Medullary Thyroid Cancer in Patients Older than 45—Epidemiologic Trends and Predictors of Survival

Gogna, Shekhar; Goldberg, Michael D.; Samson, David J; Gachabayov, Mahir; Felsenreich, Daniel Moritz; Azim, Asad; Dong, Xiang Da

doi:10.3390/cancers12113124

Cited by 15 publications

(9 citation statements)

References 34 publications

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“…Age at the time of diagnosis has been reported to be an independent prognostic factor. 18 Based on the SEER database, Gogna et al 30 analyzed 2533 MTC patients aged ≥45 years and found that increasing age was detrimental to OS. In another study, age >55 years was recommended as the cutoff point for prognosis.…”

Section: Discussionmentioning

confidence: 99%

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

Zheng

2022

Technol Cancer Res Treat

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Purpose: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine malignancy with relatively early lymphatic metastatic spread. The clinical features of MTC remain controversial owing to the low incidence rate. This study aimed to analyze the clinical characteristics, prognostic factors, and long-term follow-up of MTC. Methods: Medical records of MTC patients treated at our hospital between December 2000 and November 2020 were reviewed retrospectively. Clinicopathologic features of MTC were analyzed using univariate and multivariate analyses. Cumulative survival rates were estimated using the Kaplan-Meier method. Results: In total, 152 patients with MTC were included. The rates of central and lateral lymph node metastases (LNM) were 52.0% and 42.8%, respectively. All patients were followed up with a median follow-up time of 43.5 (17.0−76.3) months. Univariate and multivariate analyses identified two independent factors associated with progressive disease. They were lateral LNM (p < 0.001) and lymph node ratio (LNR) >1/3 (p = 0.009). The 5-, 10-, and 15-year cumulative overall survival (OS) rates of MTC were 88.2%, 83.1%, and 76.2%, respectively. The 5-, 10-, and 15-year cumulative disease-free survival (DFS) rates were 61.8%, 48.6%, and 38.2%, respectively. Patients with stage I, II, and III disease had significantly longer OS and DFS than those with stage IV disease (p < 0.001). Conclusion: MTC is a rare endocrine malignancy and LNM is common. Patients with lateral LNM and LNR >1/3 are more likely to develop progressive disease. The long-term OS rates of MTC are good, but long-term DFS rates are poor.

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Section: Discussionmentioning

confidence: 99%

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

Zheng

2022

Technol Cancer Res Treat

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“…It accounts for 5%-10% of all TC cases with an annual incidence rate of 0.19/100,000 (4,5). According to the etiology, MTC could be classified into sporadic MTC and hereditary MTC, accounting for 75% and 25%, respectively (6). RET mutations occur in almost all hereditary MTC and a considerable fraction of apparently sporadic MTC cases (7).…”

Section: Introductionmentioning

confidence: 99%

Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old

Yang¹,

Niu²,

Li³

et al. 2022

Front. Endocrinol.

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PurposeClinical guidelines presently recommend total thyroidectomy for the treatment of medullary thyroid cancer (MTC). This study was aimed to investigate whether lobectomy could be the initial treatment for stage I MTC patients.MethodsThe retrospective study was based on data from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The risk factors of survival were estimated by the univariate and multivariate Cox proportional-hazards model. The effect of age on death risk was estimated using restricted cubic splines. Survival curves were constructed according to the Kaplan–Meier method.ResultsA total of 988 stage I MTC patients was included in the study. Among them, 506 (51.2%) MTC patients received lobectomy and 482 (48.8%) received total thyroidectomy. The only independent prognostic factor for overall survival (OS) and disease-specific survival (DSS) was age, according to univariate and multivariate Cox regression analysis. The hazard ratio (HR) increased relatively slowly with age growing under the age of approximately 60 years. However, the death risk of MTC patients began to rise sharply with increasing age above 60 years. For patients under the age of 60, a significant survival difference for OS and DSS was observed between the lobectomy group and total thyroidectomy group (p < 0.05). However, for patients aged above 60, no significant survival difference was observed for OS or DSS (p > 0.05).ConclusionTotal thyroidectomy was an appropriate treatment for stage I MTC patients under the age of 60, which was consistent with the recommendation of the clinical guidelines. However, for those over the age of 60, lobectomy may be explored as a better surgical option. The findings may provide the evidence base for improving the clinical management of stage I MTC patients. Further prospective multicenter clinical studies are needed including information regarding RET status as well as calcitonin and CEA levels.

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“…In our study, age was also found to be a predictor for the 5-year, 10-year and 20-year OS and CSS of MTC patients. This was allied by a study from Gogna et al, which depicted that increasing age was detrimental to OS of patients with MTC aged ≥45 years ( 25 ). Tumor size was another predictor for the 5-year, 10-year and 20-year OS and CSS of MTC patients in this study.…”

Section: Discussionmentioning

confidence: 93%

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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Medullary Thyroid Cancer in Patients Older than 45—Epidemiologic Trends and Predictors of Survival

Cited by 15 publications

References 34 publications

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

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

Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old

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

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