Patients with early-stage medullary thyroid carcinoma (MTC) who are 60 years of age or more could benefit more from lobectomy than from total thyroidectomy, according to a recently published study in Frontiers in Endocrinology. 

Due to the poor response of MTC to chemotherapy and radioactive iodine, total thyroidectomy is the current standard of care for these patients. However, due to the important surgical complications associated with total thyroidectomy, there is growing interest in identifying subpopulations that could benefit from lobectomy without significant risk of recurrence, Binfeng Yang, of the Suzhou Ninth People’s Hospital in China, and colleagues noted.

Previous research suggests that factors such as BRAF gene status, age, and RET line mutations could provide guidance as to which patients could benefit from minimally invasive surgery to minimize the risk of postoperative complications, the researchers noted. Unfortunately, the majority of these studies have small sample sizes and short follow-up periods, they added.


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Therefore, the authors aimed to assess the feasibility of using lobectomy as initial therapy for patients with stage I MTC through a retrospective study. Researchers used data from the Surveillance, Epidemiology, and End Results database.

The study included close to 1000 patients with stage I MTC, of which approximately 51% underwent lobectomy and 48% had a total thyroidectomy. The cohort was divided into 2 groups based on the surgical approach. 

Statistical analysis with Kaplan–Meier survival analysis revealed no significant difference in overall survival between the 2 groups. 

Univariate and multivariate analysis revealed a significant difference in overall survival and disease-specific survival between the lobectomy and total thyroidectomy groups under the age of 60. However, for patients who were 60 years of age or more, there was no significant difference between the 2 groups.

“In summary, total thyroidectomy was an appropriate treatment for stage I patients under the age of 60, which was consistent with the recommendation of the clinical guidelines,” the authors wrote. “However, for those over the age of 60, lobectomy may be considered as a better surgical option.”

Reference

Yang B, Niu G, Li X, et al. Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old. Front Endocrinol. Publishes online October 21, 2022. doi:10.3389/fendo.2022.1015319