Skip metastases in thyroid cancer leaping the central lymph node compartment

HYPOTHESIS: Discontinuous nodal metastasis, or skip metastasis, in thyroid cancer may display clinicopathologic features different from those seen in continuous nodal metastasis and thus may have a different prognosis. DESIGN: Retrospective analysis. SETTING: Tertiary referral center at a university hospital. PATIENTS: Two hundred fifteen consecutive patients who underwent systematic central lymph node dissection for papillary, follicular, or medullary thyroid cancer and who on histopathologic analysis exhibited nodal metastases in at least 1 lateral or mediastinal lymph node compartment. MAIN OUTCOME MEASURES: Various clinicopathologic variables that were stratified for tumor entity and type of nodal metastasis (discontinuous vs continuous). RESULTS: Skip metastases (negative central and positive lateral or mediastinal compartments) were found in 13 (19.7%) of 66 papillary, 0 of 8 follicular, and 30 (21.3%) of 141 medullary thyroid cancers. After adjustment for multiple testing, skip metastasis was only associated with significantly fewer positive lymph nodes: 3.7 vs 12.9 nodes (r = -0.43, P<.001) in papillary thyroid cancer and 6.0 vs 17.1 nodes (r = -0.40, P<.001) in medullary thyroid cancer. No other significant correlation was identified with any other clinicopathologic variable. CONCLUSIONS: Skip metastasis is an epiphenomenon of low-intensity nodal metastasis in thyroid cancer and entails a moderate risk of local recurrence. Consequently, clearing the central lymph node compartment should be considered when lateral or mediastinal lymph node compartments are involved.     

血清癌胚抗原预测可手术甲状腺髓样癌淋巴结转移的临床价值

目的探讨血清癌胚抗原(carcinoembryonic antigen,CEA)在预测可手术甲状腺髓样癌(medullary thyroid carcinoma,MTC)淋巴结转移中的临床应用价值。方法选取2009年1月至2019年2月在中国科学院大学附属肿瘤医院(浙江省肿瘤医院)头颈肿瘤外科和杭州市第一人民医院肿瘤外科接受手术的140例MTC,回顾性分析血清CEA和140例可手术MTC淋巴结转移的相关性,计算血清CEA预测可手术MTC总体、中央区、侧颈和上纵隔淋巴结转移的受试者工作特征曲线下面积(area under the curve,AUC)、敏感性、特异性,以评估血清CEA表达水平预测可手术MTC淋巴结转移的临床价值。结果140例可手术MTC中有108例血清CEA呈阳性表达,阳性率77.14%。伴淋巴结转移的MTC患者血清CEA显著高于无淋巴结转移者(P<0.001),且血清CEA与淋巴结转移数目正相关(P<0.001)。血清CEA预测可手术MTC总体、中央区、侧颈和上纵隔淋巴结转移的AUC分别为0.773、0.768、0.827及0.847。以约登指数最大时,分别取界值为6.58、11.43、15.74、30.45 ng/ml,血清CEA预测总体、中央区、侧颈和上纵隔淋巴结转移的敏感性分别为88.46%、81.43%、85.00%、95.00%,特异性分别为56.45%、60.00%、71.25%、69.17%。结论血清CEA在可手术MTC中有较高的阳性率,其表达水平在评估MTC淋巴结转移方面具有重要的临床价值。     

散发性甲状腺髓样癌术式选择及预后分析

散发性甲状腺髓样癌是甲状腺髓样癌的主要类型,尽管临床少见,但预后较差。手术是治疗散甲状腺发性髓样癌的主要手段,不规范的手术会导致肿瘤和转移淋巴结残留,增加复发风险,降低治愈率和存活率。全甲状腺切除和双侧中央区淋巴结清扫及治疗性颈侧区淋巴结清扫是治疗散发性甲状腺髓样癌的主要手术方式,在无明确影像学证据情况下,不推荐预防性颈侧区淋巴结清扫。年龄、肿瘤大小、淋巴结转移、腺外侵袭、远处转移、手术方式、RET基因突变、血清降钙素和CEA水平是影响散发性甲状腺髓样癌预后的危险因素。     

