Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Thyroid. 2021 Apr;31(4):616-626. doi: 10.1089/thy.2020.0167. Epub 2020 Nov 25.
Medullary thyroid cancer (MTC) can be associated with significant morbidity and mortality in advanced cases. Hence, we aimed to identify factors at the time of MTC surgery that predict overall survival (OS), disease-specific survival (DSS), locoregional recurrence/persistence (LR), and distant metastases (DM). We performed a retrospective study of clinicopathologic, radiological, and laboratory data in MTC patients who underwent thyroidectomy at Mayo Clinic from January 1995 to December 2015. We identified 163 patients (mean age 48.4 years, 48% males), 102 with sporadic MTC and 61 with hereditary disease ( = 46 multiple endocrine neoplasia [MEN] 2A, = 3 MEN 2B, = 12 familial MTC) with a median follow-up time of 5.5 years. On univariate analysis, age >55 years, male sex, DM at the time of surgery (M1), lateral neck lymph node (LN) involvement (N1b), gross extrathyroidal extension (ETE), American Joint Committee on Cancer (AJCC) stage 3/4, tumor size (T) 3/4, tumor size, and postoperative calcitonin (Ctn) and carcinoembryonic antigen (CEA) were significant predictors of worse OS and DSS. On multivariable analysis, both gross ETE (hazard ratio [HR] 4.62, 6.58) and M1 (HR 5.11, 10.45) remained significant predictors of worse OS as well as DSS, while age >55 years (HR 3.21), male sex (HR 2.42), and postoperative Ctn (HR 1.002 for every 100 pg/mL increase) were significant only for worse OS. On univariate analysis, male sex, M1, N1b, gross ETE, stage 3/4, T 3/4, tumor size, number of LNs involved, and postoperative Ctn were significant predictors of LR and DM; age >55 years was additionally significant for DM. On multivariable analysis, gross ETE (HR 3.16, 5.93) and N1b (HR 4.31, 4.64) remained significant predictors of LR and DM; ratio of resected/involved LN (HR 10.91) was additionally predictive for LR and postoperative Ctn (HR 1.003 for every 100 pg/mL increase) for DM. Disease burden at initial surgery, especially gross ETE, lateral neck LN involvement, and DM, as well as the biochemical response to surgery appear to be more important than demographic factors in terms of MTC prognosis. These findings highlight the importance of rigorous perioperative assessment to better predict MTC outcomes.
甲状腺髓样癌（MTC）在晚期病例中可能导致显著的发病率和死亡率。因此，我们旨在确定 MTC 手术时预测总生存（OS）、疾病特异性生存（DSS）、局部区域复发/持续存在（LR）和远处转移（DM）的因素。我们对 1995 年 1 月至 2015 年 12 月在梅奥诊所接受甲状腺切除术的 MTC 患者的临床病理、影像学和实验室数据进行了回顾性研究。我们确定了 163 名患者（平均年龄 48.4 岁，48%为男性），其中 102 名患有散发性 MTC，61 名患有遗传性疾病（ = 46 例多发性内分泌肿瘤 [MEN] 2A， = 3 MEN 2B， = 12 例家族性 MTC），中位随访时间为 5.5 年。在单因素分析中，年龄>55 岁、男性、手术时存在 DM（M1）、侧颈部淋巴结（LN）受累（N1b）、大体甲状腺外延伸（ETE）、美国癌症联合委员会（AJCC）分期 3/4、肿瘤大小（T）3/4、肿瘤大小和术后降钙素（Ctn）和癌胚抗原（CEA）是 OS 和 DSS 较差的显著预测因素。在多变量分析中，大体 ETE（风险比 [HR] 4.62，6.58）和 M1（HR 5.11，10.45）仍然是 OS 和 DSS 较差的显著预测因素，而年龄>55 岁（HR 3.21）、男性（HR 2.42）和术后 Ctn（每增加 100pg/ml，HR 1.002）仅与 OS 较差相关。在单因素分析中，男性、M1、N1b、大体 ETE、3/4 期、T3/4、肿瘤大小、受累淋巴结数量和术后 Ctn 是 LR 和 DM 的显著预测因素；年龄>55 岁对 DM 也有显著影响。在多变量分析中，大体 ETE（HR 3.16，5.93）和 N1b（HR 4.31，4.64）仍然是 LR 和 DM 的显著预测因素；切除/受累淋巴结的比例（HR 10.91）对 LR 和术后 Ctn（每增加 100pg/ml，HR 1.003）也具有预测作用。初始手术时的疾病负担，尤其是大体 ETE、侧颈部 LN 受累和 DM，以及手术的生化反应，在 MTC 预后方面似乎比人口统计学因素更为重要。这些发现强调了进行严格围手术期评估的重要性，以便更好地预测 MTC 结果。
