Risk Factors Associated With Reoperation and Disease-Specific Mortality in Patients With Medullary Thyroid Carcinoma

Abstract Context Long-term data are scarce on large cohorts with sporadic (sMTC) and hereditary medullary thyroid carcinoma (hMTC). Objectives To compare long-term disease-specific survival (DSS) and outcomes between sMTC and hMTC groups. Design Retrospective analysis Setting German tertiary referral center Patients 673 patients with MTC that underwent surgery from January 1974 to July 2019 Intervention None (observational study) Main Outcome Measure Differences between sMTC and hMTC in long-term, stage-dependent survival and outcomes Results Surgery was performed at median ages of 49 years for sMTC (n=477, 44% male) and 29 years for hMTC (n=196, 43% male; p<0.0001). The mean follow-up times were 9.2±8.0 (sMTC) and 14.6±10.3 years (hMTC). Age and tumor stage at diagnosis were significantly different between the two groups (p<0.0001). The sMTC and hMTC groups had different overall DSS (log rank, p=0.0183), but similar stage-dependent DSS (log rank, p=0.1242 to 0.8981). In a multivariate analysis, sMTC and hMTC did not differ in DSS (HR=1.56, 95%CI=0.94-2.57), but in both groups, a worse DSS was significantly associated with age at diagnosis (HR=1.04, 95%CI=1.02-1.05), male sex (HR=0.49, 95%CI=0.32-0.76), and stages III and IV at diagnosis (HR=20.00, 95%CI=2.74-145.91 and HR=97.47, 95%CI=13.07-726.67, respectively). The groups had significantly different (p<0.0001) outcomes (i.e., cured, minimal residual disease, structural detectable disease, and death), but similar stage-dependent outcomes (p=0.9449 to 0.0511), except for stage III (p=0.0489). Conclusion Patients with sMTC and hMTC had different ages of onset, but similar stagedependent DSS and outcomes after the MTC diagnosis. This finding suggested that tumor behavior was similar in sMTC and hMTC. Précis This observational study of 673 patients with sporadic (n=477) and hereditary MTC (n=196) revealed similar disease-specific survival rates and outcomes, which suggested similar tumor behavior.

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What Factors Are Related to Disease-Specific Mortality in Patients with Medullary Thyroid Cancer?

Clinical Thyroidology ◽

10.1089/ct.2020;32.577-579 ◽

2020 ◽

Vol 32 (12) ◽

pp. 577-579

Author(s):

Tracy S. Wang

Keyword(s):

Thyroid Cancer ◽

Medullary Thyroid Cancer ◽

Medullary Thyroid ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Disease Specific

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Clinical presentation, treatment and outcome of anaplastic thyroid carcinoma: results of a multicenter study in Germany

Acta Endocrinologica ◽

10.1530/eje-16-0574 ◽

2016 ◽

Vol 175 (6) ◽

pp. 521-529 ◽

Cited By ~ 37

Author(s):

Julia Wendler ◽

Matthias Kroiss ◽

Katja Gast ◽

Michael C Kreissl ◽

Stephanie Allelein ◽

...

Keyword(s):

Risk Factors ◽

Thyroid Carcinoma ◽

Tertiary Care ◽

Significant Risk ◽

Anaplastic Thyroid Carcinoma ◽

External Beam Radiation ◽

Beam Radiation ◽

Treatment Pathways ◽

Factors Associated ◽

Disease Specific

Context Anaplastic thyroid carcinoma (ATC) is an orphan disease and confers a dismal prognosis. Standard treatment is not established. Objective The aim of this study is to describe clinical characteristics, current treatment regimens and outcome of ATC and to identify clinical prognostic markers and treatment factors associated with improved prognosis. Design Retrospective cohort study at five German tertiary care centers. Patients and methods Totally 100 ATC patients diagnosed between 2000 and 2015 were included in the analysis. Disease-specific overall survival (OS) was compared with the Kaplan–Meier method and log-rank test; Cox proportional hazard model was used to identify risk factors. Results The 6-month, 1-year and 5-year disease-specific OS rates were 37, 28 and 5%, respectively. Stage-dependent OS at 6 months was 78, 54 and 18% for stage IVA, B and C, respectively. 29% patients survived >1 year. Multivariate analysis of OS identified age ≥70 years, incomplete local resection status and the presence of distant metastasis as significant risk factors associated with shorter survival. Radical surgery (hazard ratio [HR] 2.20, 95% confidence interval (CI) 1.19–4.09, P = 0.012), external beam radiation therapy (EBRT) ≥40 Gy (HR = 0.34, 0.15–0.76, P = 0.008) and any kind of chemotherapy (CTX) (HR = 11.64, 2.42–60.39, P = 0.003) were associated with longer survival in multivariate analyses adjusted for age and tumor stage. A multimodal treatment regimen was significantly associated with a survival benefit (HR = 1.04, 1.01–1.08, P < 0.0001) only in IVC patients. Conclusion Disease-specific OS is still poor in ATC. Treatment factors associated with improved OS provide a rationale to devise treatment pathways for routine care. Collaborative research structures should be aimed to advance treatment of ATC.

