Verbeek Hans H G, Meijer Johannes A A, Zandee Wouter T, Kramp Kelvin H, Sluiter Wim J, Smit Johannes W, Kievit Job, Links Thera P, Plukker John Th M
Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands.
Ann Surg Oncol. 2015 Apr;22(4):1207-13. doi: 10.1245/s10434-014-4115-6. Epub 2014 Oct 15.
Surgery is still the only curative treatment for medullary thyroid cancer (MTC). We evaluated clinical outcome in patients with locoregional MTC with regard to adequacy of treatment following ATA guidelines and number of sessions to first intended curative surgery in different hospitals.
We reviewed all records of MTC patients (n = 184) treated between 1980 and 2010 in two tertiary referral centers in the Netherlands. Symptomatic MTC (palpable tumor or suspicious lymphadenopathy) patients without distant metastasis were included (n = 86). Patients were compared with regard to adequacy of surgery according to ATA recommendations, tumor characteristics, number of local cancer reoperations, biochemical cure, clinical disease-free survival (DFS), overall survival (OS), and complications.
Adherence to ATA guidelines resulted in fewer cancer-related reoperations (0.24 vs. 0.60; P = 0.027) and more biochemical cure (40.9 vs. 20 %; P = 0.038). Surgery according to ATA-guidelines on patients treated in referral centers was significantly more often adequate (59.2 vs. 26.7 %; P = 0.026). Tumor size and LN+ were the most important predictors for clinical recurrence [relative risk (RR) 4.1 (size > 40 mm) 4.1 (LN+) and death (RR 4.2 (size > 40 mm) 8.1 (LN+)].
ATA-compliant surgery resulted in fewer local reoperations and more biochemical cure. Patients in referral centers more often underwent adequate surgery according to ATA-guidelines. Size and LN+ were the most important predictors for DFS and OS.
手术仍然是甲状腺髓样癌（MTC）唯一的治愈性治疗方法。我们评估了局部区域性MTC患者的临床结局，包括遵循美国甲状腺协会（ATA）指南进行治疗的充分性以及在不同医院首次进行意向性根治性手术的次数。
我们回顾了1980年至2010年在荷兰两家三级转诊中心接受治疗的MTC患者（n = 184）的所有记录。纳入无远处转移的有症状MTC患者（可触及肿瘤或可疑淋巴结病，n = 86）。根据ATA建议，比较患者手术的充分性、肿瘤特征、局部癌症再次手术次数、生化治愈情况、临床无病生存期（DFS）、总生存期（OS）和并发症。
遵循ATA指南可减少与癌症相关的再次手术（0.24对0.60；P = 0.027），提高生化治愈率（40.9%对20%；P = 0.038）。在转诊中心接受治疗的患者，按照ATA指南进行的手术明显更充分（59.2%对26.7%；P = 0.026）。肿瘤大小和淋巴结阳性是临床复发[相对风险（RR）4.1（肿瘤大小>40 mm），4.1（淋巴结阳性）]和死亡[RR 4.2（肿瘤大小>40 mm），8.1（淋巴结阳性）]的最重要预测因素。
符合ATA标准的手术可减少局部再次手术，提高生化治愈率。转诊中心的患者更常按照ATA指南接受充分的手术。肿瘤大小和淋巴结阳性是DFS和OS的最重要预测因素。
