. Four cases exhibited complex aberrations involving several chromosomes, sometimes with a mosaicism. In two patients with an initial abnormal karyotype, further cytogenetic analysis during the disease course showed the appearance of additional clonal anomalies, and particularly of a probable Philadelphia (Ph1) variant in one case. Treatment was essentially supportive. Survival was significantly shorter in group II (median, 30 months) compared with group I (median, not reached at 6 years; P = .015). In univariate analysis, other parameters significantly associated with a poor prognosis (P less than .05) were higher age, anemia, and increased percentage of circulating blasts. However, in a multivariate analysis, only cytogenetic abnormalities and age retained their independent prognostic value.     

不同大小的肝细胞癌超声造影特点

目的:分析不同大小肝细胞癌(hepatocellular carcinoma,HCC)的超声造影(contrast-enhanced ultrasound,CEUS)特点,提高超声对HCC的诊断水平.方法:将我院2011-01/2011-09行超声造影检查并经手术及病理证实为HCC的连续性病例75例90个病灶按照病灶最大直径分为小肝癌(≤3cm)和大肝癌(>3cm)2组,回顾性分析不同大小的HCC超声造影特点.结果:75例90个病灶小肝癌组39个,大肝癌组51个.动脉期,小HCC组39个病灶均呈高增强,其中整体均匀增强37个(94.9%),不均匀增强2个(5.1%);大HCC组51个病灶均呈高增强,其中整体均匀增强27个(52.9%),不均匀增强21个(41.2%),不典型增强3个(6%),不同大小HCC动脉期增强形态具有统计学差异(P<0.05).门脉期,小HCC组等增强10个(25.6%),低增强29个(74.4%),大HCC组高增强7个(13.7%),等增强2个(3.9%),低增强42个(82.4%),不同大小的HCC门脉期增强水平具有统计学差异(P<0.05).延迟期,小HCC组所有病灶均呈低增强,大HCC组1个(2.0%)呈等增强,50个(98.0%)呈低增强,不同大小的HCC延迟期增强水平无统计学差异.结论:HCC超声造影表现与肿瘤大小有一定的相关性,小HCC动脉期增强多为整体均匀增强,大HCC不均匀增强比例较多,门脉期和延迟期大HCC造影剂廓清可能早于小HCC.     

Nuclear DNA content by cytofluorometry of stage I adenocarcinoma of the lung in relation to postoperative recurrence

Forty-six cases of adenocarcinoma of the lung, categorized as stage I (T1N0M0, T2N0M0) pathologically, were studied in terms of nuclear DNA content (NDC) determined by cytofluorometry. They comprised 23 cases each with and without tumor recurrence within five years postoperatively, and the NDC was compared in 23 pairs in which the tumor size and the degree of histologic differentiation were completely matched. The NDC was larger in the recurrent group than in the nonrecurrent group in terms of mean nuclear DNA content (MNDC), DNA histogram pattern, and occurrence of the aneuploid stem cell line, of which the difference in MNDC was statistically significant (p less than 0.05). When the comparison of NDC was made between the nonrecurrent and recurrent groups in the well differentiated (W/D), moderately to poorly differentiated (M.P/D), T1, and T2 subgroups, the NDC of the recurrent group was significantly larger than that of the nonrecurrent group in the W/D (MNDC, p less than 0.01 and DNA histogram pattern, p less than 0.005) and T1 subgroups (MNDC, p less than 0.05), but not in the M.P/D and T2 subgroups. The results indicate that the NDC is a good predictor of prognosis in stage I adenocarcinoma of the lung and its prognostic importance increases in more differentiated and smaller tumors, compared to less differentiated and larger tumors.     

