ENDO 2013: The Endocrine Society 95th Annual Meeting & Expo:

Surgery's Effect on Survival in Patients with Medullary Thyroid Cancer

The effect of surgery on the survival of patients diagnosed with medullary thyroid cancer (MTC) was studied by Nazanene H. Esfandiari, MD. Dr. Esfandiari is a Clinical Assistant Professor in the Department of Internal Medicine at the University of Michigan at Ann Arbor. The results of the study were presented at ENDO 2013.

According to the American Thyroid Association (ATA), 5% to 10% of thyroid malignancies are MTC, and in most occurrences, tend to run in families. Total thyroidectomy with central neck dissection is the ATA-recommended treatment for all patients with medullary thyroid cancer.

The purpose of the study was to determine the relationship between survival and the number of lymph node and distant metastases, tumor size, and extent of the surgery performed. Another aspect of the study compared the effect of no surgery versus lobectomy, total thyroidectomy, and total thyroidectomy with resection of cervical lymph nodes. The study involved analyzing data from 2968 patients diagnosed with MTC.

Survival Variables Average Range
Older age 5.69 3.34 - 9.72
Larger tumor size 2.89 2.14 - 3.90
Distant metastases 5.68 4.61 - 6.99
Positive cervical lymph nodes (>16) 3.40 2.41 - 4.79

Overall Survival: Tumor Size (all surgical treatment)
≤ 2 cm, no distant metastases:  No significant difference
≥ 2.1 cm, no distant metastases: Significant survival improvement

Overall Survival: Distant Metastases: 22%
Total thyroidectomy, cervical lymph node resection: 30%
No surgical intervention: 15%

Overall Survival: Positive cervical lymph node(s)
None: 90%
1 to 5: 74%
6 to 10: 61%
11 to 16: 69%
16 or more: 55%

The take-away from this study is surgical treatment of patients with medullary thyroid cancer should consider the size of the tumor and the presence of distant metastases.

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