Surgical selection and prognostic analysis of sporadic medullary thyroid carcinoma

doi:10.3877/cma.j.issn.1674-0793.2021.06.006

Abstract

Abstract:

Objective

To analyze the surgical resection range and prognosis of sporadic medullary thyroid carcinoma (MTC).

Methods

Clinical data of 65 sporadic MTC patients firstly treated in Tianjin Medical University Cancer Institute and Hospital from January 2015 to June 2017 were reviewed retrospectively. The patients were divided into total thyroidectomy group (group A) and unilateral lobectomy group (group B), the differences in clinicopathological characteristics, the biochemical cure, recurrence and progression-free survival were compared between the two groups.

Results

There were 25 cases in group A and 40 cases in group B. The ratio of stage Ⅰ+Ⅱ patients in group A (8/25, 32.0%) was significantly lower than that in group B (23/40, 57.5%) ( χ²=4.010, P=0.045), and there were no significant differences in the other clinicopathological characteristics between the groups. The median follow-up time was 35 months. The biochemical cure rate was 67.9% (38/56) and the recurrence rate was 18.5% (12/65). There were no significant differences in biochemical cure rate (63.6% vs 70.6%), recurrence rate (28.0% vs 12.5%) and progression-free survival [(46.29±3.21) months vs (61.94±3.58) months] between the groups.

Conclusion

For sporadic MTC patients, total thyroidectomy is not always necessary, and selective unilateral lobectomy is feasible.

Key words: Carcinoma, medullary, Thyroidectomy, Unilateral lobectomy, Biochemical cure rate, Recurrence, Progress-free survival

Jingzhu Zhao, Xiangqian Zheng, Ming Gao, Jiadong Chi, Xinwei Yun, Dapeng Li, Xianhui Ruan. Surgical selection and prognostic analysis of sporadic medullary thyroid carcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 429-431.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2021.06.006

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2021/V15/I06/429

Figures/Tables 1

References 14

[1]	Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma[J]. Thyroid, 2015, 25(6): 567-610.
[2]	Kebebew E, Ituarte PH, Siperstein AE, et al. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems[J]. Cancer, 2000, 88(5): 1139-1148.
[3]	Fleming JB, Lee JE, Bouvet M, et al. Surgical strategy for the treatment of medullary thyroid carcinoma[J]. Ann Surg, 1999, 230(5): 697-707.
[4]	Evans DB, Fleming JB, Lee JE, et al. The surgical treatment of medullary thyroid carcinoma[J]. Semin Surg Oncol, 1999, 16(1): 50-63.
[5]	Haddad RI, Nasr C, Bischoff L, et al. NCCN Guidelines Insights: Thyroid Carcinoma, Version 2. 2018[J]. J Natl Compr Canc Netw, 2018, 16(12): 1429-1440.
[6]	董文武，张浩. 2018年版日本《甲状腺肿瘤诊疗指南》外科治疗部分更新解读[J]. 中国实用外科杂志, 2019, 39(12): 1260-1264.
[7]	王宇，田文，嵇庆海, 等. 甲状腺髓样癌诊断与治疗中国专家共识(2020版)[J].中国实用外科杂志, 2020, 40(9): 1012-1020.
[8]	程文元，徐本义，李树玲. 基础水平降钙素与甲状腺髓样癌颈淋巴结转移相关临床研究(附48例临床分析)[J]. 中国肿瘤临床与康复, 2002, 9(6): 79.
[9]	于洋，高明，冯影, 等. 甲状腺髓样癌外科处理与基因筛查原则探讨[J]. 中国肿瘤临床, 2007, 34(21): 1226-1228.
[10]	Miyauchi A, Matsuzuka F, Hirai K, et al. Unilateral surgery supported by germline RET oncogene mutation analysis in patients with sporadic medullary thyroid carcinoma[J]. World J Surg, 2000, 24(11): 1367-1372.
[11]	Miyauchi A, Matsuzuka F, Hirai K, et al. Prospective trial of unilateral surgery for nonhereditary medullary thyroid carcinoma in patients without germline RET mutations[J]. World J Surg, 2002, 26(8): 1023-1028.
[12]	Ito Y, Miyauchi A, Yabuta T, et al. Alternative surgical strategies and favorable outcomes in patients with medullary thyroid carcinoma in Japan: experience of a single institution[J]. World J Surg, 2009, 33(1): 58-66.
[13]	Ito Y, Miyauchi A, Kihara M, et al. Static prognostic factors and appropriate surgical designs for patients with medullary thyroid carcinoma: the second report from a single-institution study in Japan[J]. World J Surg, 2018, 42(12): 3954-3966.
[14]	Roman S, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases[J]. Cancer, 2006, 107(9): 2134-2142.

