Else Marie Opsahl1,2, Lars Andreas Akslen3,4, Ellen Schlichting1, Turid Aas5, Katrin Brauckhoff5, Anne Irene Hagen6, Alf Frimann Rosenlund7, Eva Sigstad8, Krystyna K Grøholt8, Lars H Jørgensen9, Trine Bjøro2,10. 1. Section of Breast- and Endocrine Surgery, Department of Oncology, Oslo University Hospital, Oslo, Norway. 2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 3. Section for Pathology, Department of Clinical Medicine, Centre for Cancer Biomarkers CCBIO, University of Bergen, Bergen, Norway. 4. Department of Pathology, Haukeland University Hospital Bergen, Bergen, Norway. 5. Department of Breast- and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway. 6. Department of Breast- and Endocrine Surgery, St. Olavs University Hospital, Trondheim, Norway. 7. Section of Breast- and Endocrine Surgery, Department of Surgery, University Hospital of North Norway, Tromsø, Norway. 8. Department of Pathology, Oslo University Hospital, Oslo, Norway. 9. Department of Thoracic Surgery, Oslo University Hospital, Oslo, Norway. 10. Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
Abstract
BACKGROUND: Preoperative predictors for the need of prophylactic lymph node dissection in the lateral neck have been studied in patients with medullary thyroid carcinoma (MTC). OBJECTIVES: To evaluate the ability of serum calcitonin to predict the extent of surgery needed in the lateral neck. METHODS: This retrospective population-based cohort study includes data from 94 of 139 patients with MTC surgically treated in Norway from 2003 to 2016. Patients were identified in the 4 regional centers treating MTC and by the Cancer Registry of Norway, and grouped according to calcitonin levels. In 58 patients without distant metastases or disease progression to the next tumor level (NPNL), data were compared in prognostic groups (N0-NPNL), (N1a-NPNL), and (N1b-NPNL). RESULTS: At calcitonin levels ≤500, 501-1,000, and >1,000 pmol/L, metastatic lymph nodes in the lateral neck were found in 16, 50, and 71% of the patients, respectively. In the prognostic groups, 19% of N0-NPNL patients had calcitonin >500 pmol/L and 17% of N1b-NPNL patients had calcitonin ≤500 pmol/L. In multivariate analysis, factors predicting biochemical cure and calcitonin level ≤500 pmol/L were no metastatic lymph nodes in the lateral neck (p = 0.030) and tumor diameter ≤20 mm (p < 0.001), respectively. Factors related to metastatic lymph nodes in the lateral neck were extrathyroidal extension (p = 0.007) and no biochemical cure (p = 0.028). CONCLUSIONS: Basal calcitonin cannot predict the need for prophylactic lateral lymph node dissection in patients with MTC. Further prospective, randomized studies are warranted.
BACKGROUND: Preoperative predictors for the need of prophylactic lymph node dissection in the lateral neck have been studied in patients with medullary thyroid carcinoma (MTC). OBJECTIVES: To evaluate the ability of serum calcitonin to predict the extent of surgery needed in the lateral neck. METHODS: This retrospective population-based cohort study includes data from 94 of 139 patients with MTC surgically treated in Norway from 2003 to 2016. Patients were identified in the 4 regional centers treating MTC and by the Cancer Registry of Norway, and grouped according to calcitonin levels. In 58 patients without distant metastases or disease progression to the next tumor level (NPNL), data were compared in prognostic groups (N0-NPNL), (N1a-NPNL), and (N1b-NPNL). RESULTS: At calcitonin levels ≤500, 501-1,000, and >1,000 pmol/L, metastatic lymph nodes in the lateral neck were found in 16, 50, and 71% of the patients, respectively. In the prognostic groups, 19% of N0-NPNL patients had calcitonin >500 pmol/L and 17% of N1b-NPNL patients had calcitonin ≤500 pmol/L. In multivariate analysis, factors predicting biochemical cure and calcitonin level ≤500 pmol/L were no metastatic lymph nodes in the lateral neck (p = 0.030) and tumor diameter ≤20 mm (p < 0.001), respectively. Factors related to metastatic lymph nodes in the lateral neck were extrathyroidal extension (p = 0.007) and no biochemical cure (p = 0.028). CONCLUSIONS: Basal calcitonin cannot predict the need for prophylactic lateral lymph node dissection in patients with MTC. Further prospective, randomized studies are warranted.
Authors: Gemma Gatta; Laura Ciccolallo; Ian Kunkler; Riccardo Capocaccia; Franco Berrino; Michel P Coleman; Roberta De Angelis; Jean Faivre; Jean Michel Lutz; Carmen Martinez; Torgil Möller; Risto Sankila Journal: Lancet Oncol Date: 2006-02 Impact factor: 41.316
Authors: John M Stulak; Clive S Grant; David R Farley; Geoffrey B Thompson; Jon A van Heerden; Ian D Hay; Carl C Reading; J William Charboneau Journal: Arch Surg Date: 2006-05
Authors: Jan Willem B de Groot; John T M Plukker; Bruce H R Wolffenbuttel; Theo Wiggers; Willem J Sluiter; Thera P Links Journal: Clin Endocrinol (Oxf) Date: 2006-12 Impact factor: 3.478
Authors: M R Pelizzo; I M Boschin; P Bernante; A Toniato; A Piotto; C Pagetta; O Nibale; L Rampin; P C Muzzio; D Rubello Journal: Eur J Surg Oncol Date: 2006-11-27 Impact factor: 4.424
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