Disease-free survival and the prognostic factors affecting disease-free survival in patients with medullary thyroid carcinoma: a multicenter cohort study
Sayid Shafi Zuhur, Beyza Olcay Ozturk, Gulsah Elbuken, Umran Keskin, Mazhar Muslum Tuna, Serhat Uysal, Pinar Kadioglu, Sait Gonen, Aysa Hacioglu, Zuleyha Karaca, Ugur Avci, Seda Karsli, Sema Ciftci, Burak Andac, Mehmet Celik, Sibel Guldiken, Umit Nur Ozbay, Dilek Tuzun, Faruk Kilinc, Selvinaz Erol, Yuksel Altuntas, Merve Catak, Hulyanur Sodan, Mujde Akturk, Zafer Pekkolay, Sebnem Burhan, Mutlu Niyazoglu, Gulhan Akbaba, Nese Cinar, Coskun Ates, Ozen Oz Gul, Goknur Yorulmaz, Medine Nur Kebapci, Aysen Akalin, Sakin Tekin, T Bayraktaroglu, Birol Topcu
article (Uluslararası, Hakemli) | Yazar(lar): Sayid Shafi Zuhur, Beyza Olcay Ozturk, Gulsah Elbuken, Umran Keskin, Mazhar Muslum Tuna, Serhat Uysal, Pinar Kadioglu, Sait Gonen, Aysa Hacioglu, Zuleyha Karaca, Ugur Avci, Seda Karsli, Sema Ciftci, Burak Andac, Mehmet Celik, Sibel Guldiken, Umit Nur Ozbay, Dilek Tuzun, Far
Purpose Despite several factors that may have been associated with poor disease-free survival (DFS) in patients with medullary thyroid carcinoma (MTC), only a few studies have evaluated the prognostic factors affecting DFS in MTC patients. Therefore, this study evaluated the prognostic factors affecting DFS, in a large number of patients with MTC. Methods Patients treated for MTC were retrospectively analyzed. Patients were stratified as having persistent/recurrent disease and no evidence of disease (NOD) at the last follow-up. The factors affecting DFS after the initial therapy and during the follow-up period were investigated. Results This study comprised 257 patients [females 160 (62.3%), hereditary disease 48 (18.7%), with a mean follow-up time of 66.8 +/- 48.5 months]. Persistent/recurrent disease and NOD were observed in 131 (51%) and 126 (49%) patients, respectively. In multivariate analysis, age > 55 (HR: 1.65, p = 0.033), distant metastasis (HR: 2.41, p = 0.035), CTN doubling time (HR: 2.7, p = 0.031), and stage III vs. stage II disease (HR 3.02, p = 0.048) were independent predictors of persistent/recurrent disease. Although 9 (8%) patients with an excellent response after the initial therapy experienced a structural recurrence, the absence of an excellent response was the strongest predictor of persistent/recurrent disease (HR: 5.74, p < 0.001). Conclusions The absence of an excellent response after initial therapy is the strongest predictor of a worse DFS. However, a significant proportion of patients who achieve an excellent response could experience a structural recurrence. Therefore, careful follow-up of patients, including those achieving an excellent response is essential.