ObjectiveTo understand the role of calcitonin testing for the diagnosis and treatment of medullary thyroid cancer (MTC) as well as recent research progress, so as to provide assistance in the early clinical diagnosis and treatment of MTC and improve patients’ prognosis. MethodThe literatures about the role of calcitonin testing in MTC in recent years were reviewed. ResultsIn recent years, both domestic and international scholars had extensively investigated the role of calcitonin in the early detection of MTC and accurate postoperative prognosis assessment. With respect to early diagnosis, advancements had been made in the three main measurement methods: basal calcitonin, stimulated calcitonin, and calcitonin measurement in the thyroid nodule fine-needle aspiration washout fluid. These developments in calcitonin levels had contributed to improved guidance in surgical treatment and prognosis evaluation. While calcitonin monitoring could inform treatment decisions and improve patients’prognosis, numerous challenges remain to be addressed. ConclusionThe study of calcitonin detection can deepen the understanding of MTC, further research on calcitonin related detection in the future will be of great significance for the diagnosis, treatment and prognosis evaluation of MTC.
ObjectiveTo investigate the effect of surgery and influence of posttreatment with non-standardized and standardized operation by reviewing and analyzing the sporadic medullary thyroid carcinoma operation cases. MethodsThe clinical data of 26 patients with sporadic medullary thyroid carcinoma treated by surgery from January 2000 to March 2013 in this hospital were analyzed retrospectively.These patients were divided into non-standardized operation group and standardized operation group (total thyroidectomy with lymph node dissection) according to the operation models.The biochemical cure rate, the complication rates of recurrent laryngeal nerve injury and hypopara-thyroidism of these two groups were investigated and compared. ResultsThe 1-year biochemical cure rate had no statistical difference between the non-standardized operation group and standardized operation group (84.21% versus 100%, χ2=1.249 4, P > 0.05), the 1-year recurrence rate was 15.79% and 0, respectively.The 5-year biochemical cure rate of the standardized operation group was significantly higher than that of the non-standardized operation group (100% versus 16.67%, χ2=4.444 4, P < 0.05).The 5-year recurrence rate was 0 and 83.33%, respectively.However, there was no obvious difference between the two groups on the injury rate of recurrent laryngeal nerve (χ2=0.070 8, P > 0.05), as well as the rate of hypoparathyroidism (χ2=2.722 7, P > 0.05). ConclusionsCompared with the non-standardized model, the standardized operation model (total thyroidectomy with lymph node dissection) shows a higher cure rate and a lower recurrent rate, and it does not increase the complication rates of hypoparathyroidism and recurrent laryngeal nerve injury
Objective To establish a predictive model for long-term tumor-specific survival after surgery for patients with intermediate to advanced medullary thyroid cancer (MTC) based on American Joint Committee on Cancer (AJCC) TNM staging, by using the Surveillance, Epidemiology, and End Results (SEER) Database. Methods The data of 692 patients with intermediate to advanced MTC who underwent total thyroidectomy and cervical lymph node dissection registered in the SEER database during 2004–2017 were extracted and screened, and were randomly divided into 484 cases in the modeling group and 208 cases in the validation group according to 7∶3. Cox proportional hazard regression was used to screen predictors of tumor-specific survival after surgery for intermediate to advanced stage MTC and to develop a Nomogram model. The accuracy and usefulness of the model were tested by using the consistency index (C-index), calibration curve, time-dependent ROC curve and decision curve analysis (DSA). Results In the modeling group, the multivariate Cox proportional hazard regression model indicated that the factors affecting tumor-specific survival after surgery in patients with intermediate to advanced MTC were AJCC TNM staging, age, lymph node ratio (LNR), and tumor diameter, and the Nomogram model was developed based on these results. The modeling group had a C-index of 0.827 and its area under the 5-year and 10-year time-dependent ROC curves were 0.865 [95%CI (0.817, 0.913)], 0.845 [95%CI (0.787, 0.904)], respectively, and the validation group had a C-index of 0.866 and its area under the 5-year and 10-year time-dependent ROC curves were 0.866 [95%CI (0.798, 0.935)] and 0.923 [95%CI (0.863, 0.983)], respectively. Good agreement between the model-predicted 5- and 10-year tumor-specific survival rates and the actual 5- and 10-year tumor-specific survival rates were showed in both the modeling and validation groups. Based on the DCA curve, the new model based on AJCC TNM staging was developed with a significant advantage over the former model containing only AJCC TNM staging in terms of net benefits obtained by patients at 5 years and 10 years after surgery. Conclusion The prognostic model based on AJCC TNM staging for predicting tumor-specific survival after surgery for intermediate to advanced MTC established in this study has good predictive effect and practicality, which can help guide personalized, precise and comprehensive treatment decisions and can be used in clinical practice.