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Therapeutic Outcomes of Recurrent Well-Differentiated Thyroid Carcinomas

International Surgery ◽

10.9738/intsurg-d-17-00132.1 ◽

2019 ◽

Vol 104 (7-8) ◽

pp. 304-313

Author(s):

Chih-Yiu Tsai ◽

Shu-Fu Lin ◽

Szu-Tah Chen ◽

Chuen Hsueh ◽

Yann Sheng Lin ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Carcinoma ◽

Recurrent Disease ◽

Differentiated Thyroid Carcinoma ◽

Thyroid Carcinomas ◽

Specific Mortality ◽

Disease Specific Mortality ◽

Well Differentiated ◽

Disease Specific

Objective The aim of this study was to evaluate outcomes of the recurrent and non-recurrent groups including disease-specific mortality of patients with well-differentiated thyroid carcinoma after multimodality treatment. In addition, prognostic factors for disease-specific mortality were analyzed. Summary of Background Data Among 2,844, there were 166 patients with recurrent disease. Recurrent disease was defined as the presence of papillary or follicular thyroid cancer 6 months after the initial thyroidectomy, including locoregional or distant metastasis, diagnosed using diagnostic or therapeutic 131I scans or other imaging techniques. Methods The study was a retrospective analysis of prospectively collected data for a long-term follow-up result of well-differentiated thyroid carcinoma patients. Results The mean age of 166 patients was 45.8 ± 1.2 years, 116 (69.9%) were women, 111 (66.9%) had locoregional neck recurrence, and 55 (33.1%) had metastatic recurrence in distant organs. We found that when recurrences were observed, more than half were detected within the first 5 years following the initial therapy. The longest period of time before relapse was 29.8 years. After a mean follow-up period of 12.7 ± 0.5 years, 37 (22.3%) patients experienced disease-specific mortality. Multivariable analysis revealed that older age, male sex, and development of a second primary malignancy were associated with disease-specific mortality. Higher post-operative levels of thyroglobulin predicted a shorter time to relapse. Conclusions These data indicate that among the recurrent cases over 50% of recurrent well-differentiated thyroid carcinomas were diagnosed within 5 years after initial thyroidectomy. Additionally, more than 20% of the patients died of thyroid cancer.

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Familial non-medullary thyroid carcinoma: clinico-pathological features, current knowledge and novelty regarding genetic risk factors

Minerva Endocrinology ◽

10.23736/s2724-6507.20.03338-6 ◽

2021 ◽

Vol 46 (1) ◽

Author(s):

Valentina CIRELLO

Keyword(s):

Risk Factors ◽

Thyroid Carcinoma ◽

Medullary Thyroid Carcinoma ◽

Genetic Risk ◽

Current Knowledge ◽

Genetic Risk Factors ◽

Pathological Features ◽

Medullary Thyroid

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Skeletal Complications and Mortality in Thyroid Cancer: A Population-Based Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2016-3906 ◽

2017 ◽

Vol 102 (4) ◽

pp. 1254-1260 ◽

Cited By ~ 23

Author(s):

Palak Choksi ◽

Maria Papaleontiou ◽

Cui Guo ◽

Francis Worden ◽

Mousumi Banerjee ◽

...

