Analysis of some prognostic factors significance for medullary thyroid cancer metastasis

Authors

  • V.O. Palamarchuk Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0001-9554-4817
  • V.A. Smolyar Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine
  • O.A. Tovkay Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine https://orcid.org/0000-0002-1329-279X
  • V.V. Kuts Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine, Kyiv, Ukraine; SI “F.G. Yanovskyi National Institute of Phthisiology and Pulmonology of the NAMS of Ukraine”, Kyiv, Ukraine https://orcid.org/0000-0002-4434-7298

DOI:

https://doi.org/10.22141/2224-0721.18.1.2022.1139

Keywords:

medullary thyroid cancer, calcitonin, predictor of metastasis, relapse

Abstract

Background. The urgency of the study is due to the need to find effective methods for the diagnosis and treatment of medullary thyroid cancer. Basal calcitonin is a biomarker that determines both the presence of this disease and the level of metastasis. Howe­ver, above-threshold calcitonin levels have a low prognostic value of the positive result. The study was aimed to analyze the importance of additional factors (besides calcitonin) in predicting the medullary thyroid cancer metastasis: age, sex, tumor focus, tumor volume (total volume). Materials and me­thods. A retrospective monocenter analysis was performed using the records of 194 patients treated for medullary thyroid cancer. The study involved 143 patients with primary forms of the di­sease. The required characteristics of the tumor were assessed in the postoperative period based on the pathomorphological exa­mination. Results. The association between age and metastasis was not found, but a moderate relationship between sex and metastasis has been shown. The ratio of the chances of metastases detected in male patients is estimated at 3 : 1. It is proved that in the presence of tumor multifocality, the likelihood of metastasis detection increa­ses. With an odds ratio of 2.368, the multifocal factor shows a weak but statistically significant strong association with the presence of metastases. Total tumor size is associated with metastasis. More than half (54.5 %) of cases are in the range of tumor sizes smaller than the selected cut-off threshold, with 16.7% metastasi­zing. On the other hand, the share of cases of exceeding the cut-off threshold (Cut-off = 1.9 cm; AUC = 0.703, Se = 0.745, Sp = 0.680) is 45.5 %, and metastasis is observed in 53.8 % of patients in this range. Conclusions. No association was found between age and metastasis. Male gender is a risk factor for metastasis. Multifocality is a risk factor for metastasis with a weak connection. The total size of the tumor is associated with metastasis with medium strength.

Downloads

Download data is not yet available.

References

Torre LA, Siegel RL, Ward EM, Jemal A. Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer Epidemiol Biomarkers Prev. 2016 Jan;25(1):16-27. doi: 10.1158/1055-9965.EPI-15-0578.

Ceolin L, Duval MADS, Benini AF, Ferreira CV, Maia AL. Medullary thyroid carcinoma beyond surgery: advances, challenges, and perspectives. Endocr Relat Cancer. 2019 Aug 1;26(9):R499-R518. doi: 10.1530/ERC-18-0574.

Turkdogan S, Forest VI, Hier MP, Tamilia M, Florea A, Payne RJ. Carcinoembryonic antigen levels correlated with advanced disease in medullary thyroid cancer. J Otolaryngol Head Neck Surg. 2018 Sep 17;47(1):55. doi: 10.1186/s40463-018-0303-x.

Wells SA Jr, Asa SL, Dralle H, et al; American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25(6):567-610. doi: 10.1089/thy.2014.0335.

Oltmann SC, Schneider DF, Chen H, Sippel RS. All thyroid ultrasound evaluations are not equal: sonographers specialized in thyroid cancer correctly label clinical N0 disease in well differentiated thyroid cancer. Ann Surg Oncol. 2015 Feb;22(2):422-8. doi: 10.1245/s10434-014-4089-4.

Kumbhar SS, O'Malley RB, Robinson TJ, et al. Why Thyroid Surgeons Are Frustrated with Radiologists: Lessons Learned from Pre- and Postoperative US. Radiographics. 2016 Nov-Dec;36(7):2141-2153. doi: 10.1148/rg.2016150250.

Yip DT, Hassan M, Pazaitou-Panayiotou K, et al. Preoperative basal calcitonin and tumor stage correlate with postoperative calcitonin normalization in patients undergoing initial surgical management of medullary thyroid carcinoma. Surgery. 2011 Dec;150(6):1168-77. doi: 10.1016/j.surg.2011.09.043.

Haddad RI, Nasr C, Bischoff L, et al. NCCN Guidelines Insights: Thyroid Carcinoma, Version 2.2018. J Natl Compr Canc Netw. 2018 Dec;16(12):1429-1440. doi: 10.6004/jnccn.2018.0089.

Patel KN, Yip L, Lubitz CC, et al. The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg. 2020 Mar;271(3):e21-e93. doi: 10.1097/SLA.0000000000003580.

Park H, Park SY, Park J, et al. Prognostic Value of Preoperative Serum Calcitonin Levels for Predicting the Recurrence of Medullary Thyroid Carcinoma. Front Endocrinol (Lausanne). 2021 Oct 5;12:749973. doi: 10.3389/fendo.2021.749973.

Palamarchuk V, Smolyar V, Tovkay O, et al. The role of calcitonin in the preoperative stage as the predictor of medullary thyroid cancer metastasis. The Ukrainian Scientific Medical Youth Journal. 2021;(127):68-76. doi: 10.32345/USMYJ.4(127).2021.68-76.

