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Carl E. Silver MD Randall P. Owen MD MS Juan P. Rodrigo MD PhD Kenneth O. Devaney MD JD FCAP Alfio Ferlito MD DLO DPath FRCSEd ad hominem FRCS ad eundem FDSRCS ad eundem FHKCORL FRCPath FASCP IFCAP 《Head & neck》2011,33(7):1052-1059
A number of histologic variants of well‐differentiated papillary carcinoma have been found to be associated with more aggressive tumor behavior. Tall cell, columnar cell, diffuse sclerosing, solid/trabecular, and insular variants of well‐differentiated papillary thyroid cancer are all potentially more aggressive than conventional papillary thyroid cancer. When subjected to multivariate analysis, however, evidence that the histologic subtype of tumor is an independent predictor of outcome is weak. Rather, the aggressive variants tend to present with features recognized by other staging systems as associated with a worse prognosis, including higher histologic grade, extracapsular spread, large tumor size, and the presence of distant metastases. Prognosis is directly related to the presence of these features. The state of our knowledge is limited by the relatively small number of cases that have been studied. The presence of an aggressive variant of papillary carcinoma should alert the surgeon that he is dealing with a potentially aggressive tumor. Clinical treatment decisions should be based on the stage of the disease, influenced by the knowledge that the aggressive variants tend to be associated with higher risk factors. The surgeon must be prepared to perform at the first, or second stage, a total thyroidectomy, central compartment neck dissection, additional lymphadenectomy, and/or resection of invaded surrounding structures, and search for distant metastasis. Postoperative radioactive iodine should generally be administered for these variants as they will generally be intermediate to advanced tumors. The tall cell variant is often refractory to such treatment but may be susceptible to treatment targeted against BRAF mutation. External beam irradiation may be used in cases of incomplete resection. © 2010 Wiley Periodicals, Inc. Head Neck, 2011 相似文献
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Jesus E. Medina MD Alfio Ferlito MD DLO DPath FRCSEd ad hominem FRCS ad eundem FDSRCS ad eundem FHKCORL FRCPath FASCP IFCAP K. Thomas Robbins MD FRCSC Carl E. Silver MD Juan P. Rodrigo MD PhD Remco de Bree MD Mohamed N. Elsheikh MD Randal S. Weber MD Jochen A. Werner MD 《Head & neck》2011,33(5):746-752
We report here a review of the literature intended to clarify the nomenclature and boundaries of the nodes in the “central compartment” of the neck, the frequency with which tumors from the different laryngeal sites metastasize to these nodes, and the indications for central compartment node dissection in the treatment of cancers of the larynx. From this review, we conclude that, until consensus is reached about grouping of the lymph nodes in this area, it is best to refer to these nodes by their anatomic location, ie, prelaryngeal, pretracheal, or paratracheal lymph nodes. It is also advisable to describe dissection of these nodes as selective neck dissection (SND) with an annotation about the specific lymph node groups removed. Metastases in prelaryngeal and paratracheal lymph nodes in patients with squamous cell carcinoma of the larynx are associated with increased tumor recurrence, more frequent metastases in lymph nodes of the lateral compartment of the neck, and decreased survival. If untreated, they may lead to the development of peristomal recurrence. Therefore, elective treatment of level VI nodes is recommended in patients with squamous cell carcinomas of the subglottic region, advanced glottis carcinomas with subglottic extension, and in certain advanced carcinomas of the supraglottic region. © 2010 Wiley Periodicals, Inc. Head Neck, 2011 相似文献
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Raghav C. Dwivedi MRCS DOHNS MS Suzanne St.Rose PhD Justin W. G. Roe MSc Cert MRCSLT Edward Chisholm FRCS MD Behrad Elmiyeh MRCS DOHNS Christopher M. Nutting FRCR Peter M. Clarke FRCS Cyrus J. Kerawala FRCS FDSRCS Peter H. Rhys‐Evans FRCS Kevin J. Harrington FRCR PhD Rehan Kazi MS FRCS 《Head & neck》2011,33(3):341-348
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Brettingham-Moore KH Duong CP Heriot AG Thomas RJ Phillips WA 《Annals of surgical oncology》2011,18(5):1484-1491
Cancer treatment is now moving toward a personalized approach, promising improved rates of response and survival. A number of studies have employed the use of microarrays to investigate the predictive potential of expression profiling in gastrointestinal (GI) cancer patients. However while many robust predictive classifiers relating to response and prognosis have been generated for GI cancer patients, these have yet to make the transition to the clinic. The main obstacle is the limited cross validation between predictive gene lists identified for the same tumor type and outcome. Differences in the experimental design, analysis, and interpretation of results all contribute to this variation, with numerous factors influencing which genes are highlighted as predictive. While predictive genomics shows immense potential, it is still a relatively new field and the validation of predictive gene lists derived from microarray data remains a challenge. Future studies must carefully consider all aspects of experimental design to ensure a clinically applicable predictive test can be developed. With this in mind, more extensive and collaborative research must be undertaken before microarray-based platforms can be used routinely in tailoring GI cancer treatment and change clinical practice. Larger cohorts and consistency in methodology will enable the findings from this research to make the transition to the clinic. 相似文献
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