Limited Thyroidectomy Achieves Equivalent Survival to Total Thyroidectomy for Early Localized Medullary Thyroid Cancer

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2024 Dec 17

PMID 39682246

Authors

Jessan A Jishu

Mohammad H Hussein

Salman Sadakkadulla

Solomon Baah

Yaser Y Bashumeel

Eman Toraih

Emad Kandil

Affiliations

Soon will be listed here.

Abstract

Background: The optimal surgical approach for localized T1 medullary thyroid cancer remains unclear. Total thyroidectomy is standard, but lobectomy and subtotal thyroidectomy may minimize mortality while maintaining oncologic control.

Methods: This retrospective analysis utilized the National Cancer Institute's Surveillance, Epidemiology, and End Results registry to identify 2702 MTC patients including 398 patients with T1N0/1M0 MTC treated with total thyroidectomy or lobectomy/subtotal thyroidectomy from 2000 to 2019. Cox regression analyses assessed thyroid cancer-specific and overall mortality.

Results: The majority (89.7%) underwent total thyroidectomy, while 10.3% had lobectomy/subtotal thyroidectomy. Nodal metastases were present in 29.6%. Over a median follow-up of 8.75 years, no significant difference was observed in cancer-specific mortality (5.7% vs. 8.1%, = 0.47) or overall mortality (13.2% vs. 12.8%, = 0.95). On multivariate analysis, undergoing cancer-directed surgery was associated with significantly improved overall survival (HR 0.18, < 0.001) and cancer-specific survival (HR 0.17, < 0.001) compared to no surgery. However, no significant survival difference was seen between total thyroidectomy and lobectomy/subtotal thyroidectomy for overall mortality (HR 0.77, = 0.60) or cancer-specific mortality (HR 0.44, = 0.23). The extent of surgery also did not impact outcomes within subgroups stratified by age, gender, T stage, or nodal status. Delayed surgery >1 month after diagnosis was associated with worse overall survival ( = 0.012).

Conclusions: For localized T1 MTC, lobectomy/subtotal thyroidectomy appears to achieve comparable long-term survival to total thyroidectomy in this population-based analysis. The selective use of limited thyroidectomy may be reasonable for low-risk T1N0/1M0 MTC patients. Delayed surgery is associated with worse survival and additional neck dissection showed no benefit for this select group of patients.

References

Hussein M, Toraih E, Ohiomah I, Siddeeque N, Comeaux M, Landau M . Navigating Choices: Determinants and Outcomes of Surgery Refusal in Thyroid Cancer Patients Using SEER Data. Cancers (Basel). 2023; 15(14). PMC: 10378250. DOI: 10.3390/cancers15143699. View

Okafor C, Hogan J, Raygada M, Thomas B, Akshintala S, Glod J . Update on Targeted Therapy in Medullary Thyroid Cancer. Front Endocrinol (Lausanne). 2021; 12:708949. PMC: 8416904. DOI: 10.3389/fendo.2021.708949. View

Gui Z, Wang Z, Xiang J, Sun W, He L, Dong W . Incidental T1 stage medullary thyroid carcinoma: The effect of tumour diameter on prognosis and therapeutic implications. Clin Endocrinol (Oxf). 2022; 97(3):355-362. DOI: 10.1111/cen.14702. View

Dabelic N, Jukic T, Frobe A . Medullary Thyroid Cancer - Feature Review and Update on Systemic Treatment. Acta Clin Croat. 2021; 59(Suppl 1):50-59. PMC: 8212605. DOI: 10.20471/acc.2020.59.s1.06. View

Groen A, Beckham T, Links T, Goldman D, Sherman E, Tuttle M . Outcomes of surgery and postoperative radiation therapy in managing medullary thyroid carcinoma. J Surg Oncol. 2019; 121(2):234-243. PMC: 8011335. DOI: 10.1002/jso.25761. View

Stamatakos M, Paraskeva P, Stefanaki C, Katsaronis P, Lazaris A, Safioleas K . Medullary thyroid carcinoma: The third most common thyroid cancer reviewed. Oncol Lett. 2012; 2(1):49-53. PMC: 3412473. DOI: 10.3892/ol.2010.223. View

