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Clin Endocrinol (Oxf). 2016 Apr;84(4):587-97. doi: 10.1111/cen.12852. Epub 2015 Jul 30.

Postoperative biochemical remission of serum calcitonin is the best predictive factor for recurrence-free survival of medullary thyroid cancer: a large-scale retrospective analysis over 30 years.

Author information

1
Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
2
Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
3
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
4
Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
5
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
6
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
7
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.
8
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
9
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Abstract

CONTEXT:

The increase in thyroid screening in the general population may lead to earlier detection of medullary thyroid carcinoma (MTC).

OBJECTIVE:

We aimed to evaluate secular trends in clinicopathological characteristics and long-term prognosis of MTC and its prognostic factors.

DESIGN:

This was a retrospective analysis from 1982 to 2012.

PATIENTS:

Three hundred and thirty-one patients with MTC were included and grouped based on the year of diagnosis (1982-2000, 2001-2005, 2006-2010 and 2011-2012).

MEASUREMENTS:

These included recurrence and mortality as well as biochemical remission (BCR) of serum calcitonin.

RESULTS:

Mean tumour size (from 2·5 cm to 1·7 cm, P < 0·001) and percentage of extrathyroidal extension (from 52·0% to 26·0%, P = 0·026) decreased. The percentage of patients achieving BCR within six postoperative months (po-BCR) increased with time (from 39·6% to 76·1%, P < 0·001). The 5-year overall recurrence rate significantly decreased in 2006-2012 compared to 1982-2005 (10% vs 18%, respectively, P = 0·031), although the 5-year survival rate did not improve (92% vs 92%, P = 0·929). Failure to achieve po-BCR was the strongest predictive factor associated with recurrence (hazard ratio [HR] = 58·04, 95% CI 7·14-472·11; P < 0·001). Male gender (HR = 3·18, 95% CI 1·18-8·56; P = 0·022), tumour size >2 cm (HR = 18·33, 95% CI 2·35-143·06; P = 0·006) and distant metastasis (HR = 4·00, 95% CI 1·31-12·21; P = 0·015) were significant prognostic factors for mortality.

CONCLUSIONS:

Clinicopathological characteristics and recurrence of MTC improved with time. Po-BCR was the best predictive factor for recurrence-free survival.

PMID:
26175307
DOI:
10.1111/cen.12852
[Indexed for MEDLINE]

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