The relationship between chronic lymphocytic leukaemia and prolymphocytic leukaemia

The prognostic value of biological, clinical and laboratory features was analysed in a series of 265 patients with chronic lymphocytic leukaemia (CLL) and prolymphocytic leukaemia (PLL). On univariate analysis seven features were shown to influence significantly the survival of the whole group of patients: absolute prolymphocyte count (ABS PROL), percentage of prolymphocytes (%PROL), WBC, spleen size, age, intensity of surface-membrane immunoglobulin (SmIg) and mouse (M) rosettes. Multivariate regression analysis of these features showed that only ABS PROL and spleen size had independent prognostic significance. The survival in PLL (38 cases) was significantly shorter than in CLL (227 cases) (median survival = 3 and 8 years, respectively). Patients with CLL with an increased %PROL (11-55%), defined as CLL/PL, could be divided into two groups: those with ABS PROL less than or equal to 15 X 10(9)/l (26 cases) fell within the 'standard-prognostic risk' for typical CLL (i.e. less than or equal to 10% PROL), whereas the survival outlook for the cases with ABS PROL greater than 15 X 10(9)/l (40 cases) was as bad as for PLL. A scoring system was generated with the four features that showed high prognostic significance: ABS PROL, spleen size, SmIg and M-rosettes. The score proved to be superior to any single feature as a predictor of survival, being especially useful in the analysis of the CLL/PL group: cases with high scores (greater than 2) had a median survival of 2.5 years, while the median has not been reached for those with low scores (less than or equal to 2). We suggest that this scoring system may help to identify the cases of CLL/PL that behave as PLL, and as such may benefit from different treatment.     

Valvular replacement for isolated aortic stenosis. Predictive value of the preoperative cardiac index in survival

The immediate and long-term results of aortic valve replacement for pure or predominant aortic valve stenosis were evaluated in 186 patients operated upon since 1975 and followed for up to 10 years. This population fell into two groups depending on whether the pre-operative cardiac index was superior (group I, n = 111) or inferior (group II, n = 75) to 2.3 l/min/m2. There was no significant difference between the two groups as regards the immediate (i.e. within 30 days) post-operative mortality rate (6.6% vs 8.1% respectively). In contrast, the cardiac index proved to be a significant post-operative prognostic factor in aortic stenosis, since the probability of survival at 5 years was 96.4% in group I and only 71.7% in group II (p less than 0.001). This high rate of mortality in group II was exclusively due to myocardial dysfunction (sudden deaths included) in these patients with low cardiac index. When late mortality was analyzed according to age (over or below 60 years) and to pre-operative cardiothoracic ratio (over or below 50), these two criteria also proved to be significant prognostic factors. However, considering the poor prognosis of unoperated aortic stenosis, these long-term results in group II should encourage surgical treatment in many cases, even those with advanced cardiopathy.     

Anterior ST depression in inferior myocardial infarction: correlation with results of intracoronary thrombolysis

Thirty-eight patients underwent left ventricular angiography and coronary arteriography within the first 6 hours of inferior myocardial infarction, in an attempt at intracoronary thrombolysis with streptokinase. Twenty-three of these patients presented with ST segment depression of more than 1 mm on the anterior leads (V1 to V4) of ECGs done immediately before the attempt at thrombolysis (group I), whereas 15 did not (group II). Quantitative analysis of left ventricular angiography showed an ejection fraction significantly lower in group I (51 +/- 10%) than in group II (59 +/- 7%; p less than 0.01). This difference was the result of inferior hypokinesia which was larger both in surface area (group I = 11.5 +/- 6.5 cm2; group II = 4.2 +/- 2.7 cm2; p less than 0.001) and in percentage of ventricular perimeter (group I = 46 +/- 14%; group II = 27 +/- 12%; p less than 0.001). The prevalence of a left anterior descending artery lesion and the degree of stenosis were the same in both groups. The success rate of thrombolysis was not significantly different. However, in cases of persistent success, there was an improvement of regional contraction only in group I, as opposed to absence of change in group II. These results suggest that patients with inferior myocardial infarction and ST anterior depression have an extensive ischemic area rather than anterior wall ischemia. An attempt at coronary thrombolysis seems to be worthwhile only in these patients, as it results in appreciable myocardial salvage when successful.     

