Primary tumor resection with or without neck lymph node dissection as a viable initial therapy for medullary thyroid carcinoma with distant metastasis.

IF 3.7 3区医学 Q2 Medicine

Endocrine Pub Date : 2024-12-19 DOI:10.1007/s12020-024-04133-3

Ziyi Chen, Wangwang Qiu, Ting Yan, Huaiyu Weng, Yufan Tang, Jianyong Lv, Zhili Yang

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引用次数: 0

Abstract

Objective: Patients with distant metastatic medullary thyroid carcinoma (DMMTC) often undergo primary tumor resection (PTR) with or without neck lymph node dissection (NLND) before systemic therapy. However, whether these patients benefit from treatment remains unclear.

Methods: Patients with DMMTC were identified from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2020. The overall survival (OS) and disease-specific survival (DSS) were established by Kaplan-Meier curves and were compared using the log-rank test or two-stage test between different treatment modalities (surgery, non-surgery) after propensity score matching (PSM). We also analyzed the effects of surgical and non-surgical treatments on the OS and DSS of patients stratified by TNM stages T1-2 and T3-4 in this cohort.

Results: Among the 2336 patients with medullary thyroid carcinoma from the SEER database, 186 were diagnosed with DMMTC, with an average follow-up period of 28.12 months. Pairwise analysis after PSM revealed that the surgery group had a significantly improved survival rate compared to the non-surgery group (OS p = 0.00039, DSS p = 0.001). The survival advantages of the above-mentioned surgery group were maintained when stratified by stages T1-2 and T3-4.

Conclusion: Our results demonstrate that PTR with or without NLND, as an initial therapy, can benefit the survival rate of patients with DMMTC.

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原发性肿瘤切除伴或不伴颈部淋巴结清扫作为甲状腺髓样癌远处转移的可行的初始治疗方法。

目的：远端转移性甲状腺髓样癌（DMMTC）患者在接受全身治疗前常行原发肿瘤切除（PTR）伴或不伴颈部淋巴结清扫（NLND）。然而，这些患者是否从治疗中获益仍不清楚。方法：从2010年至2020年的监测、流行病学和最终结果（SEER）数据库中确定DMMTC患者。通过Kaplan-Meier曲线建立总生存期（OS）和疾病特异性生存期（DSS），并在倾向评分匹配（PSM）后使用log-rank检验或两阶段检验比较不同治疗方式（手术和非手术）之间的差异。我们还分析了手术和非手术治疗对TNM分期为T1-2和T3-4的患者的OS和DSS的影响。结果：来自SEER数据库的2336例甲状腺髓样癌患者中，有186例诊断为DMMTC，平均随访时间28.12个月。PSM后的两两分析显示，手术组与非手术组相比生存率显著提高（OS p = 0.00039, DSS p = 0.001）。上述手术组按T1-2、T3-4分期分层时，仍保持生存优势。结论：我们的研究结果表明，PTR合并或不合并NLND作为初始治疗可提高DMMTC患者的生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine 医学-内分泌学与代谢

CiteScore

6.40

自引率

5.40%

发文量

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.