Torresan Francesca, Cavedon Elisabetta, Mian Caterina, Iacobone Maurizio
Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
Endocrinology Unit, Department of Medicine, University of Padua, Padua, Italy.
World J Surg. 2018 Feb;42(2):367-375. doi: 10.1007/s00268-017-4321-z.
Medullary thyroid carcinoma (MTC) is a rare C cells-derived tumor, with a hardly predictable long-term prognosis. This study was aimed to evaluate the predictive factors of cure and survival after surgery for MTC in a monocentric series.
A retrospective analysis of the long-term outcomes was assessed in 255 MTC patients operated between 1980 and 2015 at Padua University hospital.
Sporadic MTC occurred in 65.1% and hereditary MTC in 34.9% of patients. At a median follow-up of 93 months (range 7-430), the cure rate was 56.8%. The overall 10-year survival was 84.4%, and MTC-related death rate was 15.3%. Patients who died because of MTC had a median age of 61 years (range 21-84) and were at stages III-IV in all cases; deaths occurred in 18% of sporadic MTC, 6% of MEN2a and 66.7% of MEN2b patients. None of the patients at stages I-II died because of the disease, but 17.7% had persistent/recurrent disease. Based on univariate analysis, age, gender, genetic variant, extent and year of surgery, tumor size, lymph-nodal metastases and tumor stage significantly affected cure and survival rates. At multivariate analysis, only patient- and tumor-related features (age, lymph-nodal status and stage) remained significant independent prognostic factors.
Radical surgery is the only chance of definitive cure in MTC, but it is possible only at early stage; in advanced stages, even extensive surgery could not grant cure and prolonged survival. Stage, nodal metastases and age remain the main predictive factors for cure and survival.
甲状腺髓样癌（MTC）是一种罕见的源自C细胞的肿瘤，其长期预后很难预测。本研究旨在评估单中心队列中MTC手术后治愈和生存的预测因素。
对1980年至2015年间在帕多瓦大学医院接受手术的255例MTC患者的长期结局进行回顾性分析。
散发性MTC发生于65.1%的患者，遗传性MTC发生于34.9%的患者。中位随访93个月（范围7 - 430个月），治愈率为56.8%。总体10年生存率为84.4%，MTC相关死亡率为15.3%。因MTC死亡的患者中位年龄为61岁（范围21 - 84岁），所有病例均处于III - IV期；散发性MTC患者中有18%死亡，MEN2a患者中有6%死亡，MEN2b患者中有66.7%死亡。I - II期患者均无因该病死亡，但17.7%有持续性/复发性疾病。单因素分析显示，年龄、性别、基因变异、手术范围和年份、肿瘤大小、淋巴结转移和肿瘤分期显著影响治愈率和生存率。多因素分析显示，只有患者和肿瘤相关特征（年龄、淋巴结状态和分期）仍然是显著的独立预后因素。
根治性手术是MTC实现确定性治愈的唯一机会，但仅在早期可行；在晚期，即使进行广泛手术也无法保证治愈和延长生存期。分期、淋巴结转移和年龄仍然是治愈和生存的主要预测因素。
