Adherence to American Thyroid Association (ATA) guidelines for the treatment of medullary thyroid carcinoma (MTC) appears to have increased in recent years, according to a recently published study in Annals of Surgical Oncology.

MTC is a particularly aggressive form of thyroid cancer that, unlike other types of thyroid cancer, does not respond well to radioactive iodine and requires aggressive surgical treatment. To unify national treatment patterns as well as improve outcomes on a national level, the ATA released treatment guidelines for MTC in 2009, Jessica Liu McMullin, MD, MS, of Emory University in Atlanta, Georgia, and colleagues noted.

Although the adherence rates to guidelines have been quantified using the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results program, so far, there are no studies analyzing the impact of guideline adherence on survival rates.

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Therefore, the authors aimed to analyze guideline adherence, reasons associated with guideline discordance, and correlations between survival rates and guideline adherence using propensity score-matched cohorts.

The retrospective cohort study was carried out using data from the NCDB and included over 6000 patients. ATA recommendations for patients from 2004 to 2008 were used as a comparison.

The main recommendations of interest to the study included total thyroidectomy and prophylactic level 6 central lymph node dissection in patients without advanced local invasion, central and modified radical neck dissection with lateral neck dissection for patients with limited local metastasis and less aggressive surgery for patients with distant metastases.

In the included cohort, approximately 70% of patients with and without advanced disease adhered to guidelines between 2009 and 2015. Only 8% of patients received radioactive iodine and chemotherapy, which are not recommended in the ATA guidelines. These statistics represented an approximate 7% increase with respect to adherence rates before 2009.

The factors most commonly associated with discordant treatment included treatment at nonacademic facilities, living within 50 miles of treatment facility, and older age. Kaplan-Meier survival analysis suggested that guideline adherence had a positive impact on overall survival.

“Protocolization and standardization of therapy is 1 of the fundamental concepts to improving clinical care and surgical outcomes on a national level,” the authors wrote. “We have found that the dissemination of standardized guidelines has led to increased concordance with MTC guidelines and has led to improvement in patient outcomes and survival.”


McMullin J, Sharma J, Gillespie T, et al. Improved adherence to ATA medullary thyroid cancer treatment guidelines. Ann Surg Oncol. Published online November 11, 2022. doi:10.1245/s10434-022-12734-3