Biomedical subjects

Brian Hung-Hin Lang

Publications and source records attributed to Brian Hung-Hin Lang.

6 recordsLinked to original sources

PubMed2006

Prognostic factors in papillary and follicular thyroid carcinoma: their implications for cancer staging.

BACKGROUND: Papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC) are two distinct histological types of thyroid carcinoma but have often been studied and staged as a collective group, known as differentiated thyroid carcinoma (DTC). However, this may not be an optimal approach to cancer staging. METHODS: A total of 760 patients with DTC, comprising 589 (77.5%) with PTC and 171 with (22.5%) FTC, being managed at our institution from 1961 to 2001 were retrospectively reviewed. Their clinicopathological features, treatment modalities received, and postoperative outcome were analyzed. Both univariate and multivariate analyses were performed to identify prognostic factors related to cancer-specific survival (CSS) for PTC and FTC. RESULTS: There were statistically significant differences between PTC and FTC in terms of age >/=50 years at diagnosis (P = .040), tumor size (P < .001), lymph node metastases (P < .001), distant metastases (P < .001), extrathyroidal extension (P < .001), multifocality (P = .002), capsular invasion (P < .001), extent of thyroid resection (P < .001), radioiodine ablation (P < .001), and external-beam irradiation (P = .003). Although PTC and FTC had similar 10-year and 15-year CSS (P = .846), each possessed its own set of independent prognostic factors for CSS. Age at diagnosis and completeness of resection were independent prognostic factors in both PTC and FTC. CONCLUSIONS: There were marked differences in clinicopathologic features, treatment, and prognostic factors between the two histologic types of DTC. Different staging systems should be evaluated and validated for PTC and FTC individually in the future.

Adenocarcinoma, Follicular↗

PubMed2006

The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk.

BACKGROUND: The role of intraoperative neuromonitoring of recurrent laryngeal nerve (RLN) during thyroidectomy has not been well established. The present study evaluates whether RLN injury can be reduced by the application of this technique during thyroidectomy in a single center. METHODS: Of 1000 RLNs that were at risk of injury in 639 consecutive patients who underwent thyroidectomy, the outcome of 501 RLNs with the use of neuromonitoring was compared with that of 499 nerves that were operated by routine identification only. The incidences of RLN paralysis were compared between the 2 groups and the assigned risk subgroups. RESULTS: Postoperative palsy was identified in 47 RLNs (4.7%), with complete recovery in 37 of 44 RLNs (84%) without documented injury. The overall incidence of postoperative RLN paralysis was significantly higher during thyroidectomy for malignancy (P = .025) and secondary thyroidectomy (P = .017). There was no significant difference in postoperative, transient, and permanent paralysis rates between the neuromonitoring and control groups. In subgroup analysis, the postoperative RLN palsy rate was higher during reoperative thyroidectomy (19% vs 4.6%; P = .019) in the control group but not in the neuromonitoring group (7.8% vs 3.8%; P > .05). CONCLUSION: Neuromonitoring of the RLN during thyroid surgery could not be demonstrated to reduce RLN injury significantly, compared with the adoption of routine RLN identification. However, its application can be considered for selected high-risk thyroidectomies.

Adolescent↗

PubMed2006

Classical and follicular variant of papillary thyroid carcinoma: a comparative study on clinicopathologic features and long-term outcome.

INTRODUCTION: The follicular variant of papillary thyroid carcinoma (FVPTC) is the most common histologic subtype of papillary thyroid carcinoma (PTC). However, it is still controversial whether FVPTC should behave differently from classical PTC (CPTC). The present study aimed at evaluating any potential difference in clinicopathologic features and long-term outcome of FVPTC as compared with CPTC. PATIENTS AND METHODS: Of 568 patients with PTC managed from 1973 to 2004, 308 were shown to have CPTC (54.2%) and 67 (11.8%) FVPTC after histologic review. The mean (+/- SD) follow-up period was 11.3 (+/- 8.9) years. The two groups were compared in terms of clinicopathological features, treatment received, and outcome regarding recurrence and disease-specific survival. RESULTS: There was no difference in age and gender ratio between the CPTC and FVPTC patients. Both groups had similar tumor characteristics in terms of tumor size, presence of multifocality, capsular invasion, lymphovascular permeation, and perineural infiltration. However, FVPTC patients had significantly fewer histologically confirmed cervical lymph node metastases (P = 0.027) and extrathyroidal involvement (P = 0.005). The proportion of bilateral resection, adjuvant radioactive iodine, and lymph node dissection did not differ significantly between the two groups. The FVPTC patients had a more favorable tumor risk by DeGroot classification (P = 0.003) and MACIS (Metastasis, Age, Completeness of excision, Invasiveness, and Size) score (P = 0.026). The 10- and 15-year actuarial disease-specific survivals did not differ significantly between FVPTC and CPTC patients (96.2% versus 90.7% and 96.2% versus 89.1%, respectively). CONCLUSIONS: Although patients with FVPTC had more favorable clinicopathologic features and a better tumor risk group profile, their long-term outcome was similar to that of CPTC patients.

