PDF(Pubmed)
Abstract：
UNASSIGNED: Standard treatment for patients with medullary thyroid cancer (MTC) consists of total thyroidectomy with central neck dissection, but the rationale for bilateral surgery in patients with unilateral disease on ultrasonography remains unclear.
UNASSIGNED: To determine the presence of occult contralateral disease (lesions not seen on preoperative ultrasonography) in patients with MTC as a rationale for total thyroidectomy.
UNASSIGNED: This multi-institutional, retrospective cohort study was conducted from September 1998 to April 2022 in academic medical centers and included patients with MTC who underwent thyroidectomy with preoperative imaging.
UNASSIGNED: The primary end point was the prevalence of sonographically occult foci of MTC in the contralateral lobe among patients with sporadic MTC.
UNASSIGNED: The cohort comprised 176 patients with a median age at diagnosis of 55 years (range, 2-87 years), 69 (57.6%) of whom were female. Genetic testing was performed in 109 patients (61.9%), 48 (27.5%) of whom carried germline RET variants. Initial surgical management consisted of total thyroidectomy (161 [91.0%]), lobectomy followed by completion thyroidectomy (7 [4.0%]), and lobectomy alone (8 [4.5%]). Central and lateral neck dissections were performed as part of initial therapy for 146 patients (83.1%). In the entire cohort of 176 patients, 46 (26.0%) had contralateral foci disease and 9 (5.1%) had occult contralateral foci that were not identified on preoperative ultrasonography. Among 109 patients who underwent genetic testing, 38 (34.9%) had contralateral disease, 8 (7.3%) of whom had occult contralateral disease not seen on preoperative ultrasonography. Patients with sporadic MTC experienced a 95.7% reduction in the odds of having a focus of MTC in the contralateral lobe compared with patients with a germline RET variant (odds ratio, 0.043; 95% CI, 0.013-0.123). When adjusting for age, sex, tumor size, and lymph node involvement, the odds ratio of having contralateral MTC in patients with sporadic disease was 0.034 (95% CI, 0.007-0.116). Among patients who underwent lobectomy alone with postoperative calcitonin levels, 5 of 12 (41.7%) achieved undetectable calcitonin levels (<2.0 pg/mL; to convert to pmol/L, multiply by 0.292).
UNASSIGNED: The results of this cohort study suggest that a staged approach involving initial thyroid lobectomy could be considered in patients with sporadic MTC and no contralateral ultrasonography findings, with no further surgery if calcitonin levels became undetectable. Further work using prospective randomized clinical trials to evaluate lobectomy as a biochemical cure in patients presenting with unilateral disease is warranted.
UNASSIGNED: To determine the presence of occult contralateral disease (lesions not seen on preoperative ultrasonography) in patients with MTC as a rationale for total thyroidectomy.
UNASSIGNED: This multi-institutional, retrospective cohort study was conducted from September 1998 to April 2022 in academic medical centers and included patients with MTC who underwent thyroidectomy with preoperative imaging.
UNASSIGNED: The primary end point was the prevalence of sonographically occult foci of MTC in the contralateral lobe among patients with sporadic MTC.
UNASSIGNED: The cohort comprised 176 patients with a median age at diagnosis of 55 years (range, 2-87 years), 69 (57.6%) of whom were female. Genetic testing was performed in 109 patients (61.9%), 48 (27.5%) of whom carried germline RET variants. Initial surgical management consisted of total thyroidectomy (161 [91.0%]), lobectomy followed by completion thyroidectomy (7 [4.0%]), and lobectomy alone (8 [4.5%]). Central and lateral neck dissections were performed as part of initial therapy for 146 patients (83.1%). In the entire cohort of 176 patients, 46 (26.0%) had contralateral foci disease and 9 (5.1%) had occult contralateral foci that were not identified on preoperative ultrasonography. Among 109 patients who underwent genetic testing, 38 (34.9%) had contralateral disease, 8 (7.3%) of whom had occult contralateral disease not seen on preoperative ultrasonography. Patients with sporadic MTC experienced a 95.7% reduction in the odds of having a focus of MTC in the contralateral lobe compared with patients with a germline RET variant (odds ratio, 0.043; 95% CI, 0.013-0.123). When adjusting for age, sex, tumor size, and lymph node involvement, the odds ratio of having contralateral MTC in patients with sporadic disease was 0.034 (95% CI, 0.007-0.116). Among patients who underwent lobectomy alone with postoperative calcitonin levels, 5 of 12 (41.7%) achieved undetectable calcitonin levels (<2.0 pg/mL; to convert to pmol/L, multiply by 0.292).
