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ABSTRACT: BACKGROUND: The purpose of this study was to determine whether the proportion of metastatic cervical lymph nodes resected (metastatic lymph node ratio [MLNR]) predicted papillary thyroid carcinoma (PTC) recurrence, and whether MLNR could alter the predictive ability of TNM nodal classification for recurrence in PTC. METHODS: We conducted a retrospective review of patients with PTC who underwent a total or near-total thyroidectomy with at least 1 lymph node removed at our institution. RESULTS: Of 253 patients, 35 (13.8%) developed recurrent disease. The total MLNR (ratio between total metastatic lymph nodes and total number of lymph nodes resected) independently predicted PTC recurrence (odds ratio [OR], 1.024; 95% confidence interval [CI], 1.010-1.039; p = .001). In receiver operating characteristic (ROC) curve analysis, TNM nodal classification with total MLNR had greater accuracy in predicting PTC recurrence than did TNM nodal classification alone (0.726 and 0.675, respectively). CONCLUSION: MLNR is an independent predictor of PTC recurrence and enhances the predictive value of TNM nodal classification. © 2012 Wiley Periodicals, Inc. Head Neck [B]00:[/B] 000-000, 2012.
Head & Neck 06/2012; · 2.40 Impact Factor
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Steven Orlov BSc,
David Orlov HBSc,
Michael Shaytzag HBSc,
Mark Dowar HBSc,
Vafa Tabatabaie MD,
Philip Dwek HBSc,
Jonathan Yip HBSc,
Cindy Hu BSc,
FRCSC Jeremy L. Freeman MD,
FRCPC Paul G. Walfish MD,
Steven Orlov, David Orlov,
Michael Shaytzag,
Mark Dowar,
Vafa Tabatabaie,
Philip Dwek,
Jonathan Yip,
Cindy Hu,
Jeremy L. Freeman,
Paul G. Walfish
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ABSTRACT: Background.Though age and primary tumor size predict cancer-specific survival in well-differentiated thyroid carcinoma (WDTC), their influence on residual/recurrent disease has not been elucidated.Methods.In a retrospective study, residual/recurrent disease was defined by the surrogate outcome of positive (≥2 μg/L) follow-up stimulated thyroglobulin after surgery and radioactive remnant ablation. Age, primary tumor size, and clinical staging systems were examined in the context of stimulated thyroglobulin outcome.Results.A total of 246 patients were followed up for a mean of 5.8 years. No significant difference in age (t(239) = 0.61, p > .05) or tumor size (t(237) = 0.16, p > .05) was found among patients with positive follow-up stimulated thyroglobulin compared with those with negative results. pTNM staging failed to demonstrate significant, stage-dependent increase in the percentage of patients with positive stimulated thyroglobulin, χ2(2, N = 229) = 0.17, p > .05, unlike staging based solely on surgical pathology, χ2(2, N = 241) = 34.97, p < .001.Conclusion.Age, primary tumor size, and pTNM staging do not predict risk for residual/recurrent WDTC, whereas extrathyroidal extension at initial surgery is predictive. © 2009 Wiley Periodicals, Inc. Head Neck, 2009
Head & Neck 05/2009; 31(6):782 - 788. · 2.40 Impact Factor
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ABSTRACT: This observational study explored the potential utility of oxygen extraction ratio (O2ER) as an adjunct to the hemoglobin (Hb) concentration for guiding red blood cell (RBC) transfusion decisions after cardiac surgery with cardiopulmonary bypass (CPB).
Hb and O2ER measures were obtained before as well as 15 and 120 minutes after RBC transfusion episodes (defined as 1-2 RBC units given in succession after CPB, within 24 hr. of surgery). Changes related to RBC transfusions among patients with normal (30%) and elevated(>30%) pretransfusion O2ERs were analyzed.
Of the 176 patients enrolled, 74 received RBC transfusions. Of these, 50 had data available for 62 transfusion episodes. Pretransfusion episode O2ER values were elevated in 27 cases and normal in 35(56%) cases. Among those who received transfusion for low Hb concentration, 43 percent (27/62) had normal pretransfusion O2ER values. While the posttransfusion O2ER values did not change in patients with normal pretransfusion O2ER values, they did decrease inpatients with elevated pretransfusion O2ER values (% change [+/-SD] at 15 and 120 min after transfusion was -5.2 +/- 7.8 and -3.8 +/- 8.0%, respectively; p < 0.05).
If a normal O2ER in anemic patients with no evidence of organ dysfunction indicates adequate tissue oxygen delivery, then our findings suggest that incorporating O2ER into the transfusion decision will substantially reduce post-cardiac surgery RBC transfusions by allowing us to safely avoid transfusing this group of patients. Future studies are needed to assess the validity of this conclusion.
Transfusion 04/2009; 49(4):682-8. · 3.22 Impact Factor
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ABSTRACT: Though age and primary tumor size predict cancer-specific survival in well-differentiated thyroid carcinoma (WDTC), their influence on residual/recurrent disease has not been elucidated.
In a retrospective study, residual/recurrent disease was defined by the surrogate outcome of positive (>or=2 microg/L) follow-up stimulated thyroglobulin after surgery and radioactive remnant ablation. Age, primary tumor size, and clinical staging systems were examined in the context of stimulated thyroglobulin outcome.
A total of 246 patients were followed up for a mean of 5.8 years. No significant difference in age (t(239) = 0.61, p > .05) or tumor size (t(237) = 0.16, p > .05) was found among patients with positive follow-up stimulated thyroglobulin compared with those with negative results. pTNM staging failed to demonstrate significant, stage-dependent increase in the percentage of patients with positive stimulated thyroglobulin, chi(2)(2, N = 229) = 0.17, p > .05, unlike staging based solely on surgical pathology, chi(2)(2, N = 241) = 34.97, p < .001.
Age, primary tumor size, and pTNM staging do not predict risk for residual/recurrent WDTC, whereas extrathyroidal extension at initial surgery is predictive.
Head & Neck 03/2009; 31(6):782-8. · 2.40 Impact Factor
