Endocrine Abstracts (2017) 49 EP1374 | DOI: 10.1530/endoabs.49.EP1374

Trends in the clinicopathological features and clinical outcomes of medullary thyroid carcinoma - an Israeli multicenter study

Dania Hirsch1,8, Orit Twito2,8, Sigal Levy3, Gideon Bachar4,8, Eyal Robenshtok1,8, David J Gross5, Haggi Mazeh6 & Carlos Benbassat7,8

1Institute of Endocrinology, Rabin Medical Center, Petach Tikva, Israel; 2Institute of Endocrinology, Meir Medical Center, Kfar Saba, Israel; 3Sackler Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel; 4Department of Otorhinolaryngology, Rabin Medical Center, Petach Tikva, Israel; 5Neuroendocrine Tumor Unit, Endocrinology & Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; 6Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; 7Endocrine Institute, Assaf Harofeh Medical Center, Zerifin, Israel; 8Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: The massive use of neck sonography has led to a dramatic increase in the incidence of thyroid cancer detection, predominantly small papillary carcinomas. However, changes in the presentation and course of medullary thyroid carcinoma (MTC) over time remain unclear.

Objective: To evaluate trends in the presentation and outcomes of MTC.

Methods: Patients treated for MTC at four medical centers in Israel were divided into two groups by year of diagnosis, 1963–2005 (period A) and 2006–2016 (period B), and compared for clinicopathological variables.

Results: The cohort included 189 patients (55% female) of mean age 48.9±18.6 years followed for 10.1±9.4 years. Of these, 104 patients (55%) were diagnosed in period A, and 85 (45%) in period B. No significant between-group differences were found in primary tumor size at diagnosis (26.2±18.5 and 23.7±17.6 mm, respectively), proportion of micro-MTCs (<1 cm) (18/74, 24.3% and 19/75, 25.3%, respectively), or TNM staging. Period A was characterized by a higher rate of familial MTC (28/98, 28.6% vs 6/73, 8.2%; P=0.001) and lower age at diagnosis (45.2±18.6 years vs 53.7±17.7 years; P=0.002). Cervical lymph node dissection was more commonly performed in period B (58/81, 71.6% vs 68/80, 85%; P=0.05), but no concomitant increase in the rate of metastatic lymph node excision (46/64, 71.9% and 45/70, 64.3% respectively, P=0.36). There was no significant difference between groups A and B in disease-free-survival (DFS) at one year after diagnosis (34/87, 39.1% and 35/70, 50%, respectively P=0.2) or at last follow-up, comparing patients with similar surveillance periods (11/28, 39.3% and 36/75, 48%, P=0.5).

Conclusions: Unlike differentiated thyroid cancer, most presenting features of MTC have not changed in recent years. The most significant temporal change is a decreased rate of familial MTC. Despite the use of more extensive surgical procedures and new treatment modalities, there has not been significant improvement in disease-related outcomes.

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