{"title":"Prognostic factors for progression free survival in patients with medullary thyroid cancer: a multicenter cohort study.","authors":"Guibin Zheng, Jianing Liu, Hao Xu, Chaopeng Dong, Xianjiao Cao, Qingqing He, Guanyu Zhang, Wei Wang, Liquan Wang, Xiaoqing Yang, Jiaqi Liu, Min Hao, Kecheng Xue, Guolou Li, Xianqiang Liu, Changyuan Ding, Xufu Wang, Haitao Zheng","doi":"10.1007/s13304-025-02193-2","DOIUrl":null,"url":null,"abstract":"<p><p>Many patients with medullary thyroid cancer (MTC) experience recurrent or persistent disease after surgery due to its aggressive nature. However, the prognostic factors for progression-free survival (PFS) have been poorly investigated. This study aimed to explore prognostic factors associated with PFS in patients with MTC. Patients with MTC were enrolled from 15 medical centers in Shandong Province, China, between January 2010 and December 2021. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors for PFS in patients with MTC. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of the metastatic lymph node ratio (LNR) in predicting PFS. Patients with MTC from the Surveillance, Epidemiology, and End Results (SEER) database were used to test the predictive value of the LNR cutoff for overall survival (OS) and disease-specific survival (DSS). In the Shandong cohort, extrathyroidal extension (HR, 1.622; 95% CI 1.022-2.575, P = 0.040), LNR (HR, 2.806; 95% CI 1.121-7.025, P = 0.028), and T3 stage (HR, 2.060; 95% CI 1.074-3.952, P = 0.030) were independent risk factors for PFS in patients with MTC. The optimal cutoff value of the LNR for predicting PFS was 0.19. Compared to patients with LNR < 0.19, those with LNR ≥ 0.19 suffered worse PFS (Log-rank P < 0.0001) in the Shandong cohort, and worse OS (Log-rank P < 0.0001) and DSS (Log-rank P < 0.0001) in the SEER cohort. This study identified prognostic factors for PFS in patients with MTC. LNR ≥ 0.19 could be used as an adverse prognostic factor for patients with MTC.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Updates in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13304-025-02193-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Many patients with medullary thyroid cancer (MTC) experience recurrent or persistent disease after surgery due to its aggressive nature. However, the prognostic factors for progression-free survival (PFS) have been poorly investigated. This study aimed to explore prognostic factors associated with PFS in patients with MTC. Patients with MTC were enrolled from 15 medical centers in Shandong Province, China, between January 2010 and December 2021. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors for PFS in patients with MTC. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of the metastatic lymph node ratio (LNR) in predicting PFS. Patients with MTC from the Surveillance, Epidemiology, and End Results (SEER) database were used to test the predictive value of the LNR cutoff for overall survival (OS) and disease-specific survival (DSS). In the Shandong cohort, extrathyroidal extension (HR, 1.622; 95% CI 1.022-2.575, P = 0.040), LNR (HR, 2.806; 95% CI 1.121-7.025, P = 0.028), and T3 stage (HR, 2.060; 95% CI 1.074-3.952, P = 0.030) were independent risk factors for PFS in patients with MTC. The optimal cutoff value of the LNR for predicting PFS was 0.19. Compared to patients with LNR < 0.19, those with LNR ≥ 0.19 suffered worse PFS (Log-rank P < 0.0001) in the Shandong cohort, and worse OS (Log-rank P < 0.0001) and DSS (Log-rank P < 0.0001) in the SEER cohort. This study identified prognostic factors for PFS in patients with MTC. LNR ≥ 0.19 could be used as an adverse prognostic factor for patients with MTC.
由于其侵袭性，许多甲状腺髓样癌（MTC）患者在手术后复发或持续疾病。然而，对无进展生存期（PFS）的预后因素研究甚少。本研究旨在探讨与MTC患者PFS相关的预后因素。2010年1月至2021年12月期间，从中国山东省的15个医疗中心招募了MTC患者。采用单因素和多因素Cox回归分析探讨MTC患者PFS的预后因素。进行受试者工作特征曲线分析，确定转移淋巴结比率（LNR）预测PFS的最佳临界值。来自监测、流行病学和最终结果（SEER）数据库的MTC患者被用于检验LNR截止点对总生存期（OS）和疾病特异性生存期（DSS）的预测价值。在山东队列中，甲状腺外扩张(HR, 1.622；95% ci 1.022-2.575, p = 0.040), LNR (hr, 2.806；95% CI 1.121 ~ 7.025, P = 0.028)和T3分期(HR, 2.060；95% CI 1.074 ~ 3.952, P = 0.030)是MTC患者PFS的独立危险因素。LNR预测PFS的最佳截止值为0.19。与LNR患者比较
期刊介绍：
Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future.
Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts.
Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.
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