Biomedical subjects

Miin-Fu Chen

Publications and source records attributed to Miin-Fu Chen.

At least 37 records · Page 2Linked to original sources

PubMed2005

Characterization of intrahepatic cholangiocarcinoma of the intraductal growth-type and its precursor lesions.

A cohort of patients with intraductal growth-type intrahepatic cholangiocarcinoma (IG-ICC) and its precursor lesions, collectively termed intraductal papillary neoplasm of the liver (IPNL), was characterized with respect to demographics, clinical manifestations, perioperative management, long-term survival, and molecular features associated with carcinogenesis. A total of 122 patients with IPNL types 1 through 4, 108 patients with non-IG-ICC and 210 patients with hepatolithiasis alone were studied. Expression of CDX2, TFF1, MUC1, MUC2, MUC5AC, EGFR, and p53 was determined by using immunohistochemistry. Females predominated in those with hepatolithiasis alone and IPNL. The mean age of patients with hepatolithiasis alone was 6 to 8 years younger than that of those with IPNL. The association with hepatolithiasis in patients with IPNL types 1 and 2, IPNL types 3 and 4, and non-IG-ICC was 100%, 79%, and 64%, respectively. Mucobilia, anemia, and elevated serum carcinoembryonic antigen levels were helpful in distinguishing IG-ICC and its precursor lesions. The mean survival of patients with IPNL type 3, IPNL type 4, and non-IG-ICC was 55.5 months, 36.9 months, and 15.8 months, respectively. The incidence of expression of CDX2 and TFF1 was maximal in IPNL type 3. Expression and cellular distribution of MUC2 and CDX2 were similar. MUC5AC was strongly expressed in all patients with IPNL; EGFR and p53 were rarely expressed in patients with IPNL. In conclusion, hepatolithiasis appears to be a precipitating factor in the development of IPNL. Signs of mucobilia were specific for the diagnosis of IPNL. Expression of CDX2 and MUC2 are helpful in differentiating IPNL and non-IG-ICC. Significant differences in survival associated with the various lesions studied warrants a more aggressive surgical strategy in their management.

Bile Duct Neoplasms↗

PubMed2005

Gallbladder carcinoma with biliary invasion: clinical analysis of the differences from nonbiliary invasion.

Gallbladder carcinoma is the most common malignancy of the biliary tract. Because of a lack of specific presentations, this condition frequently is diagnosed only at an advanced stage. The clinical difference between gallbladder carcinoma with and without biliary involvement remains uncertain. This study recruited all patients with gallbladder carcinoma treated at Chang Gung Memorial Hospital (Taoyuan, Taiwan) from 1987 to 2002. The sample included 120 patients aged 28 to 91 years (mean 65.5 +/- 12.3 years) (39 men, 81 women), whose medical records were reviewed retrospectively. Based on the 2002 newly revised TNM classification, 25, 38, 28, and 29 patients had stage I, II, III, and IV disease, respectively. After we excluded patients with stage I, the other patients were classified into two groups as follows: group I, gallbladder carcinoma with biliary invasion (n = 41); group II, carcinoma without biliary involvement (n = 54). The clinical presentations, laboratory data, operative methods, and outcome of these two groups were compared. The two groups did not differ in terms of age, sex distribution, cholelithiasis, and most clinical presentations. Chemistry laboratory data also identified patients in group I with significantly elevated liver function tests. Group II had a borderline tendency toward better curative resectability than group I (p = 0.09). Survival was significantly better for group I patients who underwent curative resection (n = 5) via cholecystectomy, partial hepatectomy, and bile duct resection than for those with noncurative resection (p < 0.05). However, long-term survival demonstrated that gallbladder carcinoma had the same poor prognosis in the two groups. In conclusion, gallbladder carcinoma with biliary invasion has been found to a more overt clinical presentation and abnormal laboratory data, which might alert clinicians to consider gallbladder carcinoma at an advanced stage or biliary invasion and examine the underlying disease. Generally, the outcome of gallbladder carcinoma is dismal, and radical curative resection combined with cholecystectomy, partial hepatectomy, and bile duct resection perhaps may offer good benefits for advanced gallbladder carcinoma. Furthermore, surgical resection should be performed whenever possible in patients with gallbladder carcinoma to increase life expectancy.

