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Medullary carcinoma of the thyroid: Prognostic factors and treatment recommendations

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Abstract

Background: Because medullary thyroid carcinoma accounts for only 7% of all thyroid malignancies, data to support treatment strategies are scarce.

Methods: We retrospectively reviewed treatment and outcome in 34 patients with MTC treated at Roswell Park between 1961 and 1995. Univariate analysis was performed using the variables age, sex, tumor size, N stage, and M stage.

Results: Median survival was 4.7 years, with 51% and 32% of patients alive at 5 and 15 years, respectively. Nodal metastases were seen in 76% and distant metastases in 67% of all patients. More than 60% of the patients with nodal metastases survived longer than 10 years. Once diagnosed with distant metastases, 90% of the patients died within 5 years. Local failure rate with lobectomy was 44%, compared to 10% after total thyroidectomy (P<.02). Age, extrathyroid extension, and M stage portend a poor outcome. Nodal status had no statistically significant impact on survival.

Conclusion: Survival with tumors confined to the thyroid gland is independent of nodal status. Long-term survival in patients with distant metastases is rare. This study underscores the role of total thyroidectomy in the initial treatment and the need to develop effective adjuvant therapy for MTC.

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References

  1. Williams ED. Histogenesis of medullary carcinoma of the thyroid.J Clin Pathol 1966;19:114–8.

    CAS  PubMed  Google Scholar 

  2. Norman T. Medullary thyroid carcinoma in Norway: epidemiological and genetic data.Acta Pathol Microbiol Scand 1977;85:775–86.

    Google Scholar 

  3. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc 1958;53:457–86.

    Google Scholar 

  4. Wilcoxon F. Individual comparison by ranking methods.Biometrics 1945;1:80–3.

    Google Scholar 

  5. Kallinowski F, Buhr HJ, Meybier H, Eberhardt M, Herfarth C. Medullary carcinoma of the thyroid—therapeutic strategy derived from fifteen years of experience.Surgery 1993;14:491–6.

    Google Scholar 

  6. Thompson NW. Thyroid cancer. In: Niederhuber JE, ed.Current Therapy in Oncology. Philadelphia: BC Decker, 1993:240–8.

    Google Scholar 

  7. Thompson NW. Surgery for medullary thyroid carcinoma. In: Fee WE, Goepfert H, Johns ME, eds.Head and Neck Cancer. Vol. 2. Philadelphia: BC Decker, 1990:196–8.

    Google Scholar 

  8. Block MA. Surgical treatment of medullary carcinoma of the thyroid.Otolaryngol Clin North Am 1990;23:453–73.

    CAS  PubMed  Google Scholar 

  9. Simpson WJ, Palmer JA, Rosen IB, Mustard RA. Management of medullary carcinoma of the thyroid.Am J Surg 1982;144:420–2.

    Article  CAS  PubMed  Google Scholar 

  10. Moley F. Medullary thyroid cancer.Surg Clin North Am 1995;75:405–20.

    CAS  PubMed  Google Scholar 

  11. Duh QY, Sancho JJ, Greenspan FS, et al. Medullary thyroid carcinoma. The need for early diagnosis and total thyroidectomy.Arch Surg 1989;124:1206–10.

    CAS  PubMed  Google Scholar 

  12. Marsh DJ, Leanoyd DL, Andrews SD, et al. Somatic mutations in the RET proto-oncogene in sporadic medullary thyroid carcinoma.Clin Endocrinology 1996;44:249–57.

    CAS  Google Scholar 

  13. Callender DL, Sherman SI, Gagel RF, Burgess MA, Goepfert H. Cancer of the thyroid. In: Meyers EN, Suen JY, eds.Cancer of the Head and Neck. Philadelphia: WB Saunders, 1996:485–515.

    Google Scholar 

  14. Scopsi L, Sampietro G, Borachi P, Del Bo R, Gullo M, Placucci M, Pilotti S. Multivariate analysis of prognostic factors in sporadic medullary carcinoma of the thyroid. A retrospective study of 109 consecutive patients.Cancer 1996;78:2173–83.

    Article  CAS  PubMed  Google Scholar 

  15. Ellenhorn GD, Shah JP, Brennan MF. Impact of therapeutic regional lymph node dissection for medullary carcinoma of the thyroid gland.Surgery 1993;114:1078–81.

    CAS  PubMed  Google Scholar 

  16. Saad MF, Ordonez NG, Rashid RK, Guido JJ, Hill S, Hickey RC, Samaan NA. Medullary carcinoma of the thyroid. A study of the clinical features and prognostic factors in 161 patients.Medicine 1984;63:319–42.

    CAS  PubMed  Google Scholar 

  17. Foster RS. Thyroid gland. In: Davis JH, Sheldon GF, eds.Surgery: A Problem-Solving Approach, 2nd ed. St. Louis: Mosby, 1996:2183–2247.

