Cervical lymph node spread and high calcitonin
secretion predict recurrence of medullary thyroid carcinoma
(November 2003)
The background of
the study. Some patients with medullary thyroid carcinoma
who are thought to have complete tumor removal at surgery and have
no evidence of tumor postoperatively, as determined by imaging studies,
later have recurrent carcinoma. This study was done to determine
the long-term outcome in patients with these findings.
How the study was done. The study
subjects were 63 patients with medullary carcinoma who underwent
thyroidectomy and lymph node resection, with apparently complete
tumor removal, and had normal postoperative imaging studies (ultrasonography,
computed tomography) three to six months after surgery. After surgery,
plasma calcitonin was undetectable in 56 percent and high in 44
percent. The patients had clinical examinations, measurements of
plasma calcitonin, and imaging studies at 6- to 12-month intervals
thereafter.
The results of the study. The average
duration of follow-up was 7 years (range, 0.4 to 15), during which
time 71 percent of the patients remained free of tumor and 29 percent
had recurrent tumor. The recurrent tumor was in cervical lymph nodes
in eight patients, distant sites (liver, lungs, bone) in eight patients,
and lymph nodes and distant sites in two patients. The overall five-year
survival rate was 97 percent. The factors that predicted recurrence
were tumor stage, percentage of positive lymph nodes at surgery,
and the postoperative plasma calcitonin value.
The conclusions of the study. Patients
with medullary thyroid carcinoma who have extensive cervical lymph
node involvement and high postoperative plasma calcitonin concentrations
are likely to have recurrent carcinoma.
The original article. Pellegriti
G, Leboulleux S, Baudin E, Bellon N, Scollo C, Travagli JP, Schlumberger
M. Long-term outcome of medullary thyroid carcinoma in patients
with normal postoperative medical imaging. Br J Cancer 2003;88:1537-42.
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