Adult↗

PubMed2005

Surgical treatment of Hurthle cell tumors of the thyroid.

Hurthle cell tumors are relatively rare thyroid tumors and their management and prognosis is controversial. We retrospectively review 135 Hurthle cell adenomas and 28 Hurthle cell carcinomas of the thyroid surgically treated at our institute. No significant difference was found between the adenoma and carcinoma groups in patient age, gender, and tumor size. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of fine-needle aspiration cytology (FNAC) in detecting malignancy were 87.5%, 19.3%, 31.2%, 18.6%, and 88.0%. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of frozen section in detecting malignancy of the thyroid gland were 40.0%, 100.0%, 92.9%, 100.0%, and 92.0%. Most of the adenomas were treated with procedures no less invasive than lobectomy/isthmusectomy. Meanwhile, most of the carcinoma patients underwent total thyroidectomy. Operative morbidity occurred in six patients (3.8%), including transient recurrent laryngeal nerve palsy in three patients, damage to the external branch of the superior laryngeal nerve in two patients, and transient hypocalcemia in one patient. No recurrence of Hurthle cell adenomas was noted. Five adenoma patients died of causes unrelated to their Hurthle cell tumors, but no carcinoma patients died during the follow-up period. In conclusion, clinical factors and FNAC are not helpful in the differentiation between adenoma and carcinoma. Unilateral Hurthle cell adenoma can be treated by lobectomy/isthmusectomy, and Hurthle cell carcinoma can be treated by total thyroidectomy with minimal operative morbidity.

Adenoma, Oxyphilic↗

PubMed2005

Clinicopathological factors predicting long-term overall survival after hepatectomy for peripheral cholangiocarcinoma.

Peripheral cholangiocarcinoma (PCC) is clinically challenging because patients typically do not present until the disease is relatively advanced. Three-year to 5-year survival rates even with resection thus remain dismal. This study aimed to determine the clinicopathological factors for predicting overall survival longer than 5 years in PCC patients treated with hepatectomy. From 1977 to 1997, the clinicopatholgical features of 11 PCC patients who underwent hepatectomy with long-term overall survival (group A) were reviewed. Comparison was made with the clinical features and factors influencing the outcome of 70 PCC patients who survived less than 5 years after hepatectomy (group B). Of 81 PCC patients undergoing hepatectomy, 11 (13.6%) were 5-year survivors. The 81 PCC patients comprised 32 men and 49 women, with a mean age of 56.0 years (range: 34-83 years). Univariate analysis showed that female gender, absence of physical findings, a higher percentage of presence of mucobilia, early staged tumor, intraductal papillary tumor growth, and curative hepatic resection were more frequent in group A patients than group B patients. However, multivariate logistic regression analysis showed that absence of physical findings, presence of mucobilia, early staged tumor, and curative hepatic resection were the four independent factors differentiating group A from B patients. The 1-, 3-, 5-, and 10-year survival rates of the group A patients were 100%, 100%, 100%, and 40%, whereas those of the group B patients were 46.0%, 9.5%, 0%, and 0%, respectively. Absence of physical findings, presence of mucobilia, early staged tumor, and curative hepatectomy could independently predict PCC patients with long-term overall survival after hepatectomy.

Aged↗

PubMed2005

Assessment of hepatic reserve for indication of hepatic resection: how I do it.

