Clinical Characteristics, Surgical Management, and Prognostic Factors of Medullary Thyroid Carcinoma: A Retrospective, Single-Center Study

Wu, Xin; Li, Binglu; Zheng, Congyi

doi:10.1177/15330338221078435

Cited by 8 publications

(9 citation statements)

References 36 publications

(61 reference statements)

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“…The present study is the first to explore the clinical value of an early six months CT evaluation in patients with only locoregional disease at diagnosis, thus virtually eligible to surgical radicalization and biochemical cure. In line with the former evidence (11,(15)(16)(17)(18)(19)(20), patients' long-term prognosis is favourable when a timely biochemical cure is reached. On the other side, in non-M1 patients, the persistence of low detectable CT values, irrespective of their raw levels, may hide persistent disease and identify a potential intermediate-risk subgroup, requiring additional monitoring.…”

Section: Discussionsupporting

confidence: 56%

“…To date, several studies explored potential prognostic factors for MTC. According to those studies, the presence of lymph node involvement, distant metastasis and the disease extension at diagnosis were unanimously recognized as unfavourable prognostic factors (11,(15)(16)(17)(18)(19)(20). On the other hand, the significance of clinical features, such as age and gender, are more controversial, at odds with differentiated thyroid cancer.…”

Section: Discussionmentioning

confidence: 99%

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Early calcitonin levels in medullary thyroid carcinoma: Prognostic role in patients without distant metastases at diagnosis

Sparano

Adornato²,

Puccioni³

et al. 2023

Front. Oncol.

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IntroductionCalcitonin is the most specific marker for medullary thyroid carcinoma, thus, low detectable calcitonin values after surgery can conceal persistent disease. The present study aimed to explore the prognostic role of pre-operative and early calcitonin levels in patients without distant metastases at diagnosis.MethodsA retrospective cohort of patients suffering from medullary thyroid carcinoma was considered (N=55). The final disease status, i.e. complete response (undetectable calcitonin levels and negative radiological assessments) or persistent disease (detectable calcitonin levels and/or positive radiological assessments), was deduced from the last available follow-up. Pre-operative and early calcitonin levels (i.e. six months after surgery) have been correlated to several clinical and histological features, according to the final disease status.ResultsPersistent disease patients showed higher pre-operative and early calcitonin values (p=0.028 and p<0.001, respectively), compared to complete response sub-cohort. Cox-regression models show that early detectable calcitonin increases up to 18-fold the risk of persistent disease, independently from tumour size and pre-operative calcitonin levels (p=0.006). Of note, when considering only patients who finally developed distant metastasis, ROC curve analysis shows that an early calcitonin level ≥16 pg/ml predicts the final disease status with a sensitivity of 89% and a specificity of 82% (AUC=0.911, CI95%: 0.819-1000, p<0.001).ConclusionCalcitonin levels six months after surgery represents an easy and effective predictor of persistent disease for medullary thyroid carcinoma without distant metastasis at diagnosis.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Early calcitonin levels in medullary thyroid carcinoma: Prognostic role in patients without distant metastases at diagnosis

Sparano

Adornato²,

Puccioni³

et al. 2023

Front. Oncol.

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“…An evaluation of adherence with the 2009 American Thyroid Association Guidelines indicated that the prognosis of MTC patients depends on the stage of the disease at diagnosis ( 28 ). Wu et al also found that MTC patients at stage I, II, and III had more favorable outcomes than those at stage IV ( 22 ). These gave support to the results of the current study, which delineated that tumor stage was an important index of the prognosis of MTC patients.…”

Section: Discussionmentioning

confidence: 96%

“…A retrospective multicenter study from Rozenblat et al showed that LNR was an independent factor for disease-free survival of MTC patients ( 14 ). Wu et al identified that LNR >1/3 were more likely to develop progressive disease in patients with MTC ( 22 ). Chen et al conducted a study based on that data of 1,237 MTC patients from the SEER revealed that LNR was a predictor for the prognosis of MTC patients ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

A prediction model for the 5-year, 10-year and 20-year mortality of medullary thyroid carcinoma patients based on lymph node ratio and other predictors

Lu²,

Hu³

et al. 2023

Front. Surg.