Prednisone and azathioprine compared with prednisone and placebo for treatment of chronic graft-v-host disease: prognostic influence of prolonged thrombocytopenia after allogeneic marrow transplantation

We conducted a randomized, double-blind comparison of prednisone and placebo (group I) v prednisone and azathioprine (1.5 mg/kg/day) (group II) as early treatment of extensive chronic graft-v-host disease (GVHD). Patients with platelet counts less than 100,000/microL were placed into therapy with prednisone alone (group III). All three groups received identical doses of prednisone (1 mg/kg every other day) and one double-strength trimethoprim-sulfamethoxazole (TMP-SMX) tablet twice daily. Between January 1980 and December 1983, 179 previously untreated patients were enrolled and 164 were evaluable. Patients randomized to group I (n = 63) and group II (n = 63) were well matched for prognostic factors; those placed into group III (n = 38) had more frequent acute GVHD and progressive onset of chronic GVHD. Median duration of therapy was 2 years. Complications included diabetes (5%), aseptic necrosis (5%) and infection. For groups I, II, and III, the respective incidence of infection was disseminated varicella, 11%, 24%, 34%; bacteremia, 6%, 11%, 34%; and interstitial pneumonia, 5%, 14%, 18%. Recurrent malignancy was the most frequent cause of death and did not differ significantly across the groups. Nonrelapse mortality, however, did differ: 21% in group I, 40% in group II, and 58% in group III (I v II, P = .003; I v III, P = .001). Forty patients in group I, 30 in group II, and 10 in group III survive with a minimum follow-up of 3.8 years. Karnofsky performance scores for 68 survivors are 90% to 100%, scores for seven survivors are 70% to 89% and scores for five survivors are less than 70%. Actuarial survival at 5 years after transplant is 61% in group I, 47% in group II, and 26% in group III (I v II, P = .03; I v III, P = .0001). Treatment with prednisone alone results in fewer infections and better survival than prednisone and azathioprine in standard-risk chronic GVHD. Treatment with prednisone alone is less effective in high-risk patients with thrombocytopenia, and other strategies are required.     

Clinical detection of the hepatic lesion of pericentral sclerosis in chronic alcoholics.

It has been shown that a specific liver lesion--that is, pericentral sclerosis associated with pericellular fibrosis--is the precursor of alcoholic liver sclerosis. It is, however, difficult to diagnose this hepatic lesion in chronic alcoholics, using only clinical data without liver biopsy. To investigate the possibility of a clinical test reflecting the presence of this hepatic lesion, ethanol (0.75 g/kg body weight) was given orally to chronic alcoholics, and serum glycoprotein levels (prealbumin, alpha HS glycoprotein, haptoglobin, alpha 2-macroglobulin) were measured before and six hours after. Chronic alcoholics were divided into three groups according to the histological findings in the liver at the time of study. Group I (alcoholic fatty liver or non-specific change) consisted of seven cases without pericentral sclerosis. Group II (alcoholic hepatic fibrosis or alcoholic hepatitis) consisted of five cases with pericentral sclerosis and pericellular fibrosis. Group III consisted of five cases with alcoholic liver cirrhosis. After the ethanol administration, serum glycoprotein levels decreased significantly in group I (P less than 0.05), whereas they increased in group II and group III. Their alternative ratios (see text) apparently differed (P less than 0.005) between group I and group II, and between group I and group III. These results indicate that the determination of serum glycoprotein levels before and after oral ethanol administration is useful way of discriminating alcoholic patients with hepatic pericentral sclerosis and pericellular fibrosis from alcoholics without such lesions.     