散发性甲状腺髓样癌术式选择及预后分析

散发性甲状腺髓样癌是甲状腺髓样癌的主要类型,尽管临床少见,但预后较差。手术是治疗散甲状腺发性髓样癌的主要手段,不规范的手术会导致肿瘤和转移淋巴结残留,增加复发风险,降低治愈率和存活率。全甲状腺切除和双侧中央区淋巴结清扫及治疗性颈侧区淋巴结清扫是治疗散发性甲状腺髓样癌的主要手术方式,在无明确影像学证据情况下,不推荐预防性颈侧区淋巴结清扫。年龄、肿瘤大小、淋巴结转移、腺外侵袭、远处转移、手术方式、RET基因突变、血清降钙素和CEA水平是影响散发性甲状腺髓样癌预后的危险因素。     

Contralateral cervical and mediastinal lymph node metastasis in medullary thyroid cancer: systemic disease?

BACKGROUND: The current American Joint Committee on Cancer/International Union Against Cancer classification designates cervical and mediastinal lymph nodes as regional lymph nodes. In a unilateral thyroid neoplasm, however, involvement of the contralateral cervical lymph node compartment or the mediastinal lymph node compartment, both of which have been designated "distant" lymph nodes, may serve as a surrogate parameter of distant metastases. METHODS: This institutional series consisted of 105 consecutive patients with medullary thyroid cancer who underwent systematic dissections of both distant lymph node compartments. RESULTS: Thirty-eight patients had no distant lymph node metastasis, 36 patients had involvement of only 1, and 31 patients of both distant lymph node compartments. Significant associations (P < .001) were seen on univariate analysis between the number of involved "distant" lymph node compartments (none, one, or both) and extrathyroidal extension (3%, 33%, and 58%), the number of positive lymph nodes (means of 3, 13, and 33), and distant metastasis (8%, 36%, and 61%). In a multivariate logistic regression model, only involvement of one or both "distant" lymph node compartments (versus no distant lymph node metastasis) remained significantly related to distant metastasis in a dose-dependent fashion. CONCLUSIONS: "Distant" lymph nodes in medullary thyroid cancer should be regarded as nonregional lymph nodes because their involvement is indicative of distant metastasis.     

甲状腺微小乳头状癌颈部淋巴结转移的危险因素分析

目的:探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法:回顾性分析贵州医科大学附属医院甲状腺外科2014年1月—2016年3月收治的169例PTMC患者临床病理资料。结果:169例患者均行预防性中央区淋巴结清扫,其中54例(32.0%)发生中央区淋巴结转移,单因素分析发现中央区淋巴结转移与年龄45岁、多灶性肿瘤、侵出包膜有关(均P0.05),多因素分析显示,年龄、多灶性肿瘤、侵出包膜都是中央区淋巴结转移的独立危险因素(均P0.05)。30例行中央区淋巴结加侧颈区淋巴结清扫,其中18例(10.7%)发生侧颈区淋巴结转移,单因素分析显示,肿瘤最大径、侵出包膜、多灶性肿瘤、中央区淋巴结转移与侧颈区淋巴结转移有关(均P0.05),多因素分析显示,肿瘤侵出包膜为侧颈区淋巴结转移的高危因素(P0.05);11例(6.5%)发生中央区并侧颈区淋巴结转移,侵出包膜、多灶性肿瘤为中央区并侧颈区淋巴结共同发生转移的高危因素(均P0.05)。高分辨率颈部淋巴结B超对中央区淋巴结转移的灵敏度、特异度分别为14.8%、96.5%,其对侧颈区淋巴结转移的灵敏度、特异度分别为94.4%、83.3%。结论:年龄45岁、多灶性肿瘤、侵出包膜是PTMC颈部淋巴结转移的危险因素。高分辨率颈部淋巴结B超可以作为甲状腺癌颈部淋巴结转移术前评估的重要手段。     

