Risk Factors for Lateral Lymph Node Metastases in Patients With Sporadic Medullary Thyroid Carcinoma

Wu, Xin; Li, Binglu; Zheng, Congyi; Liu, Wei; Hong, Tao; He, Xiaodong

doi:10.1177/1533033820962089

Cited by 9 publications

(9 citation statements)

References 36 publications

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“…LN metastasis of MTC is common (25), and the ATA guidelines recommended that central LN dissection should be performed regardless of LN status (10). There is currently a disagreement over lateral LN dissection (26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old

Yang¹,

Niu²,

Li³

et al. 2022

Front. Endocrinol.

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PurposeClinical guidelines presently recommend total thyroidectomy for the treatment of medullary thyroid cancer (MTC). This study was aimed to investigate whether lobectomy could be the initial treatment for stage I MTC patients.MethodsThe retrospective study was based on data from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The risk factors of survival were estimated by the univariate and multivariate Cox proportional-hazards model. The effect of age on death risk was estimated using restricted cubic splines. Survival curves were constructed according to the Kaplan–Meier method.ResultsA total of 988 stage I MTC patients was included in the study. Among them, 506 (51.2%) MTC patients received lobectomy and 482 (48.8%) received total thyroidectomy. The only independent prognostic factor for overall survival (OS) and disease-specific survival (DSS) was age, according to univariate and multivariate Cox regression analysis. The hazard ratio (HR) increased relatively slowly with age growing under the age of approximately 60 years. However, the death risk of MTC patients began to rise sharply with increasing age above 60 years. For patients under the age of 60, a significant survival difference for OS and DSS was observed between the lobectomy group and total thyroidectomy group (p < 0.05). However, for patients aged above 60, no significant survival difference was observed for OS or DSS (p > 0.05).ConclusionTotal thyroidectomy was an appropriate treatment for stage I MTC patients under the age of 60, which was consistent with the recommendation of the clinical guidelines. However, for those over the age of 60, lobectomy may be explored as a better surgical option. The findings may provide the evidence base for improving the clinical management of stage I MTC patients. Further prospective multicenter clinical studies are needed including information regarding RET status as well as calcitonin and CEA levels.

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Section: Discussionmentioning

confidence: 99%

Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old

Yang¹,

Niu²,

Li³

et al. 2022

Front. Endocrinol.

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“…The thyroid capsule can be regarded as a barrier. Once the malignant tissue infiltrates the capsule, it is easy to enter the lymphatic circulation system, which makes it extremely prone to LN and distant metastasis ( 29 ). In this study, in MTC patients with CLNM, the invasion of the capsule was significantly higher than that of noninvasive (80.5% vs 18.2%), which indicates that the invasion of the capsule has a greater impact on CLNM.…”

Section: Discussionmentioning

confidence: 99%

Nomogram for preoperative estimation risk of cervical lymph node metastasis in medullary thyroid carcinoma

et al. 2022

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ObjectivesCervical lymph node metastasis (CLNM) is common in medullary thyroid carcinoma (MTC), but how to manage cervical lymph node involvement of clinically negative MTC is still controversial. This study evaluated the preoperative features and developed an ultrasound (US)-based nomogram to preoperatively predict the CLNM of MTC.Materials and methodsA total of 74 patients with histologically confirmed MTC were included in this retrospective study and assigned to the CLNM-positive group and CLNM-negative group based on the pathology. The associations between CLNM and preoperative clinical and sonographic characteristics (size, location, solid component, shape, margin, echogenicity, calcification, and extracapsular invasion of the tumor) were evaluated by the use of univariable and multivariable logistic regression analysis. A nomogram to predict the risk of the CLNM of MTC was built and assessed in terms of discrimination, calibration, and clinical usefulness.ResultsThe nomogram was based on three factors (tumor margin, US-reported suspicious lymph node, and extracapsular invasion US features) and exhibited good discrimination with an area under the curve (AUC) of 0.919 (95% CI, 0.856–0.932). The calibration curves of the nomogram displayed a good agreement between the probability as predicted by the nomogram and the actual CLNM incidence.ConclusionsWe constructed and validated a US-based nomogram to predict the risk of CLNM in MTC patients, which can be easily evaluated before surgery. This model is helpful for clinical decision-making.

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“…Surgical treatment is currently the first-choice method for the treatment of medullary thyroid carcinoma [ 5 , 25 , 33 , 62 , 63 , 64 ]. The primary technique cited by most of the papers and guidelines we found as the valid technique for initial treatment of MTC was total thyroidectomy (TT) combined with central compartment lymph node dissection (CCLND) [ 25 , 33 , 64 , 65 , 66 , 67 , 68 ]. The reason for choosing TT over hemithyroidectomy is the fact that multifocal and bilateral disease is present in most hereditary and 6% of sporadic MTC cases [ 5 , 62 ], and according to some sources, even in all hereditary and as many as 30% of sporadic MTC cases [ 7 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…TT combined with CCLND (level VI) is recommended for any MTC by ATA 2015 and the United Kingdom Multidisciplinary Guidelines 2016 [ 25 , 68 ]. Recommendations from the ATA are, at the same time, among the most frequently described recommendations by contemporary works as a standard of practice [ 64 , 65 , 66 , 67 ]. This method is justified by the presence of central lymph node metastases in 50–70% of both patients with sporadic MTC and those with hereditary MTC, regardless of whether the primary tumor is smaller than 1 cm or larger than 4 cm [ 62 ].…”

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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Risk Factors for Lateral Lymph Node Metastases in Patients With Sporadic Medullary Thyroid Carcinoma

Cited by 9 publications

References 36 publications

Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old

Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old

Nomogram for preoperative estimation risk of cervical lymph node metastasis in medullary thyroid carcinoma

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

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