Department of Oncology, Suzhou Ninth People's Hospital, Suzhou, China.
Department of Gastrointestinal Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China.
Front Endocrinol (Lausanne). 2022 Oct 21;13:1015319. doi: 10.3389/fendo.2022.1015319. eCollection 2022.
Clinical guidelines presently recommend total thyroidectomy for the treatment of medullary thyroid cancer (MTC). This study was aimed to investigate whether lobectomy could be the initial treatment for stage I MTC patients.
The retrospective study was based on data from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The risk factors of survival were estimated by the univariate and multivariate Cox proportional-hazards model. The effect of age on death risk was estimated using restricted cubic splines. Survival curves were constructed according to the Kaplan-Meier method.
A total of 988 stage I MTC patients was included in the study. Among them, 506 (51.2%) MTC patients received lobectomy and 482 (48.8%) received total thyroidectomy. The only independent prognostic factor for overall survival (OS) and disease-specific survival (DSS) was age, according to univariate and multivariate Cox regression analysis. The hazard ratio (HR) increased relatively slowly with age growing under the age of approximately 60 years. However, the death risk of MTC patients began to rise sharply with increasing age above 60 years. For patients under the age of 60, a significant survival difference for OS and DSS was observed between the lobectomy group and total thyroidectomy group (p < 0.05). However, for patients aged above 60, no significant survival difference was observed for OS or DSS (p > 0.05).
Total thyroidectomy was an appropriate treatment for stage I MTC patients under the age of 60, which was consistent with the recommendation of the clinical guidelines. However, for those over the age of 60, lobectomy may be explored as a better surgical option. The findings may provide the evidence base for improving the clinical management of stage I MTC patients. Further prospective multicenter clinical studies are needed including information regarding status as well as calcitonin and CEA levels.
临床指南目前建议对甲状腺髓样癌（MTC）患者进行全甲状腺切除术治疗。本研究旨在探讨对于 I 期 MTC 患者，能否采用甲状腺叶切除术作为初始治疗方案。
本回顾性研究基于 2004 年至 2015 年期间监测、流行病学和最终结果（SEER）数据库中的数据。采用单因素和多因素 Cox 比例风险模型估计生存的危险因素。使用限制性立方样条估计年龄对死亡风险的影响。根据 Kaplan-Meier 方法构建生存曲线。
共纳入 988 例 I 期 MTC 患者。其中，506 例（51.2%）MTC 患者接受甲状腺叶切除术，482 例（48.8%）接受全甲状腺切除术。单因素和多因素 Cox 回归分析显示，年龄是影响总生存（OS）和疾病特异性生存（DSS）的唯一独立预后因素。根据单因素和多因素 Cox 回归分析，年龄与 OS 和 DSS 呈负相关。在 60 岁以下的年龄组中，随着年龄的增长，HR 增长相对缓慢。然而，在 60 岁以上的年龄组中，MTC 患者的死亡风险随着年龄的增长急剧上升。对于 60 岁以下的患者，甲状腺叶切除术组与全甲状腺切除术组在 OS 和 DSS 方面存在显著的生存差异（p < 0.05）。然而，对于 60 岁以上的患者，OS 或 DSS 方面的生存差异无统计学意义（p > 0.05）。
对于 60 岁以下的 I 期 MTC 患者，全甲状腺切除术是一种合适的治疗方法，这与临床指南的推荐一致。然而，对于 60 岁以上的患者，甲状腺叶切除术可能是一种更好的手术选择。这些发现可能为改善 I 期 MTC 患者的临床管理提供依据。需要进一步开展包括 状态、降钙素和 CEA 水平在内的多中心前瞻性临床研究。
