Scientific Reports (Sep 2023)

Preoperative identification of low-risk medullary thyroid carcinoma: potential application to reduce total thyroidectomy

  • Hyunju Park,
  • Hyun Jin Ryu,
  • Jung Heo,
  • Man Ki Chung,
  • Young Ik Son,
  • Jung-Han Kim,
  • Soo Yeon Hahn,
  • Jung Hee Shin,
  • Young Lyun Oh,
  • Sun Wook Kim,
  • Jae Hoon Chung,
  • Jee Soo Kim,
  • Tae Hyuk Kim

DOI
https://doi.org/10.1038/s41598-023-42907-3
Journal volume & issue
Vol. 13, no. 1
pp. 1 – 9

Abstract

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Abstract Current guidelines recommend total thyroidectomy with central lymph node dissection (CND) for patients with medullary thyroid carcinoma (MTC). This study aimed to identify low-risk MTC patients who may be candidates for lobectomy. We retrospectively reviewed MTC patients who underwent primary surgery at a tertiary referral center from 1998 to 2019. Eighty-five MTC patients were enrolled, excluding patients with primary tumor size > 2.0 cm. Among them, one (1.2%) patient had bilateral tumors. During a median follow-up of 84 months, 12 of the 85 patients experienced structural recurrence. 13 patients had occult lymph node metastasis, and structural recurrence occurred in 2 patients. Factors that significantly affected disease-free survival were clinical N stage (cN0 vs. cN1, log-rank P 250 pg/mL, P = 0.017). After categorizing patients into four groups, patients with preoperative calcitonin levels > 250 pg/mL and cN1 or pN1 had a significantly worse prognosis. Patients with a primary tumor size of 2 cm or less, cN0, and preoperative calcitonin of 250 pg/mL or less can be classified as low-risk MTC patients. We used preoperative clinical information to identify low-risk MTC patients. Lobectomy with prophylactic CND may be a potential therapeutic approach.