Surgical cure rates of sporadic medullary thyroid cancer in the era of calcitonin screening

Abstract

Objective: Time trends of the extent of disease at first diagnosis and biochemical cure remain ill-defined for sporadic medullary thyroid cancer (MTC). This investigation aimed to delineate time trends and biochemical cure rates for sporadic MTC. Design: This was an observational study of consecutive patients operated on for sporadic MTC between 1995 and 2015. Methods: Time trends of clinical and histopathological variables indicative of the extent of disease and biochemical cure were calculated for 600 patients with sporadic MTC, 322 of whom had initial neck surgery and 278 of whom had neck reoperation at a tertiary surgical center in Germany. Results: From 1995-2000 to 2011-2015, significant declines (all P < 0.001) were noted in the percentage of node-positive tumors (from 73 to 49%), mediastinal lymph node metastasis (from 21 to 6%) and distant metastasis (from 23 to 6%). These changes were paralleled by significant increases (all P < 0.001) in mean patient age (from 49.1 to 57.3 years) and the percentage of MTC ≤10 mm (from 19 to 39%) and biochemical cure (from 28 to 62%). When only patients with primary tumors >10 mm were considered, the decreasing percentage of mediastinal lymph node metastasis and distant metastasis, and rising mean patient age and biochemical cure rates remained statistically significant. Conclusions: Significant reductions in the extent of the disease and improved biochemical cure rates pointed toward increasing therapeutic control of sporadic MTC. The independent contribution of routine calcitonin screening to these time-dependent changes warrants more research.

Trends in Diagnostics, Surgical Treatment, and Prognostic Factors for Outcomes in Medullary Thyroid Carcinoma in Norway: A Nationwide Population-Based Study

“…These findings both concur with and diverge from previous studies. Machens and Dralle [34] found a significant reduction in the extent of disease and improved biochemical cure with time, while Randle et al[13] found a significant reduction in tumor diameter and extrathyroidal extension but no reduction in tumor stage over time. In studies by de Groot et al [9] and Modigliani et al[11], extrathyroidal extension and stage were found to be the only prognostic factor for biochemical cure.…”

Unique Case of a Large Indolent Medullary Thyroid Carcinoma: Time to Reconsider the Medullary Thyroid Adenoma Entity?

“…Further molecular and histopathological investigations are needed to better define the behavior of MTC at the time of its diagnosis. It is well known that MTC can have a variable outcome, with some rapidly aggressive variants and others taking an indolent course, irrespective of tumor stage at diagnosis, and with or without distant metastases [13, 14]. …”

Medullary Thyroid Carcinoma: Why Is Specialization Mandatory?

“…During the last years, biochemical cure rates of patients with sporadic MTC improved constantly in the era of calcitonin screening [17]. Therefore, the German Association of Endocrine Surgeons recommends routine calcitonin screening before every thyroid operation to exclude or detect MTC [18,19].…”

“…Other studies defined 60-65 pg/ml as cut-off values of calcitonin to detect MTC [21,22]. Earlier detection of MTC leads to better biochemical cure rates, as shown by Machens and Dralle in 2015 [17]. …”

“…If MTC is diagnosed incidentally by histopathological examination, the results of completion thyroidectomy and lymph node dissection are less favorable than for primary surgery [9,17]. …”