Lymph node metastases and elevated postoperative calcitonin: Predictors of poor survival in medullary thyroid carcinoma

Abstract

Background. Total thyroidectomy is the treatment of choice for medullary thyroid carcinoma (MTC), but the extent of neck dissection is controversial. Lymph node metastases, distant metastases, and old age are known predictors of poor survival. Patients. Patients treated for primary MTC at Helsinki University Hospital from 1990 to 2009 were included (n=54). Their clinical characteristics, treatment, and outcome were analysed retrospectively, these patients were followed until death or their last follow-up date. Results. At last follow-up (3.4-23 years), of 54 MTC patients, 19 (35%) were disease-free, 17 (32%) were alive with disease, and 12 (22%) had died of MTC; six patients died of unrelated causes (11%). All disease-free patients were node negative and had normal postoperative calcitonin level. Of 19 disease-free patients, only four (21%) had undergone lymph node dissection. All patients who died of MTC were Stage IV at diagnosis and died with distant metastases. Disease-specific five-and 10-year survival was 84%and 76.2%. Advanced T-stage (p=0.004), lymph node metastases (p<0.001), distant metastases (p<0.001), stage (p<0.001), and elevated postoperative calcitonin (p<0.001) significantly associated with survival. Conclusions. Lymph node metastasis and elevated postoperative calcitonin are important prognostic factors. Patients with lymph node metastasis and/or elevated postoperative calcitonin with present treatments cannot become disease-free, but most of them can live a long life with metastasis.