ETA2024 Poster Presentations Medullary thyroid cancer-1 (10 abstracts)
Trends in the incidence, organization of care, and treatment of medullary thyroid cancer in the netherlands over the last three decades: a population-based study
Eline Jager 1 , Madelon Metman 2 , Inger Timmenga 3 , Wouter Zandee 3 , Liesbeth Jansen 2 , Bettien van Hemel 4 , Lutske Lodewijk 5 , Menno Vriens 5 , Medard van den Broek 6 , Anton Engelsman 7 , Koen Dreijerink 8 , Romana Netea-Maier 9 , Tessa van Ginhoven 10 , Robin Peeters 11 , Eline de Heus 12 , Thera Links 3 & Schelto Kruijff 2
1University Medical Center Groningen, Endocrinology / Surgical Oncology, Groningen, Netherlands; 2Department of Surgery, Division of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands; 3Department of Internal Medicine, Division of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands; 4Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands; 5Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; 6Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; 7Department of Surgery, Amsterdam University Medical Centers, Location Vumc, Cancer Center Amsterdam, Amsterdam, The Netherlands; 8Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Location Vu University, Cancer Center Amsterdam, Amsterdam, The Netherlands; 9Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, The Netherlands; 10Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus Mc Cancer Institute, Rotterdam, The Netherlands; 11Department of Endocrinology, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, The Netherlands; 12Department of Research and Development, Netherlands Comprehensive Cancer Organisation (Iknl), Utrecht, The Netherlands
Introduction: The worldwide incidence of thyroid cancer has shown a steady incline over the past 35 years. While differentiated thyroid cancers are mostly responsible for this increase, population-based studies also show elevated medullary thyroid cancer (MTC) incidence rates. MTC is a rare, C-cell derived thyroid cancer, with a variable disease course that challenges treatment and follow-up. To enable adequate care of this rare cancer, international guidelines and centralization are of vital importance.
Objectives: Describe trends in the incidence, organization of care, surgical treatment and subsequent outcomes of MTC over 30 years in The Netherlands.
Methods: All patients with a histological MTC diagnosis between 1989 and 2018 were identified from the Netherlands Cancer Registry (NCR), and linked to the Dutch Pathology register (PALGA). Incidence rates, relative to the Dutch population, were determined and evaluated over time. Clinicopathological parameters and extent of lymph node surgery were extracted from PALGA pathology reports. Period A (1989 – 1998), period B (1999 – 2008) and period C (2009 – 2018) were compared.
Results: Throughout the 30 years, the population-adjusted incidence of MTC remained stable with 0.17 ± 0.04 diagnoses per 100,000 people, per year (P = 0.247). Of all 795 patients, 426 (54%) were female and 504 (63%) were treated in an academic hospital, at a median age of 48 years (IQR 34 – 61). Age at diagnosis increased over time from 42 years (IQR 25 – 61) in period A to 52 years (IQR 42 – 63) in period C (P < 0.001). The proportion of treatments occurring in an academic hospital increased from 41% of patients in period A, to 58% and 86% in period B and C, respectively (both P < 0.001). At primary treatment, a lymph node dissection was performed in 582 (73%) patients. Of these patients, 88%, 36% and 20% underwent a central neck dissection (CND), unilateral neck dissection and bilateral neck dissection, respectively. A CND was performed more frequently in period B and C than in period A (P = 0.027, P = 0.009, respectively). Overall survival improved from period B to C and A to C (P = 0.022, P = 0.007, respectively). The rate of locoregional recurrences remained stable over time.
Conclusions: This study shows a stable incidence of MTC in the Dutch population, over the last three decades. In addition, these data indicate a transition of treatment to academic hospitals, possibly resulting in better adherence to international consensus guidelines that advise prophylactic dissection of the central neck.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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