Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2021 Oct;28(11):6572-6579. doi: 10.1245/s10434-021-09683-8. Epub 2021 Mar 21.
Patients with medullary thyroid carcinoma (MTC) often receive lateral lymph node dissection with total thyroidectomy when calcitonin levels are elevated, even in the absence of structural disease, but the effect of this intervention on disease-specific outcomes is not known.
We retrospectively reviewed patients from 1986 to 2017 who underwent thyroidectomy with curative intent for MTC at our institution. The association of disease-specific survival and clinicopathologic features was examined using univariate and multivariate Cox regression.
We identified 316 patients who underwent curative resection for MTC. Overall and disease-specific survival were 76% and 86%, respectively, at 10 years. To investigate the effect of prophylactic ipsilateral lateral lymph node dissection, we analyzed 89 patients without known structural disease in the neck lymph nodes at the time of resection and preoperative calcitonin > 200 pg/ml, of whom 45 had an ipsilateral lateral lymph node dissection (LND) and 44 did not. There were no differences in tumor size or preoperative calcitonin levels. There was no difference at 10 years in cumulative incidence of recurrence in the neck (20.9% LND vs. 30.4% no LND, p = 0.46), cumulative incidence of distant recurrence (18.3% vs. 18.4%, p = 0.97), disease-specific survival (86% vs. 93%, p = 0.53), or overall survival (82% vs. 90%, p = 0.6).
Lateral neck dissection in the absence of clinical or radiologic abnormal lymph nodes is not associated with improved survival in patients with MTC.
当降钙素水平升高时，即使没有结构疾病，患有髓样甲状腺癌（MTC）的患者通常会接受颈侧淋巴结清扫术和甲状腺全切除术，但这种干预对疾病特异性结局的影响尚不清楚。
我们回顾性分析了 1986 年至 2017 年在我院接受甲状腺切除术治疗 MTC 的患者。使用单变量和多变量 Cox 回归分析疾病特异性生存与临床病理特征的关系。
我们共确定了 316 例接受 MTC 根治性切除术的患者。10 年时，总体生存率和疾病特异性生存率分别为 76%和 86%。为了探讨预防性同侧颈侧淋巴结清扫术的效果，我们分析了 89 例在手术时颈部淋巴结无已知结构疾病且术前降钙素>200 pg/ml 的患者，其中 45 例行同侧颈侧淋巴结清扫术（LND），44 例未行 LND。肿瘤大小或术前降钙素水平无差异。10 年时，颈部累积复发率（LND 组 20.9%，无 LND 组 30.4%，p=0.46）、远处复发率（18.3% vs. 18.4%，p=0.97）、疾病特异性生存率（86% vs. 93%，p=0.53）或总生存率（82% vs. 90%，p=0.6）均无差异。
在无临床或影像学异常淋巴结的情况下进行颈侧淋巴结清扫术，不能提高 MTC 患者的生存。