Kandil E, Gilson MM, Alabbas HH, Tufaro AP, Dackiw A, Tufano RP. Survival implications of cervical lymphadenectomy in patients with medullary thyroid cancer. Ann Surg Oncol. 2011 Apr;18(4):1028-34. doi: 10.1245/s10434-010-1363-y.

Moley JF, DeBenedetti MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg. 1999 Jun;229(6):880-7; discussion 887-8. doi: 10.1097/00000658-199906000-00016.

Scollo C, Baudin E, Travagli JP, et al. Rationale for central and bilateral lymph node dissection in sporadic and hereditary medullary thyroid cancer. J Clin Endocrinol Metab. 2003 May;88(5):2070-5. doi: 10.1210/jc.2002-021713.

Perros P, Boelaert K, Colley S, et al; British Thyroid Association. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf). 2014 Jul;81 Suppl 1:1-122. doi: 10.1111/cen.12515.

Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol. 2013 Oct;20(11):3477-83. doi: 10.1245/s10434-013-3125-0.

Chen L, Sun W, Qian K, et al. High Ratio of Early Postoperative Calcitonin to Preoperative Calcitonin Could be a Novel Indicator of Poor Prognosis in Patients with Biochemical Incomplete Responses in Sporadic Medullary Thyroid Cancer. Endocr Pract. 2020 Jul;26(7):738-747. doi: 10.4158/EP-2019-0404.

Tovkay OA, Palamarchuk VО, Lishchinsky PО, Kuts VV, Stotska LV, Chirkov YE. Possibilities of ultrasound imaging in the detection of central lymph nodes metastases of papillary thyroid cancer. Clinical Endocrinology and Endocrine Surgery. 2020;(71):7-15. doi: 10.30978/CEES-2020-3-7. (in Ukrainian).

Henry NL, Hayes DF. Cancer biomarkers. Mol Oncol. 2012 Apr;6(2):140-6. doi: 10.1016/j.molonc.2012.01.010.

Yotsukura S, Mamitsuka H. Evaluation of serum-based cancer biomarkers: a brief review from a clinical and computational viewpoint. Crit Rev Oncol Hematol. 2015 Feb;93(2):103-15. doi: 10.1016/j.critrevonc.2014.10.002.

Machens A, Schneyer U, Holzhausen HJ, Dralle H. Prospects of remission in medullary thyroid carcinoma according to basal calcitonin level. J Clin Endocrinol Metab. 2005 Apr;90(4):2029-34. doi: 10.1210/jc.2004-1836.

Machens A, Schneyer U, Holzhausen HJ, Dralle H. Prospects of remission in medullary thyroid carcinoma according to basal calcitonin level. J Clin Endocrinol Metab. 2005 Apr;90(4):2029-34. doi: 10.1210/jc.2004-1836.

Park H, Park J, Choi MS, et al. Preoperative Serum Calcitonin and Its Correlation with Extent of Lymph Node Metastasis in Medullary Thyroid Carcinoma. Cancers (Basel). 2020 Oct 9;12(10):2894. doi: 10.3390/cancers12102894.

Gimm O. Extent of surgery in clinically evident but operable MTC - when is central and/or lateral lympadenectomy indicated? Thyroid Res. 2013 Mar 14;6 Suppl 1(Suppl 1):S3. doi: 10.1186/1756-6614-6-S1-S3.

Cohen R, Campos JM, Salaün C, et al. Preoperative calcitonin levels are predictive of tumor size and postoperative calcitonin normalization in medullary thyroid carcinoma. Groupe d'Etudes des Tumeurs a Calcitonine (GETC). J Clin Endocrinol Metab. 2000 Feb;85(2):919-22. doi: 10.1210/jcem.85.2.6556.

Machens A, Lorenz K, Dralle H. Prediction of biochemical cure in patients with medullary thyroid cancer. Br J Surg. 2020 May;107(6):695-704. doi: 10.1002/bjs.11444.

Yen TW, Shapiro SE, Gagel RF, Sherman SI, Lee JE, Evans DB. Medullary thyroid carcinoma: results of a standardized surgical approach in a contemporary series of 80 consecutive patients. Surgery. 2003 Dec;134(6):890-9; discussion 899-901. doi: 10.1016/s0039-6060(03)00408-2.

Jung KY, Kim SM, Yoo WS, et al. Postoperative biochemical remission of serum calcitonin is the best predictive factor for recurrence-free survival of medullary thyroid cancer: a large-scale retrospective analysis over 30 years. Clin Endocrinol (Oxf). 2016 Apr;84(4):587-97. doi: 10.1111/cen.12852.

Lindsey SC, Ganly I, Palmer F, Tuttle RM. Response to initial therapy predicts clinical outcomes in medullary thyroid cancer. Thyroid. 2015 Feb;25(2):242-9. doi: 10.1089/thy.2014.0277.

Arvai J. Thinking, fast and slow, Daniel Kahneman, Farrar, Straus & Giroux, Journal of Risk Research. 2013;(16)10:1322-1324. doi: 10.1080/13669877.2013.766389.

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.

Ray P, Le Manach Y, Riou B, Houle TT. Statistical evaluation of a biomarker. Anesthesiology. 2010 Apr;112(4):1023-40. doi: 10.1097/ALN.0b013e3181d47604.

Published

2022-06-29

How to Cite

Palamarchuk, V., Smolyar, V., Tovkay, O., & Kuts, V. (2022). Analysis of some prognostic factors significance for medullary thyroid cancer metastasis. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 18(1), 4–11. https://doi.org/10.22141/2224-0721.18.1.2022.1139

Issue

Section

Original Researches