BACKGROUND/PURPOSE: Hepatic resection may result in liver failure in patients with cirrhotic livers. Preoperative evaluation of liver function in cirrhotic patients, to prevent postoperative liver failure, is very important. METHODS: Sixteen patients with hepatocellular carcinoma in cirrhotic livers were enrolled in this study. Liver function was determined quantitatively by monoethylglycinexylidide (MEGX) formation from the metabolism of lidocaine. The whole liver volume and tumor volume were measured by computed tomographic volumetry. The volume of resected liver was recorded by water displacement. The relationship between liver function and remnant liver volume was determined. RESULTS: A relationship between the percentage remnant liver volume and ratio of MEGX formation after hepatectomy was found. The regression equation was: (postoperative MEGX formation/preoperative MEGX formation) x 100% = (0.688 x percentage remnant liver volume + 0.179) x 100% (r (2) = 0.49). A relationship between MEGX formation after hepatectomy and the international ratio (INR) of prothrombin time was also found. The regression equation was INR = 1.99 - 0.01 x MEGX (r (2) = 0.30). CONCLUSIONS: Post-hepatectomy liver function can be estimated for an individual patient by the appropriate regression equations. Prevention of post-hepatectomy liver failure for patients with cirrhotic livers is feasible.

Carcinoma, Hepatocellular↗

PubMed2005

Perforation through small bowel malignant tumors.

Data on 19 patients (6 women and 13 men) with malignancy perforation through small bowel tissue were retrospectively reviewed. The median patient age was 57 years (range, 41-81 years). The histopathology included lymphoma (seven patients), leiomyosarcoma (two patients), gastrointestinal stromal tumor (one patient), adenocarcinoma (one patient), metastatic carcinomas with unknown primary tumor (four patients), metastatic adenocarcinoma from the lung (one patient), and metastatic carcinomas from the hypopharynx (one patient), cervix (one patient), and lung (one patient). Resection of a segment of perforated bowel with primary anastomosis was performed in 16 patients, wedge resection of perforated lesion with plication in two patients, and loop ileostomy in one patient. Postoperative deaths occurred in 10 (52.6%) patients, owing to sepsis and organ functional failure. Seven patients died from the primary malignancy at a median follow-up of 6.5 months (range, 5 months to 1 year 9 months) after surgery. Moreover, two patients with small bowel lymphoma were alive with disease at 4 years 8 months and 7 years 1 month after surgery. In conclusion, perforation through small bowel malignant tumors had a high postoperative mortality rate. High index of suspicion of the disease with early surgical treatment may improve treatment outcomes.

Adult↗

PubMed2005

Intrahepatic cholangiocarcinoma escapes from growth inhibitory effect of transforming growth factor-beta1 by overexpression of cyclin D1.

Transforming growth factor-beta1 (TGF-beta1) is involved in tumor progression by promoting angiogenesis or suppressing the immune system; yet TGF-beta1 also has a growth-inhibitory effect on epithelial cells including carcinoma cells. Several mechanisms of impaired TGF-beta1 responsiveness of carcinoma cells have been reported. In this study, we examined how TGF-beta1 participates in the development and progression of intrahepatic cholangiocarcinoma (ICC) associated with hepatolithiasis, and how ICC cells escape from growth inhibitory effect of TGF-beta1. A total of 40 cases of hepatolithiasis were studied, including 16 cases of ICC, and in vitro studies were conducted with cultured murine non-neoplastic biliary epithelial cells (MBEC) and three ICC cell lines. Immunohistochemically, TGF-beta1 was expressed in mononuclear cells and mesenchymal cells around the stone-containing bile ducts and invasive ICC, and also in biliary epithelial cells (hyperplastic and precursor lesions, and ICC). TGF-beta type II receptor (TbetaR-II) was constantly expressed on biliary epithelial cells irrespective of biliary lesions. In cell culture studies, TGF-beta1 significantly inhibited proliferation of MBEC via downregulation of cyclin D1, cdk4, and cdk6, while TGF-beta1 did not influence the proliferation of ICC cells. After suppression of cyclin D1 expression in one ICC cell line using cyclin D1 small interfering RNA, TGF-beta1 significantly inhibited the proliferation of ICC cells. In conclusion, high levels of TGF-beta1 around ICC or its precursors may be involved in development and progression of ICC in hepatolithiasis. ICC cells could escape the growth inhibitory effect of TGF-beta1 by overexpression of cyclin D1.

