| BackgroundThyroid cancer is the most common endocrine gland malignancy,and the incidence has increased significantly in recent years.In developed countries,the incidence of thyroid cancer is 9.1 out of every 100,000 women,and 2.9 out of every100,000 men.Pathological types of thyroid cancer include:papillary thyroid carcinoma(PTC),follicular thyroid carcinoma(FTC),medullary thyroid carcinoma(MTC),and anaplastic thyroid carcinoma(ATC).Papillary thyroid carcinoma and follicular thyroid carcinoma are differentiated thyroid cancers,accounting for 90%of thyroid cancer.The prognosis is relatively good.Medullary thyroid carcinoma and anaplastic thyroid carcinoma are undifferentiated thyroid cancers with a low incidence,but the prognosis is relatively poor.In particular,anaplastic thyroid carcinoma is a rare advanced thyroid malignancy with a very poor prognosis.The mean median survival time is 5 months,and less than 20%of patients survive within 1 year after diagnosis.Medullary thyroid carcinoma is a neuroendocrine tumor of the thyroid gland derived from thyroid follicular cells(C cells).Medullary thyroid carcinoma accounts for 5%to 10%of all thyroid cancers,of which 75%are sporadic and 25%are hereditary.Calcitonin is a major secretion of medullary thyroid carcinoma and is a highly specific and sensitive biomarker.Carcinoembryonic antigen(CEA)is also produced by thyroid follicular cells.These molecules are widely used as prognostic markers during follow-up of MTC patients.The 10-year mortality rates reported for medullary thyroid carcinoma vary from 13.5%to 38%.In particular,medullary thyroid carcinoma with cervical lymph node metastasis is more likely to have local recurrence or distant metastasis,which increases the mortality rate of patients.ObjectiveCollect and analyze clinical relevant case data,explore the clinical features of medullary thyroid carcinoma,and further analyze the characteristics and risk factors of lymph node metastasis of medullary thyroid carcinoma to guide clinical work.MethodsRetrospective analysis of 84 cases of medullary thyroid carcinoma patients admitted to the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University from January 2012 to June 2018.All patients underwent preoperative ultrasonography(including assessment of thyroid region and bilateral neck),thyroid function,calcitonin level,neck and chest CT,some patients detected carcinoembryonic antigen levels,and patients with clinically suspected medullary thyroid carcinoma Fine needle aspiration cytology(FNAC).The following characteristics of each patient were recorded:age,sex,maximum tumor diameter,number of lesions,invasion of the capsule,and lymph node metastasis in the diagnosis of medullary thyroid carcinoma.Results84 patients ranged in age from 15 to 72 years with a median age of 50 years.There were 30 male patients and 54 female patients,with a male to female ratio of1:1.8.There were 34 cases of thyroid monofocal tumor and 50 cases of multifocal tumor.The largest tumor diameter is 0.2 to 7.5 cm,with an average of 1.9 cm.There were 29 cases of thyroid capsule invasion and 55 cases of no thyroid capsule invasion.56 patients had preoperative calcitonin>200 pg/mL,and 28 patients had preoperative calcitonin<200 pg/mL.18 patients were tested for carcinoembryonic antigen before surgery,8 patients had carcinoembryonic antigen>30 ng/mL,and 10 patients had carcinoembryonic antigen<30 ng/mL.48 patients had metastases in the central region,and 36 patients had no metastases in the central region.39 patients had metastases in the cervical region,and 45 patients had no metastases in the cervical region.Statistical analysis found that:1.The incidence of lymph node metastasis in the central region was≥1cm in tumor diameter(χ~2=4.196,P=0.041),multiple lesions(χ~2=5.946,P=0.015),thyroid capsule invasion(χ~2=15.277,P<0.001)patients significantly increased and the difference was statistically significant;the incidence of cervical lymph node metastasis was tumor diameter≥1cm(χ~2=5.269,P=0.022),multiple lesions(χ~2=4.550,P=0.033),thyroid capsule invasion(χ~2=19.253,P<0.001)was significantly higher in the patients and the difference was statistically significant.Logistic regression analysis showed that only thyroid capsule invasion was an independent risk factor for central lymph node metastasis(OR=7.551,P=0.001)and cervical lymph node metastasis(OR=8.067,P<0.001).2.Among the 84 patients who were tested for calcitonin before surgery,56 patients had preoperative calcitonin>200 pg/mL,cervical lymph node metastasis rate was 55.4%(31/56),and 28 patients had preoperative calcium reduction.The rate of cervical lymph node metastasis was28.6%(8/28),and the difference was statistically significant(χ~2=5.385,P=0.020).Among the 18 patients who detected carcinoembryonic antigen before surgery,8patients had carcinoembryonic antigen>30 ng/mL,cervical lymph node metastasis was 75%,and 10 patients had carcinoembryonic antigen<30 ng/mL.Lymph node metastasis was 60%.Conclusion1.Patients with medullary thyroid carcinoma have a high rate of cervical lymph node metastasis.If the tumor invades the thyroid capsule,cervical lymph node metastasis is more likely to occur.2.The elevation of calcitonin is closely related to the occurrence of medullary thyroid carcinoma.Patients with higher calcitonin levels are more likely to have cervical lymph node metastasis.3.Patients with higher levels of carcinoembryonic antigen may be more likely to develop cervical lymph node metastasis. |
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