Does the extent of neck surgery based on preoperative calcitonin level influence survival in medullary thyroid carcinoma: a retrospective tertiary centre experience.

Autor:	Ansley W; St George's University Hospitals NHS Foundation Trust, UK.; St George's University of London, UK., Kamyab A; St George's University Hospitals NHS Foundation Trust, UK.; St George's University of London, UK., Noden L; University of Cambridge, UK., Odutoye B; St George's University Hospitals NHS Foundation Trust, UK., Williamson P; St George's University Hospitals NHS Foundation Trust, UK., Wong KH; Royal Marsden NHS Foundation Trust, UK., Dent P; St George's University Hospitals NHS Foundation Trust, UK., Sharma A; St George's University Hospitals NHS Foundation Trust, UK., Weller A; St George's University Hospitals NHS Foundation Trust, UK., Pitiyage G; St George's University Hospitals NHS Foundation Trust, UK., Ofo E; St George's University Hospitals NHS Foundation Trust, UK.; St George's University of London, UK.
Jazyk:	angličtina
Zdroj:	Annals of the Royal College of Surgeons of England [Ann R Coll Surg Engl] 2024 Apr 25. Date of Electronic Publication: 2024 Apr 25.
DOI:	10.1308/rcsann.2024.0033
Abstrakt:	Introduction: Medullary thyroid carcinoma (MTC) is a rare thyroid cancer arising from the calcitonin-secreting parafollicular cells. Previous studies suggested a preoperative calcitonin level >200ng/l is an indication for prophylactic lateral neck dissection (LND) to remove micrometastases and improve survival outcomes. Methods: This retrospective single-centre study assessed the efficacy of preoperative calcitonin levels as a marker for determining need for prophylactic LND in MTC. Data were obtained on demographics, preoperative calcitonin levels, size and laterality of index tumour, type of neck dissection (central neck dissection (CND), LND), nodes removed, levels with involved nodes, number of nodes histologically involved, mortality, adjuvant therapy and locoregional recurrence. Results: A total of 33 patients were identified from St George's University Hospitals NHS Foundation Trust between 1 January 2001 and 19 August 2021; 8 were excluded for data quality issues. Of the 18 classified with a high preoperative calcitonin level (>200ng/l), 10 (56%) had a LND and 8 (44%) had a CND. In the low-calcitonin group, three (43%) patients had a CND only and four (57%) had a LND. There was no difference in absolute or disease-free survival between the low and high groups ( p =0.960, p =0.817), or between those who had a CND and LND in the high-calcitonin group ( p =0.607, hazard ratio (HR) 0.55; p =0.129, HR 8.78). Conclusion: There was no statistically significant difference in outcomes between high and low calcitonin groups. A selective approach to performing LND in MTC patients based on clinical and imaging findings suggesting disease presence in the lateral neck should be explored further.
Databáze:	MEDLINE
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