Jishu Jessan A, Hussein Mohammad H, Sadakkadulla Salman, Baah Solomon, Bashumeel Yaser Y, Toraih Eman, Kandil Emad
School of Medicine, Tulane University, New Orleans, LA 70112, USA.
Division of Endocrine and Oncologic Surgery, Department of Surgery, School of Medicine, Tulane University, New Orleans, LA 70112, USA.
Cancers (Basel). 2024 Dec 4;16(23):4062. doi: 10.3390/cancers16234062.
The optimal surgical approach for localized T1 medullary thyroid cancer remains unclear. Total thyroidectomy is standard, but lobectomy and subtotal thyroidectomy may minimize mortality while maintaining oncologic control.
This retrospective analysis utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results registry to identify 2702 MTC patients including 398 patients with T1N0/1M0 MTC treated with total thyroidectomy or lobectomy/subtotal thyroidectomy from 2000 to 2019. Cox regression analyses assessed thyroid cancer-specific and overall mortality.
The majority (89.7%) underwent total thyroidectomy, while 10.3% had lobectomy/subtotal thyroidectomy. Nodal metastases were present in 29.6%. Over a median follow-up of 8.75 years, no significant difference was observed in cancer-specific mortality (5.7% vs. 8.1%, = 0.47) or overall mortality (13.2% vs. 12.8%, = 0.95). On multivariate analysis, undergoing cancer-directed surgery was associated with significantly improved overall survival (HR 0.18, < 0.001) and cancer-specific survival (HR 0.17, < 0.001) compared to no surgery. However, no significant survival difference was seen between total thyroidectomy and lobectomy/subtotal thyroidectomy for overall mortality (HR 0.77, = 0.60) or cancer-specific mortality (HR 0.44, = 0.23). The extent of surgery also did not impact outcomes within subgroups stratified by age, gender, T stage, or nodal status. Delayed surgery >1 month after diagnosis was associated with worse overall survival ( = 0.012).
For localized T1 MTC, lobectomy/subtotal thyroidectomy appears to achieve comparable long-term survival to total thyroidectomy in this population-based analysis. The selective use of limited thyroidectomy may be reasonable for low-risk T1N0/1M0 MTC patients. Delayed surgery is associated with worse survival and additional neck dissection showed no benefit for this select group of patients.
局限性T1期甲状腺髓样癌的最佳手术方式仍不明确。甲状腺全切除术是标准术式，但甲状腺叶切除术和甲状腺次全切除术可能在维持肿瘤学控制的同时将死亡率降至最低。
这项回顾性分析利用美国国立癌症研究所的监测、流行病学和最终结果登记系统，确定了2702例甲状腺髓样癌患者，其中包括2000年至2019年接受甲状腺全切除术或甲状腺叶切除术/甲状腺次全切除术治疗的398例T1N0/1M0甲状腺髓样癌患者。Cox回归分析评估了甲状腺癌特异性死亡率和总死亡率。
大多数患者（89.7%）接受了甲状腺全切除术，而10.3%的患者接受了甲状腺叶切除术/甲状腺次全切除术。29.6%的患者存在淋巴结转移。在中位随访8.75年期间，甲状腺癌特异性死亡率（5.7%对8.1%，P = 0.47）或总死亡率（13.2%对12.8%，P = 0.95）未观察到显著差异。多因素分析显示，与未手术相比，接受针对癌症的手术与总体生存率（HR 0.18，P < 0.001）和甲状腺癌特异性生存率（HR 0.17，P < 0.001）显著改善相关。然而，甲状腺全切除术和甲状腺叶切除术/甲状腺次全切除术在总死亡率（HR 0.77，P = 0.60）或甲状腺癌特异性死亡率（HR 0.44，P = 0.23）方面未观察到显著的生存差异。手术范围在按年龄、性别、T分期或淋巴结状态分层的亚组中也未影响预后。诊断后延迟手术>1个月与总体生存率较差相关（P = 0.012）。
在这项基于人群的分析中，对于局限性T1期甲状腺髓样癌，甲状腺叶切除术/甲状腺次全切除术似乎能实现与甲状腺全切除术相当的长期生存率。对于低风险的T1N0/1M0甲状腺髓样癌患者，选择性使用有限的甲状腺切除术可能是合理的。延迟手术与较差的生存率相关，并且额外的颈部清扫术对这组特定患者没有益处。
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