Hemithyroidectomy Versus Total Thyroidectomy for Sporadic Medullary Thyroid Cancer: A Chinese Nationwide Large-Scale Cohort Study

Authors:
Xiao Shi Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Cenkai Shen Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Chuqiao Liu Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Likun Zhang Department of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Yuxin Du Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Hao Zhang Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China

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Hongwei Liu Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China

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Jianbiao Wang Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Chuang Chen Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China

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Yijun Wu Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Chunyan Zhang Department of Pathology, Affiliated Hospital of Jining Medical University, Jining, China

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Zimeng Li Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Haitao Tang Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Min Yin Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Xiaoqi Mao Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Shuyi Liu Department of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Yaoting Sun Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Research Center for Industries of the Future, School of Medicine, School of Life Sciences, Westlake University, Hangzhou, China

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Yan Zhou Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Research Center for Industries of the Future, School of Medicine, School of Life Sciences, Westlake University, Hangzhou, China

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Wenjun Wei Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Naisi Huang Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Zhihong Wang Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China

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Zhiqiang Gui Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning, China

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Hanqing Liu Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China

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Jiaxi Wang Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China

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Jian Li Department of Head and Neck Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China

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Cuiwei Li Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

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Shiyu Xiang Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China

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Liang Guo Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China

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Yan Zhang Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China

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Yi He Department of Urology, The Second Hospital of Dalian Medical University, Dalian, China

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Tiannan Guo Westlake Center for Intelligent Proteomics, Westlake Laboratory of Life Sciences and Biomedicine, Research Center for Industries of the Future, School of Medicine, School of Life Sciences, Westlake University, Hangzhou, China

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Qinghai Ji Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Zhiyan Liu Department of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Yu Wang Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

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Volume/Issue:
Volume 23: Issue 3
Online Publication Date:
07 Feb 2025
DOI:
https://doi.org/10.6004/jnccn.2024.7088
Restricted access

Background: Medullary thyroid cancer (MTC) is a rare thyroid malignancy, with 70% to 80% of cases being sporadic (sMTC). Current guidelines recommend total thyroidectomy (TT) for all preoperatively suspicious sMTC, though there has been increasing support for reducing the surgical extent in recent years. However, relevant data are limited. This study aimed to comprehensively evaluate the safety of hemithyroidectomy (HT) in sMTC. Patients and Methods: This study included 797 patients with MTC who received curative-intent initial surgery at 19 participating referral centers. Genetic testing was performed to identify disease heredity. We evaluated the safety of HT in sMTC across 5 aspects: (1) prevalence of occult bilateral foci, (2) prevalence of contralateral lobe recurrence, (3) biochemical response, (4) structural recurrence-free survival (SRFS), and (5) overall survival (OS). Results: Of the 797 patients, 648 were genetically confirmed as having sMTC. HT and TT were performed as the index surgery in 232 (35.8%) and 416 (64.2%) patients, respectively. In the TT group, bilateral foci were found in 34 (8.2%) patients, of whom only 10 (2.4%) had sonographically occult foci, and of these, only 3 (0.72%) had a maximal tumor size ≤2 cm. In the HT group, only 1.7% (4/232) had recurrence in the preserved lobe, with only 1 (0.43%) having a maximal tumor size ≤2 cm. After propensity score matching, 230 pairs of patients were included in further analysis. No significant differences were found in OS (log-rank: P=.484; Cox regression: P=.380), SRFS (log-rank: P=.914; Cox regression: P=.309), or biochemical response (chi-square: P=.744; logistic regression: P=.818) between the 2 groups. Subgroup analyses showed that HT conferred comparable structural and biochemical outcomes with TT in small (≤2 cm) sMTCs, even for patients with high-risk factors such as high preoperative calcitonin, multifocal disease, lymph node metastases, RET M918T mutation, and desmoplasia. Conclusions: For small unilateral sMTCs, HT may be considered an alternative treatment that does not compromise prognosis while avoiding additional complications associated with TT.

Submitted August 17, 2024; final revision received November 4, 2024; accepted for publication November 13, 2024. Published online February 7, 2025.

X. Shi, C. Shen, C. Liu, L. Zhang, and Y. Du contributed equally.

Author contributions: Conception & design: Y. Wang, Z. Liu, Q. Ji, T. Guo, X. Shi. Provision of study materials & patients: Y. Wu, Z. Liu, H. Zhang, H.W. Liu, J.B. Wang, C. Chen, Y. Wang, C. Zhang, L. Guo. Data analysis & interpretation: X. Shi, C. Shen, C. Liu, Y. Du, Z. Li, H. Tang, M. Yin, X. Mao, S. Liu. Development of methodology: X. Shi, C. Shen, C. Liu. Administrative support: Y. Wang, Z. Liu. Supervision: All authors. Writing—original draft: X. Shi, C. Shen, C. Liu, Y. Du. Writing—review & editing: X. Shi, Y. Sun, Y. Zhou, W. Wei, N. Huang, Z. Wang, Z. Gui, H.Q. Liu, J.X. Wang, J. Li, C. Li, S. Xiang, Y. Zhang, Y. He.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by funding from the National Natural Science Foundation of China (82072951, Y. Wang; 82373008 and 82002830, X. Shi) and Science and Technology Commission of Shanghai Municipality (22Y21900100 and 23DZ2305600, Y. Wang; 23ZR1412000, X. Shi), Shanghai Anticancer Association Foundation (SACA-AX202213, Y. Wang), and Shanghai Municipal Health Commission (WJWRC202302, X. Shi).

Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7088. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.

Correspondence: Yu Wang, MD, Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, 270 Dong’An Road, Xuhui District, Shanghai 200032, P.R. China. Email: neck130@sina.com;
Zhiyan Liu, MD, Department of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Xuhui District, Shanghai 200233, P.R. China. Email: zhiyanliu@shsmu.edu.cn;
Qinghai Ji, MD, Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, 270 Dong’An Road, Xuhui District, Shanghai 200032, P.R. China. Email: jq_hai@126.com; and
Tiannan Guo, PhD, Westlake Center for Intelligent Proteomics, Westlake University, 18 Shilongshan Road, Hangzhou 310024, P.R. China. Email: guotiannan@westlake.edu.cn

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Print ISSN:
1540-1405
Online ISSN:
1540-1413
Publisher:
National Comprehensive Cancer Network
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Copyright:
Copyright © 2025 by the National Comprehensive Cancer Network 2025
Page Numbers:
8
Article Category:
Research Article
Received:
17 Aug 2024
Accepted:
13 Nov 2024
Print Publication Date:
01 Mar 2025
Online Publication Date:
07 Feb 2025

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