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Extrathyroidal extension compromises survival in cancer
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Adults with medullary or differentiated thyroid cancer with extrathyroidal extension have lower 5-year survival rates than those whose tumors have not spread to surrounding structures, study data show.
Julie Ann Sosa, MD, professor of surgery and medicine at Duke University Medical Center in Durham, North Carolina, and colleagues evaluated data from the National Cancer Database (1998-2012) on 241,118 adults with differentiated thyroid cancer and 3,415 adults with medullary thyroid cancer to determine the association between extrathyroidal extension and survival.
Among participants with differentiated thyroid cancer, 9.1% had minimal extrathyroidal extension, 4% had extensive extrathyroidal extension and 86.9% had no extrathyroidal extension. Compared with participants without extrathyroidal extension, participants with extrathyroidal extension, whether minimal or extensive, were more likely to have larger tumors, lymphovascular invasion, positive margins after thyroidectomy and regional lymph node metastases (P < .01 for all). Five-year survival was highest among participants without extrathyroidal extension (96%), followed by those with minimal extrathyroidal extension (94%) and those with extensive extrathyroidal extension (88%). Compromised survival was associated with minimal extrathyroidal extension (P < .01) and extensive extrathyroidal extension (P < .01) compared with no extrathyroidal extension after adjustment for patient demographic, clinical and pathologic factors.
Among participants with medullary thyroid cancer, 7.1% had minimal extrathyroidal extension, 5% had extensive extrathyroidal extension and 87.9% had no extrathyroidal extension. Participants with extrathyroidal extension, whether minimal or extensive, were more likely to have larger tumors, lymphovascular invasion, positive margins after thyroidectomy and regional lymph node metastases compared with participants without extrathyroidal extension (P < .01 for all). Five-year survival was highest for participants without extrathyroidal extension (93%), followed by those with minimal extrathyroidal extension (83%) and those with extensive extrathyroidal extension (75%). Compared with participants without extrathyroidal extension, participants with extensive extrathyroidal extension had compromised survival after adjustment for demographic, clinical and pathologic factors (P = .001); there was no association between compromised survival and minimal extrathyroidal extension.
“This is the first study utilizing a nationwide database examining the association of [extrathyroidal extension] on survival in patients with thyroid cancer,” the researchers wrote. “In patients with differentiated thyroid cancer, [extrathyroidal extension] appears to be associated with compromised survival in a dose-dependent fashion. In patients with medullary thyroid cancer, extensive [extrathyroidal extension] is associated with compromised survival, while minimal [extrathyroidal extension] trends toward compromised survival. Further studies are needed to clarify this point. However, given these findings, [extrathyroidal extension] should be included in the thyroid cancer treatment guidelines.” – by Amber Cox
Disclosure: Sosa reports being a member of the data monitoring committee of the Medullary Thyroid Cancer Consortium Registry and various financial ties with AstraZeneca, Eli Lilly, GlaxoSmithKline and Novo Nordisk.
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