Cell Division↗

PubMed2005

Identifying good prognosis group of breast cancer patients with 1-3 positive axillary nodes for adjuvant cyclophosphamide, methotrexate and 5-fluorouracil (CMF) chemotherapy.

OBJECTIVE: We conducted a retrospective analysis of prognosis factors for survival in breast cancer patients with 1-3 axillary lymph node metastases and tried to identify a subset of patients with good prognosis suitable for cyclophosphamide, methotrexate and 5-fluorouracil (CMF) adjuvant chemotherapy. METHODS: A cohort of 446 breast cancer patients received definite surgery and adjuvant chemotherapy with CMF at Chang Gung Memorial Hospital from 1990 to 1998. They were enrolled in the study. The median follow-up time was 69 months. Prognostic factors including age, tumor size, number of involved nodes, steroid receptor status, tumor ploidy, synthetic-phase fraction, histologic grade and administration of tamoxifen were analysed for disease-free survival (DFS) and overall survival (OS) by Cox regression model. RESULTS: The estimated 5 year OS and DFS for all patients were 85.4 and 71.5%, respectively. Multivariate analysis revealed that tumor size, age and estrogen receptor (ER) status were independent prognostic factors for OS, and tumor size, age, ER status and number of involved nodes were independent prognostic factors for DFS. The 5 year OS rates of the low-risk group (age >40, tumor < or =3 cm and positive ER) and average-risk group (either age < or =40, tumor >3 cm or negative ER) were 98.8 and 82.4%, respectively (P = 0.0001). The 5 year DFS of the low-risk and high-risk group were 88.2 and 67.7%, respectively (P = 0.0001). CONCLUSION: Among breast cancer patients with 1-3 positive lymph nodes excellent survival rate was found in those who had favorable prognostic factors, including age >40, tumor size < or =3 cm and positive ER. Adjuvant chemotherapy with CMF regimen is optimal for these low-risk patients.

Adenocarcinoma↗

PubMed2005

Aberrant expression of cdx2 homeobox gene in intraductal papillary-mucinous neoplasm of the pancreas but not in pancreatic ductal adenocarcinoma.

OBJECTIVES: The authors investigated differential expression of cdx2 in intraductal papillary mucinous neoplasm of the pancreas (IPMN) and ductal adenocarcinoma. METHODS: Patients with IPMN (n = 23) and pancreatic ductal adenocarcinoma (n = 30) were studied. Expression of cdx2 mRNA, CDX2 protein, muc2 mRNA, MUC2 apomucin, and MUC5AC apomucin were determined. RESULTS: Of 23 IPMN, expression of cdx2 was detected in 8 of 9 adenomas, 6 of 8 borderline malignancies, and 3 of 6 malignancies, respectively. Of the 3 cdx2-expressing malignant IPMN, 2 did not display CDX2 expression. The appearance of CDX2-positive neoplastic cells in IPMN coincided with that of MUC2-positive neoplastic cells. All 23 IPMN displayed a positive MUC5AC expression irrespective to the status of CDX2 expression. Of 30 ductal adenocarcinomas, none displayed cdx2, CDX2, and MUC2 expression, while 10 cases displayed positive MUC5AC expression. CONCLUSION: Aberrant expression of cdx2 homeobox gene was detected in IPMN but not in ductal adenocarcinoma, which might determine their diverse carcinogenesis.

Adenocarcinoma↗

PubMed2005

Delayed neutrophil apoptosis attenuated by melatonin in human acute pancreatitis.

