Predicting Structural Progression-Free Survival After Surgery for Medullary Thyroid Carcinoma

Area of Science:

• Endocrinology
• Oncology
• Surgical Oncology

Background:

• Medullary thyroid cancer (MTC) is an aggressive malignancy where surgery is the primary curative treatment.
• Post-surgical recurrence or persistence necessitates identification of prognostic factors for structural disease-free survival (SDFS).
• Understanding these factors is crucial for optimizing patient follow-up and management strategies.

Purpose of the Study:

• To evaluate structural disease-free survival (SDFS) in patients diagnosed with medullary thyroid cancer (MTC).
• To identify and analyze factors influencing SDFS in MTC patients post-surgery.

Main Methods:

• A retrospective observational study was conducted on 140 MTC patients without distant metastases.
• Data collected included demographics, tumor characteristics (size, stage, vascular invasion), lymph node ratio (LNR), calcitonin (Ct), and CEA levels.
• Statistical analysis involved univariate and multivariate Cox regression to determine predictors of SDFS.

Main Results:

• The study evaluated 140 patients with a median age of 34 years; 24% experienced structural disease.
• Univariate analysis revealed that sporadic MTC, older age, elevated preoperative CEA, larger tumor size, lymph node involvement, higher LNR, vascular invasion, and high-risk status, along with Ct levels > 150pg/mL at 6-12 months, influenced SDFS.
• Multivariate analysis identified age, LNR, T category, and postoperative Ct levels as independent predictors of SDFS.

Conclusions:

• Structural disease-free survival (SDFS) in medullary thyroid cancer (MTC) is significantly impacted by lymph node ratio (LNR).
• Tumor T category and postoperative calcitonin (Ct) levels measured at 6-12 months are also critical independent predictors of SDFS.
• These findings underscore the importance of LNR, T category, and postoperative Ct in predicting MTC recurrence and guiding patient management.