Results of Surgical Therapy in Patients with Medullary Thyroid Carcinoma

Abstract

Medullary thyroid carcinoma (MTC) is a rare form of malignancy, having an intermediate prognosis. Controversies exist regarding the best surgical approach. The aim of the study was to analyze the outcome in a group of patients with MTC, diagnosed and followed up in a single care center. We performed a retrospective analysis of all the patients diagnosed with MTC in the Department of Endocrinology from the County Emergency Hospital Timisoara between 1992 and 2012. The study group included 19 patients, 6 men (31.6 %), mean age 41.2±12.5 years (20-72 years). The preoperative diagnosis was based on the protocol for nodular thyroid disease. Total or near-total thyroidectomy was performed in 10 out of 16 patients who could be operated. Postoperative follow-up included repeated measurements of serum calcitonin and imaging investigations. Nine out of the total of 19 (47.3 %) patients had hereditary forms of MTC. Most of the cases (84.2 %) were submitted to surgery. The median duration of follow-up was 84 months. The pTNM staging indicated that the majority of the patients with hereditary MTC were diagnosed in an earlier stage. Disease remission was achieved in 7 cases (43.8 %). Four patients, all with sporadic forms, died. Survival rates at 1, 5 and 10 years were significantly higher (p=0.048) in patients with hereditary MTC. An early diagnosis of MTC allows a better surgical approach and an improved survival rate. We support the general recommendation that modified radical neck dissection is not necessary for all the patients with MTC.

What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer

“…Of note, other more aggressive endocrine malignancies, such as medullary thyroid carcinoma, anaplastic thyroid carcinoma, and adrenocortical carcinoma, have little data on outcomes with regard to delays in surgery. Due to the frequency in which patients with these patients present with advanced stage or rapid progression, it is apparent that these are more urgent, and delays with these malignancies would likely be devastating [ 60 – 62 ].…”

Novel Markers for Early Diagnosis and Prognostic Classification in Medullary Thyroid Carcinoma

“…Specific germline mutations in RET predict the aggressiveness of the tumour, although not so clear genotype-phenotype correlations exist for sporadic MTC (2). High preoperative serum carcinoembryonic antigen (CEA) (3), a rising CEA level associated with a stable or declining CT level, immunostaining for CEA associated with scant or absent tissue staining for CT (4), CT and CEA doubling times-provide sensitive markers for progression and aggressiveness of metastatic MTC (5,6) and requires surgery (7). Other factors that may predict poor prognosis include cellular heterogeneity, prominent tissue immunostaining for galectin-3 (8), an elevated serum procalcitonin: CT ratio (9) or a less than 10-fold increase in preoperative CT levels after stimulation with pentagastrin (10).…”