ECE2024 Poster Presentations Thyroid (58 abstracts)
Diagnosis and therapy of medullary thyroid cancer. A real-life, retrospective, multicentric, Hungarian study
Zsuzsánna Réti 1 , 2 , Judit Tőke 1 , Réka Balla 3 , Péter Reismann 1 , Kristóf Attila Kovács 4 , Zoltán Sápi 5 , Miklós Bodor 6 , Endre Nagy 6 , Gábor Iványi 7 , Zsuzsanna Valkusz 7 , Emese Mezosi 8 & Miklós Tóth 1
1Semmelweis University, Faculty of Medicine, Department of Internal Medicine and Oncology, Budapest, Hungary; 2George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of Medicine, Department of Endocrinology, Târgu Mure¸, Romania; 3Semmelweis University, Faculty of Medicine, Students’ Scientific Association, Budapest, Hungary; 4Semmelweis University, Faculty of Medicine, Department of Pathology, Forensic and Insurance Medicine, Budapest, Hungary; 5Semmelweis University, Faculty of Medicine, Department of Pathology and Experimental Cancer Research, Budapest, Hungary; 6University of Debrecen, Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Debrecen, Hungary; 7Albert Szent-Györgyi Medical School, University of Szeged, Department of Medicine, Szeged, Hungary; 8Medical School, University of Pécs, First Department of Medicine, Pécs, Hungary
Introduction: Medullary thyroid cancer (MTC) is a rare thyroid neoplasm arising from parafollicular C-cells secreting calcitonin. Although it possesses specific histological and biochemical markers, real-life diagnosis and management remain challenging.
Aim: A retrospective analysis of MTC patients from four Hungarian endocrine university centres over 23 years (2000-2023) was undertaken. Demographic data and biochemical markers, staging, germ-line RET mutation, intervention types, and monitoring through calcitonin-doubling time were analyzed.
Results: Data from 156 patients were collected from patient files. Bilateral disease was demonstrated in 26, 6% of patients, with 37, 5% having lymph node involvement at the time of diagnosis. Preoperative calcitonin was measured in 84, 2% of cases, and FNAB was performed in 72% of patients. Diagnosis of MTC based on preoperative cytology accounted for 67, 4% of cases. The use of preoperative diagnostics increased with time (P<0, 05). Nearly one-third of patients were diagnosed with advanced disease (stage IV). Total thyroidectomy and node dissection were performed in 53, 8%; this rate was higher following 2015 vs before (P<0.05). Progression of disease was recorded in 47, 8% of patients. Two, three and four neck dissections were performed in 43, 17 and 4 patients, respectively. In the first year after surgery, calcitonin measurements were available in 75% of patients. Forty-four patients (29.53%) were declared cured after the first surgery. Postoperative calcitonin doubling time less than two years was associated with significantly lower progression-free survival than calcitonin doubling time longer than two years (P<0.05). RET mutation analysis was performed in 73% of patients, and of these, 34, 2% were confirmed to have RET germ-line mutation, and the most frequent genetic alteration was on codon 634. In advanced disease, tyrosine kinase inhibitors were instituted in 35 cases. Disease progression and drug-induced adverse events were significantly more frequent with multikinase inhibitors as compared to that of selpercatinib (P<0.05).
Conclusion: Despite the progress and more widespread use in diagnostic procedures and recent advances in drug treatment options, there are still unmet needs in managing MTC. Preoperative calcitonin measurement is the best marker for diagnosis, although its routine use in screening is debated. FNAB alone is often not sufficient for exact preoperative diagnosis of MTC; completion with immunocytology or calcitonin measurement from the washout fluid could increase the sensitivity of preoperative biopsies. Surgery can be curative, mostly in local diseases. Advanced cases need an individualized approach. Recently, germ-line/somatic RET mutation analysis has become indispensable in choosing appropriate targeted medical treatment for MTC.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more