Refining the tumor-node-metastasis staging system for individualized treatment of differentiated thyroid carcinoma

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Young Nam Kim, Mijin Kim, Hyeon Seon Ahn, Kyunga Kim, So Young Park, Hye In Kim, Min Ji Jeon, Won Gu Kim, Sun Wook Kim, Won Bae Kim, Jae Hoon Chung, Young Kee Shong, Tae Yong Kim, Tae Hyuk Kim

Abstract

Background

Patients with differentiated thyroid carcinoma (DTC) are staged according to the single age cut point in addition to anatomic extent. A novel staging system is needed to properly show the character and prognosis of DTC by considering age as a continuous variable. We aimed to refine stage and prognostic groups of the eighth edition tumor-node-metastasis (TNM-8) staging system for DTC and to suggest a possible revision.

Methods

We conducted a retrospective data abstraction study of patients with newly diagnosed DTC who were treated at one of two tertiary referral centres in Seoul, Korea between 1994 and 2005. We used recursive partitioning analysis to derive a new staging classification (TNM-RPA) and compared its prediction of cancer-specific survival with that of TNM-8.

Results

The cohort comprised 6342 patients with DTC who were followed up for a median of 11.4 years. Higher TNM-RPA groups were associated with increased risk of death (10-year cancer-specific survival for stages IA, IB, IIA, IIB, III, and IV: 99.6%, 98.1%, 93.0%, 92.4%, 75.1%, and 56.6%, respectively; P < 0.001). The C-index values were 0.869 (95% CI, 0.833–0.905) for the TNM-RPA and 0.819 (0.789–0.850) for TNM-8. The proportions of variance explained for the ability of the TNM-RPA and TNM-8 stages to predict cancer-specific survival were 7.1% and 5.7%, respectively.

Conclusion

This study presents a RPA-based TNM stage groupings that incorporate multiple age cutoffs and essential anatomic information, which can be conveniently used to facilitate the individual prediction of long-term cancer-specific survival in patients with DTC.

https://ift.tt/2QUjV5Y

FDG‐PET/CT for diagnosis and follow‐up of necrotizing (malignant) external otitis

Objective

Imaging is important for the diagnosis and follow‐up of necrotizing external otitis (NEO). The best imaging modality is controversy. To suggest 2‐deoxy‐2‐[fluorine‐18] fluoro‐D‐glucose‐positron emission tomography/computed tomography (18F‐FDG‐PET/CT) as an alternative to technetium‐99m and gallium‐67 scans for diagnosis and assessment of response to treatment for patients with NEO.

Study Design

Case series.

Methods

Tertiary referral center. From 2013 through 2017, 12 patients were diagnosed with NEO based on clinical features and positive FDG uptake within the temporal bone on PET/CT. Mean age was 74 ± 11.5; 83% of the patients were male; and 83% had diabetes.

Results

PET/CT scans were reviewed independently by two nuclear medicine specialists. Imaging located osteomyelitis in external ear canal, mastoid, temporomandibular joint, and nasopharyngeal region (100%, 50%, 16%, 8%, respectively).

Mean follow‐up was 16 months. Eight patients (67%) underwent a second PET/CT scan after active otitis resolved and after at least 6 weeks of antibiotic treatment. The scan demonstrated no or substantially reduced FDG uptake and treatment was stopped. The patients had no NEO symptoms at the end of follow‐up. One patient had significant uptake, and antibiotic treatment was continued until a third scan demonstrated no FDG uptake. Two patients died before the second PET/CT, and two were lost to follow‐up.

Conclusion

18F‐FDG‐PET/CT is a reliable imaging modality for diagnosis, disease localization, and decision making regarding treatment cessation. 18F‐FDG‐PET/CT should be considered as the imaging modality of choice for initial diagnosis and follow‐up in NEO patients. Larger, controlled studies are warranted.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2QSADTq

Impact of high‐ versus low‐risk genotype on sinonasal radiographic disease in cystic fibrosis

Objective

Understanding of how specific mutations impact the cystic fibrosis transmembrane conductance regulator (CFTR) protein has given rise to the classification of CF patients into low‐risk and high‐risk genotypes. Few prior studies have investigated differences in sinonasal disease between low‐risk and high‐risk CF genotypes. This multi‐institutional review aimed to evaluate radiographic sinus disease severity based on genotype.