Objective To summarize the research progress on diagnostic criteria of lymph node metastasis in medullary thyroid carcinoma (MTC), and the indication and scope of lateral cervical lymph node dissection (LCLND). Method By searching PubMed and CNKI databases, the related guidelines and literature about the diagnosis and treatment of lateral cervical lymph node metastasis in MTC in recent years were obtained and reviewed. Results The metastatic rate of lateral cervical lymph nodes in MTC patients was high. The indication of LCLND was both consensus and controversy. The LCLND of MTC was also controversial, and the focus of controversy mainly focused on the survival rate, recurrence rate, distant metastasis and postoperative complications of patients receiving prophylactic LCLND. Different imaging methods had their own advantages and disadvantages in diagnosing lymph node metastasis of MTC. Nuclear medicine was effective but expensive. Fine needle puncture was also an effective method for the diagnosis of lymph node metastasis of MTC. At present, calcitonin level, tumor size and lymph node metastasis were still important indicators for evaluating MTC for prophylactic LCLND, but the application of related indications had not been unified. Many scholars recommended comprehensive consideration of various indicators to evaluate whether MTC carried out preventive LCLND. Conclusions The LCLND of MTC needs to be further explored and standardized on the basis of the existing consensus. The focus of prophylactic LCLND should be to improve the survival rate of patients while reducing complications as much as possible.
Objective To summarize the clinical and research status in the surgical management of medullary thyroid carcinoma. Methods The related literatures on treatment of medullary thyroid carcinoma were collected and reviewed. Results A total thyroidectomy and dissection of the lymph nodes in the central compartment were effective treatments for patients with medullary thyroid carcinoma. The extent of lateral compartment lymph-node dissection did not reach an agreement. Prophylactic thyroidectomy was suggested for patients with a RET (rearranged during transfection) germline mutation. Palliative therapy was the main treatment of metastatic medullary thyroid carcinoma. Conclusions Surgery is the mainstay of treatment for medullary thyroid carcinoma. The combination of preoperative assessment, genetic testing, and appropriate surgical strategy may improve the prognosis of patients with medullary thyroid carcinoma.
ObjectiveTo investigate the impact of postoperative application of Pseudomonas aeruginosa injection on recurrence free survival (RFS) and overall survival (OS) in patients with abnormal serum calcitonin levels following surgery for medullary thyroid carcinoma (MTC). MethodsA retrospective collection of data was conducted for 214 patients with abnormal serum calcitonin levels following MTC surgery at West China Hospital of Sichuan University from January 2015 to April 2024. Propensity score matching (1∶2) was utilized to match patients’ data to reduce confounding bias, comparing RFS and OS between patients who used (Pseudomonas group) and did not use (control group) Pseudomonas aeruginosa injection. ResultsAfter propensity score matching, 72 patients with abnormal postoperative calcitonin levels were included, with 24 in the Pseudomonas group and 48 in the control group. The median follow-up time for the 72 patients was 66 months (11–168 months). The 1-year RFS rates for the Pseudomonas group and the control group were 100% and 75.0%, respectively, and the 2-year RFS rates were 87.5% and 56.3%, respectively. The RFS in the Pseudomonas group was superior to that in the control group (χ2=4.791, P=0.029). The 5-year OS rates for the Pseudomonas group and the control group were 90.9% and 93.5%, respectively, with no significant difference between the two groups (χ2=0.469, P=0.491). The Cox proportional hazards regression model indicated that the median RFS was extended in the Pseudomonas group [25 months vs. 21 months, RR=0.350, 95%CI (0.135, 0.900), P=0.029], but there was no significant impact on OS [66 months vs. 69 months, RR=2.22, 95%CI (0.229, 21.444), P=0.503]. ConclusionPostoperative use of Pseudomonas aeruginosa injection in MTC patients with abnormal serum calcitonin level shows significant improvement in RFS, but no significant change in OS.
ObjectiveTo investigate diagnosis, gene detection, and treatment principle of medullary thyroid carcinoma.Method The relevant literatures and guidelines about diagnosis and treatment of medullary thyroid carcinoma were summarized and analyzed retrospectively. Resultsmedullary thyroid carcinoma was given priority to surgical treatment. hereditary medullary cancer could be prophylactic thyroidectomy by the RET gene test results. advanced progressive medullary thyroid carcinoma, could be treated by palliative surgery, external radiotherapy, or systemic treatment with the tyrosine kinase inhibitor. ConclusionsPrognosis of medullary thyroid carcinoma is worse, and occurrence of early metastasis is easy. so the first operation should be thoroughgoing. and the operation timing of prophylactic total thyroidectomy for hereditary medullary cancer could be determined by the results of RET gene detection to achieving early cure.