Chen Ziyi, Qiu Wangwang, Yan Ting, Weng Huaiyu, Tang Yufan, Lv Jianyong, Yang Zhili
Department of Thyroid, Parathyroid, Breast, and Hernia Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Endocrine. 2025 Apr;88(1):194-202. doi: 10.1007/s12020-024-04133-3. Epub 2024 Dec 19.
Patients with distant metastatic medullary thyroid carcinoma (DMMTC) often undergo primary tumor resection (PTR) with or without neck lymph node dissection (NLND) before systemic therapy. However, whether these patients benefit from treatment remains unclear.
Patients with DMMTC were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2020. The overall survival (OS) and disease-specific survival (DSS) were established by Kaplan-Meier curves and were compared using the log-rank test or two-stage test between different treatment modalities (surgery, non-surgery) after propensity score matching (PSM). We also analyzed the effects of surgical and non-surgical treatments on the OS and DSS of patients stratified by TNM stages T1-2 and T3-4 in this cohort.
Among the 2336 patients with medullary thyroid carcinoma from the SEER database, 186 were diagnosed with DMMTC, with an average follow-up period of 28.12 months. Pairwise analysis after PSM revealed that the surgery group had a significantly improved survival rate compared to the non-surgery group (OS p = 0.00039, DSS p = 0.001). The survival advantages of the above-mentioned surgery group were maintained when stratified by stages T1-2 and T3-4.
Our results demonstrate that PTR with or without NLND, as an initial therapy, can benefit the survival rate of patients with DMMTC.
远处转移性甲状腺髓样癌（DMMTC）患者在接受全身治疗前，常接受原发肿瘤切除术（PTR），可伴有或不伴有颈部淋巴结清扫术（NLND）。然而，这些患者是否能从治疗中获益仍不明确。
从2010年至2020年的监测、流行病学和最终结果（SEER）数据库中识别出DMMTC患者。通过Kaplan-Meier曲线确定总生存期（OS）和疾病特异性生存期（DSS），并在倾向评分匹配（PSM）后，使用对数秩检验或两阶段检验比较不同治疗方式（手术、非手术）之间的生存期。我们还分析了手术和非手术治疗对该队列中按TNM分期T1-2和T3-4分层的患者的OS和DSS的影响。
在SEER数据库中的2336例甲状腺髓样癌患者中，186例被诊断为DMMTC，平均随访期为28.12个月。PSM后的成对分析显示，手术组的生存率明显高于非手术组（OS p = 0.00039，DSS p = 0.001）。当按T1-2和T3-4分期分层时，上述手术组的生存优势得以维持。
我们的结果表明，无论是否进行NLND的PTR作为初始治疗，都可以提高DMMTC患者的生存率。
