Temporal Trends in the Presentation, Treatment, and Outcome of Medullary Thyroid Carcinoma - An Israeli Multicenter Study.

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Temporal Trends in the Presentation, Treatment, and Outcome of Medullary Thyroid Carcinoma - An Israeli Multicenter Study.

Thyroid. 2018 Feb 05;:

Authors: Hirsch D, Twito O, Levy S, Bachar G, Robenshtok E, Gross D, Mazeh H, Benbassat C, Grozinsky-Glasberg S

Abstract
BACKGROUND: The widespread use of neck sonography in recent years has led to a dramatic increase in the detection of thyroid cancer, accompanied by changes in the clinicopathological features of the disease. However, small papillary carcinomas account for the bulk of this increase, while little is known about temporal changes in medullary thyroid carcinoma (MTC). The aim of this study was to evaluate trends in the presentation, treatment, and outcome of MTC.
METHODS: Patients treated for MTC at four medical centers in Israel were divided into three groups by year of diagnosis: 1981-1995 (period A), 1996-2005 (period B), and 2006-2016 (period C). Clinicopathological and survival data were collected retrospectively from the medical files and compared among the groups.
RESULTS: The cohort included 182 patients (54.9% female) of mean age 49.2±18.7 years: 43 (23.6%) diagnosed in period A, 54 (29.7%) in period B, and 85 (46.7%) in period C. No significant differences were found among the groups in primary tumor size (25.7±18.9 mm, 26.6±18 mm, and 23.7±17.6 mm), proportion of micro-MTC (30.8%, 20.0%, and 25.3%), or TNM staging. Age at diagnosis significantly increased over time (38.7±17.2 years, 51.7±18.4 years, and 53.7±17.7, respectively, p<0.001), and the rate of familial MTC significantly decreased (41.9%, 14.8%, and 8.2%, respectively, p=0.002). Although the implementation of cervical lymph node dissection increased (62.1%, 78.4% and 85%, respectively, p=0.01), detection of metastatic lymph nodes decreased from 88.9% in period A to 65.0% in periods B and C (p=0.06). There was no difference among the groups in disease-specific survival or disease-free state at 1 year from diagnosis (37.5%, 43.1%, 50%) and last follow-up (27%, 41.2%, 48%, respectively). Similar findings on MTC presentation and outcomes were obtained when only patients with non-familial MTC were analyzed.
CONCLUSIONS: Unlike differentiated thyroid cancer, most of the presenting features of MTC have not changed over time. The most significant temporal change is a decreased rate of familial MTC. Despite more extensive surgery and the use of new treatment modalities in recent years, we did not find significant improvement in disease-related outcomes.

PMID: 29402183 [PubMed - as supplied by publisher]

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