OBJECTIVES: This study evaluated the expression of neutrophil apoptosis and the effects of melatonin at different concentrations on delayed neutrophil apoptosis in different severities of acute pancreatitis in patients. METHODS: The study population was comprised of 10 patients with severe acute pancreatitis (SAP) and 10 with mild acute pancreatitis (MAP). A total of 10 mL of blood was drawn 24 hours after the onset of the clinical disease for isolation and incubation of the human neutrophils with 4 different concentrations of melatonin. Neutrophil apoptosis activity, CD18 expression, and respiratory burst activity were assessed with flow cytometry 12 hours after incubation. Another group of neutrophils from a healthy control group was used (n = 6) for comparison. RESULTS: Neutrophil apoptosis in patients with SAP is delayed compared with that of patients with MAP. Neutrophils from patients with SAP or MAP are functionally activated. Melatonin at concentrations of 10(-8), 10(-7), or 10(-6) M reverses the delayed process and enhances apoptosis activity in neutrophils in patients with MAP. Melatonin at concentrations of 10(-7) and 10(-6) M reverses the delayed process and increases apoptosis activity in neutrophils in patients with SAP. Neutrophils from patients with SAP and MAP showed significantly increased CD18 expression and respiratory burst activity. Melatonin at concentrations of 10(-7) or 10(-6) M reverses CD18 expression and respiratory burst activity in neutrophils in patients with SAP. CONCLUSIONS: This study highlights the importance of neutrophil apoptosis in patients with SAP and raises the possibility of a therapeutic strategy. Study data show that melatonin promotes neutrophil apoptosis in human acute pancreatitis.

Acute Disease↗

PubMed2005

Clinical relevance of nonvisualized sentinel lymph nodes in unselected breast cancer patients during lymphoscintigraphy.

BACKGROUND: Sentinel lymph node (SLN) biopsy in breast cancer is an effective technique with a high degree of accuracy and low false-negative rate to replace axillary lymph node dissection (ALND). This study analyzed the major clinicopathological factors associated with nonvisualized sentinel nodes during preoperative lymphoscintigraphy. METHODS: Breast cancer patients who underwent preoperative lymphoscintigraphy and sentinel node biopsy between 2000 and 2003 were retrospectively reviewed. Sentinel node biopsy was performed with a two-day protocol. On day one, a filtered (45 micro m Millipore) technetium-99m sulfur colloid isotope with a mean radioactive dose of 37 MBq (1 mCi) in a diluted volume of 1 ml was injected subdermally just above the primary breast tumor site. Serial dynamic images were taken with a high-resolution collimator and a static image was acquired after the SLN was identified. No hot spot identified two hours after injection was classified as nonvisualization unless lymphatic drainage channels were viewed by the lymphoscintigraphy and a prolonged two hour scan was obtained. Sentinel nodes were harvested on day two. The cases with nonvisualized sentinel nodes were analyzed according to clinical histopathologic parameters to determine the clinical significance. RESULTS: A total of two hundred thirty-two breast cancer patients were enrolled in this study. Twenty-four of these cases presented with advanced breast cancer prior to neoadjuvant chemotherapy. The sentinel node was nonvisualized in twenty-seven of two hundred thrity-two cases (11.6%). Tumor size (p = 0.025) and lymph node metastasis (p = 0.001) were two factors associated with nonvisualized sentinel node in univariate analysis. Multivariate logistic regression analysis showed that more than three nodes (p = 0.001) and more than ten nodes (p = 0.001) metastasis were independent factors associated with nonvisualized sentinel node. CONCLUSIONS: Patients with more than three axillary nodes metastasis is an independent factor associated with nonvisualized sentinel node during lymphoscintigraphy.

Adult↗

PubMed2005

Aggressive multimodality treatment for intra-hepatic recurrence of hepatocellular carcinoma following hepatic resection.

