Thyroidectomy without lymph node dissection should be considered for stage T1 medullary thyroid carcinoma: a...

Area of Science:

• Oncology
• Surgical Oncology
• Endocrinology

Background:

• The necessity of lymph node dissection (LND) in early-stage T1 medullary thyroid cancer (MTC) is debated.
• Current guidelines often recommend LND, but its therapeutic value in this specific patient group remains controversial.

Purpose of the Study:

• To investigate the impact of lymph node dissection (LND) on survival outcomes in patients with early-stage T1 medullary thyroid cancer (MTC).
• To identify factors associated with lymph node metastasis in T1 MTC.
• To compare survival and prognosis between patients who underwent LND and those who did not.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify T1 MTC patients.
• Employed Poisson regression to analyze factors promoting lymph node metastasis.
• Applied propensity score matching (PSM) to control for baseline differences between LND and non-LND groups.
• Assessed survival outcomes using Kaplan-Meier method and Cox regression.

Main Results:

• Among 1231 T1 MTC patients, 72.0% underwent LND, and 22.0% had lymph node metastasis.
• Younger age, male sex, and larger tumor size (>10mm) were associated with higher metastasis risk.
• LND provided no significant overall survival (OS) or disease-specific survival (DSS) benefit compared to non-LND, even after PSM.
• Subgroup analyses confirmed no prognostic advantage of LND.

Conclusions:

• Early-stage T1 MTC patients often have a low risk of lymph node metastasis.
• Avoiding routine LND may offer similar prognosis to standard procedures while potentially enhancing quality of life.
• Further large-scale prospective multi-center studies are needed to validate these findings.