UNASSIGNED: The results of this cohort study suggest that a staged approach involving initial thyroid lobectomy could be considered in patients with sporadic MTC and no contralateral ultrasonography findings, with no further surgery if calcitonin levels became undetectable. Further work using prospective randomized clinical trials to evaluate lobectomy as a biochemical cure in patients presenting with unilateral disease is warranted.
摘要：
■甲状腺髓样癌（MTC）患者的标准治疗包括甲状腺全切除术和中央颈淋巴结清扫术，但单侧疾病患者在超声检查中进行双侧手术的理由尚不清楚.
■确定MTC患者是否存在隐匿性对侧疾病（术前超声检查未发现病变）作为甲状腺全切除术的依据。
■这种多机构，回顾性队列研究于1998年9月至2022年4月在学术医疗中心进行,纳入了接受甲状腺切除术和术前影像学检查的MTC患者.
■主要终点是散发性MTC患者对侧肺叶的超声隐匿病灶的患病率。
■该队列包括176例患者，诊断年龄中位数为55岁（范围，2-87岁),69人（57.6%）为女性。109例患者（61.9%）进行基因检测，48人（27.5%）携带种系RET变异。最初的手术治疗包括甲状腺全切除术（161[91.0%]），肺叶切除术后完成甲状腺切除术（7[4.0%]），和单独肺叶切除术（8[4.5%]）。作为初始治疗的一部分，对146例患者（83.1％）进行了中央和外侧颈淋巴结清扫术。在整个176名患者中，46例（26.0％）患有对侧病灶，9例（5.1％）患有隐匿性对侧病灶，在术前超声检查中未发现。在109名接受基因检测的患者中，38例（34.9%）患有对侧疾病，其中8人（7.3％）在术前超声检查中未发现隐匿性对侧疾病。与具有种系RET变异的患者相比，散发性MTC患者在对侧肺叶出现MTC病灶的几率降低了95.7%（优势比，0.043；95%CI，0.013-0.123）。当调整年龄时，性别,肿瘤大小,淋巴结受累，散发性疾病患者发生对侧MTC的比值比为0.034(95%CI,0.007~0.116).在仅接受肺叶切除术的患者中，术后降钙素水平，12个中的5个（41.7％）达到了无法检测的降钙素水平（<2.0pg/mL；转换为pmol/L，乘以0.292）。
这项队列研究的结果表明，对于散发性MTC且没有对侧超声检查结果的患者，可以考虑采用包括初始甲状腺叶切除术的分期方法，如果无法检测到降钙素水平，则无需进一步手术。有必要使用前瞻性随机临床试验进行进一步的工作，以评估肺叶切除术作为单侧疾病患者的生化治疗。
■确定MTC患者是否存在隐匿性对侧疾病（术前超声检查未发现病变）作为甲状腺全切除术的依据。
■这种多机构，回顾性队列研究于1998年9月至2022年4月在学术医疗中心进行,纳入了接受甲状腺切除术和术前影像学检查的MTC患者.
■主要终点是散发性MTC患者对侧肺叶的超声隐匿病灶的患病率。
■该队列包括176例患者，诊断年龄中位数为55岁（范围，2-87岁),69人（57.6%）为女性。109例患者（61.9%）进行基因检测，48人（27.5%）携带种系RET变异。最初的手术治疗包括甲状腺全切除术（161[91.0%]），肺叶切除术后完成甲状腺切除术（7[4.0%]），和单独肺叶切除术（8[4.5%]）。作为初始治疗的一部分，对146例患者（83.1％）进行了中央和外侧颈淋巴结清扫术。在整个176名患者中，46例（26.0％）患有对侧病灶，9例（5.1％）患有隐匿性对侧病灶，在术前超声检查中未发现。在109名接受基因检测的患者中，38例（34.9%）患有对侧疾病，其中8人（7.3％）在术前超声检查中未发现隐匿性对侧疾病。与具有种系RET变异的患者相比，散发性MTC患者在对侧肺叶出现MTC病灶的几率降低了95.7%（优势比，0.043；95%CI，0.013-0.123）。当调整年龄时，性别,肿瘤大小,淋巴结受累，散发性疾病患者发生对侧MTC的比值比为0.034(95%CI,0.007~0.116).在仅接受肺叶切除术的患者中，术后降钙素水平，12个中的5个（41.7％）达到了无法检测的降钙素水平（<2.0pg/mL；转换为pmol/L，乘以0.292）。
这项队列研究的结果表明，对于散发性MTC且没有对侧超声检查结果的患者，可以考虑采用包括初始甲状腺叶切除术的分期方法，如果无法检测到降钙素水平，则无需进一步手术。有必要使用前瞻性随机临床试验进行进一步的工作，以评估肺叶切除术作为单侧疾病患者的生化治疗。