Methods

A review was conducted on adult patients with CF evaluated between 2005 to 2017 at three academic institutions. Data including age, gender, CFTR mutation, and presence of a maxillofacial/sinus computed tomography scan was collected. A modified Lund‐Mackay score (MLMS) was assigned to each scan, and the presence of sinus aplasia or hypoplasia was determined. Patients were further grouped depending on genotype into low‐ or high‐risk for comparison.

Results

A total of 126 patients were included with 99 patients in the high‐risk and 21 in the low‐risk groups. The high‐risk group had significantly higher MLMS than the low‐risk group (mean 13.88 vs. 8.06, P < 0.0001, 95% CI −8.196 to −3.462) The rate of frontal (P < 0.01), maxillary (P = 0.04), and sphenoid (P < 0.001) hypoplasia/aplasia was significantly higher in high‐risk patients compared to low‐risk.

Conclusion

This is one of the largest studies to date evaluating the impact of CF genotype on paranasal sinus development and disease. Genotype appears to impact sinonasal disease severity and also potentially paranasal sinus cavity development to a degree, although the exact mechanism is unknown.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2QWbtmJ

Significance of intraparotid node metastasis in predicting local control in primary parotid cancer

Objective

To analyze the metastasis rate in intraglandular lymph nodes (IGLNs) with a focus on discussing the significance of IGLN metastasis in local control (LC) of parotid gland cancer (PGC).

Methods

A total of 337 patients were enrolled. Information including age; sex; and pathologic variables such as tumor (T) stage, IGLN metastasis, and follow‐up findings was extracted and analyzed.

Results

IGLN metastasis was noted in 111 (32.9%) patients. Tumor stage, pathologic nodal stage, perineural invasion, resection status, and lymphovascular invasion were significantly related to IGLN metastasis. Local recurrence was noted in 67 (19.9%) patients. IGLN metastasis was an independent predictor of LC. The 10‐year LC rate was 94% for patients without IGLN metastasis, 56% for patients with metastasis in no more than two IGLNs, and 22% for patients with metastasis in more than two IGLNs. This difference was significant (P < 0.001).

Conclusion

The IGLN metastasis rate is relatively high in PGC patients and is significantly associated with disease grade and T stage. IGLN metastasis is associated with poorer local LC, and patients with more than two metastatic nodes have the worst prognosis.

Level of Evidence

4. Laryngoscope, 2018

https://ift.tt/2SN7giz

In Response to combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma

https://ift.tt/2QSAP56

In reference to combination of panendoscopy and positron emission tomography/computed tomography increases detection of unknown primary head and neck carcinoma

https://ift.tt/2SQHQAr

The Role of Free Tissue Transfer in the Management of Chronic Frontal Sinus Osteomyelitis

Objectives/Hypothesis

Chronic frontal sinus infection is managed with a combination of medical and surgical interventions. Frontal bone osteomyelitis due to recurrent infection following trauma or prior open surgery may require more significant debridement. Free tissue transfer may allow for extensive debridement with replacement of tissue, and definitive eradication of osteomyelitis.

Study Design

Retrospective chart review.

Methods

Patients undergoing free flap obliteration of the frontal sinus for frontal bone osteomyelitis at a single institution were included in the study. Clinical, radiologic, and surgical data were collected. Surgeries before and after free flap obliteration were compared by Wilcoxon signed rank test.

Results

Fifteen patients were identified; however, one patient had less than 6 months of follow‐up and was excluded from analysis. Of the remaining 14 patients, mean follow‐up duration was 26 months (range, 6–120 months). Mean number of surgeries prior to free flap was 3.7 (range, 1–8 surgeries). Free flap obliteration resolved chronic frontal sinusitis in all patients. Two patients experienced postoperative infection, and the overall complication rate was 29%. Eight patients underwent cranioplasty (six immediate, two delayed) without complication. All patients received planned courses of postoperative antibiotics. A statistically significant decrease in the number of surgeries after free flap obliteration was observed P ≤ .01).

Conclusions

Extensive debridement followed by free tissue transfer and antibiotics offers a definitive treatment for complicated, recurrent frontal osteomyelitis. Simultaneous cranioplasty provides immediate protective and aesthetic benefit without complication. Consideration should be given for free tissue transfer and cranioplasty earlier in the algorithm for treatment of refractory frontal sinus osteomyelitis.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2SV0EPp