BACKGROUND: Intra-hepatic recurrence following hepatic resection is the primary challenge for patients with hepatocellular carcinoma (HCC). The aim of this investigation was to evaluate the long-term results of multimodality treatment of patients with intra-hepatic recurrent HCC following hepatic resection. METHODS: From January 1995 through December 2001, a total of 846 patients who underwent hepatic resection for primary HCC at the Chang Gung Memorial Hospital (Taoyuan, Taiwan) were analyzed through long-term follow-up; intra-hepatic recurrence of HCC was identified in 444 (52.5%) patients. Patients with intra-hepatic recurrence were categorized into two groups based on whether they underwent regional treatment. A comparison analysis of the survival rates of these two groups following treatment for recurrent intra-hepatic HCC was performed. RESULTS: Patients treated with multiple modalities exhibited significantly better survival results, both after initial hepatectomy and intra-hepatic recurrence compared with patients in the non-regional-treatment group. (p < 0.001) The 1-, 3-, and 5-year survival rates of patients in the regional-treatment group after initial hepatic resection were 88.1%, 60.1%, and 35.8%, respectively. The 1-, 3-, 5-year survival rates after treatment of intra-hepatic recurrence in the regional-treatment group were 74.8%, 39.3%, and 25.2%, respectively. CONCLUSION: The incidence of intra-hepatic recurrence following hepatic resection for HCC remains high. Aggressive multimodality treatment could extend the survival for patients with recurrent postoperative intra-hepatic HCC.

Adult↗

PubMed2005

Outcome of pancreaticoduodenectomy for chronic pancreatitis.

BACKGROUND AND PURPOSE: Some patients with chronic pancreatitis may require surgery, mainly because of disabling medically intractable pain, suspicion of malignancy or complications related to chronic pancreatitis. This study analyzed the efficacy of pancreaticoduodenectomy (PD) for patients with chronic pancreatitis in terms of pain relief, control of local complications and pancreatic endocrine/exocrine function. METHODS: This retrospective analysis included 24 consecutive patients with chronic pancreatitis who received PD from April 1995 to March 2003. There were 21 men and 3 women. The age of the patients ranged from 21 years to 73 years, with a mean age of 44 years. Alcohol abuse, found in 14 patients (58.3%), was the most common predisposing factor. Local complications included stenosis of the pancreatic duct in 15 patients, biliary obstruction in 9, duodenal obstruction in 4 and left-sided portal hypertension in 1. The surgical indications were recurrent intractable pain (n=16), local complications (n=18), and suspicion of malignancy (n=6). Endocrine pancreatic function was assessed by the need to treat diabetes mellitus with dietary modification, oral hypoglycemic agents or insulin. Pancreatic exocrine function was assessed based on clinical symptoms. Pain severity was evaluated using a scoring system based on the use of analgesic medication. The mean duration of follow-up in 22 of 24 patients was 31 months, with a range of 4 to 90 months. RESULTS: Preoperatively, pancreatic exocrine insufficiency was detected in 3 patients (3/24, 12.5%), exocrine insufficiency in 5 (5/24, 20.8%) and intractable abdominal pain requiring morphine injection in 16 (16/24, 66.7%). After PD, 4 patients had 5 complications, resulting in a morbidity rate of 17% and a mortality rate of 4%. Postoperative diabetes mellitus developed de novo in 3 patients (3/20, 15%) and postoperative pancreatic exocrine insufficiency was detected in 14 patients (14/22, 63.6%). Complete pain relief after surgery was noted in 12 patients (12/14, 85.7%). CONCLUSIONS: In selected patients with chronic pancreatitis, PD is a safe procedure and can effectively relieve pain and control local complications. Deterioration of pancreatic endocrine function after PD was mainly related to disease progression. Pancreatic resection plays an important role in progressing pancreatic exocrine function.

Adult↗

PubMed2004

Prognostic impact of Fas ligand on hepatocellular carcinoma after hepatectomy.