Prediction of mediastinal lymph node metastasis in medullary thyroid carcinoma

BACKGROUND: Mediastinal lymph node metastases can be life threatening owing to their proximity to vital organs. Reliable identification of mediastinal metastasis is of utmost importance for timely mediastinal lymph node dissection, although suitable clinicopathological variables for their detection in patients with thyroid cancer have yet to be identified. METHODS: This was an analysis of 83 consecutive patients with radiological suspicion of mediastinal metastasis who underwent trans-sternal mediastinal lymph node dissection for node-positive medullary thyroid carcinoma between November 1994 and March 2003. RESULTS: Univariate analysis revealed that extrathyroidal extension (P < 0.001), distant metastasis (P = 0.001), the preoperative serum calcitonin level (P = 0.001), operation type (P = 0.004), contralateral cervicolateral metastasis (P = 0.016) and bilateral nodal metastasis (P = 0.031) were significantly associated with mediastinal involvement. Only extrathyroidal extension remained significant in a multivariate logistic regression analysis of mediastinal lymph node metastasis. Prediction of mediastinal metastasis by extrathyroidal extension was best at reoperation, with a specificity of 97 per cent and a positive predictive value of 88 per cent. CONCLUSION: Mediastinal lymph node dissection should be considered in patients undergoing reoperation for node-positive medullary thyroid carcinoma who have extrathyroidal extension and cervical lymph node metastases.     

甲状腺癌患者外周血CEACAM1水平及其临床意义

目的:探讨癌胚抗原黏附分子1(CEACAM1)在甲状腺癌患者外周血中水平及其对甲状腺癌的诊断价值。方法:用ELISA法检测76例甲状腺癌患者、48例甲状腺良性肿瘤患者和38例健康体检者外周血中CEACAM1水平,同时检测所有入组样本的癌胚抗原(CEA)及甲状腺球蛋白(TG)水平,分析外周血CEACAM1水平与甲状腺癌临床病理特征的关系,制作ROC曲线,比较CEACAM1、CEA、TG对甲状腺癌的诊断价值。结果:甲状腺癌患者血清CEACAM1水平明显高于甲状腺良性肿瘤患者及健康对照者(547.11 ng/mL vs.469.77 ng/mL、369.04 ng/mL,均P0.05)。血清CEACAM1水平与甲状腺癌的TNM分期和淋巴结转移有关(均P0.05)。血清CEACAM1水平诊断甲状腺癌的ROC曲线下面积为0.94,敏感性97.4%,特异性80.3%,CEACAM1对甲状腺癌的诊断价值优于CEA和TG。结论:血清CEACAM1检测对甲状腺癌的诊断及其病情评估有一定意义。     

微小乳头状癌淋巴结转移及预防性淋巴结清扫的价值

目的探讨微小乳头状癌颈侧区淋巴结转移的危险因素及预防性清扫的价值。方法选取2010年2月至2016年2月收治的172例甲状腺微小乳头状癌患者进行回顾性分析,根据颈淋巴结分区有92例淋巴结转移阴性患者,其中50例采取了预防性单侧或双侧淋巴结清扫(预防组),42例未行预防性淋巴结清扫(未预防组),比较两组预后。应用SPSS 19.0进行分析,住院时间等计量资料用均数±标准差(x珋±s)表示,比较采用独立样本t检验;性别、年龄、肿瘤大小、包膜浸润、侧别、肿瘤位置、肿瘤数目、中央区转移、并发症发生率、肿瘤局部复发或远处转移率、病死率等计数资料计算构成比(%),采用χ2检验;危险因素的预测采用多因素Logical回归,P0.05为差异有统计学意义。结果颈侧区淋巴结转移阳性患者中年龄≤45岁、肿瘤0.5~1.0 cm、包膜浸润、肿瘤位于甲状腺上极、中央区转移者占67.5%、72.5%、45.0%、87.5%、67.5%,均高于阴性患者(P0.05)。中央区转移、肿瘤位于甲状腺上极为颈侧区淋巴结转移的危险因素。预防组患者随访期间未见肿瘤局部复发、远处转移与死亡情况,未预防组病死率2.4%(P0.05),肿瘤局部复发或远处转移率为9.5%(P0.05)。结论肿瘤位于甲状腺上极、存在中央区转移的微小乳头状癌患者更易出现颈侧区淋巴结转移。颈侧区淋巴结转移阴性患者行预防性淋巴结清扫术可有效改善远期预后,且术后并发症未明显增加。     

