What Is the Extent of Neck Dissection in Medullary Thyroid Carcinoma?

Asarkar, Ameya; Chang, Brent A.; Nathan, Cherie‐Ann O.

doi:10.1002/lary.28686

Cited by 6 publications

(4 citation statements)

References 5 publications

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“…Nevertheless, at present, the scope of lymph node dissection in the treatment of MTC has been controversial because of the uncertainty of lymph node metastasis. ATA guidelines suggest that LLND is needed to be therapeutically performed on cN1 lateral cervical compartment, but the role of prophylactic dissection on cN0 lateral cervical compartment remains controversial ( 18 ). On the one hand, some scholars pointed out that the rate of occult metastasis in the cN0 lateral cervical compartment was also relatively high for patients with central lymph node metastasis.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Normally, lateral neck dissection is recommended for patients with structural evidence of lateral compartment metastasis. Moreover, prophylactic lateral neck dissection (PLND) should be considered in patients with high calcitonin levels 7 . However, the effect of prophylactic lateral neck dissection on recurrence, disease‐free survival (DFS) and overall survival (OS) has not been clearly demonstrated.…”

Section: Introductionmentioning

confidence: 99%

The survival outcomes of prophylactic lateral neck dissection for medullary thyroid carcinoma, a retrospective cohort study

Hao,

Zhao,

Guo

et al. 2023

Clinical Otolaryngology

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ObjectivesThe purpose of this study was to evaluate the benefits of prophylactic lymph node dissection in medullary thyroid carcinoma (MTC) patients without radiographically lateral neck metastases.DesignRetrospective cohort study.SettingTianjin Medical University Cancer Institute and Hospital.ParticipantsPatients who underwent primary surgery for MTC between 2011 and 2019 and without structural disease of the lateral neck preoperatively.Main outcome measuresLocoregional recurrence, disease‐free survival (DFS), and overall survival (OS) were examined.ResultsThe patients were divided into two groups: the central lymph node dissection (CLND) only group and the prophylactic lateral lymph node dissection (PLND) group, which included CLND and ipsilateral lateral lymph node dissection (LLND). A total of 89 patients were included: 71 patients in the CLND group and 18 patients in the PLND group. Although there were no significant differences in age, gender, multifocality, capsule invasion or TNM stage between the two groups, the tumour size and preoperative median calcitonin levels were different. The recurrence rate was 4.2% for the CLND group and 5.6% for the PLND group (p > 0.05). DFS among the CLND and PLND groups was 95.4% and 94.4%, and OS among the groups was 100% and 94.1% (p > 0.05) at 5 years. The biochemical cure rates were similar.ConclusionsPLND in the absence of structural disease of the lateral neck preoperatively is not associated with improved survival in patients with sporadic MTC.

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“…The controversy mainly focuses on whether patients without obvious evidence supporting lateral lymph node metastases (LNM) need to undergo prophylactic lateral neck dissection ( 11 ). The ATA guidelines 2015 affirmed the role of preoperative serum calcitonin on whether patients with cN0 + cN1a should undergo lateral neck dissection, but no clear cut-off value was provided ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict lateral lymph node metastases in lateral neck in patients with medullary thyroid cancer

Jin

Zhang²,

Song³

et al. 2022

Front. Endocrinol.

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BackgroundMedullary thyroid cancer (MTC) can only be cured by surgery, but the management of lateral lymph nodes is controversial, especially for patients with cN0+cN1a. To address this challenge, we developed a multivariate logistic regression model to predict lateral lymph node metastases (LNM).MethodsWe retrospectively collected clinical data from 124 consecutive MTC patients who underwent initial surgery at our institution. The data of 82 patients (from 2010 to 2018) and 42 patients (from January 2019 to November 2019) were used as the training set for building the model and as the test set for validating the model, respectively.ResultsIn the training group, the multivariate analyses indicated that male and MTC patients with higher preoperative basal calcitonin levels were more likely to have lateral LNM (P = 0.007 and 0.005, respectively). Multifocal lesions and suspected lateral LNM in preoperative ultrasound (US) were independent risk factors (P = 0.032 and 0.002, respectively). The identified risk factors were incorporated into a multivariate logistic regression model to generate the nomogram, which showed good discrimination (C-index = 0.963, 95% confidence interval [CI]: 0.9286–0.9972). Our model was validated with an excellent result in the test set and even superior to the training set (C-index = 0.964, 95% CI: 0.9121–1.000).ConclusionHigher preoperative basal calcitonin level, male sex, multifocal lesions, and lateral lymph node involvement suspicion on US are risk factors for lateral LNM. Our model and nomogram will objectively and accurately predict lateral LNM in patients with MTC.

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What Is the Extent of Neck Dissection in Medullary Thyroid Carcinoma?

Cited by 6 publications

References 5 publications

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

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

The survival outcomes of prophylactic lateral neck dissection for medullary thyroid carcinoma, a retrospective cohort study

A nomogram to predict lateral lymph node metastases in lateral neck in patients with medullary thyroid cancer

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