Evaluation of Survival and Postoperative Radiation Among Patients with Advanced Medullary Thyroid Carcinoma: An Analysis of the National Cancer Database.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
13
08
2021
accepted:
15
11
2021
pubmed:
25
1
2022
medline:
24
3
2022
entrez:
24
1
2022
Statut:
ppublish
Résumé
This study compared survival between patients who had medullary thyroid cancer (MTC) treated with surgery alone and patients who underwent surgery and radiation (SRT). Patients from the National Cancer Database (NCDB) with a diagnosis of stage 3 or 4 MTC, lymph node disease, and no distant metastases between 2008 and 2016 were studied. Kaplan-Meier analyses and log-rank statistics were used to estimate and compare overall survival between patients treated with surgery alone and those treated with SRT. Mutlivariable Cox proportional hazards models and propensity-matching were used to adjust for confounding and selection bias. Among 1370 patients, 1112 (81%) received surgery alone, and 258 (19%) received SRT. The hazard ratio for mortality in the SRT group was 1.784 (95% confidence interval [CI] 1.313-2.43) after multivariable adjustment for confounding variables. Furthermore, SRT remained associated with a higher mortality rate (p < 0.008) after propensity-matching in an effort to adjust for selection bias. This analysis of NCDB patients showed that SRT is associated with a significantly higher mortality rate among patients treated for stage 3 or 4 IV MTC with positive lymph node disease. Although this observation can be attributed to unmeasured confounders or selection bias, the cause for the profound survival differences deserves prospective evaluation, especially as adjuvant therapies for this disease continue to evolve.
Sections du résumé
BACKGROUND
BACKGROUND
This study compared survival between patients who had medullary thyroid cancer (MTC) treated with surgery alone and patients who underwent surgery and radiation (SRT).
METHODS
METHODS
Patients from the National Cancer Database (NCDB) with a diagnosis of stage 3 or 4 MTC, lymph node disease, and no distant metastases between 2008 and 2016 were studied. Kaplan-Meier analyses and log-rank statistics were used to estimate and compare overall survival between patients treated with surgery alone and those treated with SRT. Mutlivariable Cox proportional hazards models and propensity-matching were used to adjust for confounding and selection bias.
RESULTS
RESULTS
Among 1370 patients, 1112 (81%) received surgery alone, and 258 (19%) received SRT. The hazard ratio for mortality in the SRT group was 1.784 (95% confidence interval [CI] 1.313-2.43) after multivariable adjustment for confounding variables. Furthermore, SRT remained associated with a higher mortality rate (p < 0.008) after propensity-matching in an effort to adjust for selection bias.
CONCLUSIONS
CONCLUSIONS
This analysis of NCDB patients showed that SRT is associated with a significantly higher mortality rate among patients treated for stage 3 or 4 IV MTC with positive lymph node disease. Although this observation can be attributed to unmeasured confounders or selection bias, the cause for the profound survival differences deserves prospective evaluation, especially as adjuvant therapies for this disease continue to evolve.
Identifiants
pubmed: 35067791
doi: 10.1245/s10434-021-11158-9
pii: 10.1245/s10434-021-11158-9
pmc: PMC8940671
mid: NIHMS1775109
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2582-2591Subventions
Organisme : NCI NIH HHS
ID : 2K12 CA132783-06
Pays : United States
Organisme : NIDCR NIH HHS
ID : K23 DE027425
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1TR001073
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001073
Pays : United States
Organisme : NCI NIH HHS
ID : K12 CA132783
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002556
Pays : United States
Informations de copyright
© 2022. Society of Surgical Oncology.
Références
Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363–85. https://doi.org/10.3322/caac.21565. .
doi: 10.3322/caac.21565.
pubmed: 31184787
Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25:567–610. https://doi.org/10.1089/thy.2014.0335 .
doi: 10.1089/thy.2014.0335
pubmed: 25810047
pmcid: 4490627
Nose V. Familial thyroid cancer: a review. Mod Path. 2011;24(Suppl 2):S19-33. https://doi.org/10.1038/modpathol.2010.147 .
doi: 10.1038/modpathol.2010.147
Adam MA, Thomas S, Roman SA, Hyslop T, Sosa JA. Rethinking the current American Joint Committee on Cancer TNM staging system for medullary thyroid cancer. JAMA Surg. 2017;152:869–76. https://doi.org/10.1001/jamasurg.2017.1665 .
doi: 10.1001/jamasurg.2017.1665
pubmed: 28636692
pmcid: 5710458
Machens A, Dralle H. Prognostic impact of N staging in 715 medullary thyroid cancer patients: proposal for a revised staging system. Ann Surg. 2013;257:323–9. https://doi.org/10.1097/SLA.0b013e318268301d .
doi: 10.1097/SLA.0b013e318268301d
pubmed: 22968075
Haddad RI, Nasr C, Bischoff L, et al. NCCN Guidelines insights: thyroid carcinoma, version 2.2018. JNCCN J Natl Comp Cancer Network. 2018;16:1429–40. https://doi.org/10.6004/jnccn.2018.0089 .
