Total thyroidectomy and central neck dissection are the procedures of choice in patients affected with medullary thyroid carcinoma (MTC). The clinical courses and prognostic factors have been studied, but the significance of some factors remains controversial especially among those patients with advanced MDC.
We reviewed our advanced MDC patients with greater tumor and underwent the surgical treatment to discuss the clinical outcomes and the prognostic factors.
132 MTC patients underwent total/subtotal thyroidectomy and central neck dissections with either ipsilateral (n=96) or bilateral (n=36) modified radical neck dissections based on the evidence of suspicious lymph nodes. Follow-up time ranged from 5 to 125 months. Patients were considered ‘cured’ when stimulated Calcitonins were undetectable. Age, gender, tumor size, neck lymph node metastasis, TNM stage, extent of surgical resection, postoperative external beam radiation and postoperative chemotherapy were analyzed in all patients.
Of 132 MTC patients underwent locally curative surgery, there were 68 cases (51.5%) with tumors larger than 4 cm and 72 cases (54.5%) with stage Ⅳ. Ninety two cases (69.7%) were biochemically cured and 76 cases (57.6%) were involved with lymph node metastasis. The biochemical cure rate was significantly correlated with the extrathyroid extension (p<0.005), tumor size (p<0.005), and lymph node metastases (p<0.0001). The 5-year and 10-year cancer specific cumulative survival rates were 73.4% and 19.6% respectively. In univariate analysis, both age and the presence of node metastases were significant prognostic factors. Only age remained to be an independent prognostic factor in multivariate analysis.
Clinical outcomes of MTC patients who aged <45 years were significantly better than older patients regardless of tumor size and lymph node metastases. Age is the independent prognostic factor for MTC survival.