Keyword(s):

Thyroid Cancer ◽

Bone Metastases ◽

Prognostic Indicator ◽

Medullary Thyroid ◽

Specific Mortality ◽

Skeletal Complications ◽

Disease Specific Mortality ◽

Poor Prognostic Indicator ◽

The Impact ◽

Disease Specific

Abstract Context: Although bone is a common site for tumor metastases, the burden of bone events [bone metastases and skeletal-related events (SREs)] in patients with thyroid cancer is not well known. Objective: To measure the prevalence of bone events and their impact on mortality in patients with thyroid cancer. Patients, Design, and Setting: We identified patients diagnosed with thyroid cancer between 1991 and 2011 from the linked Surveillance Epidemiology and End Results–Medicare dataset. Multivariable logistic regression was used to identify the risk factors for bone metastases and SREs. We used Cox proportional hazards regressions to assess the impact of these events on mortality, after adjusting for patient and tumor characteristics. Results: Of the 30,063 patients with thyroid cancer, 1173 (3.9%) developed bone metastases and 1661 patients (5.5%) developed an SRE. Compared with papillary thyroid cancer, the likelihood of developing bone metastases or an SRE was higher in follicular thyroid cancer [odds ratio (OR), 2.25; 95% confidence interval (CI), 1.85 to 2.74 and OR, 1.40; 95% CI, 1.15 to 1.68, respectively] and medullary thyroid cancer (OR, 2.16; 95% CI, 1.60 to 2.86 and OR, 1.62; 95% CI, 1.23 to 2.11, respectively). The occurrence of a bone event was associated with greater risk of overall and disease-specific mortality [hazard ratio (HR), 2.14; 95% CI, 1.94 to 2.36 and HR, 1.59; 95% CI, 1.48 to 1.71, respectively]. Bone events were a poor prognostic indicator even when compared with patients with other distant metastases (P < 0.001 and P < 0.001 for overall and disease-specific mortality, respectively). Conclusions: Bone events in patients with thyroid cancer are a poor prognostic indicator. Patients with follicular and medullary thyroid cancers are at especially high risk for skeletal complications.

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Prognostic Factors of Disease-Free Survival after Thyroidectomy in 170 Young Patients with a RET Germline Mutation: A Multicenter Study of the Groupe Français d'Etude des Tumeurs Endocrines

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2010-1234 ◽

2011 ◽

Vol 96 (3) ◽

pp. E509-E518 ◽

Cited By ~ 71

Author(s):

V. Rohmer ◽

G. Vidal-Trecan ◽

A. Bourdelot ◽

P. Niccoli ◽

A. Murat ◽

...

Keyword(s):

Prognostic Factors ◽

Thyroid Carcinoma ◽

Medullary Thyroid Carcinoma ◽

Disease Free Survival ◽

Tnm Staging ◽

Free Survival ◽

Medullary Thyroid ◽

Factors Associated ◽

Class D ◽

Disease Free

Background: In hereditary medullary thyroid carcinoma (HMTC), prophylactic surgery is the only curative option, which should be properly defined both in time and extent. Objectives: To identify and characterize prognostic factors associated with disease-free survival (DFS) in children from HMTC families. Design: We conducted a retrospective analysis of a multi-center cohort of 170 patients below age 21 at surgery. Demographic, clinical, genetic, biological data [basal and pentagastrine-stimulated calcitonin (CT and CT/Pg, respectively)], and tumor node metastasis (TNM) status were collected. DFS was assessed based on basal CT levels. Kaplan–Meier curves, Cox regression, and logistic regression models were used to determine factors associated with DFS and TNM staging. Results: No patients with a preoperative basal CT <31 ng/ml had persistent or recurrent disease. Medullary thyroid carcinoma defined by a diameter ≥10 mm [hazard ratio (HR): 6.0; 95% confidence interval (95% CI): 1.8–19.8] and N1 status (HR: 20.8; 95% CI: 3.9–109.8) were independently associated with DFS. Class D genotype [odds ratio (OR): 48.5, 95% CI: 10.6–225.1], preoperative basal CT >30 ng/liter (OR: 43.4, 95% CI: 5.2–359.8), and age >10 (OR: 5.5, 95% CI: 1.4–21.8) were associated with medullary thyroid carcinoma ≥10 mm. No patient with a preoperative basal CT <31 ng/ml had a N1 status. Class D genotype (OR: 48.6, 95% CI: 8.6–274.1), and age >10 (OR: 4.6, 95% CI: 1.1–19.0) were associated with N1 status. Conclusion: In HMTC patients, DFS is best predicted by TNM staging and preoperative basal CT level below 30 pg/ml. Basal CT, class D genotype, and age constitute key determinants to decide preoperatively timely surgery.

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