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Outcomes of Advanced Medullary Thyroid Carcinoma in the Era of Targeted Therapy

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Medullary thyroid carcinoma (MTC) can be targeted with tyrosine kinase inhibitors (TKIs). We aimed to report the outcomes of surgically managed MTC and to evaluate the impact of TKI use on patient survival.

Methods

Consecutive patients treated surgically for MTC from 1986 to 2020 were identified from a prospectively collected database and were compared on the basis of stage at operation and TKI use. The primary outcome was overall survival (OS).

Results

Among 154 patients with a median age of 52 years, 40% presented with stage I/II disease and 60% presented with advanced (stage III or IV) disease. During a median follow-up of 7.5 years, 21% received TKIs for systemic disease. Those presenting with advanced disease were more likely to receive a TKI (31% vs. 7%), present with tumor invasion of the recurrent laryngeal nerve (RLN; 12% vs. 0%) and undergo reoperation (42% vs. 23%) compared with stage I–II patients. For the 11 patients found to have invasion of the RLN, five had preoperative functional vocal cords. Five-year OS was 84% for advanced disease, and stage IV patients who received TKIs had a median survival of 21 years, versus 15 years for those who did not (p = 0.3).

Conclusions

Surgery achieves long-term survival for patients with advanced disease, however these patients are at greater risk of requiring RLN resection due to invasion. A significant OS benefit was not seen for TKI use. For patients with local invasion, neoadjuvant TKI therapy may have a role in reducing local morbidity if confirmed to be of benefit in clinical trials.

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Authors and Affiliations

  1. Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia

    Nicholas L. Kesby, Alexander J. Papachristos MBBS (Hons), Ahmad Aniss BSc, MSc, PhD, Mark S. Sywak MBBS, MMed (Clin Epi), Stan B. Sidhu MBBS (Hons), PhD & Anthony R. Glover MBBS, PhD

  2. Faculty of Medicine, Garvan Institute of Medical Research, Endocrine Cancer Program, The Kinghorn Cancer Centre and St. Vincent’s Clinical School, University of New South Wales, Sydney, NSW, Australia

    Nicholas L. Kesby & Anthony R. Glover MBBS, PhD

  3. Faculty of Medicine and Health, Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia

    Matti Gild BSc, MBBS (Hons), PhD, Mark S. Sywak MBBS, MMed (Clin Epi), Roderick Clifton-Bligh BSc (Med), MBBS (Hons), PhD, Stan B. Sidhu MBBS (Hons), PhD & Anthony R. Glover MBBS, PhD

  4. Hormones and Cancer Group, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia

    Matti Gild BSc, MBBS (Hons), PhD, Roderick Clifton-Bligh BSc (Med), MBBS (Hons), PhD & Stan B. Sidhu MBBS (Hons), PhD

  5. Department of Endocrinology, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia

    Matti Gild BSc, MBBS (Hons), PhD & Roderick Clifton-Bligh BSc (Med), MBBS (Hons), PhD

Authors
  1. Nicholas L. Kesby
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  2. Alexander J. Papachristos MBBS (Hons)
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  3. Matti Gild BSc, MBBS (Hons), PhD
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  4. Ahmad Aniss BSc, MSc, PhD
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  5. Mark S. Sywak MBBS, MMed (Clin Epi)
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  6. Roderick Clifton-Bligh BSc (Med), MBBS (Hons), PhD
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  7. Stan B. Sidhu MBBS (Hons), PhD
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  8. Anthony R. Glover MBBS, PhD
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Corresponding author

Correspondence to Anthony R. Glover MBBS, PhD.

Ethics declarations

Roderick Clifton-Bligh has participated in advisory boards and speaker bureaus for Amgen and Eisai. Nicholas L. Kesby, Alexander J. Papachristos, Matti Gild, Ahmad Aniss, Mark S. Sywak, Stan B. Sidhu, and Anthony R. Glover have no conflicts of interest to declare.

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Kesby, N.L., Papachristos, A.J., Gild, M. et al. Outcomes of Advanced Medullary Thyroid Carcinoma in the Era of Targeted Therapy. Ann Surg Oncol 29, 64–71 (2022). https://doi.org/10.1245/s10434-021-10980-5

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  • DOI: https://doi.org/10.1245/s10434-021-10980-5

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