Analysis of risk factors for lateral lymph node metastasis in medullary thyroid carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GU Jialei ^1,2 , MAO Xiaochun ^1,2,3 , XIANG Yangfeng ^1,3 ,  SHANG Jinbiao ^1,2,3 , ZHU Yizhou ⁴

1. Department of Thyroid Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, P. R. China;
2. Zhejiang Provincial Clinical Research Center for Malignant Tumor, Hangzhou 310014, P. R. China;
3. Zhejiang Provincial Key Laboratory of Head and Neck Tumor Transformation Medicine, Hangzhou 310022, P. R. China;
4. The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, P. R. China;

Corresponding author：

SHANG Jinbiao, Email: shangjb@zjcc.org.cn

Keywords：

medullary thyroid carcinoma; lateral lymph node metastasis; risk factor

DOI：

10.7507/1007-9424.202404090

Video：

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Objective To explore the risk factors for lateral lymph node metastasis (LLNM) in medullary thyroid carcinoma (MTC). Methods A 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. Results Out 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)]. Conclusions Gender (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.

1.	Wells SA, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
2.	Randle RW, Balentine CJ, Leverson GE, et al. Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years. Surgery, 2017, 161(1): 137-146.
3.	Machens A, Lorenz K, Dralle H. Prediction of biochemical cure in patients with medullary thyroid cancer. Br J Surg, 2020, 107(6): 695-704.
4.	Abraham DT, Low TH, Messina M, et al. Medullary thyroid carcinoma: long-term outcomes of surgical treatment. Ann Surg Oncol, 2011, 18(1): 219-225.
5.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国抗癌协会甲状腺癌专业委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺髓样癌诊断与治疗中国专家共识 (2020版). 中国实用外科杂志, 2020, 40(9): 1012-1020.
6.	Polistena A, Sanguinetti A, Lucchini R, et al. Timing and extension of lymphadenectomy in medullary thyroid carcinoma: a case series from a single institution. Int J Surg, 2017, 41 Suppl 1: S70-S74.
7.	顾延仲, 杨睿, 吴红吉, 等. 甲状腺髓样癌颈侧区淋巴结清扫的诊治进展. 中国普外基础与临床杂志, 2023, 30(10): 1273-1280.
8.	Moley JF, DeBenedetti MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg, 1999, 229(6): 880-887.
9.	Lin X, Huo J, Su H, et al. Risk factors for cervical lymph node metastasis in the central or lateral cervical region in medullary thyroid carcinoma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol, 2024, 281(2): 547-561.
10.	Esfandiari NH, Hughes DT, Yin H, et al. The effect of extent of surgery and number of lymph node metastases on overall survival in patients with medullary thyroid cancer. J Clin Endocrinol Metab, 2014, 99(2): 448-454.
11.	Chen L, Wang Y, Zhao K, et al. Postoperative nomogram for predicting cancer-specific and overall survival among patients with medullary thyroid cancer. Int J Endocrinol, 2020, 2020: 8888677.
12.	Scopsi L, Sampietro G, Boracchi P, et al. Multivariate analysis of prognostic factors in sporadic medullary carcinoma of the thyroid. A retrospective study of 109 consecutive patients. Cancer, 1996, 78(10): 2173-2183.
13.	Zhou TH, Zhao LQ, Zhang Y, et al. The prediction of metastases of lateral cervical lymph node in medullary thyroid carcinoma. Front Endocrinol (Lausanne), 2021, 12: 741289. doi: 10.3389/fendo.2021.741289.
14.	Fan W, Xiao C, Wu F. Analysis of risk factors for cervical lymph node metastases in patients with sporadic medullary thyroid carcinoma. J Int Med Res, 2018, 46(5): 1982-1989.
15.	Machens A, Dralle H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab, 2010, 95(6): 2655-2663.
16.	Mitchell AL, Gandhi A, Scott-Coombes D, et al. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol, 2016, 130(S2): S150-S160.
17.	Contarino A, Dolci A, Maggioni M, et al. Is Encapsulated medullary thyroid carcinoma associated with a better prognosis? A case series and a review of the literature. Front Endocrinol (Lausanne), 2022, 13: 866572. doi: 10.3389/fendo.2022.866572.
18.	Ye L, Zhou X, Lu J, et al. Combining serum calcitonin, carcinoembryonic antigen, and neuron-specific enolase to predict lateral lymph node metastasis in medullary thyroid carcinoma. J Clin Lab Anal, 2020, 34(7): e23278. doi: 10.1002/jcla.23278.
19.	Machens A, Ukkat J, Hauptmann S, et al. Abnormal carcinoembryonic antigen levels and medullary thyroid cancer progression: a multivariate analysis. Arch Surg, 2007, 142(3): 289-293,294.
20.	唐豪佑, 唐云辉, 贺鑫, 等. 基于AJCC TNM分期建立中晚期甲状腺髓样癌术后生存的列线图模型: SEER数据库分析. 中国普外基础与临床杂志, 2023, 30(8): 944-950.