乳头状甲状腺癌颈淋巴结转移方式及其相关影响因素的研究

目的评估乳头状甲状腺癌（PTC）颈淋巴结的转移方式及相关影响因素在颈部不同区域淋巴结转移中的意义。方法回顾性分析笔者所在医院甲状腺外科2008年12月至2011年12月3年期间行手术治疗的223例PTC患者的临床资料,就患者性别、年龄、术前TSH水平、肿瘤直径、是否为多灶、是否侵及甲状腺被膜及其周围组织、是否合并桥本甲状腺炎、是否合并结节性甲状腺肿以及肿瘤的T分期等因素与颈部不同区域的淋巴结转移之间的关系进行分析。结果单变量分析结果显示,年龄≥45岁及合并结节性甲状腺肿与中央区淋巴结转移有关（P〈0．05）,多发病灶与颈侧区淋巴结转移有关（P〈0．05）;多变量分析结果显示,年龄≥45岁及合并结节性甲状腺肿是中央区淋巴结转移的保护因素（P〈0．05）,多发病灶是颈侧区淋巴结转移的危险因素（P〈0．05）。Ⅱ-Ⅳ区是颈侧区淋巴结转移的常见区域,其中Ⅲ区转移率最高,达100％;当出现跳跃性转移时,Ⅱ-Ⅳ区是转移高发区域。结论对年龄〈45岁的PTC患者应常规进行中央区淋巴结清扫;如果患者同时合并结节性甲状腺肿,中央区淋巴结转移的风险会显著降低;当原发肿瘤为多发病灶时,应加强术中对Ⅱ-Ⅳ区淋巴结的探查,尤其是Ⅲ区淋巴结;当可疑跳跃性转移出现时,Ⅱ-Ⅳ区淋巴结应是常规清扫范围。     

中央区淋巴结转移强度对甲状腺乳头状癌颈侧区淋巴结转移的临床意义

目的应用中央区淋巴结转移(central lymph node metastasis,CLNM)强度概念,探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈侧区淋巴结转移(lymph node metastasis,LNM)危险因素及对其影响。方法回顾性分析内蒙古医科大学附属医院甲状腺乳腺外科2009年1月至2017年4月收治的106例行PTC颈淋巴结清扫术完整临床资料,根据颈侧区淋巴结是否转移分为LNM阳性组(75例)、LNM阴性组(31例)。探讨性别、年龄、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)、是否合并桥本氏甲状腺炎、肿瘤位置、侵犯被膜、多灶性、肿瘤腺体内分布、肿瘤直径、CLNM数目、CLNM率等转移相关危险因素,分析CLNM强度对颈侧区LNM的影响。采用SPSS 21.0软件进行数据分析,正态分布的计量资料以均值±标准差(±s)表示,组间比较采用t检验。计数资料以率(构成比)表示,组间比较采用χ2检验或Fisher确切概率法。结果单因素分析发现,是否合并桥本氏甲状腺炎(P=0.087)、肿瘤位置(P=0.249)、肿瘤腺体内分布(P=0.219)、肿瘤直径(P=0.224)与颈侧区LNM无关,差异无统计学意义(P>0.05);而侵犯被膜(P=0.030)、多灶性(P=0.031)、CLNM数目(P=0.022)、CLNM率(P=0.001)与颈侧区LNM有关,差异有统计学意义(P<0.05)。CLNM数目和CLNM率增加与颈侧区LNM呈正相关;当CLNM数目≥4或(和)CLNM率≥20%时,颈侧区LNM发生率明显增高,差异有统计学意义(P<0.05)。结论侵犯被膜、多灶性是颈侧区LNM的危险因素;当CLNM强度:转移数目≥4枚或(和)转移率≥20%时,建议行颈侧区淋巴结清扫术。     

