Impact of therapeutic regional lymph node dissection for medullary carcinoma of the thyroid gland.
BACKGROUND
Medullary carcinoma of the thyroid gland (MCT) is a disease commonly associated with regional metastases. Apart from surgical resection, there are limited therapeutic options for such patients. Given the variable and often prolonged survival of such patients, the benefit of surgical resection is difficult to evaluate. We have reviewed our experience with regional lymph node dissection for metastatic MCT.


METHODS
From Jan. 1, 1980, to Dec. 31, 1991, 36 patients underwent dissection of regional lymph node metastases for MCT at our institution. Survival was calculated by the Kaplan-Meier method and comparisons by log rank analysis. Significance was defined as p < 0.05.


RESULTS
Thirty-six patients (13 women), with a mean age of 48 years (range 16 to 78 years), underwent operation for clinically palpable or radiologically identified nodal disease. Median follow-up was 53 months, with an overall actuarial 5-year survival of 65%. Factors significantly associated with a poor outcome included the following: age greater than 40 years, mediastinal metastases, incomplete excision, extranodal disease, and failure to reduce the thyrocalcitonin level.


CONCLUSIONS
The resection of metastatic MCT to regional lymph nodes can be associated with appreciable survival. Prognostic parameters are identified that adversely affect survival.
Ellenhorn
J D
JD
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Shah
J P
JP
Brennan
M F
MF
D000293:Adolescent; D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000097:blood; D018276:Carcinoma, Medullary / Q000097:blood / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000601:surgery*; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009333:Neck; D009362:Neoplasm Metastasis; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
D002116:Calcitonin