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Extent of surgery requires individualization in medullary thyroid cancer
New data indicate that survival after total thyroidectomy with central lymph node dissection in patients with medullary thyroid cancer was largely dependent on tumor size and distant metastases.
Guidelines advocate a more conservative approach to surgery in patients with medullary thyroid cancer, but whether this improves survival remains unclear, researchers wrote in the Journal of Clinical Endocrinology & Metabolism.
To more closely assess the relationship between surgery and overall survival in this patient population, researchers evaluated data from 2,968 patients (mean age, 54 years; 58.6% women) with medullary thyroid cancer using the National Cancer Database. Eighty-three percent underwent total thyroidectomy, 10.2% underwent lobectomy and 6.8% did not undergo surgery. Of the 1,952 patients who underwent cervical lymph nodes dissection, 58.4% had positive cervical lymph node metastases.
Decreased overall survival appeared to be linked to age older than 65 years (adjusted HR=5.69; 95% CI, 3.34-9.72), tumor size greater than 4 cm (adjusted HR=2.89; 95% CI, 2.14-3.9), presence of distant metastases (adjusted HR=5.68; 95% CI, 4.61-6.99) and having at least 16 positive regional lymph nodes (adjusted HR=3.4; 95% CI, 2.41-4.79), according to study data.
Among those with no cervical lymph node metastases and cervical lymph nodes not resected, overall survival was 90% and 76%, respectively. Overall survival was 74% for patients with one to five lymph nodes metastases; 61% for those with six to 10 lymph nodes metastases; 69% for those with 11 to 16 lymph nodes metastases, and 55% for those with 16 or more lymph nodes metastases.
Overall survival rate was 88.8% for patients with tumors sized 2 cm or less and no distant metastases. Surgical intervention also did not appear to affect survival in these patients. However, compared with no surgery, all surgical treatments were associated with increased survival in patients with tumors sized greater than 2 cm and no distant metastases (P<.001).
Only total thyroidectomy with regional lymph node resection improved survival in patients with distant metastases (P<.0001), according to study results.
“The number of lymph node metastases should be incorporated into [medullary thyroid cancer] staging,” the researchers wrote. “Extent of surgery in patients with [medullary thyroid cancer] should be tailored to tumor size and distant metastases.”
Disclosure: The researchers report no relevant financial disclosures.