Prophylactic Lateral Neck Dissection for Medullary Thyroid Carcinoma is not Associated with Improved Survival

Spanheimer, Philip M.; Ganly, Ian; Chou, Joanne F.; Capanu, Marinela; Nigam, Aradhya; Ghossein, Ronald; Tuttle, R. Michael; Wong, Richard J.; Shaha, Ashok R.; Brennan, Murray F.; Untch, Brian R.

doi:10.1245/s10434-021-09683-8

Cited by 30 publications

(24 citation statements)

References 15 publications

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“…There was no difference at 10 years in incidence of neck recurrence (20.9% LND vs 30.4% no LND, p = 0.46), incidence of distant recurrence (18.3% vs 18.4%, p = 0.97), disease-specific survival (86% vs 93%, p = 0.53), or overall survival (82% vs 90%, p = 0.6). 48 …”

Section: Resultsmentioning

confidence: 99%

Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

Bartz-Kurycki

Oluwo

Morris‐Wiseman

2021

Therapeutic Advances in Endocrinology

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Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that represents <5% of all thyroid malignancies and is generally more aggressive than differentiated thyroid cancer. The aim of this study is to provide an update, through review of clinical studies of patients with MTC published between January 1, 2016, and June 1, 2021, on recent advances in the diagnosis and treatment of MTC. This review focuses on updates in biochemical testing, imaging, hereditary disease, surgical management, adjuvant therapies, and prognosis. Recent advances reviewed herein have sought to diagnose MTC at earlier stages of disease, predict when patients with a hereditary syndrome may develop MTC, use functional imaging to assess for distant metastases, perform optimal initial surgery with appropriate lymphadenectomy, employ targeted systemic therapies for patients with progressive metastatic disease, and better predict patient-specific outcomes.

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Section: Resultsmentioning

confidence: 99%

Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

Bartz-Kurycki

Oluwo

Morris‐Wiseman

2021

Therapeutic Advances in Endocrinology

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“…On the other hand, LLND did not confer a survival benefit for patients at early stage but lead to low quality of life even after cure. Some authors suggest that expanding surgical field increases the risk of injury to parathyroid glands and recurrent laryngeal nerves, without any demonstrable benefits in terms of long-term survival ( 4 ). Conzo et al.…”

Section: Discussionmentioning

confidence: 99%

“…However, the extent of initial surgery for cervical lymph node dissection is controversial, in particular, whether lateral lymph node dissection (LLND) in MTC is needed. Some surgeons prefer more aggressive management to perform LLND or prophylactic dissection to improve postoperative biochemical recovery rates, whereas others advocate for conservative surgical management for possibility of complications and its unknown benefits ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

The Prediction of Metastases of Lateral Cervical Lymph Node in Medullary Thyroid Carcinoma

Zhou

Zhao

et al. 2021

Front. Endocrinol.

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PurposeDevelopment and validation of a nomogram for the prediction of lateral lymph node metastasis (LLNM) in medullary thyroid carcinoma (MTC).MethodsWe retrospectively reviewed the clinical features of patients with MTC in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017 and in our Department of Surgical Oncology, Hangzhou First People’s Hospital between 2009 and 2019. The log‐rank test was used to compare the difference in the Kaplan–Meier (K–M) curves in recurrence and survival. The nomogram was developed to predict the risk of LLNM in MTC patients. The prediction efficiency of the predictive model was assessed by area under the curve (AUC) and concordance index (C-index) and calibration curves. Decision curve analysis (DCA) was performed to determine the clinic value of the predictive model.ResultA total of 714 patients in the SEER database and 35 patients in our department were enrolled in our study. Patients with LLNM had worse recurrence rate and cancer-specific survival (CSS) compared with patients without LLNM. Five clinical characteristics including sex, tumor size, multifocality, extrathyroidal extension, and distant metastasis were identified to be associated with LLNM in MTC patients, which were used to develop a nomogram. Our prediction model had satisfied discrimination with a C-index of 0.825, supported by both training set and internal testing set with a C-index of 0.825, and 0.816, respectively. DCA was further made to evaluate the clinical utility of this nomogram for predicting LLNM.ConclusionsMale sex, tumor size >38mm, multifocality, extrathyroidal extension, and distant metastasis in MTC patients were significant risk factors for predicting LLNM.

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“…Currently, lateral compartment lymph node dissection (LCLND) is the most controversial [ 5 , 7 , 25 , 33 , 64 , 65 , 72 , 73 ]. One view on deciding whether to perform prophylactic LCLND when there is no evidence of neck metastases on the US is based on the Ctn level [ 5 , 8 , 25 , 70 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…However, there are several papers that do not support prophylactic LCLND [ 64 , 65 , 72 ]. Yamashita et al [ 64 ] in their study showed that prophylactic LCLND in the absence of structural disease had no effect on overall recurrence, locoregional recurrence or even overall survival in both patients with sporadic MTC and those with hereditary MTC relative to patients who did not undergo this surgery.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Update on the Diagnosis and Management of Medullary Thyroid Cancer: What Has Changed in Recent Years?

Kaliszewski

Ludwig

et al. 2022

Cancers

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Medullary thyroid carcinoma (MTC) is a neoplasm originating from parafollicular C cells. MTC is a rare disease, but its prognosis is less favorable than that of well-differentiated thyroid cancers. To improve the prognosis of patients with MTC, early diagnosis and prompt therapeutic management are crucial. In the following paper, recent advances in laboratory and imaging diagnostics and also pharmacological and surgical therapies of MTC are discussed. Currently, a thriving direction of development for laboratory diagnostics is immunohistochemistry. The primary imaging modality in the diagnosis of MTC is the ultrasound, but opportunities for development are seen primarily in nuclear medicine techniques. Surgical management is the primary method of treating MTCs. There are numerous publications concerning the stratification of particular lymph node compartments for removal. With the introduction of more effective methods of intraoperative parathyroid identification, the complication rate of surgical treatment may be reduced. The currently used pharmacotherapy is characterized by high toxicity. Moreover, the main limitation of current pharmacotherapy is the development of drug resistance. Currently, there is ongoing research on the use of tyrosine kinase inhibitors (TKIs), highly specific RET inhibitors, radiotherapy and immunotherapy. These new therapies may improve the prognosis of patients with MTCs.

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Prophylactic Lateral Neck Dissection for Medullary Thyroid Carcinoma is not Associated with Improved Survival

Cited by 30 publications

References 15 publications

Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

Medullary thyroid carcinoma: recent advances in identification, treatment, and prognosis

The Prediction of Metastases of Lateral Cervical Lymph Node in Medullary Thyroid Carcinoma

Update on the Diagnosis and Management of Medullary Thyroid Cancer: What Has Changed in Recent Years?

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