Patients diagnosed with medullary thyroid cancer (MTC) who were treated with surgery may have improved survival rates when compared to patients who underwent both surgery and radiation, as published in Annals of Surgical Oncology.
Patients treated with surgery and radiation for stage 3 or 4 MTC with lymph node disease had a significantly higher mortality rate.
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The hazard ratio calculated for mortality in this group was 1.784 (95% CI, 1.313-2.43) after multivariable adjustment for confounding variables. The association between higher mortality rate and cotreatment with surgery and radiation remained significant after adjustment for selection bias.
“Although this observation can be attributed to unmeasured confounders or selection bias, the cause for the profound survival differences deserves prospective evaluation, especially as adjuvant therapies for this disease continue to evolve,” the authors said.
The study analyzed data from patients included in the National Cancer Database who were diagnosed with stage 3 or 4 MTC, lymph node disease, and no distant metastases. Most (81%, n=1112) patients were treated with surgery, while the remaining 19% (n=258) underwent surgery and radiation.
The authors performed Kaplan-Meier and log-rank analyses to estimate and compare the survival between the 2 groups (ie, treated with surgery alone and cotreated with surgery and radiation).
They then applied the mutlivariable Cox proportional hazards model and used propensity-matching in an attempt to adjust for confounding and selection bias. Currently, surgical treatment is the only curative option available for patients with MTC.
Ow TJ, Mehta V, Kim S, Vakil M, Friedmann P, In H. Evaluation of survival and postoperative radiation among patients with advanced medullary thyroid carcinoma: an analysis of the National Cancer Database. Ann Surg Oncol. Published online January 23, 2022. doi:10.1245/s10434-021-11158-9