Endocrinology, Diabetes and Metabolism Department and Center for Thyroid Diseases, Ordine Mauriziano Hospital, Turin 10128, Italy.
Endocrinology and Diabetes Center, Italian Hospital, Ente Ospedaliero Cantonale (EOC), Viganello 6962, Switzerland.
Endocr J. 2023 Nov 28;70(11):1061-1067. doi: 10.1507/endocrj.EJ23-0273. Epub 2023 Sep 9.
The diagnosis of medullary thyroid carcinoma (MTC) is challenging since the accuracy of ultrasound (US) and fine-needle aspiration cytology are suboptimal. As a result, MTC has a generally poor prognosis. The aim of this study was to analyze whether perioperative data can modify the risk of relapse in these patients. The institutional database of Turin Mauriziano Hospital was searched to extract records of MTCs diagnosed between 2000 and 2021. Kaplan-Meier curves and Cox and logistic regression analyses were performed, and the hazard ratio (HR) was calculated. Seventy-three MTC patients (median age 58 yr) were found. Disease-free survival was significantly different according to staging (HR: 9.12; p = 0.037), capsular status (HR: 5.49; p = 0.02), and neck US (HR: 9.19; p = 0.04). In the logistic regression analysis, CEA level (β: -0.01; p = 0.043), histological multifocality (OR: 7.4; p = 0.034), and metastatic lymph nodes at histology (β: -0.13; p = 0.006) were significantly associated with structural recurrence. Two logistic multivariate models best explained the variance in recurrence: 1) neck US presentation plus histological multifocality (AIC: 27; r: 0.37; x: 12.4; p = 0.002) and 2) number of neck metastases plus capsular invasion (AIC: 26; r: 0.40; x: 13.7; p = 0.001). Pathological data are associated with MTC prognosis. Preoperative neck US can significantly help to predict MTC outcome.
甲状腺髓样癌（MTC）的诊断具有挑战性，因为超声（US）和细针穿刺细胞学的准确性并不理想。因此，MTC 的总体预后较差。本研究旨在分析围手术期数据是否可以改变这些患者的复发风险。检索都灵 Mauriziano 医院的机构数据库，以提取 2000 年至 2021 年间诊断的 MTC 记录。进行 Kaplan-Meier 曲线和 Cox 和逻辑回归分析，并计算危险比（HR）。发现 73 例 MTC 患者（中位年龄 58 岁）。根据分期（HR：9.12；p = 0.037）、包膜状态（HR：5.49；p = 0.02）和颈部 US（HR：9.19；p = 0.04），无疾病生存时间差异有统计学意义。在逻辑回归分析中，CEA 水平（β：-0.01；p = 0.043）、组织学多灶性（OR：7.4；p = 0.034）和组织学转移性淋巴结（β：-0.13；p = 0.006）与结构复发显著相关。两个逻辑多元模型最好地解释了复发的方差：1）颈部 US 表现加组织学多灶性（AIC：27；r：0.37；x：12.4；p = 0.002）和 2）颈部转移灶数加包膜侵犯（AIC：26；r：0.40；x：13.7；p = 0.001）。病理数据与 MTC 预后相关。术前颈部 US 可显著帮助预测 MTC 结局。
