Thyroid Research Thyroid Research Archive Thyroid Cancer

Cervical lymph node spread and high calcitonin secretion predict recurrence of medullary thyroid carcinoma

(November 2003)

The background of the study. Some patients with medullary thyroid carcinoma who are thought to have complete tumor removal at surgery and have no evidence of tumor postoperatively, as determined by imaging studies, later have recurrent carcinoma. This study was done to determine the long-term outcome in patients with these findings.

How the study was done. The study subjects were 63 patients with medullary carcinoma who underwent thyroidectomy and lymph node resection, with apparently complete tumor removal, and had normal postoperative imaging studies (ultrasonography, computed tomography) three to six months after surgery. After surgery, plasma calcitonin was undetectable in 56 percent and high in 44 percent. The patients had clinical examinations, measurements of plasma calcitonin, and imaging studies at 6- to 12-month intervals thereafter.

The results of the study. The average duration of follow-up was 7 years (range, 0.4 to 15), during which time 71 percent of the patients remained free of tumor and 29 percent had recurrent tumor. The recurrent tumor was in cervical lymph nodes in eight patients, distant sites (liver, lungs, bone) in eight patients, and lymph nodes and distant sites in two patients. The overall five-year survival rate was 97 percent. The factors that predicted recurrence were tumor stage, percentage of positive lymph nodes at surgery, and the postoperative plasma calcitonin value.

The conclusions of the study. Patients with medullary thyroid carcinoma who have extensive cervical lymph node involvement and high postoperative plasma calcitonin concentrations are likely to have recurrent carcinoma.

The original article. Pellegriti G, Leboulleux S, Baudin E, Bellon N, Scollo C, Travagli JP, Schlumberger M. Long-term outcome of medullary thyroid carcinoma in patients with normal postoperative medical imaging. Br J Cancer 2003;88:1537-42.