Prognostic Influence of Clinical and Pathological Factors in Medullary Thyroid Carcinoma: A Study of 53 Cases

Abstract

OBJECTIVES AND INTRODUCTIONMedullary thyroid carcinoma, a neoplasia of intermediate prognosis and differentiation, does not always respond predictably to known treatments. This study aimed to correlate the clinical progression of surgically treated patients with clinical and pathological data.METHODSA total of 53 patients were followed for 75 months (mean average) in tertiary-care hospital. The clinical status of patients at the end of the study period was characterized to determine correlations with a range of disease aspects. A value of p < 0.05 was considered statistically significant.RESULTSTwenty-two patients (41.5%) were alive and disease-free at the end of the follow-up period; twenty-three patients (43.4%) had persistent disease; and eight patients (15.1%) had recurrent disease. Four patients (7.6%) died from medullary thyroid carcinoma with clinical and/or imaging evidence of neoplasia. The following aspects demonstrated statistically significant correlations with the final medical condition: positive initial cervical examination (p = 0.002); neoplastic extensions to the thyroid capsule (p = 0.004) and adjacent tissues (p = 0.034); cervical lymph node metastases (p < 0.001); diameter of neoplasia (p = 0.018); TNM (tumor, node and metastasis) Stage (p = 0.001) and evidence of distant and/or cervical diseases in the absence of a cure (p = 0.011). Through logistic regression, the presence of cervical lymph node metastases was considered an independent variable (p < 0.001).CONCLUSIONSClinical and pathological aspects of patients with surgically treated medullary thyroid carcinomas are predictors of disease progression. Specifically, even treated cervical lymph node metastases are significantly correlated with disease progression.

Survival and Long-Term Biochemical Cure in Medullary Thyroid Carcinoma in Denmark 1997–2014: A Nationwide Study

“…However, the study was limited by an inclusion of only 36% of all potential MTC patients and did not elaborate on the stage subgroups. When considering institutional series investigating the association between nodal metastasis and biochemical cure by multivariate analysis, the present results are in keeping with most (18,52–54), but not all studies (55). Disagreement with the latter study may be explained by a difference in study cohorts, as the latter study only included patients with tumor size <1.6 cm.…”

Grading of medullary thyroid carcinoma on the basis of tumor necrosis and high mitotic rate is an independent predictor of poor outcome

“…This discrepancy in regard to the prognostic value of age is well known. Indeed, several studies have shown that age does not influence survival in MTC ( 9 , 20 , 21 ). That could be the reason behind the current American Joint Committee on Cancer (AJCC) system not using age as a staging parameter in MTC.…”

Medullary thyroid carcinoma: the influence of policy changing in clinical characteristics and disease progression

“…During the last 40 years, most of the epidemiological studies have not shown any changes in the stage of the disease at diagnosis (12,14,23,30,31,32). However, a few studies have been performed in the last 40 years that have compared the clinical and biochemical characteristics of the disease during different chronological periods in the same center (16,19).…”

“…It should be noted that although one would expect a younger age at diagnosis in the group diagnosed after 2001, there was no such finding in our cohort. The stage at diagnosis is consistently found to be the most important prognostic factor for disease progression and survival (4,5,6,12,22,23,32), so, at least for the sporadic cases, the diagnosis at an earlier stage is favorable for the outcome of the disease. Indeed, Bergholm et al (33), in a study performed in Sweden, have reported that patients in stages I and II have a relative survival similar to the general population.…”