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AimTo explore the predictive value of lymph node ratio (LNR) for the prognosis of medullary thyroid carcinoma (MTC) patients, and constructed prediction models for the 5-year, 10-year and 20-year mortality of MTC patients based on LNR and other predictors.MethodsThis cohort study extracted the data of 2,093 MTC patients aged ≥18 years undergoing total thyroidectomy and neck lymph nodes dissection. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between LNR < 15% group and LNR ≥ 15% group. All data was divided into the training set (n = 1,465) and the testing set (n = 628). The random survival forest model was constructed in the training set and validated in the testing set. The area under the curve (AUC) was employed for evaluating the predictive ability of the model.ResultsThe 5-year, 10-year and 20-year overall survival (OS) and cause-specific survival (CSS) of MTC patients with LNR <15% were higher than those with LNR ≥15%. The OS was 46% and the CSS was 75% after 20 years' follow-up. The AUC of the model for the 5-year, 10-year, and 20-year OS in MTC patients was 0.878 (95%CI: 0.856–0.900), 0.859 (95%CI: 0.838–0.879) and 0.843 (95%CI: 0.823–0.862) in the training set and 0.845 (95%CI: 0.807–0.883), 0.841 (95%CI: 0.807–0.875) and 0.841 (95%CI: 0.811–0.872) in the testing set. In the training set, the AUCs were 0.869 (95%CI: 0.845–0.892), 0.843 (95%CI: 0.821–0.865), 0.819 (95%CI: 0.798–0.840) for the 5-year, 10-year and 20-year CCS in MTC patients, respectively. In the testing set, the AUCs were 0.857 (95%CI: 0.822–0.892), 0.839 (95%CI: 0.805–0.873) and 0.826 (95%CI: 0.794–0.857) for the 5-year CCS, 10-year CCS and 20-year CCS in MTC patients, respectively.ConclusionThe models displayed good predictive performance, which might help identify MTC patients might have poor outcomes and appropriate interventions should be applied in these patients.

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Section: Discussionmentioning

confidence: 99%

Early calcitonin levels in medullary thyroid carcinoma: prognostic role in patients without distant metastases at diagnosis

Sparano¹,

Adornato²,

Puccioni³

et al. 2023

EJEA

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Introduction: Calcitonin is the most specific marker for medullary thyroid carcinoma, thus, low detectable calcitonin values after surgery can conceal persistent disease. The present study aimed to explore the prognostic role of pre-operative and early calcitonin levels in patients without distant metastases at diagnosis. Methods: A retrospective cohort of patients suffering from medullary thyroid carcinoma was considered (N=55). The final disease status, i.e. complete response (undetectable calcitonin levels and negative radiological assessments) or persistent disease (detectable calcitonin levels and/or positive radiological assessments), was deduced from the last available follow-up. Pre-operative and early calcitonin levels (i.e. six months after surgery) have been correlated to several clinical and histological features, according to the final disease status.Results: Persistent disease patients showed higher pre-operative and early calcitonin values (p=0.028 and p<0.001, respectively), compared to complete response sub-cohort. Cox-regression models show that early detectable calcitonin increases up to 18-fold the risk of persistent disease, independently from tumour size and pre-operative calcitonin levels (p=0.006). Of note, when considering only patients who finally developed distant metastasis, ROC curve analysis shows that an early calcitonin level ≥16 pg/ml predicts the final disease status with a sensitivity of 89% and a specificity of 82% (AUC=0.911, CI95%: 0.819-1000, p<0.001). Conclusion:Calcitonin levels six months after surgery represents an easy and effective predictor of persistent disease for medullary thyroid carcinoma without distant metastasis at diagnosis.

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Clinical Characteristics, Surgical Management, and Prognostic Factors of Medullary Thyroid Carcinoma: A Retrospective, Single-Center Study

Cited by 8 publications

References 36 publications

Early calcitonin levels in medullary thyroid carcinoma: Prognostic role in patients without distant metastases at diagnosis

Early calcitonin levels in medullary thyroid carcinoma: Prognostic role in patients without distant metastases at diagnosis

A prediction model for the 5-year, 10-year and 20-year mortality of medullary thyroid carcinoma patients based on lymph node ratio and other predictors

Early calcitonin levels in medullary thyroid carcinoma: prognostic role in patients without distant metastases at diagnosis

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