RESUMO
BACKGROUND: Medullary thyroid carcinoma (MTC) is a rare development of thyroid cancer with a no negligible mortality rate. Our aim was to determine factors that predict outcome in patients with MTC. METHODS: We reviewed the records of all patients with MTC (n=56) who underwent treatment at our institution between January 1990 and December 2000. Univariate and multivariate analysis of clinicopathologic predictors of MTC outcome were performed to identify subsets of patients with different probabilities in terms of overall survival, local recurrence, and distant metastases. RESULTS: Multivariate analysis demonstrated that a statistically significant decrease in overall survival is associated with T4b tumours (p=0.06), the presence of distant metastases at the time of presentation (p=0.033), lymphatic invasion (p=0.099), and postoperative treatment (p=0.045). CONCLUSIONS: The analysis of survival curves of patients with MTC shows that the occurrence of locoregional and distant metastases occurs preferentially within the first 5 years, which identifies this as a crucial period for follow-up. In this series of patients with MTC, the tumours classified as T4b, metastases at presentation, the presence of lymphovascular invasion, and postoperative treatment were the most important prognostic features. At present, there is no available beneficial adjuvant therapy. However, as the development of molecular therapy progresses, it should be tested in clinical trials with the purpose of achievement of novel targeted therapies for selected MTC patients with risk factors.
Assuntos
Carcinoma Medular/mortalidade , Neoplasias da Glândula Tireoide/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Calcitonina/sangue , Carcinoma Medular/sangue , Feminino , Seguimentos , Humanos , Excisão de Linfonodo/métodos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 2a/mortalidade , Análise Multivariada , Esvaziamento Cervical , Invasividade Neoplásica , Metástase Neoplásica , Recidiva Local de Neoplasia , Portugal/epidemiologia , Prognóstico , Análise de Sobrevida , Neoplasias da Glândula Tireoide/sangue , Tireoidectomia , Fatores de TempoRESUMO
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Background. Medullary thyroid carcinoma (MTC)is a rare development of thyroid cancer with a nonegligible mortality rate. Our aim was to determinefactors that predict outcome in patients with MTC.Methods. We reviewed the records of all patientswith MTC (n = 56) who underwent treatment at ourinstitution between January 1990 and December2000. Univariate and multivariate analysis of clinicopathologicpredictors of MTC outcome were performedto identify subsets of patients with differentprobabilities in terms of overall survival, local recurrence,and distant metastases.Results. Multivariate analysis demonstrated that astatistically significant decrease in overall survivalis associated with T4b tumours (p = 0.06), the presenceof distant metastases at the time of presentation(p = 0.033), lymphatic invasion (p = 0.099), andpostoperative treatment (p = 0.045).Conclusions. The analysis of survival curves of patientswith MTC shows that the occurrence of locoregionaland distant metastases occurs preferentiallywithin the first 5 years, which identifies this asa crucial period for follow-up. In this series of patientswith MTC, the tumours classified as T4b,metastases at presentation, the presence of lymphovascularinvasion, and postoperative treatment werethe most important prognostic features. At present,there is no available beneficial adjuvant therapy.However, as the development of molecular therapyprogresses, it should be tested in clinical trials withthe purpose of achievement of novel targeted therapiesfor selected MTC patients with risk factors