    Google Scholar 

  18. Moley JF, Wells SA, Dilley WG, Tisell LE. Reoperation for recurrent or persistent medullary thyroid cancer.Surgery 1993;114:1090–5.

    CAS  PubMed  Google Scholar 

  19. Block MA, Jackson CE, Tashjian AH. Management of occult medullary thyroid carcinoma.Arch Surg 1978;113:368–72.

    CAS  PubMed  Google Scholar 

  20. Gautvik KM, Talle K, Hager B, Jorgensen OG. Early liver metastases in patients with medullary carcinoma of the thyroid gland.Cancer 1989;63:175–80.

    CAS  PubMed  Google Scholar 

  21. Ahuja S, Ernst H. Dormant metastases in medullary thyroid carcinoma. A case report.Exp Clin Endocrinol 1991;98:37–41.

    CAS  PubMed  Google Scholar 

  22. Tung WS, Vesely TM, Moley JF. Laparoscopic detection of hepatic metastases in patients with residual or recurrent medullary thyroid cancer.Surgery 1995;118:1024–9.

    CAS  PubMed  Google Scholar 

  23. Van Heerden JA, Grant CS, Gherib H, Hay ID, Ilstrup DM. Long-term course of patients with persistent hypercalcitonemia after apparent curative primary surgery for medullary thyroid carcinoma.Ann Surg 1990;212:395–400.

    PubMed  Google Scholar 

  24. Raue F, Winter J, Frank-Raue K, Lorenz D, Herfarth C, Ziegler R. Diagnostic procedure before reoperation in patients with medullary thyroid carcinoma.Horm Metab Res Suppl 1989;21:31–4.

    CAS  PubMed  Google Scholar 

  25. Block MA, Jackson CE, Greenwald KA, Yott JB, Tashjian AH. Clinical characteristics distinguishing hereditary from sporadic medullary thyroid carcinoma.Arch Surg 1980;115:142–8.

    CAS  PubMed  Google Scholar 

  26. Ugur O, Kostaglu L, Guler N, et al. Comparison of 99 mTc-DMSA, 201Tl and 99 Tc MIBI imaging in the follow-up of patients with medullary carcinoma of the thyroid.Eur J Nucl Med 1996;23:1367–71.

    CAS  PubMed  Google Scholar 

  27. Soybel DI, Wells SA. Medullary thyroid carcinoma. In: Cady B, Rossi RL eds.Surgery of the Thyroid and Parathyroid Glands. Philadelphia: WB Saunders, 1991:152–78.

    Google Scholar 

  28. Simpson WJ, Palmer JA, Rosen JB, Mustard RA. Management of medullary carcinoma of the thyroid.Am J Surg 1982;144:420–2.

    Article  CAS  PubMed  Google Scholar 

  29. Tissels LE, Hansson G, Jansson S, Salander H. Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma.Surgery 1986;99:60–6.

    Google Scholar 

  30. Pomorski L, Rybinski K. Lymphadenectomy in thyroid gland carcinoma—staging and therapy [in German].Zentralblatt fuer Chirurgie 1996;121:455–8.

    CAS  Google Scholar 

  31. Bergholm U, Adami HD, Bergstroem R, et al. Clinical characteristics in sporadic and familial medullary thyroid carcinoma.Cancer 1989;63:1196–1204.

    CAS  PubMed  Google Scholar 

  32. Gautvik KM. Medullary carcinoma of the thyroid. An update of diagnostic and prognostic factors.Scand J Clin Lab Invest 1991;206(Suppl):85–92.

    CAS  Google Scholar 

  33. Kullberg BJ, Nieuwenhuijzen Kruseman AC. Multiple endocrine neoplasia type 2b with a good prognosis.Arch Intern Med 1987;47:1125–7.

    Google Scholar 

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Authors and Affiliations

  1. From the Department of Head and Neck Surgery, Division of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York

    Pascal R. Fuchshuber MD, PhD, Thom R. Loree MD, FACS, Wesley L. Hicks Jr. DDS, MD & Donald P. Shedd MD, FACS

  2. Division of Pathology, Roswell Park Cancer Institute, Buffalo, New York

    Richard T. Cheney MD

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  1. Pascal R. Fuchshuber MD, PhD
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  2. Thom R. Loree MD, FACS
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  3. Wesley L. Hicks Jr. DDS, MD
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  4. Richard T. Cheney MD
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  5. Donald P. Shedd MD, FACS
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Fuchshuber, P.R., Loree, T.R., Hicks, W.L. et al. Medullary carcinoma of the thyroid: Prognostic factors and treatment recommendations. Annals of Surgical Oncology 5, 81–86 (1998). https://doi.org/10.1007/BF02303768

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  • DOI: https://doi.org/10.1007/BF02303768

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