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Age, extent of disease, and extent of treatment predict survival in patients with medullary thyroid cancer
The background of the study. Medullary thyroid cancer is an uncommon type of thyroid cancer that has a poor prognosis. This study was done to identify factors determining prognosis of this cancer in a large group of patients.
How the study was done. The study subjects were 1252 patients with medullary cancer recorded in the database of the Surveillance, Epidemiology, and End Results (SEER) program between 1979 and 2002. This database contains demographic, clinical, pathologic, treatment, and outcome data for cases of all types of carcinoma in 13 regions comprising 26 percent of the U.S. population.
The results of the study. The 1252 patients included 746 women and 506 men. Their average age at the time of diagnosis was 50 years. The carcinomas averaged 2.8 cm in longest dimension, were localized to the thyroid in 595 patients (48 percent), and extended into the surrounding tissue in 437 (35 percent), and there were distant metastases in 166 (13 percent). Information regarding lymph node metastases was available for 594 patients; 368 (62 percent) had none, 121 (20 percent) had node involvement in the same side of the neck as the tumor, 49 (8 percent) had bilateral or opposite side node involvement, and 56 (10 percent) had distant node involvement.
Detailed information regarding treatment was available for 643 patients (51 percent). Ninety-one patients (14 percent) underwent thyroid lobectomy, 235 (37 percent) thyroidectomy, and 283 (44 percent) thyroidectomy and limited or extensive lymph-node dissection; 34 patients (5 percent) were not operated on.
As of December 2003, 851 (68 percent) of the patients were alive. The average survival time was 9 years (range, 0 to 30). Among patients with tumor confined to the thyroid, the 10-year survival rate was 96 percent; it was 76 percent in patients with regional lymph node involvement; and it was 40 percent in those with distant disease. Age at diagnosis, tumor stage, and extent of surgery were strong predictors of survival.
The conclusions of the study. Among patients with medullary thyroid cancer, younger age, disease localized to the thyroid gland, and more extensive surgery are associated with improved long-term survival.
The original article. Roman S, Lin R, Sosa JA. Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases. Cancer 2006;107:2134-42.
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