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Abstract：
Few studies have investigated the impact of primary tumor resection (PTR) on patients with distant metastasis medullary thyroid carcinoma (DMMTC). This population-based study aims to assess the application of PTR in DMMTC patients, ascertain its benefits, and identify optimal surgical indications. DMMTC Patients diagnosed between 2010 and 2020 were included through the Surveillance, Epidemiology, and End Results (SEER) program. Logistic regression analysis identified driving factors of surgical decision-making. Propensity score matching (PSM), Kaplan-Meier method, and Cox regression were utilized to compare overall survival (OS) and disease-specific survival (DSS) between surgical and non-surgical groups. Subgroup analyses were performed to determine optimal surgical indications. Of 238 DMMTC patients included, 122 (51.3%) patients underwent PTR. Extrathyroidal extension and N1 stage emerged as independent factors promoting the surgical decision. PSM-adjusted survival analyses revealed significant advantages in both OS and DSS for the surgical group. Moreover, subgroup analyses indicated that except for patients aged ≥ 65 years, tumors ≤ 20 mm, or with multiple metastasized sites (> 1), the others significantly benefit from PTR. PTR significantly improves prognosis in selected DMMTC patients. The decision to undergo PTR in other patients should be based on a comprehensive assessment of the disease, surgeon\'s experience, and family discussions for potential survival benefits.
摘要：
很少有研究研究原发性肿瘤切除术（PTR）对远处转移的甲状腺髓样癌（DMMTC）患者的影响。这项基于人群的研究旨在评估PTR在DMMTC患者中的应用，确定它的好处，并确定最佳的手术适应症。2010年至2020年期间诊断的DMMTC患者被纳入监测，流行病学,和结束结果（SEER）程序。Logistic回归分析确定了手术决策的驱动因素。倾向得分匹配(PSM)，Kaplan-Meier方法,和Cox回归用于比较手术组和非手术组的总生存期(OS)和疾病特异性生存期(DSS).进行亚组分析以确定最佳手术指征。包括238名DMMTC患者，122例（51.3%）患者接受PTR。甲状腺外延伸和N1分期是促进手术决定的独立因素。PSM调整后的生存分析显示，手术组在OS和DSS方面均具有显着的优势。此外，亚组分析表明，除了年龄≥65岁的患者，肿瘤≤20毫米，或具有多个转移位点(>1)，其他人显著受益于PTR。PTR显著改善了选定DMMTC患者的预后。其他患者接受PTR的决定应基于对疾病的全面评估，外科医生的经验，和家庭讨论潜在的生存福利。
