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The prognostic value of lymph node ratio in Medullary thyroid carcinoma: A multi-center study |
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| Institution: | 1. Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel;2. Institute of Endocrinology, Rabin Medical Center – Beilinson Hospital, Petach Tikva, Israel;3. Neuroendocrine Tumor Unit, Endocrinology & Metabolism Service, Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel;4. Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel;5. Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, Israel;6. Institute of Endocrinology, Meir Medical Center, Kfar Saba, Israel;7. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;8. Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Israel;1. Oncology Urology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Carrer de Cartagena 340-350, 08025, Barcelona, Spain;2. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Urology, Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda, 10, 20122, Milan, Italy;3. Department of Urology, Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041, Madrid, Spain;1. Dept of Gastroenterology and Hepatology, Isala, Dokter van Heesweg 2, 8025, AB Zwolle, the Netherlands;2. Isala Oncology Center, Isala, Dokter van Heesweg 2, 8025, AB Zwolle, the Netherlands;3. Dept of Epidemiology & Statistics, Isala, Dokter van Heesweg 2, 8025, AB Zwolle, the Netherlands;4. Dept of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025, AB Zwolle, the Netherlands;5. Dept of Surgery, Isala, Dokter van Heesweg 2, 8025, AB Zwolle, the Netherlands;6. Dept of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA Nijmegen, the Netherlands;1. Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama;2. Department of Surgery, University of Wisconsin, Madison, Wisconsin;3. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama;4. Birmingham & Tuscaloosa Veteran''s Affairs Hospital, Tuscaloosa, Alabama |
| Abstract: | IntroductionThe lymph node ratio (LNR), which represents the proportion of metastatic lymph nodes resected, has been found to be a prognostic variable in several cancers, but data for Medullary thyroid carcinoma (MTC) are sparse. The aim of this study was to determine the value of the LNR in predicting outcome in patients with MTC.Materials and methodsA retrospective multicenter study design of 107 patients with MTC who underwent total thyroidectomy with neck dissection between 1984 and 2016. The association of LNR with patient and tumor characteristics and prognostic factors was evaluated.ResultsStudy population consisted of 53.3% female, mean age at diagnosis was 50.3 ± 18.4 years; 16.8% had inherited MTC. LNR was positively correlated with tumor size (p = 0.018) and inversely correlated with age at diagnosis (p = 0.024). A higher LNR was associated with extrathyroidal extension (p < 0.001), multifocality (p = 0.001), bilateral tumor (p = 0.002), distant metastases (p < 0.001), and tumor recurrence (OR = 14.7, p < 0.001). LNR was also correlated to postoperative calcitonin levels (p < 0.001) and carcinoembryonic antigen (p = 0.011). LNR >0.1 was associated with shorter disease-specific survival in patients at risk: tumor larger than 20 mm at diagnosis (p = 0.013), sporadic MTC (p = 0.01), and age above 40 years at diagnosis (p = 0.004). Cox multivariate survival analysis revealed LNR as the only significant independent factor for disease free survival (p = 0.005).ConclusionsThis study showed that LNR correlates well with patient and tumor characteristics and prognostic variables. We suggest that LNR should be considered an important parameter for predicting outcome in MTC. |
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