Trends in the Diagnosis and Treatment of Patients with Medullary Thyroid Carcinoma in Korea

Ahn, Hwa Young; Chae, Jae Eun; Moon, Hyemi; Noh, Junghyun; Park, Young Joo; Kim, Sin Gon

doi:10.3803/enm.2020.709

Cited by 15 publications

(19 citation statements)

References 27 publications

(37 reference statements)

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“…The clinical features, treatment, and prognosis of MTC are quite different from those of differentiated thyroid carcinomas due to their different origins. 3 , 14 Due to its low incidence, the clinical characteristics of MTC remain understudied. Previous studies are mainly retrospective.…”

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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“…Extensive surgery involving total thyroidectomy with central lymph node dissection is recommended as the initial treatment for patients with MTC as the condition is refractory to most medical therapies [ 3 , 22 ]. In the evaluation of recurrence following surgery, tumor-node-metastasis staging is an established prognostic approach [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

Kim

Park

et al. 2021

Cancers

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The lymph node ratio (LNR) has been investigated as a prognostic factor in many different types of cancers, including differentiated thyroid cancer; however, reports regarding medullary thyroid cancer (MTC) are limited. Therefore, this study aims to evaluate LNR as a risk factor for structural recurrence in patients with MTC. Medical records of patients treated for MTC in a single tertiary center between 1995 and 2017 were retrospectively reviewed. LNR is defined as the number of metastatic lymph nodes or lymph node metastases (LNM) divided by the number of retrieved lymph nodes or lymph node yield (LNY). In the survival analysis, recurrence-free survival was defined as the time from the date of total thyroidectomy to recurrence or last follow-up. To identify risk factors influencing structural recurrence, univariable and multivariable Cox proportional hazard models were used. A total of 132 patients were enrolled. The mean age of study participants was 49.7 years, and 86 patients (65%) were women. Structural recurrence was identified in 39 patients at the end of the study period, and the median follow-up period was 8.7 years. In univariable analyses, gross extra thyroidal extension, N stage, postoperative serum calcitonin and carcinoembryonic antigen (CEA) levels, and LNR were significant (p < 0.05) predictors of structural recurrence. In multivariable analysis, postoperative serum calcitonin, postoperative serum CEA, and LNR were identified as a predictor of disease-free survival (p < 0.05). LNR can potentially predict structural recurrence as a quantitative evaluation tool for lymph node metastasis in patients with MTC.

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“…The incidence rates were slightly lower than in Western countries (0.13-0.82 cases per 100,000 women and 0.07-0.62 cases per 100,000 men) [23]. In large case series from Asian countries, MTC accounted for 0.5% (Korea), 1.2% (Japan), 1.3% (China), and 2.8% (Taiwan) of all thyroid malignancies [4,[24][25][26]. Our previous report introduced how MTC is handled in contemporary Asian thyroid FNA practice [14].…”

Section: Discussionmentioning

confidence: 85%

Constitutive Cytomorphologic Features of Medullary Thyroid Carcinoma Using Different Staining Methods

et al. 2021

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(1) Background: Accurate preoperative identification of medullary thyroid carcinoma (MTC) is challenging due to a spectrum of cytomorphologic features. However, there is a scarcity of studies describing the cytomorphologic features as seen on fine-needle aspiration (FNA) smears prepared using different staining methods. (2) Methods: We performed a retrospective study on MTC cases with available FNA slides from 13 hospitals distributed across 8 Asia-Pacific countries. The differences in the constitutive cytomorphologic features of MTC with each cytopreparatory method were recorded. A comparative analysis of cytologic characteristics was carried out with appropriate statistical tests. (3) Results: Of a total of 167 MTC samples retrospectively recruited, 148 (88.6%) were interpreted as MTC/suspicious for MTC (S-MTC). The staining methods used were Papanicolaou, hematoxylin-eosin, and Romanowsky stains. Seven out of the eleven cytologic criteria can be readily recognized by all three cytopreparatory methods: high cellularity, cellular pleomorphism, plasmacytoid cells, round cells, dyshesive cells, salt-and-pepper chromatin, and binucleation or multinucleation. An accurate diagnosis was achieved in 125 (84.5%) of the 148 samples whose FNAs exhibited five or more atypical features. Conclusions: The present work is the first study on MTC to compare the morphological differences among the cytologic staining techniques. We investigated the constitutive features and the reliability of diagnostic parameters. A feasible scoring system based upon cytomorphologic data alone is proposed to achieve a high degree of diagnostic accuracy.

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Trends in the Diagnosis and Treatment of Patients with Medullary Thyroid Carcinoma in Korea

Cited by 15 publications

References 27 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

Metastatic Lymph Node Ratio for Predicting Recurrence in Medullary Thyroid Cancer

Constitutive Cytomorphologic Features of Medullary Thyroid Carcinoma Using Different Staining Methods

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