Kyong Yeun Jung1, Seok-Mo Kim2, Won Sang Yoo3,4, Bup-Woo Kim2, Yong Sang Lee2, Kyung Won Kim3, Kyu Eun Lee5, Jong Ju Jeong2, Kee-Hyun Nam2, Se Hoon Lee3,6, Jeong Hun Hah7, Woong Youn Chung2, Ka Hee Yi3,8, Do Joon Park3,6, Yeo-Kyu Youn5, Myung-Whun Sung7, Bo Youn Cho3,9, Cheong Soo Park2, Young Joo Park3,6, Hang-Seok Chang2. 1. Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. 2. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. 3. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. 4. Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea. 5. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 6. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. 7. Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea. 8. Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea. 9. Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Abstract
CONTEXT: The increase in thyroid screening in the general population may lead to earlier detection of medullary thyroid carcinoma (MTC). OBJECTIVE: We aimed to evaluate secular trends in clinicopathological characteristics and long-term prognosis of MTC and its prognostic factors. DESIGN: This was a retrospective analysis from 1982 to 2012. PATIENTS: Three hundred and thirty-one patients with MTC were included and grouped based on the year of diagnosis (1982-2000, 2001-2005, 2006-2010 and 2011-2012). MEASUREMENTS: These included recurrence and mortality as well as biochemical remission (BCR) of serum calcitonin. RESULTS: Mean tumour size (from 2·5 cm to 1·7 cm, P < 0·001) and percentage of extrathyroidal extension (from 52·0% to 26·0%, P = 0·026) decreased. The percentage of patients achieving BCR within six postoperative months (po-BCR) increased with time (from 39·6% to 76·1%, P < 0·001). The 5-year overall recurrence rate significantly decreased in 2006-2012 compared to 1982-2005 (10% vs 18%, respectively, P = 0·031), although the 5-year survival rate did not improve (92% vs 92%, P = 0·929). Failure to achieve po-BCR was the strongest predictive factor associated with recurrence (hazard ratio [HR] = 58·04, 95% CI 7·14-472·11; P < 0·001). Male gender (HR = 3·18, 95% CI 1·18-8·56; P = 0·022), tumour size >2 cm (HR = 18·33, 95% CI 2·35-143·06; P = 0·006) and distant metastasis (HR = 4·00, 95% CI 1·31-12·21; P = 0·015) were significant prognostic factors for mortality. CONCLUSIONS: Clinicopathological characteristics and recurrence of MTC improved with time. Po-BCR was the best predictive factor for recurrence-free survival.
CONTEXT: The increase in thyroid screening in the general population may lead to earlier detection of medullary thyroid carcinoma (MTC). OBJECTIVE: We aimed to evaluate secular trends in clinicopathological characteristics and long-term prognosis of MTC and its prognostic factors. DESIGN: This was a retrospective analysis from 1982 to 2012. PATIENTS: Three hundred and thirty-one patients with MTC were included and grouped based on the year of diagnosis (1982-2000, 2001-2005, 2006-2010 and 2011-2012). MEASUREMENTS: These included recurrence and mortality as well as biochemical remission (BCR) of serum calcitonin. RESULTS: Mean tumour size (from 2·5 cm to 1·7 cm, P < 0·001) and percentage of extrathyroidal extension (from 52·0% to 26·0%, P = 0·026) decreased. The percentage of patients achieving BCR within six postoperative months (po-BCR) increased with time (from 39·6% to 76·1%, P < 0·001). The 5-year overall recurrence rate significantly decreased in 2006-2012 compared to 1982-2005 (10% vs 18%, respectively, P = 0·031), although the 5-year survival rate did not improve (92% vs 92%, P = 0·929). Failure to achieve po-BCR was the strongest predictive factor associated with recurrence (hazard ratio [HR] = 58·04, 95% CI 7·14-472·11; P < 0·001). Male gender (HR = 3·18, 95% CI 1·18-8·56; P = 0·022), tumour size >2 cm (HR = 18·33, 95% CI 2·35-143·06; P = 0·006) and distant metastasis (HR = 4·00, 95% CI 1·31-12·21; P = 0·015) were significant prognostic factors for mortality. CONCLUSIONS: Clinicopathological characteristics and recurrence of MTC improved with time. Po-BCR was the best predictive factor for recurrence-free survival.
Authors: Fan Wu; Tianhan Zhou; Kaining Lu; Ting Pan; Yeqin Ni; Lingqian Zhao; Kecheng Jiang; Yu Zhang; Dingcun Luo Journal: Zhejiang Da Xue Xue Bao Yi Xue Ban Date: 2021-12-25