Pilaete K, Delaere P, Decallonne B, Bex M, Hauben E, Nuyts S, Clement P, Hermans R, Vander Poorten V
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
B-ENT. 2012;8(2):113-21.
We reviewed our experience with MTC (medullary thyroid cancer), focusing on recurrence and survival, recommendations for the extent of lymph node (LN) dissection and surgery for recurrent disease.
Of 51 MTC patients treated between 1988 and 2008 at the University Hospitals Leuven, 38 previously untreated patients were analysed.
Overall and disease-specific (DSS) five-year survival rates were 75% and 82%. Variables univariately associated with DSS were age, pN, stage, vascular invasion, pre-operative recurrent laryngeal nerve function and last calcitonin level. Recurrence occurred in 10 patients (26%). For recurrence, age was no longer a prognostic factor and post-operative calcitonin, number of positive LN and of positive compartments proved to be prognostic factors. Of 21 clinical NO patients, 2 out of 6 (33%) undergoing a prophylactic central neck dissection (ND) based on per-operative palpatory suspicion proved pN+, and 2 out of 9 patients (22%) undergoing a prophylactic lateral ND were pN+. Five patients surgically treated for recurrence did not achieve long-term normalisation of calcitonin, but remained alive with locoregional control.
Overall survival and DSS rates are within the range reported in the literature. The results confirm that (1) total thyroidectomy and central compartment dissection is the treatment of choice in the cN0 patients, (2) additional ipsilateral lateral ND is needed for cN+ disease in the ipsilateral lateral compartment, and (3) in the clinically uninvolved contralateral lateral neck, per-operative inspection should serve as a basis for a decision about further ND. Locoregional control and prolonged survival is achieved in surgically treated locoregionally recurrent MTC.
我们回顾了我们在髓样甲状腺癌（MTC）方面的经验，重点关注复发和生存情况、淋巴结清扫范围的建议以及复发性疾病的手术治疗。
在鲁汶大学医院1988年至2008年期间治疗的51例MTC患者中，对38例先前未接受治疗的患者进行了分析。
总生存率和疾病特异性生存率（DSS）的五年生存率分别为75%和82%。单因素分析中与DSS相关的变量有年龄、pN、分期、血管侵犯、术前喉返神经功能和最后降钙素水平。10例患者（26%）出现复发。对于复发，年龄不再是预后因素，术后降钙素、阳性淋巴结数量和阳性分区被证明是预后因素。在21例临床N0患者中，6例基于术中触诊怀疑接受预防性中央颈清扫（ND）的患者中有2例（33%）被证明为pN+，9例接受预防性侧颈清扫的患者中有2例（22%）为pN+。5例接受复发性疾病手术治疗的患者降钙素未实现长期正常化，但通过局部区域控制存活。
总生存率和DSS率在文献报道的范围内。结果证实：（1）全甲状腺切除术和中央区清扫是cN0患者的首选治疗方法；（2）同侧外侧区cN+疾病需要额外进行同侧侧颈清扫；（3）在临床上未受累的对侧侧颈，术中检查应作为决定是否进一步进行颈清扫的依据。手术治疗局部区域复发的MTC可实现局部区域控制和延长生存期。
