Background: The optimal surgical approach for localized T1 medullary thyroid cancer remains unclear. Total thyroidectomy is standard, but lobectomy and subtotal thyroidectomy may minimize mortality while maintaining oncologic control. Methods: This retrospective analysis utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results registry to identify 2702 MTC patients including 398 patients with T1N0/1M0 MTC treated with total thyroidectomy or lobectomy/subtotal thyroidectomy from 2000 to 2019. Cox regression analyses assessed thyroid cancer-specific and overall mortality. Results: The majority (89.7%) underwent total thyroidectomy, while 10.3% had lobectomy/subtotal thyroidectomy. Nodal metastases were present in 29.6%. Over a median follow-up of 8.75 years, no significant difference was observed in cancer-specific mortality (5.7% vs. 8.1%,p= 0.47) or overall mortality (13.2% vs. 12.8%,p= 0.95). On multivariate analysis, undergoing cancer-directed surgery was associated with significantly improved overall survival (HR 0.18,p< 0.001) and cancer-specific survival (HR 0.17,p< 0.001) compared to no surgery. However, no significant survival difference was seen between total thyroidectomy and lobectomy/subtotal thyroidectomy for overall mortality (HR 0.77,p= 0.60) or cancer-specific mortality (HR 0.44,p= 0.23). The extent of surgery also did not impact outcomes within subgroups stratified by age, gender, T stage, or nodal status. Delayed surgery >1 month after diagnosis was associated with worse overall survival (p= 0.012). Conclusions: For localized T1 MTC, lobectomy/subtotal thyroidectomy appears to achieve comparable long-term survival to total thyroidectomy in this population-based analysis. The selective use of limited thyroidectomy may be reasonable for low-risk T1N0/1M0 MTC patients. Delayed surgery is associated with worse survival and additional neck dissection showed no benefit for this select group of patients.
背景：局限性T1期甲状腺髓样癌的最佳手术方式尚未明确。全甲状腺切除术是标准术式，但腺叶切除术及次全甲状腺切除术在保证肿瘤控制的同时可能降低死亡率。方法：本回顾性研究利用美国国家癌症研究所监测、流行病学和最终结果数据库，筛选2000年至2019年间接受全甲状腺切除术或腺叶/次全甲状腺切除术的398例T1N0/1M0期MTC患者（共纳入2702例MTC患者）。采用Cox回归分析评估甲状腺癌特异性死亡率及总死亡率。结果：大多数患者（89.7%）接受全甲状腺切除术，10.3%接受腺叶/次全甲状腺切除术。29.6%存在淋巴结转移。中位随访8.75年期间，两组在癌症特异性死亡率（5.7% vs. 8.1%，p=0.47）和总死亡率（13.2% vs. 12.8%，p=0.95）方面均无显著差异。多变量分析显示，与未手术相比，接受癌症导向手术可显著改善总生存期（HR 0.18，p<0.001）和癌症特异性生存期（HR 0.17，p<0.001）。但全甲状腺切除术与腺叶/次全甲状腺切除术在总死亡率（HR 0.77，p=0.60）和癌症特异性死亡率（HR 0.44，p=0.23）方面均无显著生存差异。按年龄、性别、T分期或淋巴结状态分层的亚组分析中，手术范围也未影响预后。诊断后延迟手术>1个月与较差的总生存期相关（p=0.012）。结论：基于人群数据分析显示，对于局限性T1期MTC，腺叶/次全甲状腺切除术可获得与全甲状腺切除术相当的长期生存率。对低风险T1N0/1M0期MTC患者选择性采用局限性甲状腺切除术可能是合理的。延迟手术与较差的生存率相关，而额外颈部淋巴结清扫术对该特定患者群体未见获益。
肿瘤(癌症)患者之家