1. Wells SA, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid, 2015, 25(6): 567-610.
2. Randle RW, Balentine CJ, Leverson GE, et al. Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years. Surgery, 2017, 161(1): 137-146.
3. Machens A, Lorenz K, Dralle H. Prediction of biochemical cure in patients with medullary thyroid cancer. Br J Surg, 2020, 107(6): 695-704.
4. Abraham DT, Low TH, Messina M, et al. Medullary thyroid carcinoma: long-term outcomes of surgical treatment. Ann Surg Oncol, 2011, 18(1): 219-225.
5. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国抗癌协会甲状腺癌专业委员会, 中国研究型医院学会甲状腺疾病专业委员会. 甲状腺髓样癌诊断与治疗中国专家共识 (2020版). 中国实用外科杂志, 2020, 40(9): 1012-1020.
6. Polistena A, Sanguinetti A, Lucchini R, et al. Timing and extension of lymphadenectomy in medullary thyroid carcinoma: a case series from a single institution. Int J Surg, 2017, 41 Suppl 1: S70-S74.
7. 顾延仲, 杨睿, 吴红吉, 等. 甲状腺髓样癌颈侧区淋巴结清扫的诊治进展. 中国普外基础与临床杂志, 2023, 30(10): 1273-1280.
8. Moley JF, DeBenedetti MK. Patterns of nodal metastases in palpable medullary thyroid carcinoma: recommendations for extent of node dissection. Ann Surg, 1999, 229(6): 880-887.
9. Lin X, Huo J, Su H, et al. Risk factors for cervical lymph node metastasis in the central or lateral cervical region in medullary thyroid carcinoma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol, 2024, 281(2): 547-561.
10. Esfandiari NH, Hughes DT, Yin H, et al. The effect of extent of surgery and number of lymph node metastases on overall survival in patients with medullary thyroid cancer. J Clin Endocrinol Metab, 2014, 99(2): 448-454.
11. Chen L, Wang Y, Zhao K, et al. Postoperative nomogram for predicting cancer-specific and overall survival among patients with medullary thyroid cancer. Int J Endocrinol, 2020, 2020: 8888677.
12. Scopsi L, Sampietro G, Boracchi P, et al. Multivariate analysis of prognostic factors in sporadic medullary carcinoma of the thyroid. A retrospective study of 109 consecutive patients. Cancer, 1996, 78(10): 2173-2183.
13. Zhou TH, Zhao LQ, Zhang Y, et al. The prediction of metastases of lateral cervical lymph node in medullary thyroid carcinoma. Front Endocrinol (Lausanne), 2021, 12: 741289. doi: 10.3389/fendo.2021.741289.
14. Fan W, Xiao C, Wu F. Analysis of risk factors for cervical lymph node metastases in patients with sporadic medullary thyroid carcinoma. J Int Med Res, 2018, 46(5): 1982-1989.
15. Machens A, Dralle H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab, 2010, 95(6): 2655-2663.
16. Mitchell AL, Gandhi A, Scott-Coombes D, et al. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol, 2016, 130(S2): S150-S160.
17. Contarino A, Dolci A, Maggioni M, et al. Is Encapsulated medullary thyroid carcinoma associated with a better prognosis? A case series and a review of the literature. Front Endocrinol (Lausanne), 2022, 13: 866572. doi: 10.3389/fendo.2022.866572.
18. Ye L, Zhou X, Lu J, et al. Combining serum calcitonin, carcinoembryonic antigen, and neuron-specific enolase to predict lateral lymph node metastasis in medullary thyroid carcinoma. J Clin Lab Anal, 2020, 34(7): e23278. doi: 10.1002/jcla.23278.
19. Machens A, Ukkat J, Hauptmann S, et al. Abnormal carcinoembryonic antigen levels and medullary thyroid cancer progression: a multivariate analysis. Arch Surg, 2007, 142(3): 289-293,294.
20. 唐豪佑, 唐云辉, 贺鑫, 等. 基于AJCC TNM分期建立中晚期甲状腺髓样癌术后生存的列线图模型: SEER数据库分析. 中国普外基础与临床杂志, 2023, 30(8): 944-950.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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