Clinico-pathologic and dynamic prognostic factors in sporadic and familial medullary thyroid carcinoma: an Israeli multi-center study

in European Journal of Endocrinology
Correspondence should be addressed to O Twito; Email: orit.twito@clalit.org.il
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Objective

Multiple clinical, pathological and biochemical variables, including the response to initial treatment, are associated with medullary thyroid carcinoma (MTC) prognosis. Studies that include separate analyses of familial and sporadic MTC patients followed for long period are scarce. This study evaluated the association between baseline clinico-pathologic variables and response to initial treatment and short- and long-term disease outcomes in sporadic and familial MTC.

Methods

Patients treated for MTC at four tertiary medical centers were retrospectively analyzed. Clinical and pathological data were collected. The outcomes measured included disease persistence 1 year after diagnosis, disease persistence at last follow-up, disease-related mortality (DRM) and all-cause mortality.

Results

The study enrolled 193 patients (mean age: 48.9 ± 18.7, 44.7% males), of whom 18.1% were familial cases. The mean follow-up period was 10.1 ± 9.4 years (8.5 ± 8.1 in sporadic and 16.9 ± 11.6 in familial MTC). Disease persistence 1-year after diagnosis and at last follow-up was detected in 56.1 and 60.4% patients, respectively. All-cause and DRM were 28.5 and 12.6%, respectively. Extra-thyroidal extension (ETE) and distant metastases (DM) were associated with disease persistence at last follow-up. ETE and DM were also significantly associated with DRM. Complete remission 1 year after diagnosis had high correlation with no evidence of disease at last follow-up (Cramer’s V measure of association 0.884, P < 0.001) and with 100% disease-specific survival (Cramer’s V measure of association 0.38, P < 0.001).

Conclusions

Apart from clinico-pathologic parameters, close correlation was found between 1-year status and long-term prognosis. These results underscore the importance of combining classical and dynamic factors for both sporadic and familial MTC prognostication and treatment decision making.

 

     European Society of Endocrinology

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    Kaplan–Meier plot of the association between disease status at 1-year and persistence at last follow-up among 193 medullary thyroid cancer patients.

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    Kaplan–Meier survival plots on the differences between familial and sporadic medullary thyroid carcinoma at last follow-up. Panel A: disease-free survival. Panel B: overall survival.

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    Kaplan–Meier plot for the association between disease status at 1-year and disease-specific mortality in 193 patients with medullary thyroid carcinoma.

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