皮肌炎119例的预后分析

为了解皮肌炎患者的预后，１９９５年６月～９月，上海市皮肌炎医疗协作中心调查了１１９例皮肌炎患者，并对１０项预后因素进行ＬｉｆｅｒｅｇＰｒｏｃｅｄｕｒｅ多因素分析。结果表明：其２年及５年的生存率分别为７５．３％和５３．２％，肺部感染是最常见的死因，其次是恶性肿瘤。与预后不良有关的因素有：老龄，恶性肿瘤，间质性肺炎，吞咽困难，心脏累及，发热，病情不能缓解，单用激素治疗。生存曲线还显示：发病后３年内死亡幅度较大，３～７年间死亡幅度较小，７年以后无病人死亡。该结果提示：皮肌炎预后不良，其预后受多种因素影响，应尽早、正规给予激素和免疫抑制剂治疗。     

Follicular thyroid carcinomas with lung metastases: a 23-year retrospective study

Limited clinical information is specified in the presentations, results of treatment and prognostic factors of follicular thyroid carcinoma with lung metastases. In order to better characterize the information, we retrospectively analyzed the data of 2,003 thyroid cancer patients who received treatment and follow-up at the Chang Gung Memorial Hospital during the period from January 1979 to December 2002. There were 1,516 cases of papillary and 272 cases of follicular thyroid carcinomas. In the study, lung metastases of the follicular thyroid carcinomas were defined as post-operative or follow-up chest X-ray, diagnostic or therapeutic (131)I scan with positive finding of lung metastases. Serum thyroglobulin (Tg) levels under thyroxine treatment of patients with lung metastases had to be over 1.5 ng/mL. Of the follicular thyroid carcinomas, there were 70 (25.7%) with lung metastases including 50 females (mean age 54.1 +/- 12.6 years old) and 20 males (mean age 59.4 +/- 12.0 years old). Of the 70 patients, there were 53 patients (75.7%) who presented with lung metastases at the time of diagnosis. Of the 70 patients of follicular thyroid carcinoma with lung metastases, 30 patients (42.9%) died at the end of the follow-up, and only 4 patients improved to disease free status. The 5, 10, 15, and 20 year survival rates in these patients were 68.5%, 54.0%, 41.6%, 27.7%, respectively. Age, post-operative Tg level and tumor size are important prognostic factors which are demonstrated to be significantly different statistically between lung metastases group and the group of the patients without distant metastasis. Otherwise, only the tumor size and accumulative dose of (131)I therapy demonstrate a significant difference between survival and mortality groups. Seventeen of the 70 patients developed lung metastases during the follow-up period. Mean period between diagnosis and recurrence of these patients was 3.6 +/- 0.9 years. Over 75% of follicular thyroid carcinoma with lung metastases was diagnosed at the time of presentation. Forty percent (28/70 cases) of the follicular thyroid carcinoma with lung metastases had history of thyroid surgery in this study. If lung metastases are diagnosed in follicular thyroid carcinoma, it will be followed by a poor prognosis. Older patients, higher postoperative Tg, and larger tumor size in follicular thyroid carcinoma need aggressive postoperative treatment.     

肝动脉化疗栓塞结合外放射治疗大肝癌的预后因素分析

目的 观察肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE)结合外放射治疗大肝癌的远期效果并分析预后因素。方法 以TACE结合外放射治疗107例大肝癌患者（肝肿瘤最大径5-18cm)。观察近期效果与生存率，并用Cox比例风险模型分析预后因素。结果 48.6%的病例获得肿瘤缓解，1、3、5年累积生存率分别为59.4%、28.4%、15.8%。肿瘤数目、放疗剂量为独立的预后因素。单发肿瘤者的累积生存率（1、3、5年分别为75.8%、43.9%、26.8%）明显高于肝内肿瘤多发者（1、3年分别为31.3%、5.0%,P=0.0005)。放疗剂量40Gy以上者的生存率（1、3、5年分别为95.8%、74.7%、37.4%）明显高于剂量20-40Gy者（分别为60.9%、20.7%、10.3%）与剂量低于20Gy者（分别为26.7%、7.1%、7.1%，P=0.0001)。结论 TACE结合外放射为治疗不能切除大肝癌的有效方法。肿瘤数目为影响预后的最重要的临床因素。在肝脏可耐受的范围内给予最高剂量的放疗是提高疗效的关键。     

