Kuo et al identified risk factors for disease-specific mortality associated with medullary thyroid carcinoma. These can help to identify a patient who may benefit from more aggressive therapy. The authors are from the University of California Los Angeles.
Patient selection: medullary carcinoma of the thyroid gland
Recommended management: total thyroidectomy with central neck dissection, with lateral neck dissection performed for clinically lymph node metastases or preoperative calcitonin > 20 pg/mL
5-year disease-specific mortality: 14%
Risk factors for disease-specific mortality:
(1) older age (odds ratio 1.36 per decade; mean age 52.6 years)
(2) tumor size > 2 cm (hazard ratio 2.8)
(3) regional disease (hazard ratio 4.8): extrathyroidal extension or regional lymph node metastases)
(4) distant metastases (hazard ratio 21.1)
(6) administration of external beam radiotherapy (hazard ratio 2.1) or other non-radioactive iodine radiotherapy (hazard ratio 4.0)
Reoperation did not increase the risk of mortality.
