Medullary thyroid carcinoma (MTC) is a rare endocrine disease but lymph node metastases (LNM) are common among patients, according to a new study published in Technology in Cancer Research & Treatment. Of the patients included in the study, 52.0% had central LNM and 42.8% had lateral LNM.
After resection surgery, patients were followed up for a median of 43.5 months (range, 1-193 months). During follow-up, 61.2% of patients had survived without disease, 6.6% had stable disease, 3.3% had an unstable disease, 19.1% had disease recurrence, and 9.9% had died.
The cumulative 5-, 10-, and 15-year overall survival (OS) rates were found to be 88.2%, 83.1%, and 76.2%, respectively, using a Kaplan-Meier curve. Most of the deaths were in patients with stage 4 disease.
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Kaplan-Meier curves were also used to calculate the cumulative disease-free survival (DFS) rates. The 5-, 10-, and 15-year cumulative DFS rates were 61.8%, 48.6%, and 38.2%, respectively. DFS rates were significantly higher in patients with stage 1 to 3 MTC compared to those with stage 4 (P <.001).
When comparing patients with and without lateral LNM, the 15-year cumulative OS rates were 46.8% vs 94.6%. Comparison between 15-year cumulative DFS rates also showed lower rates among patients with LNM (15.5%) compared to those without (58.7%). These results indicate that survival is significantly worse for patients with lateral LNM (P <.001).
“By comparing the clinicopathologic features and survival of patients with and without lateral LNM, we found that in the group of patients with lateral LNM, the OS and DFS were worse, and there were more patients with higher calcitonin and [carcinoembryonic antigen] levels, postoperative complications, multifocality, bilaterality, capsular invasion, extrathyroidal invasion, and [lymph node ratio] ˃1/3,” the authors said.
Multivariate logistic regression yielded only 2 variables that were independently associated with disease progression including lateral LNM (odds ratio [OR]=5.73; 95% CI, 2.21-14.84; P <.001) and a lymph node ratio greater than 1/3 (OR=4.52; 95% CI, 1.46-13.98; P <.009).
During the study, 241 patients were treated for MTC between December 2000 and November 2020 at the Peking Union Medical College Hospital in Beijing, China. Of these patients, 152 met the inclusion criteria and were analyzed for the study.
Wu X, Li B, Zheng C. Clinical characteristics, surgical management, and prognostic factors of medullary thyroid carcinoma: a retrospective, single-center study. Technol Cancer Res Treat. Published online February 21, 2022. doi:10.1177/15330338221078435