| Background and objective: Medullary thyroid carcinoma is a malignant tumor derives from neuroendocrine system.It is also called C cell carcinoma.It is named for its origin from C cells near the follicle.As the origin of MTC is different from that of differentiated thyroid carcinoma(C cells migrate from the neural crest,and follicular cells are endodermal source),therefore,the clinical manifestations,treatment methods and prognosis of MTC are different from that of DTC.Since C cells can secrete special bioactive substances,the patients not only suffer voice hoarse,dysphagia and the neck neoplasm,but also suffer facial flushing,frequent diarrhea(?three times a day),pruritus universails and so on.of MTC is considered intermediate between differentiate thyroid neoplasms and anaplastic tumor.Since MTC has a different origin from DTC(C cells migrate from the neural crest,and follicular cells are endodermal source),the properties of MTC are different from that of DTC,the patients not only suffer voice hoarse,dysphagia and the neck neoplasm,but also suffer facial flushing,frequent diarrhea(?three times a day),pruritus universails and so on.Compared with DTC,the lymph node metastasis of medullary thyroid carcinoma is earlier,and more than 50% of patients with medullary thyroid carcinoma already have cervical lymph node metastasis at the time of seeing a doctor.The differences between MTC and DTC in treatment are that MTC are not sensitive to iodine-131 treatment and TSH inhibition therapy.Although the targeted drugs for medullary thyroid carcinoma have been proved to delay the disease progression in patients with advanced MTC and are effective for the treatment of advanced MTC,they have not been widely used in China due to their high price.So at present surgery become the only treatment for medullary thyroid carcinoma..In 2005,The American Thyroid Association clearly recommended the surgical method for medullary thyroid carcinoma and the scope of cervical lymph node dissection,However,domestic and foreign scholars still have disputes about the scope of neck lymph node dissection.The prognosis of medullary thyroid carcinoma is thought to be between DTC and ATC.Although there have been articles reported that cervical lymph node metastasis affects the disease free survival of patients with medullary thyroid carcinoma,many scholars have different conclusions through statistics.This study retrospective analyze relevant information of medullary thyroid carcinoma with cervical lymph node metastasis of patients,find the consequence that how cervical lymph node metastases affects the disease free survival of patients and found that what the related factors can influence cervical lymph node metastasis of medullary thyroid carcinoma to explain the importance of reasonable surgical scope and to provide relevant evidence for selecting a reasonable neck lymph node dissection area.Method: The clinical data and pathological data and Follow-up information of 50 patients with medullary thyroid carcinoma from January of 2010 to December of 2019 in the department of thyroid surgery of the first hospital of Jilin university were collected and analyzed retrospectively.Telephone follow-up and outpatient follow-up were adopted.By December 2019,the shortest follow-up time was 18 months and the longest was 118 months and the recurrence of MTC or death of patience was counted as the end of the follow-up.The survival of patients was analyzed by kaplan-meier method,and the log-rank test was used to compare the influence of cervical lymph node metastasis on survival of patients with medullary thyroid carcinoma.Single factor analysis with ?~2 test and binary logistic regression were applied to identify the clinicopathological features(age,sex,tumor size,capsule invasion,number of tumor foci,on both glands,with nodular goiter,with Hashimoto's thyroiditis,with papillary thyroid carcinoma)related to central cervical lymph node metastases.Single factor analysis with Fisher test was applied to identify the clinicopathological features(age,sex,tumor size,capsule invasion,number of tumor foci,on both glands,with nodular goiter,with Hashimoto's thyroiditis,with papillary thyroid carcinoma,central cervical lymph node metastases)related to lateral cervical lymph node metastases.Respectively analyzing the effect of carcino-embryonic antigen(CEA)and platelet-to-lymphocyte ratio(PLR)to lymph node metastases in patients with medullary thyroid carcinoma by drawing ROC curve.Result:(1)Cervical lymph node metastasis reduces disease-free survival(P=0.003).(2)membrane-invaded were independent risk factors for the central lymph node(?~2 =0.538,P=0.021)and lateral cervical lymph node(P=0.002)metastasis.(3)The central node metastasis rate of CEA>47.47ng/ml(11/12)was higher than the central node metastasis rate of CEA<47.47ng/l(3/13)(P=0.001).(4)The central lymph node metastasis rate(22/25)of PLR>110.23 higher than the central lymph node metastasis rate(16/25)of PLR<110.23,both of which were statistically significant(?~2 =3.947,P=0.047).Conclusion:(1)For patients with membrane-invaded medullary thyroid carcinoma,lymph node dissection should be excised in the central and lateral cervical regions of the affected side.(2)Complete removal of lymph nodes in the central and lateral cervical regions of the affected side during surgery can improve the patient's disease-free survival rate.(3)When CEA>47.47ng/ml or PLR>110.23,central lymph node metastasis was promoted. |
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