Initial surgical management of sporadic medullary thyroid cancer: Guidelines based optimal care - A systematic review

IF 3 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM Clinical Endocrinology Pub Date : 2024-03-12 DOI:10.1111/cen.15041
Oded Cohen, Sharon Tzelnick, Gregory Randolph, Alessandra Rinaldo, Fernando Álvarez, Juan P. Rodrigo, Nabil F. Saba, Sandra Nuyts, June Corry, Antti A. Mäkitie, Vincent Vander Poorten, Cherie-Ann Nathan, Cesare Piazza, Alfio Ferlito
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Abstract

Introduction

Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor from parafollicular cells that produce calcitonin (Ct). Despite several existing guidelines for the surgical management of sporadic MTC (sMTC), optimal initial surgical management of the thyroid, the central and the lateral neck remains a matter of debate.

Methods

A systematic review in PubMed and Scopus for current guidelines addressing the surgical management of sMTC and its referenced citations was conducted as per the PRISMA guidelines.

Results

Two-hundred and one articles were identified, of which 7 met the inclusion criteria. Overall, guidelines vary significantly in their recommendations for the surgical management of sMTC. Only one guideline recommended partial thyroidectomy for limited disease, but the possibility to avoid completion thyroidectomy in selected cases is acknowledged in 42% (3/7) of the remaining guidelines. The majority of guidelines (71.4%; 5/7) recommended prophylactic central neck dissection (CND) for all patients while the remaining two guidelines recommended CND based on Ct level and tumor size. The role of prophylactic lateral neck dissection based on preoperative Ct levels was recommended by 42% (3/7) of guidelines. Overall, these guidelines are based on low-quality evidence, mostly single-center retrospective series, some of which are over 20 years old.

Conclusion

Current surgical management guidelines of sMTC should be revised, and ought to be based on updated data challenging current recommendations, which are based on historic, low-quality evidence. Partial thyroidectomy may become a viable option for small, limited tumors. Prospective, multi-center studies may be useful to conclude whether prophylactic ND is necessary in all sMTC patients.

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散发性甲状腺髓样癌的初始外科治疗:基于指南的最佳治疗--系统综述。
简介甲状腺髓样细胞癌(MTC)是一种罕见的神经内分泌肿瘤,其来源于能产生降钙素(Ct)的滤泡旁细胞。尽管已有一些关于散发性甲状腺髓样癌 (sMTC) 手术治疗的指南,但甲状腺、颈部中央和外侧的最佳初始手术治疗仍存在争议:方法:根据PRISMA指南,在PubMed和Scopus上对目前针对散发性MTC手术治疗的指南及其参考引文进行了系统性回顾:结果:共发现 201 篇文章,其中 7 篇符合纳入标准。总体而言,各指南对sMTC手术治疗的建议差异很大。只有一份指南建议对局限性疾病进行甲状腺部分切除术,但在其余42%(3/7)的指南中,都承认在选定病例中可以避免完整甲状腺切除术。大多数指南(71.4%;5/7)建议对所有患者进行预防性颈部中央切除术(CND),而其余两份指南则建议根据Ct水平和肿瘤大小进行颈部中央切除术。42%(3/7)的指南建议根据术前 Ct 水平进行预防性侧颈切除术。总体而言,这些指南所依据的证据质量较低,大多是单中心回顾性系列研究,其中一些研究的历史已超过20年:结论:目前的sMTC手术治疗指南应予以修订,并应基于最新数据,对目前基于历史性低质量证据的建议提出质疑。甲状腺部分切除术可能成为局限性小肿瘤的可行选择。前瞻性的多中心研究可能有助于确定是否有必要对所有 sMTC 患者进行预防性 ND。
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来源期刊
Clinical Endocrinology
Clinical Endocrinology 医学-内分泌学与代谢
CiteScore
6.40
自引率
3.10%
发文量
192
审稿时长
1 months
期刊介绍: Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.
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