项目		例数	A组	B组	统计值	P值
例数			25	40
年龄（岁）			49.88±10.93	50.38±12.55	-0.162^a	0.872
术前降钙素			31.44	33.98	-0.527^b	0.598
性别					0.350	0.554
	男	29	10(40.0)	19(47.5)
	女	36	15(60.0)	21(52.5)
侵出腺叶					0.002	0.969
	是	34	13(52.0)	21(52.5)
	否	31	12(48.0)	19(47.5)
Ⅵ区淋巴结转移					0.402	0.526
	否	37	13(52.0)	24(60.0)
	是	28	12(48.0)	16(40.0)
淋巴结切除范围					3.134	0.077
	中央区	35	10(40.0)	25(62.5)
	中央区+侧颈	30	15(60.0)	15(37.5)
TNM分期					4.010	0.045
	Ⅰ+Ⅱ	31	8(32.0)	23(57.5)
	Ⅲ+Ⅳ	34	17(68.0)	17(42.5)
肿瘤直径（cm）					0.402	0.526
	≤1	28	12(48.0)	16(40.0)
	>1	37	13(52.0)	24(60.0)
病灶数（个）					0.900	0.343
	1	46	16(64.0)	30(75.0)
	>1	19	9(36.0)	10(25.0)

项目		例数	A组	B组	统计值	P值
例数			25	40
年龄（岁）			49.88±10.93	50.38±12.55	-0.162^a	0.872
术前降钙素			31.44	33.98	-0.527^b	0.598
性别					0.350	0.554
	男	29	10(40.0)	19(47.5)
	女	36	15(60.0)	21(52.5)
侵出腺叶					0.002	0.969
	是	34	13(52.0)	21(52.5)
	否	31	12(48.0)	19(47.5)
Ⅵ区淋巴结转移					0.402	0.526
	否	37	13(52.0)	24(60.0)
	是	28	12(48.0)	16(40.0)
淋巴结切除范围					3.134	0.077
	中央区	35	10(40.0)	25(62.5)
	中央区+侧颈	30	15(60.0)	15(37.5)
TNM分期					4.010	0.045
	Ⅰ+Ⅱ	31	8(32.0)	23(57.5)
	Ⅲ+Ⅳ	34	17(68.0)	17(42.5)
肿瘤直径（cm）					0.402	0.526
	≤1	28	12(48.0)	16(40.0)
	>1	37	13(52.0)	24(60.0)
病灶数（个）					0.900	0.343
	1	46	16(64.0)	30(75.0)
	>1	19	9(36.0)	10(25.0)

[1]	Tifei Yang, Chuanhu Yang, Zhenru Lu. Effect of modified non-inflatable transaxillary approach total endoscopic thyroid surgery on recurrent laryngeal nerve function [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 74-77.
[2]	Hang Chen, Xiang Min. Clinical analysis and countermeasures of 12 cases of hemorrhage after daytime thyroidectomy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 600-602.
[3]	Jia Luo, Jingjing Zhao, Xiaozhen Cao, Ling Zhong, Linjun Fan, Lingjuan Zeng. Control study of local pressure prevention of subcutaneous tunnel bleeding after unilateral axillary and bilateral areolar approach robot thyroid surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 603-606.
[4]	Chongzhi Huang, Yingsheng Xiao, Xihong Yang, Xin Lin. Application of ascending branch of inferior thyroid artery to locate recurrent laryngeal nerve during thyroid operation [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 607-610.
[5]	Zhanbin Cui, Junli Qiao, Lili Zhang, Mingqiang Han. Correlation between urinary iodine levels and stratified risk of recurrence in patients with papillary thyroid cancer after surgery [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 615-618.
[6]	Yao Chen, Boqun Xu, Zhihui Gao. Efficacy and safety of modified intermediate upper approach radical resection in the treatment of thyroid cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 619-622.
[7]	LuoBu AChong, Ying Chen, Dekun Xie. Effect of laparoscopic complete exocyst dissection in the treatment of hepatic echinococcosis and its influence on liver function and prognosis [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 666-669.
[8]	Zekun Zheng, Zhuoheng Liu, Hao Zou, Huiyuan Hu, Da Li, Wei Wu. Extended radical surgical resection of recurrent giant retroperitoneal dedifferentiated liposarcoma：a case report [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(05): 588-590.
[9]	Yi Wang, Sizhe Xu, Zhangxia Ren. Effect of endoscopic unilateral thyroid lobectomy via thoracic breast approach and open surgery on postoperative recovery in patients with differentiated thyroid cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(05): 542-545.
[10]	Xiaowei Xing, Yuchen Liu, Bing Zhao, Minggang Wang. A research on predictive value of convolutional neural network based on preoperative abdominal CT for recurrence of incisional hernia after surgical repair [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 677-681.
[11]	Ming Jiang, Rui Luo, Chengchao Long. Diagnosis and treatment of obturator hernia: An experience of 73 cases over 10 years [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 706-710.
[12]	Wenhua Zhang, Cui Tao, Tiansong Hu. Clinicopathological characteristics of pedunculated hepatocellular carcinoma in different sites and its effects on postoperative intrahepatic recurrence and prognosis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 651-655.
[13]	Wentao Ye, Zhongjun Wu, Rui Liao. Relationship between ALOX15 expression in adjacent tissues and prognosis of hepatocellular carcinoma patients after radical resection [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 708-712.
[14]	Zhengying Zhang, Yang Ju, Xiaoning Liu. Effect of oral metformin on postoperative recurrence of type 2 diabetes mellitus with colorectal adenoma [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 485-488.
[15]	Jiajun Zhou, Yongwu Yu, Han Zhou, Ling Zhang. Impact of parathyroidectomy on bone mineral density and bone metabolism in patients with secondary hyperparathyroidism [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 706-710.

Please choose a citation manager

Content to export