甲状腺髓样癌手术切除范围及预后影响因素研究

目的 分析甲状腺髓样癌（MTC）手术切除范围及预后影响因素。方法 回顾性分析2015年1月至2017年6月期间首诊于天津医科大学肿瘤医院MTC病人的临床资料。分析临床病理特征与中央区、侧颈区淋巴结转移及生化治愈的关系;探讨影响病人无进展生存期的危险因素。结果 77例病人,术前降钙素水平正常者5例,升高者72例。行全甲状腺切除28例,单侧腺叶切除49例。仅行中央区淋巴结清扫39例,中央区及患侧侧颈淋巴结清扫38例。MTC病人中央区淋巴结转移与性别、侵出腺叶、肿瘤直径、TNM分期、术前降钙素、降钙素水平/肿瘤直径具有相关性（P＜0.05）。侧颈淋巴结转移与年龄、TNM分期具有相关性（P＜0.05）。生化治愈率66.1%（39/59）,与中央区淋巴结转移、TNM分期、肿瘤直径、术前降钙素水平及降钙素水平/肿瘤直径具有相关性（P＜0.05）。中位随访时间35（7~69）个月。侵出腺叶、中央区淋巴结转移、淋巴结转移、淋巴结切除范围、TNM分期、术前降钙素水平和生化治愈是MTC病人无进展生存期的影响因素（P＜0.05）。结论 MTC病人建议至少行患侧腺叶切除及中央区淋巴结清扫,必要时行全甲状腺切除,根据超声、CT及降钙素水平等检查结果行预防性/治疗性侧颈淋巴结清扫。规范化的手术治疗是达到较高生化治愈率,减少复发的关键。     

Follicular variant of papillary thyroid carcinoma: a long-term follow-up

HYPOTHESIS: The clinical behavior of the follicular variant of papillary thyroid carcinoma (FVPTC) is similar to pure papillary thyroid carcinoma (PPTC) and completely different from follicular thyroid carcinoma (FTC). DESIGN: Retrospective analysis of prospectively documented data. SETTING: Referral center of a university hospital. PATIENTS: Two hundred thirty-seven consecutive patients with follicular cell-derived thyroid carcinomas were operated on in our institution during a 15-year period, from January 1, 1980, to December 31, 1994. Of the 154 PTC patients, 37 (24%) had FVPTC. The mean follow-up was 128.2 months (10.7 years). MAIN OUTCOME MEASURES: Demographic features, tumor characteristics, local and distant spread, persistence or recurrence of disease, and carcinoma-related mortality were compared between the groups with FVPTC, PPTC, and non-Hürthle cell FTC (NHFTC). RESULTS: The frequency of multicentricity was significantly higher in the FVPTC group than in the PPTC group (P =.03) or in the NHFTC group (P =.01) (12 [32%] of 37 patients vs 17 [15%] of 117 patients vs 6 [10%] of 58 patients, respectively). The incidence of cervical lymph node metastases was lower in the FVPTC group than in the PPTC group (P =.30) and higher than in NHFTC group (P =.004) (12 [32%] of 37 patients vs 53 [45%] of 117 patients vs 6 [10%] of 58 patients, respectively). At diagnosis, no patient with FVPTC showed distant metastases, compared with 5 patients (4%) with PPTC (P =.34) and 19 (33%) with NHFTC (P<.001). There was no carcinoma-related death in the FVPTC group. The strikingly poorer prognosis for the NHFTC group was statistically significant (P<.001), whereas the difference in carcinoma-specific survival between the PPTC and the FVPTC groups did show a trend toward better survival in the FVPTC group. CONCLUSION: The clinical behavior of the FVPTC group did not differ significantly from that of the PPTC group, whereas compared with the NHFTC group, the FVPTC group showed statistically significant differences for most of the analyzed variables.     

