The oncologist · 2025
Comparison of lobectomy vs total thyroidectomy for medullary thyroid carcinoma: a SEER analysis with Chinese cohort validation.
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Yang Jing, Wang Jin-Yu, Lu Yi-Dan, Wang Ke-Jing, Zhou Ling-Yan
Аннотация
OBJECTIVE: This study aimed to clarify whether lobectomy provides survival benefits for patients with early-stage medullary thyroid carcinoma (MTC).
DESIGN, SETTING, AND PARTICIPANTS: Patients with tumor size less than 4 cm, excluding those with lateral neck involvement, bilateral foci, extrathyroidal extension, or distant metastases, were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database and Zhejiang Cancer Hospital in China. Propensity score matching (PSM), Kaplan-Meier analysis, and Cox regression analyses were used to evaluate treatment outcomes and identify risk factors.
RESULTS: Among 1009 patients in the SEER database, TT was associated with multifocality (P < .001) and local nodal metastasis (P < .001). After PSM, 73 pairs were matched. In the Chinese cohort from Zhejiang Cancer Hospital, TT was correlated with larger tumor (P < .001), higher calcitonin peak-to-basal ratio (P = .002), and T2 stage (P = .025), with 38 matched pairs after PSM. Cox regression analyses showed that the extent of thyroid resection was not an independent prognostic factor for overall survival (SEER: OS P = .607) or progression-free survival (Chinese cohort: PFS P = .411). Kaplan-Meier analysis revealed no significant survival differences between the TT and lobectomy groups (SEER: OS P = .43; Chinese cohort: PFS P = .21). Additionally, the TT group had more frequent adverse events (transient hypocalcemia: P < .001, transient vocal cord paralysis: P < .025), longer hospital stays (P = .011), and higher costs (P = .001) than the lobectomy group.
CONCLUSIONS: For patients with early-stage MTC, lobectomy may be an optimal alternative option that does not impair prognosis and confers a low risk of adverse events.
DESIGN, SETTING, AND PARTICIPANTS: Patients with tumor size less than 4 cm, excluding those with lateral neck involvement, bilateral foci, extrathyroidal extension, or distant metastases, were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database and Zhejiang Cancer Hospital in China. Propensity score matching (PSM), Kaplan-Meier analysis, and Cox regression analyses were used to evaluate treatment outcomes and identify risk factors.
RESULTS: Among 1009 patients in the SEER database, TT was associated with multifocality (P < .001) and local nodal metastasis (P < .001). After PSM, 73 pairs were matched. In the Chinese cohort from Zhejiang Cancer Hospital, TT was correlated with larger tumor (P < .001), higher calcitonin peak-to-basal ratio (P = .002), and T2 stage (P = .025), with 38 matched pairs after PSM. Cox regression analyses showed that the extent of thyroid resection was not an independent prognostic factor for overall survival (SEER: OS P = .607) or progression-free survival (Chinese cohort: PFS P = .411). Kaplan-Meier analysis revealed no significant survival differences between the TT and lobectomy groups (SEER: OS P = .43; Chinese cohort: PFS P = .21). Additionally, the TT group had more frequent adverse events (transient hypocalcemia: P < .001, transient vocal cord paralysis: P < .025), longer hospital stays (P = .011), and higher costs (P = .001) than the lobectomy group.
CONCLUSIONS: For patients with early-stage MTC, lobectomy may be an optimal alternative option that does not impair prognosis and confers a low risk of adverse events.