Objective To summarize the clinical and research status in the surgical management of medullary thyroid carcinoma. Methods The related literatures on treatment of medullary thyroid carcinoma were collected and reviewed. Results A total thyroidectomy and dissection of the lymph nodes in the central compartment were effective treatments for patients with medullary thyroid carcinoma. The extent of lateral compartment lymph-node dissection did not reach an agreement. Prophylactic thyroidectomy was suggested for patients with a RET (rearranged during transfection) germline mutation. Palliative therapy was the main treatment of metastatic medullary thyroid carcinoma. Conclusions Surgery is the mainstay of treatment for medullary thyroid carcinoma. The combination of preoperative assessment, genetic testing, and appropriate surgical strategy may improve the prognosis of patients with medullary thyroid carcinoma.
ObjectiveTo understand the role of calcitonin testing for the diagnosis and treatment of medullary thyroid cancer (MTC) as well as recent research progress, so as to provide assistance in the early clinical diagnosis and treatment of MTC and improve patients’ prognosis. MethodThe literatures about the role of calcitonin testing in MTC in recent years were reviewed. ResultsIn recent years, both domestic and international scholars had extensively investigated the role of calcitonin in the early detection of MTC and accurate postoperative prognosis assessment. With respect to early diagnosis, advancements had been made in the three main measurement methods: basal calcitonin, stimulated calcitonin, and calcitonin measurement in the thyroid nodule fine-needle aspiration washout fluid. These developments in calcitonin levels had contributed to improved guidance in surgical treatment and prognosis evaluation. While calcitonin monitoring could inform treatment decisions and improve patients’prognosis, numerous challenges remain to be addressed. ConclusionThe study of calcitonin detection can deepen the understanding of MTC, further research on calcitonin related detection in the future will be of great significance for the diagnosis, treatment and prognosis evaluation of MTC.
ObjectiveTo explore the risk factors for lateral lymph node metastasis (LLNM) in medullary thyroid carcinoma (MTC). MethodsA retrospective analysis was conducted on 132 MTC patients who underwent initial treatment in Zhejiang Cancer Hospital from March 2015 to July 2023. Chi-square test, Mann-Whitney nonparametric test and logistic regression were used to analyze the risk factors associated with LLNM in MTC patients by SPSS 22.0 software. ResultsOut of 132 MTC patients, 46 developed LLNM. Multivariate analysis showed that male (female vs. male: OR=0.139, P=0.005), high preoperative calcitonin (Ctn) level (OR=1.001, P=0.042), capsule invasion (OR=15.164, P<0.001), and central lymph node metastasis (OR=4.573, P=0.016) were independent risk factors for LLNM in MTC patients (P<0.05). When the preoperative serum Ctn of MTC patients was greater than 482.50 pg/mL, it indicated a high possibility of LLNM [AUC=0.856, 95%CI (0.791, 0.921)]. ConclusionsGender (male), capsule invasion, high Ctn level, and central lymph node metastasis are independent predictors of LLNM in MTC. For MTC patients with the aforementioned high-risk factors, clinical physicians need to be vigilant about the possibility of LLNM.
ObjectiveTo investigate diagnosis, gene detection, and treatment principle of medullary thyroid carcinoma.Method The relevant literatures and guidelines about diagnosis and treatment of medullary thyroid carcinoma were summarized and analyzed retrospectively. Resultsmedullary thyroid carcinoma was given priority to surgical treatment. hereditary medullary cancer could be prophylactic thyroidectomy by the RET gene test results. advanced progressive medullary thyroid carcinoma, could be treated by palliative surgery, external radiotherapy, or systemic treatment with the tyrosine kinase inhibitor. ConclusionsPrognosis of medullary thyroid carcinoma is worse, and occurrence of early metastasis is easy. so the first operation should be thoroughgoing. and the operation timing of prophylactic total thyroidectomy for hereditary medullary cancer could be determined by the results of RET gene detection to achieving early cure.
ObjectiveTo investigate the effect of surgery and influence of posttreatment with non-standardized and standardized operation by reviewing and analyzing the sporadic medullary thyroid carcinoma operation cases. MethodsThe clinical data of 26 patients with sporadic medullary thyroid carcinoma treated by surgery from January 2000 to March 2013 in this hospital were analyzed retrospectively.These patients were divided into non-standardized operation group and standardized operation group (total thyroidectomy with lymph node dissection) according to the operation models.The biochemical cure rate, the complication rates of recurrent laryngeal nerve injury and hypopara-thyroidism of these two groups were investigated and compared. ResultsThe 1-year biochemical cure rate had no statistical difference between the non-standardized operation group and standardized operation group (84.21% versus 100%, χ2=1.249 4, P > 0.05), the 1-year recurrence rate was 15.79% and 0, respectively.The 5-year biochemical cure rate of the standardized operation group was significantly higher than that of the non-standardized operation group (100% versus 16.67%, χ2=4.444 4, P < 0.05).The 5-year recurrence rate was 0 and 83.33%, respectively.However, there was no obvious difference between the two groups on the injury rate of recurrent laryngeal nerve (χ2=0.070 8, P > 0.05), as well as the rate of hypoparathyroidism (χ2=2.722 7, P > 0.05). ConclusionsCompared with the non-standardized model, the standardized operation model (total thyroidectomy with lymph node dissection) shows a higher cure rate and a lower recurrent rate, and it does not increase the complication rates of hypoparathyroidism and recurrent laryngeal nerve injury