Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan;8(1):31-40.
doi: 10.1159/000493977. Epub 2018 Nov 8.

Trends in Diagnostics, Surgical Treatment, and Prognostic Factors for Outcomes in Medullary Thyroid Carcinoma in Norway: A Nationwide Population-Based Study

Else Marie Opsahl  1   2 , Lars Andreas Akslen  3   4 , Ellen Schlichting  1 , Turid Aas  5 , Katrin Brauckhoff  5 , Anne Irene Hagen  6 , Alf Frimann Rosenlund  7 , Eva Sigstad  8 , Krystyna K Grøholt  8 , Lovise Mæhle  9 , Lars Fredrik Engebretsen  10   11 , Lars H Jørgensen  12 , Jan Erik Varhaug  13 , Trine Bjøro  2   14
Affiliations

Trends in Diagnostics, Surgical Treatment, and Prognostic Factors for Outcomes in Medullary Thyroid Carcinoma in Norway: A Nationwide Population-Based Study

Else Marie Opsahl et al. Eur Thyroid J. 2019 Jan.

Abstract

Background: Medullary thyroid carcinoma (MTC) is rare. Nationwide population-based studies are important to evaluate its clinical course.

Objectives: To describe all patients with MTC in Norway during 1994-2016 and compare time-related trends in diagnostics and surgical treatment, including prognostic factors for biochemical cure and disease-specific survival (DSS).

Methods: This retrospective population-based cohort study includes data for 228 out of 237 patients (96%) with MTC; 201 patients were surgically treated. Patients were identified in the 4 regional centers treating MTC and by the Cancer Registry of Norway. Data were collected from patients' files. Trends were compared over 2 study periods.

Results: MTC accounted for 4.2% of thyroid carcinomas. During the study periods, the incidence increased from 0.18 to 0.25: 100,000 per year, preoperative diagnostics improved with increased use of calcitonin, ultrasound, and fine-needle cytology (p = 0.010, p < 0,001, and p = 0.001), patients were diagnosed at an earlier tumor stage (p = 0.004), and more patients were cured (p = 0.002). Via multivariate analysis of patients with metastatic lymph nodes, independent prognostic factors for cure were: a low ratio of metastatic and total number of dissected lymph nodes (p = 0.021) and no extrathyroidal extension (p = 0.030). Independent prognostic factors for DSS were: no distant metastasis, a younger age, and a low ratio of metastatic and dissected lymph nodes (p = 0.005, p = 0.020, p = 0.022).

Conclusions: Preoperative diagnostics have improved over time with increased therapeutic control. A low ratio of metastatic and dissected lymph nodes predicts better outcomes in patients with metastatic lymph nodes.

Keywords: Diagnostics; Medullary thyroid carcinoma; Outcome; Pathology; Surgery; Trends.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Study cohort with inclusion and exclusion flow chart.
Fig. 2
Fig. 2
DSS by TNM stage IVa+b vs. IVc in MTC in 63 (79%) patients with an available dataset. Stage IVa+b, n = 49; stage IVc, n = 14 (p < 0.001).
See this image and copyright information in PMC

References

    1. Kebebew E, Ituarte PH, Siperstein AE, Duh QY, Clark OH. Medullary thyroid carcinoma: clinical characteristics, treatment, prognostic factors, and a comparison of staging systems. Cancer. 2000 Mar;88((5)):1139–48. - PubMed
    1. Akslen LA, Haldorsen T, Thoresen SO, Glattre E. Incidence of thyroid cancer in Norway 1970-1985. Population review on time trend, sex, age, histological type and tumour stage in 2625 cases. APMIS. 1990 Jun;98((6)):549–58. - PubMed
    1. Wells SA, Jr, Asa SL, Dralle H, Elisei R, Evans DB, Gagel RF, et al. American Thyroid Association Guidelines Task Force on Medullary Thyroid Carcinoma Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015 Jun;25((6)):567–610. - PMC - PubMed
    1. Pelizzo MR, Boschin IM, Bernante P, Toniato A, Piotto A, Pagetta C. Natural history, diagnosis, treatment and outcome of medullary thyroid cancer: 37 years experience on 157 patients. Eur J Surg Oncol. 2007 May;33((4)):493–7. - PubMed
    1. Donis-Keller H, Dou S, Chi D, Carlson KM, Toshima K, Lairmore TC. Mutations in the RET proto-oncogene are associated with MEN 2A and FMTC. Hum Mol Genet. 1993 Jul;2((7)):851–6. - PubMed