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Static Prognostic Factors and Appropriate Surgical Designs for Patients with Medullary Thyroid Carcinoma: The Second Report from a Single-Institution Study in Japan
- Source :
- World Journal of Surgery
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- Background Medullary thyroid carcinoma (MTC) originates from calcitonin-producing cells of the thyroid. In 2009, we published our first report on the biological characteristics and prognosis of 118 MTC patients. Herein, we enrolled a larger number of patients with longer follow-up periods to further study the biological characteristics and appropriate therapies for MTC. Methods In general, hemithyroidectomy and total thyroidectomy were performed for sporadic MTC confined to the thyroid lobe and for hereditary MTC with central node dissection, respectively. Moreover, prophylactic modified radical neck dissection was performed on the side of macroscopic tumors. Results In total, 233 patients (99 hereditary and 134 sporadic) were enrolled. The median follow-up time was 128 months (range 7–445 months). Biochemical cure was obtained in 36 (62%) of the 58 patients who underwent prophylactic MND and were pathologically positive for lateral node metastasis. None of the patients had recurrence in the preserved thyroid. Distant recurrence was detected in 19 patients, and 12 died of MTC. Preoperative calcitonin and carcinoembryonic antigen levels, tumor size (T) > 4 cm, the male sex, clinical and pathological node metastases (N1), distant metastasis (M1), extrathyroid extension (Ex), and a lack of biochemical cure had prognostic impacts on distant recurrence and/or carcinoma-related mortality on univariate analysis. On multivariate analysis, Ex was independently correlated with distant recurrence, and Ex, T > 4 cm, and M1 independently affected carcinoma-related mortality. Conclusion MTC patients had excellent prognosis in our institutions, indicating that our surgical strategies were appropriate.
- Subjects :
- Adult
Male
medicine.medical_specialty
Original Scientific Report
endocrine system diseases
medicine.medical_treatment
Multiple Endocrine Neoplasia Type 2a
030209 endocrinology & metabolism
Modified Radical Neck Dissection
Thyroid carcinoma
03 medical and health sciences
0302 clinical medicine
Carcinoembryonic antigen
Japan
medicine
Carcinoma
Humans
Thyroid Neoplasms
Aged
Univariate analysis
biology
business.industry
Thyroid
Thyroidectomy
Middle Aged
Prognosis
medicine.disease
Carcinoma, Neuroendocrine
Dissection
medicine.anatomical_structure
Carcinoma, Medullary
Lymphatic Metastasis
030220 oncology & carcinogenesis
biology.protein
Lymph Node Excision
Female
Surgery
Radiology
Neoplasm Recurrence, Local
business
Subjects
Details
- ISSN :
- 14322323 and 03642313
- Volume :
- 42
- Database :
- OpenAIRE
- Journal :
- World Journal of Surgery
- Accession number :
- edsair.doi.dedup.....917b426f9ff1c5f50ad5fc190b4578db