Fife KM, Bower M, Harmer CL. Medullary thyroid cancer: the role of radiotherapy in local control. Eur J Surg Oncol. 1996;22:588–91.
doi: 10.1016/S0748-7983(96)92294-5
Brierley J, Tsang R, Simpson WJ, Gospodarowicz M, Sutcliffe S, Panzarella T. Medullary thyroid cancer: analyses of survival and prognostic factors and the role of radiation therapy in local control. Thyroid. 1996;6:305–10. https://doi.org/10.1089/thy.1996.6.305 .
doi: 10.1089/thy.1996.6.305
pubmed: 8875751
Schwartz DL, Rana V, Shaw S, et al. Postoperative radiotherapy for advanced medullary thyroid cancer–local disease control in the modern era. Head Neck. 2008;30:883–8. https://doi.org/10.1002/hed.20791 .
doi: 10.1002/hed.20791
pubmed: 18213725
Martinez SR, Beal SH, Chen A, Chen SL, Schneider PD. Adjuvant external beam radiation for medullary thyroid carcinoma. J Surg Oncol. 2010;102:175–8. https://doi.org/10.1002/jso.21557 .
doi: 10.1002/jso.21557
pubmed: 20648590
pmcid: 2908956
Moses LE, Oliver JR, Rotsides JM, Shao Q, Patel KN, Morris LGT, Givi B. Nodal disease burden and outcome of medullary thyroid carcinoma. Head Neck. 2021;43(2):577–84. https://doi.org/10.1002/hed.26511 .
doi: 10.1002/hed.26511
pubmed: 33107153
Call JA, Caudill JS, McIver B, Foote RL. A role for radiotherapy in the management of advanced medullary thyroid carcinoma: the Mayo Clinic experience. Rare Tumors. 2013;5:e37. https://doi.org/10.4081/rt.2013.e37 .
doi: 10.4081/rt.2013.e37
pubmed: 24179649
pmcid: 3804812
Rowell NP. The role of external beam radiotherapy in the management of medullary carcinoma of the thyroid: a systematic review. Radiother Oncol. 2019;136:113–20. https://doi.org/10.1016/j.radonc.2019.03.033 .
doi: 10.1016/j.radonc.2019.03.033
pubmed: 31015112
In H, Bilimoria KY, Stewart AK, et al. Cancer recurrence: an important but missing variable in national cancer registries. Ann Surg Oncol. 2014;21:1520–9. https://doi.org/10.1245/s10434-014-3516-x .
doi: 10.1245/s10434-014-3516-x
pubmed: 24504926
Strojan P, Hutcheson KA, Eisbruch A, et al. Treatment of late sequelae after radiotherapy for head and neck cancer. Cancer Treat Rev. 2017;59:79–92. https://doi.org/10.1016/j.ctrv.2017.07.003 .
doi: 10.1016/j.ctrv.2017.07.003
pubmed: 28759822
pmcid: 5902026
Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26:3770–6. https://doi.org/10.1200/jco.2007.14.6647 .
doi: 10.1200/jco.2007.14.6647
pubmed: 18669465
Machtay M, Moughan J, Trotti A, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26:3582–9. https://doi.org/10.1200/jco.2007.14.8841 .
doi: 10.1200/jco.2007.14.8841
pubmed: 18559875
pmcid: 4911537
Rose BS, Jeong JH, Nath SK, Lu SM, Mell LK. Population-based study of competing mortality in head and neck cancer. J Clin Oncol. 2011;29:3503–9. https://doi.org/10.1200/jco.2011.35.7301 .
doi: 10.1200/jco.2011.35.7301
pubmed: 21844503
Mell LK, Dignam JJ, Salama JK, et al. Predictors of competing mortality in advanced head and neck cancer. J Clin Oncol. 2010;28:15–20. https://doi.org/10.1200/jco.2008.20.9288 .
doi: 10.1200/jco.2008.20.9288
pubmed: 19933920
Gujral DM, Chahal N, Senior R, Harrington KJ, Nutting CM. Radiation-induced carotid artery atherosclerosis. Radiother Oncol. 2014;110:31–8. https://doi.org/10.1016/j.radonc.2013.08.009 .
doi: 10.1016/j.radonc.2013.08.009
pubmed: 24044796
Arthurs E, Hanna TP, Zaza K, Peng Y, Hall SF. Stroke after radiation therapy for head and neck cancer: what is the risk? Int J Radiat Oncol Biol Phys. 2016;96:589–96. https://doi.org/10.1016/j.ijrobp.2016.07.007 .
doi: 10.1016/j.ijrobp.2016.07.007
pubmed: 27681754
Carpenter DJ, Mowery YM, Broadwater G, et al. The risk of carotid stenosis in head and neck cancer patients after radiation therapy. Oral Oncol. 2018;80:9–15. https://doi.org/10.1016/j.oraloncology.2018.02.021 .
doi: 10.1016/j.oraloncology.2018.02.021
pubmed: 29706194
pmcid: 6827433
Dorresteijn LD, Kappelle AC, Boogerd W, et al. Increased risk of ischemic stroke after radiotherapy on the neck in patients younger than 60 years. J Clin Oncol. 2002;20:282–8. https://doi.org/10.1200/jco.2002.20.1.282 .
doi: 10.1200/jco.2002.20.1.282
pubmed: 11773180
Gild ML, Tsang VHM, Clifton-Bligh RJ, Robinson BG. Multikinase inhibitors in thyroid cancer: timing of targeted therapy. Nat Rev Endocrinol. 2021;17:225–34. https://doi.org/10.1038/s41574-020-00465-y .
doi: 10.1038/s41574-020-00465-y
pubmed: 33603220
Wirth LJ, Sherman E, Robinson B, et al. Efficacy of selpercatinib in RET-altered thyroid cancers. N Engl J Med. 2020;383:825–35. https://doi.org/10.1056/NEJMoa2005651 .
doi: 10.1056/NEJMoa2005651
pubmed: 32846061
Jozaghi Y, Zafereo M, Williams MD, et al. Neoadjuvant selpercatinib for advanced medullary thyroid cancer. Head Neck. 2021;43:E7-12. https://doi.org/10.1002/hed.26527 .
doi: 10.1002/hed.26527
pubmed: 33169506