Small hepatocellular carcinoma: current and future approaches

Over 3 decades have passed since the first report of small hepatocellular carcinoma (SHCC), which has been confirmed as one of the most significant prognostic factors. Obviously, it is indeed very important to know when an early SHCC will become more aggressive and lead to worse clinical outcome once it grows beyond a critical size. However, so far, no consensus has been achieved on the size criterion for SHCC among different authors or different clinical practice guidelines that have been used worldwide, although there are currently numerous cutoff values for tumor size used to define SHCC, including 5, 3 and 2 cm in diameter, etc. Herein, based on our current understanding concerning the pathobiological features of SHCC, we briefly review the history of SHCC study, analyze the advantages and limitations of the above criteria for SHCC, and discuss the pathobiological characteristics as well as the clinical significance of SHCC.     

Increased expression of CD133 is a strong predictor of poor outcome in stage I colorectal cancer patients

Abstract Objective. Stage I colorectal carcinomas display a highly variable behavior which is not accurately predicted by the available prognostic markers. CD133 is considered a useful marker to identify the so-called cancer stem cells in colorectal cancers (CRCs) and its expression has been shown to have prognostic significance in CRC patients. This study aimed to verify whether immunohistochemical evaluation of CD133 might correlate with the progression risk of stage I CRC patients. Material and methods. Expression levels of the CD133 molecule were analyzed and compared in two series of stage I surgically resected CRC patients showing disease progression and death for the disease and patients with no evidence of disease progression after at least 6 years after surgery. Results. A positive staining for CD133 was detected in 52% of the cases with poor prognosis and only in 9% of the group with good prognosis, and this difference was highly significant (p < 0.001). A significant correlation was detected between CD133 expression and histological parameters, such as tumor budding, vascular invasion, and presence of lymph node micrometastases but not tumor grading, gender, and age. Disease-free survival and cancer-specific survival of CD133 negative tumors were significantly longer compared to positive cases. In multivariate analyses, CD133 staining confirmed to be a predictor of shorter survival independent from vascular invasion but not from lymph nodes micrometastases. Conclusions. These findings demonstrate that CD133 immunostaining is a useful predictor of high risk progression in stage I CRC patients and might help to identify patients eligible for adjuvant chemotherapy.     

Early intervention in acute myocardial infarction: significance for myocardial salvage of immediate intravenous streptokinase therapy followed by coronary angioplasty

Sixteen patients with acute myocardial infarction underwent treatment with streptokinase up to 3 hours after the onset of chest pain. Nine patients (group I) received streptokinase within 1 hour of the onset of pain, and seven patients (group II) received it within 2 to 3 hours. All underwent multigated radionuclide ventriculography after streptokinase therapy and 1 week later. Percutaneous transluminal coronary angioplasty of the infarct artery was performed within 24 hours in all patients. An effort-limited treadmill stress test was performed before discharge. There was no mortality or serious complication. Mean peak total creatine kinase was 521 +/- 289 mU/ml in group I, and 1,614 +/- 709 mU/ml in group II (p less than 0.05). The mean initial left ventricular ejection fraction was 47 +/- 11% in group I and 37 +/- 10% in group II. After early angioplasty (within 24 hours) and at 1 week recovery, left ventricular ejection fraction increased to 53 +/- 9% in group I (p less than 0.05) and to 40 +/- 7% in group II (p = NS). Seven of the nine patients in group I had normal radionuclide ventriculograms at discharge compared with none of the seven patients in group II. Thrombolytic therapy administered less than 1 hour after the onset of symptoms of acute myocardial infarction followed by angioplasty of the infarct artery results in preservation of left ventricular function, whereas therapy given after 2 hours has only a limited effect.     