Adenocarcinoma, Papillary↗

PubMed2006

Papillary microcarcinoma: is there any difference between clinically overt and occult tumors?

INTRODUCTION: Papillary microcarcinoma (PMC) is a subtype of papillary thyroid carcinoma (PTC) associated with excellent prognosis. However, clinical and biologic behaviors of PMC may vary considerably between tumors that are clinically overt and those that are occult. MATERIALS AND METHODS: From 1964 to 2003, 185 of 628 patients with PTC were identified as having PMC, based on tumor size < or = 1 cm. There were 110 overt and 75 occult PMCs detected based on clinical presentation. The clinicopathologic features, treatment, and long-term outcome of PMCs were evaluated and compared between the two groups. RESULTS: There were 37 men and 148 women with a median age of 45 years (range: 11-84 years). The median tumor size was 6.2 mm. Thirty-eight (21%) patients presented with cervical nodal metastases. Three (1.6%) had distant metastases and 5 (2.7%) underwent incomplete resection. Bilateral procedures were performed for 129 patients (70%) and 53 (29%) received postoperative I131 treatment. During a mean follow-up of 8.2 years, 4 patients died of the disease and 13 developed recurrence. Clinically overt PMCs were significantly larger, were more likely to be multifocal, and more likely to lead to bilateral thyroidectomy. Extrathyroidal or lymphovascular invasion, nodal metastases, I131 ablation, high-risk tumors, and postoperative recurrence occurred in overt PMC only. Patients with nodal metastases had a decreased survival and an increase in locoregional recurrence. CONCLUSIONS: Despite a relatively good prognosis in PMC, a distinction should be made between clinically overt and occult PMCs in which clinically overt PMC should be managed according to tumor risk profile and clinical presentation.

Adenocarcinoma, Papillary↗

PubMed2005

Total thyroidectomy for multinodular goiter in the elderly.

BACKGROUND: Total thyroidectomy for multinodular goiter (MNG) is increasingly being performed for the elderly population and yet their perioperative and long-term outcomes remain unclear. METHODS: A total of 279 patients who underwent total thyroidectomy for MNG in a university-based hospital during a 9-year period were analyzed according to their age at the time of operation. RESULTS: The duration of operation (P=.023), intraoperative blood loss (P=.030), weight of resected thyroid glands (P<.001) and proportion of retrosternal goiter (P<.001) were significantly greater in the elderly group (>/=70 years) (n = 55), but the incidence of surgically related complications, including recurrent laryngeal nerve palsy and hypoparathyroidism, was similar. Postoperative pneumonia occurred more frequently in the elderly group (P=.034). The number of comorbidities tended to correlate with the length of hospital stay and long-term survival in elderly patients. CONCLUSIONS: Total thyroidectomy for MNG in elderly patients had a similar perioperative outcome as their younger counterparts, but their long-term outcome is likely to be influenced by the number of comorbidities.

Adult↗

PubMed2003

Perioperative and long-term outcome of major hepatic resection for small solitary hepatocellular carcinoma in patients with cirrhosis.

HYPOTHESIS: Major hepatic resection is safe and provides favorable long-term survival for cirrhotic patients with a small solitary hepatocellular carcinoma. DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: From January 1, 1989, to December 31, 2001, 218 cirrhotic patients with a solitary hepatocellular carcinoma 5 cm or less in diameter underwent either a major hepatic resection (n = 84) or a minor hepatic resection (n = 134). MAJOR OUTCOME MEASURES: Perioperative morbidity and mortality, and long-term survival rates. RESULTS: The major resection group had significantly larger tumors (median, 3.5 vs 2.5 cm; P<.001) and better liver function (median indocyanine green retention at 15 minutes, 9.3% vs 12.9%; P<.001) than the minor resection group. Postoperative morbidity (46.4% vs 39.6%) and mortality (8.3% vs 3.0%) were higher in the major resection group than in the minor resection group, but the differences did not reach statistical significance (P =.32 and P =.11, respectively). The median overall survival did not differ significantly between the 2 groups (102.0 vs 72.3 months; P =.25). However, the median disease-free survival in the major resection group was significantly better than that in the minor resection group (59.0 vs 29.5 months; P =.03). On further subgroup analysis, both disease-free and overall survival rates were significantly better in the major hepatic resection group for tumors of 3 to 5 cm. CONCLUSION: In well-selected cirrhotic patients with a small, solitary hepatocellular carcinoma, major hepatic resection is safe and may offer a better long-term survival over minor hepatic resection for patients with tumors of 3 to 5 cm.

Adolescent↗