Treatment Outcome of Papillary Carcinoma Confined to the Thyroid Isthmus

Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from 1985-2008. Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 - 71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1);two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 - 274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.

Familial Nonmedullary Thyroid Carcinoma： A Retrospective Analysis of 117 Families

Background： The first and most important step in characterizing familial nonmedullary thyroid carcinoma （NMTC） is to distinguish the true familial patients, which is the prerequisite for all accurate analyses. This study aimed to investigate whether patients from families with ≥3 first-degree relatives affected with NMTC have different characteristics than patients from families with only two affected members, and to compare these patients with those with sporadic disease. Methods： We analyzed the clinicopathological features and prognosis of 209 familial and 1120 sporadic cases of NMTC. Familial patients were further divided into two subgroups： families with two affected members and families with ≥3 affected members. Results： The familial group had a significantly higher risk of bilateral growth, multifocality, extrathyroidal extension, and lateral lymph node metastasis than the sporadic group （P 〈 0.05）. These main features were also different between the group with ≥3 affected members and the sporadic group. The only difference between the two affected members＇ group and the sporadic group was incidence of multifocality （P 〈 0.05）. The probability of disease recurrence in patients from families with ≥3 affected members was significantly higher than that in sporadic cases （14.46% vs. 5.27%; P = 0.001）, while the probability in patients from families with two affected members was similar to that in sporadic patients （6.35% vs. 5.27%; P = 0.610）. The Kaplan–Meier survival analysis showed a statistically significant difference in disease-free survival between the two subgroups （85.54% vs. 93.65%; P = 0.045）. Conclusions： Patients from families with ≥3 members affected by NMTC have more aggressive features and a worse prognosis than those from families with only two affected members. Patients from families with ≥3 affected first-degree relatives may be considered to have true familial NMTC.

Survival Outcome of Squamous Cell Carcinoma Arising from Sinonasal Inverted Papilloma

Background： Sinonasal inverted papilloma （IP） is a rare benign tumor of the nasal cavities and paranasal sinuses. It is destructive or bone-rcmodeling, tends to recur alter surgical resection, and has a significant malignant potential. The present study aimed to pertbnn a retrospective analysis of patients with squamous cell carcinoma （SCC） arising from IP, including characteristics, survival outcome, and predictors of associated malignancy. Methods： The medical records of 213 patients diagnosed with IP from January 1970 to January 2014 were retrospectively reviewed. Eighty-seven patients were diagnosed with SCC/IP; their clinical characteristics, treatments, and survival outcomes were analyzed. Results： Of the 87 patients with SCC/IP, the 5- and 10-year overall survival outcomes were 39.6% and 31.8%, respectively. Twenty-nine of these patients received surgery and 58 received combined surgery and radiation. Of the patients with stages III-IV, the 5-year survival rate was 30.7% for those treated with surgery only and 39.9% for those given the combination treatment （P = 0.849）. Factors associated with significantly poor prognosis were advanced-stage, metachronous tumors, or with cranial base and orbit invasion. Age, synchronous or metachronous tumors, and pathological stage were independent risk factors for mortality, shown by multivariate analysis. Conclusion： Patients with SCC/IP had low overall survival outcomes. Advanced age, stage, and metachronous tumors are the main factors affecting prognosis. Treatment planning should consider high-risk factors to improve survival outcome.