Response to “Breach of the thyroid capsule and lymph node capsule in node-positive papillary and medullary thyroid cancer: Different biology”

Abstract Context Risk factors of lymph node and distant metastases have rarely been analyzed in hereditary and sporadic medullary thyroid cancer (MTC) using large genetic-clinical data sets. Objective This comprehensive investigation aimed to explore risk factors of lymph node and distant metastases and interdependencies between age at thyroidectomy, primary tumor size, lymph node metastasis and distant metastasis in patients with hereditary and sporadic MTC. Methods Comparative analyses of risk factors of metastasis, stratified by hereditary MTC (four mutational risk categories) and sporadic MTC. Results There were 1115 patients with hereditary MTC (307 patients) or sporadic MTC (808 patients). Age at thyroidectomy increased proportionately from 12.2, 22.7, 34.3, and 49.8 years for patients with decreasing mutational risk, as compared to 52.1 years for patients with sporadic MTC. Metastatic primary tumors overall were 10.7–19.4 mm larger in node-positive patients and 15.9–19.3 mm larger in distant metastatic patients at thyroidectomy than nonmetastatic tumors. Distant metastases were noted in 13–50% of node-positive vs. 0% of node-negative hereditary MTC, and in 23.5% of node-positive vs. 1.7% of node-negative sporadic MTC. In multivariable logistic regression analysis for sporadic MTC, lymph node metastasis contributed to distant metastasis (odds ratio 12.4) more than primary tumor size (odds ratios of 7.8, 5.5 and 2.4 for tumors measuring >60, 41–60 and 21–40 mm). Conclusions When thyroidectomy is performed before lymph node metastases have developed, distant metastases are exceptional, both in patients with hereditary MTC, irrespective of the level of mutational risk, and patients with sporadic MTC.

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Lymph Node Positive Rate: An Ignored Factor Affecting the Prognosis of Medullary Thyroid Cancer

10.21203/rs.3.rs-705671/v1 ◽

2021 ◽

Author(s):

Wenfei Liu ◽

Xiaotian Xia ◽

Shoufei Wang

Keyword(s):

Thyroid Cancer ◽

Lymph Node ◽

Survival Rate ◽

Lymph Nodes ◽

Medullary Thyroid Cancer ◽

Medullary Thyroid ◽

Node Positive ◽

Positive Rate ◽

Lymph Node Positive ◽

The Relationship

Abstract PurposeTo investigate the relationship between the positive rate of examined lymph nodes and the prognosis of patients with medullary thyroid cancer (MTC).MethodInformation on demographic and clinicopathological characteristics of patients with medullary thyroid cancer was extracted from Surveillance, Epidemiology and End Results (SEER) database of the National Institutes of Health (NIH) between 1998 and 2015. Lymph Node Positive Rate (LNPR) is defined as the number of positive lymph nodes divided by the total number of lymph nodes removed. Eligible MTC patients were divided into four LNPR groups (0-0.25, 0.26-0.50, 0.51-0.75 and 0.76 -1.00). Compare the overall survival rate (OS) and cancer-specific survival rate (CSS) calculated by the Kaplan-Meier method between the four MTC patient groups and Perform univariate and multivariate analyzes to assess the relationship between Lymph Node Positive Rate and prognosis of the MTC patients.ResultAfter screening, there were 623 eligible patients with medullary thyroid cancer, of which the number of patients in four groups was 245 (LNPR: 0-0.25), 199 (LNPR: 0.26-0.50), 105 (LNPR: 0.51-0.75) and 99 (LNPR: 0.76-1.00).Compared to the group ((LNPR: 0-0.25), the CSS and OS rates in the two groups were ((LNPR: 0.51-0.75 and LNPR: 0.76-1.00) (both p <0.001) significantly lower, and the multivariable Cox regression analysis showed that the group (LNPR: 0.51-0.75) correlated significantly with poorer CSS and OS rates [(CSS: HR 1.77, 95% - CI 0.99 3.19, P = 0.045); (OS: HR 1.69, 95% CI 1.03-2.79, P = 0.038)] and group (LNPR: 0.76-1.00) correlated significantly with poorer CSS and OS rates [(CSS: HR 2.09.95% CI 1.12-3.92, P = 0.021); (OS: HR 2.23, 95% CI 1.32 -3.76, P = 0.003)].Conclusion The LNPR can serve as a prognostic marker for patients, and the higher the LNPR, the worse the prognosis for patients with medullary thyroid cancer.

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