Correlations of neck ultrasound and pathology in cervical lymph node of papillary thyroid carcinoma

Abstract

Background: High-resolution sonography is becoming a method of choice for the detection and diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC). The purpose of this study is to assess the diagnostic accuracy of neck ultrasound (US) in the detection of lymph node metastases from PTC.

Methods: Data for all patients with papillary thyroid cancers and preoperative neck US were reviewed retrospectively. The diagnostic accuracy of US was determined according to whether histologically confirmed cancer was present in surgical cervical lymph node specimens.

Results: A total of 206 patients (149 central and 57 central and lateral lymph nodes dissection) were included. Their mean age was 56 years (14–88 years). Central and lateral lymph nodes were involved in 68% (n?=?141 patients; 141/206) and 60% (n?=?34 patients; 34/57) of cases, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of US in predicting papillary thyroid carcinoma (PTC) metastasis in the central neck were 69%, 71%, 84% and 51% respectively, and in the lateral neck were 85%, 65%, 78% and 75% respectively.

Conclusions: Preoperative neck US is a valuable tool in the detection of cervical lymph node metastases from papillary thyroid cancer and can provide reliable information to assist in surgical management.     

Is carcino-embryonic antigen useful in the follow-up management of patients with colorectal liver metastases?

BACKGROUND: The role of carcino-embryonic antigen (CEA) in monitoring early detection of recurrent or metastatic colorectal cancer, and its impact on resectability rate and patient survival remains controversial. Our objective was to determine any association between the preoperative level of CEA and prognosis, and the resectability and survival by method of diagnosis of colorectal hepatic metastases. METHODS: We analyzed patients who underwent exploration for hepatic resection for metastatic colorectal cancer over a 15-year period. The patient population consisted of those patients who had undergone primary colon or rectal resection and were followed up with serial CEA levels and of patients who were followed up with physical examination, liver function tests (LFTs) or computed tomography (CT) of the abdomen and pelvis that led to the diagnosis of liver metastases. Also included in the study were patients who were diagnosed with liver metastases at the time of the primary colon or rectal resection and underwent planned hepatic resection at a later time. RESULTS: Three hundred and one (301) patients who underwent a total of 345 planned hepatic resections for metastatic colorectal cancer between January 1978 and December 1993 were included in this analysis. The median preoperative CEA level was 24.8 ng/mL in the resected group, 53.0 ng/mL in the incomplete resection group, and 49.1 ng/mL in the nonresected group (P = 0.02). More of the patients who had a preoperative CEA < or =30 ng/mL were in the resected group, while those who had a preoperative CEA >30 ng/mL were likely to be in the nonresected group (P = 0.002). The median survival was 25 months for patients with a preoperative CEA level < or =30 ng/mL and 17 months for patients with a preoperative CEA >30 ng/mL (P = 0.0005). The resectability rate and the survival of patients by method of diagnosing liver metastases-rising CEA versus history and physical, elevated LFTs, CT scan versus diagnosis at the time of primary resection-was not significant (P = 0.06 and P = 0.19, respectively). Given the nonstandardized retrospective nature of the study cohort and relative small groups of patients, the power to detect small differences in survival by method of diagnosis is limited. In the complete resection group of patients with unilobar liver disease (5-year survival of 28.8%) there was no difference in survival between those patients who had normal preoperative CEA and those who had elevated preoperative CEA, and approximately 90% of them had an abnormal preoperative serum CEA level. CONCLUSIONS: CEA is useful in the preoperative evaluation of patients with hepatic colorectal metastases for assessing prognosis and is complimentary to history and physical examination in the diagnosis of liver metastases. Patients with colorectal liver metastases and preoperative CEA < or =30 ng/mL are more likely to be resectable, and they have the longest survival.     

Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment

OBJECTIVE: The purpose of this study was to analyze our entire experience with pulmonary resection for metastatic colorectal carcinoma to determine prognostic factors and critically evaluate the potential role of extended metastasectomy. METHODS: We analyzed the postoperative survival of 165 patients who underwent curative pulmonary surgery at eight institutions in the Kansai region of western Japan (Kansai Clinical Oncology Group) from 1990 to 2000. RESULTS: Overall survivals at 5 and 10 years were 39.6% and 37.2%, respectively. Cumulative survival of patients who underwent simultaneous bilateral metastasectomy was significantly lower than that of the patients who underwent unilateral metastasectomy or sequential bilateral metastasectomy (P =.048). Five-year survival was 53.6% for patients without hilar or mediastinal lymph node metastasis, versus 6.2% at 4 years for patients with metastases (P <.001). Five-year survival of patients with a prethoracotomy carcinoembryonic antigen level less than 10 ng/mL was 42.7%, versus 15.1% at 4 years for patients with a carcinoembryonic antigen level 10 ng/mL or greater (P <.0001). Twenty-one patients underwent a second or third thoracotomy for recurrent colorectal carcinoma. Overall 5-year survival from the date of the second thoracotomy was 52.1%. The 34.1% 10-year survival for the 26 patients with hepatic metastasis resected before thoracotomy did not differ significantly from that of patients without hepatic metastases (P =.38). CONCLUSIONS: The status of the hilar or mediastinal lymph nodes and prethoracotomy carcinoembryonic antigen level were significant independent prognostic factors. Patients with pulmonary metastases potentially benefit from pulmonary metastasectomy even when there is a history of solitary liver metastasis. Careful follow-up is warranted, because patients with recurrent pulmonary metastases can undergo repeat thoracotomy with acceptable long-term survival. Simultaneous bilateral metastasectomy confers no survival benefit. Prospective studies may determine the significance of this type of pulmonary metastasectomy.     

The significance of lymph node status in papillary and follicular thyroid gland carcinoma for the nuclear medicine physician

The impact of lymph node metastases on prognosis of differentiated thyroid cancer is discussed controversially. Therefore the data of 596 patients with papillary or follicular thyroid cancer are analysed retrospectively, which have been treated between 1980 and 1995 at the Clinic and Policlinic for Nuclear Medicine of the University of Würzburg. The influence of lymph node metastases on prognosis with respect to survival is analysed with the univariate Kaplan-Meier-method and with the multivariate discriminant analysis. In addition, the influence of the prognostic factor "lymph node involvement" on distant metastases is analysed by a stratified comparison and an univariate test. In papillary thyroid cancer, the 15 year-survival-rate for stage pN1 is significantly lower (p < 0.001) with 88.7% as compared to stage pN0 (99.4%). In patients with follicular thyroid cancer this difference is even more pronounced (64.7% versus 97.2%, p < 0.001). However, the multivariate discriminant analysis shows that the only prognostic factors are tumour stage and distant metastases, and--in papillary thyroid cancer--patient's age. So lymph node metastases are not an independent prognostic factor concerning survival. However, lymph node metastases have a prognostic unfavourable influence with respect to distant metastases especially in papillary thyroid cancer stage pT4 (distant metastases in patients with negative lymph nodes 0% and in patients with positive lymph nodes 35.3% [p < 0.001]).     

