Semenov, Arseny1,2; Chernikov, Roman1; Buzanakov, Dmitry2; Makarin,Viktor1; Slepcov, Ilya1; Chinchuk, Igor1; Novokshonov, Konstantin1; Karelina, Julia1; Uspenskaya, Anna1; Timofeeva, Nataly1; Vorobev, Sergey3; Kulyash, Alexey3; Fedorov, Elisey1; Malyugov, Yuriy1; Bubnov, Aleksandr1,2,4; Fedotov, Yuriy4
1 Northwest center of endocrinology and endocrine surgery, University clinic, SPbSU, Saint-Petersburg, Russia
2 Faculty of Medicine,SPbSU, Saint-Petersburg, Russia
3 Department of morphology, University clinic, SPbSU, Saint-Petersburg, Russia
4 Department of operative surgery and clinical anatomy, North-Western State Medical University named after I.I.Mechnikov Saint-Petersburg, Russia
Purpose: to study the long-term results of surgical treatment of patients with medullary thyroid cancer (MTC) and to evaluate the significance of prognostic factors.
Material and methods: In a continuous retrospective study of 154 patients with histologically confirmed MTC were firstly operated at the Noth-West center of endoginology abd endocrine surgery in 2010-2015. The average age at the time of surgery was 53.5 ± 15.5 years. Patients were divided into groups of “outcomes” in accordance with the period of doubling of calcitonin in the postoperative period. The tumor size, the presence of metastases in regional lymph nodes, the preoperative level of calcitonin were assessed.
Results: In the ROC analysis of the prognostic significance of the level of preoperative calcitonin at a threshold value of 800 pg / ml, the sensitivity of the method was 76,5%, the specificity 79,9%, for the threshold size of the dominant node more than 2 cm – 86.6% and 77.7%, respectively. At the same time, the level of preoperative calcitonin over 600 predicted the presence of regional metastases with sensitivity of 76,9%, specificity 78,4% (AUC=0,75).
Conclusion: Level of preoperative calcitonin over 600 pg/ml is significant risk of neck lymph nodes involvement, and could be an indication for prophylactic lateral neck dissection or routine FNAB of them with test for calcitonin. Size of tumor less than 2 cm, calcitonin lower than 600 pg/ml, no evidence of multifocality and no germline RET mutation found could be indication for hemithyroidectomy with prophylactic central neck dissection.