Shojaie D, Hoffman A, Amaku R, Cabanillas M, Sosa J, Waguespack S . Decision Making When Cancer Becomes Chronic: Needs Assessment for a Web-Based Medullary Thyroid Carcinoma Patient Decision Aid. JMIR Form Res. 2021; 5(7):e27484. PMC: 8325074. DOI: 10.2196/27484. View

Roman S, Mehta P, Sosa J . Medullary thyroid cancer: early detection and novel treatments. Curr Opin Oncol. 2009; 21(1):5-10. DOI: 10.1097/CCO.0b013e32831ba0b3. View

Randle R, Balentine C, Leverson G, Havlena J, Sippel R, Schneider D . Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years. Surgery. 2016; 161(1):137-146. PMC: 5164945. DOI: 10.1016/j.surg.2016.04.053. View

10.

Kotwal A, Erickson D, Geske J, Hay I, Castro M . Predicting Outcomes in Sporadic and Hereditary Medullary Thyroid Carcinoma over Two Decades. Thyroid. 2020; 31(4):616-626. PMC: 11577493. DOI: 10.1089/thy.2020.0167. View

11.

Park H, Ryu H, Heo J, Chung M, Son Y, Kim J . Preoperative identification of low-risk medullary thyroid carcinoma: potential application to reduce total thyroidectomy. Sci Rep. 2023; 13(1):15663. PMC: 10511442. DOI: 10.1038/s41598-023-42907-3. View

12.

Wells Jr S, Asa S, Dralle H, Elisei R, Evans D, Gagel R . Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015; 25(6):567-610. PMC: 4490627. DOI: 10.1089/thy.2014.0335. View

13.

Dralle H, Brandenburg T, Weber F, Fuhrer-Sakel D, Theurer S, Baba H . Sporadic noninvasive medullary thyroid neoplasm: A desmoplasia-negative unifocal nonmetastatic tumor cured by hemithyroidectomy. Surgery. 2023; 174(6):1356-1362. DOI: 10.1016/j.surg.2023.09.003. View

14.

Maxwell J, Sherman S, ODorisio T, Howe J . Medical management of metastatic medullary thyroid cancer. Cancer. 2014; 120(21):3287-301. PMC: 4268545. DOI: 10.1002/cncr.28858. View

15.

Verbeek H, de Groot J, Sluiter W, Muller Kobold A, van den Heuvel E, Plukker J . Calcitonin testing for detection of medullary thyroid cancer in people with thyroid nodules. Cochrane Database Syst Rev. 2020; 3:CD010159. PMC: 7075519. DOI: 10.1002/14651858.CD010159.pub2. View

16.

Oczko-Wojciechowska M, Czarniecka A, Gawlik T, Jarzab B, Krajewska J . Current status of the prognostic molecular markers in medullary thyroid carcinoma. Endocr Connect. 2020; 9(12):R251-R263. PMC: 7774764. DOI: 10.1530/EC-20-0374. View

17.

Romei C, Casella F, Tacito A, Bottici V, Valerio L, Viola D . New insights in the molecular signature of advanced medullary thyroid cancer: evidence of a bad outcome of cases with double mutations. J Med Genet. 2016; 53(11):729-734. DOI: 10.1136/jmedgenet-2016-103833. View

18.

Kebebew E, Kikuchi S, Duh Q, Clark O . Long-term results of reoperation and localizing studies in patients with persistent or recurrent medullary thyroid cancer. Arch Surg. 2000; 135(8):895-901. DOI: 10.1001/archsurg.135.8.895. View

19.

Doherty G . Medullary Thyroid Cancer: 60 Years of Gradual Understanding. Ann Surg Oncol. 2021; 29(1):7-8. DOI: 10.1245/s10434-021-11077-9. View

20.

Lodish M, Stratakis C . RET oncogene in MEN2, MEN2B, MTC and other forms of thyroid cancer. Expert Rev Anticancer Ther. 2008; 8(4):625-32. PMC: 2670186. DOI: 10.1586/14737140.8.4.625. View