Clinico-pathological correlations in the diagnosis of acute myocardial infarction in the elderly

A series of 200 consecutive patients with autopsy-proven acute myocardial infarction (AMI) was retrospectively studied in order to assess the degree of clinico-pathological agreement and to detect the reasons for disagreement. A correct clinical diagnosis of AMI was made in 86 cases (Group A = 43%) and was missed in 114 cases (Group B = 57%). Atypical presentation and concealed history were more common in group B. The AMI qualified to be the main disease in 83 patients of group A and in 81 of group B and was considered a contributory cause of death in three of group A and in 33 of group B (P less than 0.01). The mean number of diseases coexisting with the main disease for each patient was significantly lower in group A than in group B (P less than 0.01). The mean age was 65.2 +/- 12 years for group A patients and 69.1 +/- 12 years for group B patients (P less than 0.02). With the patients grouped according to age (group I: less than 60 years = 46 cases; group II: greater than or equal to 60 years = 154 cases), the diagnostic accuracy was 61% in group I and 38% in group II (P less than 0.01). Groups I and II did not differ in clinical presentation, ECG and enzyme diagnostic accuracy, while the number of diseases coexisting with the AMI was significantly higher in group II (P less than 0.001). Ageing, the atypical presentation and the coexistence of several diseases seem to account for most of the unrecognized AMI.     

Differentiated thyroid carcinoma in the elderly.

Prognostic factors and therapeutic results in a group of 268 patients with differentiated thyroid cancer (DTC) aged over 60 years are reported. These cases were selected from a total of 1457 DTC-patients seen at our Center from 1967 to 1987. All elderly patients underwent total thyroidectomy, and were treated with 131I therapy and suppressive hormonal therapy. Moreover, external radiotherapy was performed in 20% and chemotherapy in 3.8% of all cases. Follow-up included periodical clinical examination, serum Thyroglobulin (Tg) determination, 131I total body scan (TBS), and echographic and radiologic survey. Several unfavorable prognostic factors were identified in elderly patients with DTC. In comparison with data obtained in a group of patients under 60 years of age, 1) the follicular histologic type was increased, papillary/follicular ratio was 1.1 vs 2.6; 2) the F/M ratio was decreased, 1.5 vs 2.8 for papillary tumors, and 1.7 vs 3.6 for follicular tumors; 3) the rate of cases with local extrathyroid tumor growth and distant metastases was higher, and 4) rates of metastases to bone and metastases with low 131I uptake were increased. Moreover, the 10-year survival rate in elderly patients with lymph node and distant metastases was significantly reduced compared to younger patients, both for papillary and follicular cancer. The finding of detectable serum Tg levels was well correlated with the presence of metastatic disease. Moreover, Tg sensitivity was higher than TBS in showing the presence of metastatic foci. DTC in elderly people must be considered an aggressive tumor both for follicular and papillary histologic types. A radical approach is recommended: total thyroidectomy, 131I administration, and suppressive hormonal therapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prognostic value of the Jass histopathologic classification in left colon and rectal cancer: a multivariate analysis

Variables correlated to survival were studied in 121 patients who had undergone potentially curative surgery for left colon and rectal cancer. To investigate the prognostic value of the parameters both univariate and multivariate analysis were carried out. Minimum follow-up was 5 years. Multivariate analysis showed that while disease stage (p less than 0.0001) and site of primary tumor (p less than 0.0006) independently influenced survival, type of surgical procedure and histopathologic grade had no impact on survival. Jass histopathologic classification predicted survival for patient group I and IV whereas no significant relationship was observed for group II and III, which, in our series, were the most frequently encountered groups. Of the three parameters considered for Jass classification, tubule configuration, pattern of tumor growth and lymphocytic infiltration, only the latter was significantly correlated to survival (p less than 0.005). Different results were obtained when the prognostic values of Jass group was investigated separately for the 49 patients with adenocarcinoma of the left colon and the 72 patients with rectal cancer. Further investigation is required before routine clinical application of the Jass classification can be recommended.