1 Department of ORL-Head & Neck Surgery and Audiology, Odense University Hospital, Odense, Denmark.
2 Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Thyroid. 2019 Mar;29(3):368-377. doi: 10.1089/thy.2018.0564. Epub 2019 Jan 31.
Survival of medullary thyroid carcinoma (MTC) subgroups in relation to the general population is poorly described. Data on the factors predicting long-term biochemical cure in MTC patients are nonexistent at a population level. A nationwide retrospective cohort study of MTC in Denmark from 1997 to 2014 was conducted, aiming to detect subgroups with survival similar to that of the general population and to identify prognostic factors for disease-specific survival and long-term biochemical cure.
The study included 220 patients identified from the nationwide Danish MTC cohort between 1997 and 2014. As a representative sample of the general population, a reference population matched 50:1 to the MTC cohort was used.
Patients diagnosed with hereditary MTC by screening (hazard ratio [HR] = 1.5 [confidence interval (CI) 0.5-4.3]), patients without regional metastases (HR = 1.4 [CI 0.9-2.3]), and patients with stage I (HR = 1.3 [CI 0.6-3.1]), stage II (HR = 1.1 [CI 0.6-2.3]), and III (HR = 1.3 [CI 0.4-4.2]) disease had an overall survival similar to the reference population. On multivariate analysis, the presence of distant metastases (HR = 12.3 [CI 6.0-25.0]) predicted worse disease-specific survival, while the absence of regional lymph node metastases (odds ratio = 40.1 [CI 12.0-133.7]) was the only independent prognostic factor for long-term biochemical cure.
Patients with hereditary MTC diagnosed by screening, patients without regional metastases, and patients with stages I, II, and III disease may have similar survival as the general population. The presence of distant metastases predicted worse disease-specific survival, while the absence of regional metastases predicted long-term biochemical cure.
髓样甲状腺癌（MTC）亚组与普通人群的生存情况描述不佳。在人群水平上，尚不存在预测 MTC 患者长期生化治愈的因素的数据。本研究对 1997 年至 2014 年丹麦全国性 MTC 进行了回顾性队列研究，旨在发现生存情况与普通人群相似的亚组，并确定疾病特异性生存和长期生化治愈的预后因素。
本研究纳入了 1997 年至 2014 年期间从丹麦全国性 MTC 队列中确定的 220 例患者。为了代表普通人群，我们使用了与 MTC 队列匹配 50:1 的参考人群。
通过筛查诊断为遗传性 MTC 的患者（风险比[HR] = 1.5 [置信区间（CI）0.5-4.3]）、无区域转移的患者（HR = 1.4 [CI 0.9-2.3]）、以及处于 I 期（HR = 1.3 [CI 0.6-3.1]）、II 期（HR = 1.1 [CI 0.6-2.3]）和 III 期（HR = 1.3 [CI 0.4-4.2]）疾病的患者，其总生存情况与参考人群相似。多变量分析显示，存在远处转移（HR = 12.3 [CI 6.0-25.0]）是疾病特异性生存较差的预测因素，而无区域淋巴结转移（优势比[OR] = 40.1 [CI 12.0-133.7]）是长期生化治愈的唯一独立预后因素。
通过筛查诊断为遗传性 MTC 的患者、无区域转移的患者，以及处于 I 期、II 期和 III 期疾病的患者，其生存情况可能与普通人群相似。存在远处转移预示着疾病特异性生存较差，而无区域转移预示着长期生化治愈。