The expression of Fas ligand on tumor cells may counterattack the host's immunity and worsen the prognosis. Knowledge of the prognostic impact of Fas ligand on patients with hepatocellular carcinoma (HCC) after hepatectomy is still limited. Fas ligand expression in HCCs was examined in 59 patients who underwent hepatectomy for HCC. The prognosis was analyzed and correlated to the expression of Fas ligand. Expression of Fas ligand was detected by immunohistochemical staining in 27 of the 59 HCCs (45.8%). The Fas ligand was expressed in only a small number of cancer cells. However, even though only a few cancer cells expressed it, the prognosis for patients whose HCCs showed Fas ligand expression was worse than that for patients with an HCC without Fas ligand expression. The mean disease-free survival was only 10.83 +/- 1.90 months when HCCs expressed Fas ligand compared with 43.51 +/- 7.02 months for those without Fas ligand expression ( p = 0.0007). The overall patient survival was 28.34 +/- 4.08 months when the HCC expressed Fas ligand compared with 55.31 +/- 5.37 months for HCC without Fas ligand expression ( p = 0.0003). The expression of Fas ligand did not correlate with the presentation of other prognostic factors. Fas ligand expression is thus an independent prognostic factor for HCC. Thus the HCC expressing Fas ligand has a worse prognosis than the HCC without Fas ligand expression.

Adult↗

PubMed2004

Hepatic resection for hepatocellular carcinoma with obstructive jaundice due to biliary tumor thrombi.

Hepatocellular carcinoma (HCC) with obstructive jaundice due to biliary tumor thrombi is uncommon, and few studies have examined the outcome of hepatectomy for HCC with this unusual entity. This study examined the clinicopathologic factors influencing the outcomes of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi undergoing hepatectomy. The clinical features of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi (group A) undergoing hepatectomy from 1986 to 1998 were reviewed. The clinical features and factors influencing the outcome of 555 HCC patients without biliary tumor thrombi (group B) undergoing hepatectomy were used for comparison. Of 572 patients with surgically resected HCCs, 17 (3.0%) were classified into group A. Right upper quadrant pain, physical signs of jaundice, low albumin level, elevated bilirubin level, small tumor size, more vascular invasion, and tumor rupture were characteristic of group A patients. Multivariate stepwise logistic regression analysis revealed no independently significant factor differentiating group A patients from group B patients. The disease-free survival was similar between the group A and B patients, although group B patients exhibited significantly better overall survival (p = 0.014). Vascular invasion may adversely influence overall survival in group A patients undergoing hepatic resection (p = 0.0709). When feasible, hepatic resection is the preferred treatment for HCC patients with obstructive jaundice due to biliary tumor thrombi. It can achieve a disease-free survival comparable to that of HCC patients without biliary tumor thrombi. However, HCC patients with biliary tumor thrombi had significantly worse overall survival than did those without biliary tumor thrombi, especially those with concomitant vascular invasion.

Adolescent↗

PubMed2004

Surgical treatment of thyroid cancers with concurrent Graves disease.

BACKGROUND: Thyroid cancers with concurrent Graves disease are relatively rare. Accordingly, the natural history and optimal surgical treatment of thyroid cancers with Graves disease are controversial. METHODS: Sixty-one thyroid cancers with concurrent Graves disease were retrospectively reviewed. Histopathologic diagnoses included 58 papillary thyroid carcinomas (95.1%), 1 follicular carcinoma (1.6%), 1 medullary carcinoma (1.6%), and 1 Hürthle cell carcinoma (1.6%). RESULTS: The sample included 54 females and seven males. Subjects' ages ranged from 20 to 73 years (mean +/- SD, 35.9 +/- 10.6 years; median, 37 years). Average tumor size was 10.7 +/- 15.9 mm (range, 1-70 mm). Forty-nine tumors (80.3%) were 10 mm or smaller. Surgical procedures included subtotal thyroidectomy (40 patients), total thyroidectomy (16 patients), total thyroidectomy plus neck dissection (2 patients), near-total thyroidectomy (1 patient), and lobectomy with contralateral subtotal lobectomy (1 patient). Thirty-seven patients (60.7%) underwent postoperative 131I ablation for thyroid remnant. Neck lymph node metastases occurred in three patients and lung metastases in two patients. Patients who developed metastases were younger and had significantly larger tumors and higher pretreatment serum T3 level than those who did not develop metastases. No deaths occurred during the 6.2 +/- 4.1 year follow-up period (range, 1 year and 2 months to 18 years and 11 months). CONCLUSIONS: Most thyroid cancers with concurrent Graves disease were 10 mm or smaller. Subtotal thyroidectomy is adequate for patients with Graves disease with concurrent carcinoma 10 mm or smaller.