甲状腺乳头状癌远处转移16例临床病理特征分析

目的探讨甲状腺乳头状癌合并远处转移患者的临床病理特点及预后。 方法收集2003年1月至2017年12月在中山大学附属第一医院住院诊治病例资料完整的16例甲状腺乳头状癌合并远处转移患者,回顾性分析其临床和病理特点及预后。 结果同步转移13例,其中2例老年患者死亡,中位数年龄为35岁。肿瘤的平均直径为（2.9±1.89）cm,转移部位多为肺转移,11例存在颈部淋巴结转移,占总数的68.75%。转移淋巴结的数量中位数达到9.75枚。转移淋巴结的平均最大直径为（2.5±1.50）cm。10例患者超声显示病灶为血供丰富。8例甲状腺球蛋白（TG）定量明显升高。 结论甲状腺乳头状癌远处转移可能是致命的。对于原发肿瘤直径较大并且较多肿大淋巴结、血供丰富、TG升高的患者要注意远处转移特别是肺转移的发生。     

Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer

BACKGROUND: Cervical recurrence occurs in up to 30% of patients with differentiated thyroid carcinoma. We retrospectively compared preoperative transcutaneous ultrasonography and physical examination (PE) results in the detection of local-regional metastases (lymph node and soft tissue) in patients with thyroid cancer. METHODS: Data were collected retrospectively from the medical records of patients with thyroid carcinoma who underwent preoperative ultrasonography. Patients were divided into 3 groups: group 1, those undergoing primary thyroid/neck surgery; group 2, those undergoing reoperation for persistent disease; and group 3, those undergoing reoperation for recurrent thyroid carcinoma. For each group, we recorded the frequencies with which ultrasonography detected disease in a neck compartment (central or lateral) that was normal on PE. RESULTS: Two hundred twelve patients underwent operation for primary, persistent, or recurrent papillary (n=130), medullary (n=61), or follicular/Hürthle cell (n=21) carcinoma. Ultrasonography detected additional sites of metastatic disease not appreciated on PE in 21 (20%) of 107 group 1 patients, 9 (32%) of 28 group 2 patients, and 52 (68%) of 77 group 3 patients. The surgical procedure performed was altered by the information obtained from preoperative ultrasonography in 82 (39%) of the 212 patients. Of the 107 group 1 patients, cervical recurrence has been detected in only 6 (6%) at a median follow-up of 36 months, in spite of 67 (63%) having tumors larger than 2 cm or lymph node metastases. CONCLUSIONS: Preoperative high-quality ultrasonography detected lymph node or soft-tissue metastases in neck compartments believed to be uninvolved by PE in 39% of patients. Ultrasound findings altered the operative procedure in these patients, facilitating complete resection of disease and potentially minimizing local-regional recurrence.     

Differentiated thyroid carcinoma: comparison between papillary and follicular carcinoma in a single institute

PURPOSE: To compare and contrast the clinical presentation and treatment outcome of patients with papillary and follicular thyroid carcinoma and to study the pattern of practice of treatment of differentiated thyroid carcinoma in Hong Kong. METHOD: The clinical presentation and treatment outcomes were reviewed for 1057 patients with differentiated thyroid cancers who were treated at the Queen Elizabeth Hospital, Hong Kong, from 1960 to 1997. Eight hundred forty-two patients had papillary thyroid carcinomas (PTC), and 215 had follicular thyroid carcinomas (FTC). The mean follow-up was 9.2 years. RESULTS: The differences in the clinical factors of PTC to FTC were as follows: PTC had a higher incidence (3.9:1); these patients were younger at presentation (median age, 44 vs 49), showed a higher female-male ratio (4.5 vs 2.9) and smaller primary tumor size (median 2 cm vs 3.5 cm), and a higher incidence of multifocal disease (28.3% vs 18.1%), extrathyroidal extension (39.4% vs 14%), and more lymph node metastases (33.3% vs 12.1%). The incidence of distant metastases was higher for patients with FTC (28.8% vs 8.9%), and cause-specific survival rates were lower (p =.001). The locoregional control rates were not significantly different (p =.2). The 10-year cause-specific survival, freedom from distant metastasis, and locoregional failure figures for PTC compared with FTC were 92.1% vs 81%, 90.8% vs 72.3%, and 78.5% vs 83%. CONCLUSIONS: Although patients with PTC tend to have more advanced locoregional disease compared with those with FTC, the likelihood of locoregional control is similar, and the probability of cure is better.