Analysis Of Clinical Features And Prognostic Factors Of Sporadic Medullary Thyroid Carcinoma

Objective:By collecting and summarizing the diagnosis and treatment information of patients with medullary thyroid carcinoma(MTC),exploring the clinical characteristics of sporadic medullary thyroid carcinoma,analyzing the clinical efficacy of different procedures and related prognostic factors of MTC patients,to provide some experience for the future clinical management of patients.Methods:The clinical and follow-up data of 50 patients with sporadic medullary thyroid carcinoma admitted to the Second Hospital of Jilin University from April 2009 to December 2019 were retrospectively analyzed,and the patient's age,gender,smoking history,maximum tumor diameter,multi-foci,invasion of the cyst,cervical lymph node metastasis,distant metastasis,surgical method,serological examination level,other thyroid diseases,and postoperative recurrence and metastasis were calculated.Kaplan-Meier method was used to calculate the survival rate,and the risk factors affecting prognosis were discussed by univariate and multivariate statistical methods.Results:1.The 3-year and 5-year overall survival rates of 50 patients with sporadic MTC were 93.9% and 87.2%,respectively.There was no significant difference in the curative effect of the affected side thyroidectomy,contralateral partial resection,subtotal resection,near-total resection and total thyroidectomy among the patients with sporadic MTC,and the difference in the postoperative survival rate was not statistically significant(P=0.467).There was no statistically significant difference inthe postoperative survival rate in the range of cervical lymph node dissection(P=0.556).Total thyroidectomy was performed in 11 and partial thyroidectomy in 12 of the 23 cases of medullary thyroid microcarcinoma.The largest diameter of the lesion was less than 0.5cm in 6 patients,and no cervical lymph node metastasis was found.the 3-year and 5-year survival rate was 100%,and only one patient with primary lesion1.0cm and capsule invasion received secondary surgical treatment due to recurrence.2.Univariate analysis showed that the maximum diameter of the lesion(c 2=10.272,P=0.001),breakthrough capsule(c 2=9.981,P=0.002),cervical lymph node metastasis(c2=11.108,P=0.001),distant metastasis(c2=21.611,P=0.000)and clinical stage(c2=9.296,P=0.026)were the relevant factors affecting the prognosis.Cox multivariate model analysis showed that only distant metastasis was an independent risk factor affecting the prognosis of patients(HR=29.443,95%CI=3.275~264.666,P=0.003).Conclusions:1.The surgical methods and excision range of thyroid did not affect the prognosis of patients with sporadic MTC in statistical significance.The selection of surgical plan should comprehensively consider the size of the lesion,whether it is single,calcitonin level,the patient's intention and other indicators.It is suggested that when the lesion of diffuse medullary thyroid microcarcinoma(especially the lesion <0.5cm)is confined to one side,the sweep of the affected side glandular lobe + isthmus+ central area can be considered as the basic operation.2.Distant metastasis is an independent risk factor affecting the prognosis of sporadic MTC patients.The occurrence of distant metastasis will significantly shorten the survival period of patients,and early diagnosis and early intervention can improve the prognosis of patients.