Adult↗

PubMed2004

Insular carcinoma: infrequent subtype of thyroid cancer with aggressive clinical course.

Data on four male and four female patients with insular carcinoma of the thyroid were reviewed to elucidate the clinical characteristics of this malignancy. The median age of the patients was 62.5 years (range 29-78 years). The size of the tumors ranged from 3.0 to 10.0 cm (median 4.7 cm). One patient with extensive neck disease and distant metastases underwent palliative debulking of the tumor mass and died of respiratory failure 10 days after surgery. Seven patients underwent total thyroidectomy. In addition to being given thyroxine supplement, three patients were treated with postoperative iodine-131 ((131)I) therapy, two with external radiation after (131)I treatment, and two with external radiation. Local invasion of the malignancy into strap muscles was observed in two patients, into the trachea in two patients, into the recurrent laryngeal nerve in one patient, and into the internal jugular vein in one patient. The median follow-up was 26 months (range 3-80 months). Lung metastases occurred in four patients and metastases at the neck lymph nodes in four patients; recurrence at the thyroid bed was observed in one patient. Four patients died of distant metastases and progressive recurrent disease. Of the three surviving patients, two remained disease-free, and one remained alive with lung metastases. In conclusion, insular carcinomas behave aggressively, so we believe they should be treated by total thyroidectomy plus neck dissection when nodal metastases are present.

Adult↗

PubMed2004

Resection of peritoneal implantation of hepatocellular carcinoma after hepatic resection: risk factors and prognostic analysis.

Peritoneal implantation from hepatocellular carcinoma (HCC) after hepatic resection is infrequent, and information on risk factors and long-term survival of such patients is lacking. The clinicopathologic features and risk factors of 16 HCC patients after hepatic resection who developed peritoneal implantation from an HCC and the prognosis after surgical resection of these HCC implants were assessed. The clinical features of 16 HCC patients after hepatic resection undergoing resection of peritoneal HCC implants (P-HCC) from 1986 and 2000 were reviewed. The clinical features and outcomes of 195 HCC patients undergoing hepatectomy without recurrence (NR-HCC) were used for comparison. During 1986 and 2000 a total of 749 HCC patients underwent hepatic resection. Of these 749 patients, 465 (62.1%) had HCC recurrence after hepatic resection during the follow-up period (median 26 months). Of the 465 patients, 26 (5.6%) developed peritoneal implants, and 16 of them underwent resection. Multivariate logistic regression analysis revealed that a high alpha-fetoprotein (AFP) level and capsular invasion by the tumor cells may predispose posthepatectomy patients to peritoneal implantation from their HCCs. The overall survival of the P-HCC patients after peritoneal implant resection was similar to that of the NR-HCC patients. An elevated AFP level might be regarded as a significant prognostic factor for poor overall survival ( p = 0.0577) after resection of peritoneal implants from HCCs. Peritoneal implantation occurs infrequently in posthepatectomy patients with an HCC. Elevated AFP values and capsule invasion by tumor cells may predispose posthepatectomy patients to peritoneal implantation from HCCs. Surgical resection of peritoneal implants from HCCs may prolong survival in selected patients. Elevated AFP levels may be regarded as a possibly significant prognostic factor for poor overall survival after resection of peritoneal HCC implants.

Adolescent↗