With the advances of diagnostic imaging and radiation therapy technology, the limitations of the Chinese 1992 staging system for nasopharyngeal carcinoma (NPC) become obvious, and the revision of this system was clearly needed. On December 16, 2008, the Chinese Committee for Staging of Nasopharyngeal Carcinoma (CCSNPC) was inaugurated in Guangzhou, China, with the purpose of establishing a platform for the study of the Chinese staging system and ensuring the continuity of the work of NPC staging research. Data from published studies on staging of NPC were collected and reviewed. After extensive evaluation and discussion, the Chinese 2008 staging system for NPC, which was a consensus based on evidence-based medicine and revisions made on the Chinese 1992 staging system, was recommended by CCSNPC. Changes of the staging system including emphasizing the status of MRI in diagnosis and staging; classification of parapharyngeal involvement, cranial nerve involvement, and retropharyngeal lymph node involvement; and T classification in the new system were simplified as well. CCSNPC also proposed a new criterion of the N category. This review discusses the rationale and bases of our primary revisions of this system and proposes an updated system, named the Chinese 2008 staging system for NPC. Further investigations are needed to confirm the effectiveness as well as to provide basis for further improvement of this system.
Hepatocellular carcinoma (HCC) presenting as obstructive jaundice due to intrabile duct tumor growth is being reported with increasing frequency. We describe our clinical experiences and evaluate the results of different operative procedures for this disease. A retrospective study was undertaken to review 18 patients with obstructive jaundice by tumor emboli from HCC during a 15-year period of time. We reviewed clinical features, types of operative procedures, operative findings, and survival in the patients. All patients on initial examination had recurrent episodic jaundice or cholangitis. Types of surgical procedures were choledochotomy with T-tube drainage alone in nine patients, choledochotomy with T-tube drainage followed by hepatectomy in six, and T-tube drainage followed by transcatheter hepatic arterial chemoembolization in the remaining three patients. Liver cirrhosis was the associated disease in 15 (83.3%). There were three postoperative deaths (16.7%). The mean survival time for nine patients with external drainage alone was 4.5 months. For the three patients with T-tube drainage and transcatheter hepatic arterial chemoembolization, mean survival time was 11 months. Six patients who had undergone hepatectomy had a better postoperative survival time, with 1 surviving for more than 3 years and another alive for 70 months, without evidence of recurrence at the moment. Jaundice is not necessarily a harbinger of advanced disease and a contraindication for surgery. Managed properly, these patients will have satisfactory palliation and occasional cure.
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