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

作者：Xiao Shi, Cenkai Shen, Chuqiao Liu, Likun Zhang, Yuxin Du, Hao Zhang, Hongwei Liu, Jianbiao Wang, Chuang Chen, Yijun Wu, Chunyan Zhang, Zimeng Li, Haitao Tang, Min Yin, Xiaoqi Mao, Shuyi Liu, Yaoting Sun, Yan Zhou, Wen‐Jun Wei, Naisi Huang, Zhihong Wang, Zhiqiang Gui, Hanqing Liu, Jiaxi Wang, Jian Li, Cuiwei Li, Shiyu Xiang, Liang Guo, Yan Zhang, Yi He, Tiannan Guo, Qinghai Ji, Zhiyan Liu, Yu Wang · 发表于：Journal of the National Comprehensive Cancer Network · 年份：2025 · DOI：10.6004/jnccn.2024.7088 · 被引用次数：17 · 研究领域：Thyroid and Parathyroid Surgery、Thyroid Cancer Diagnosis and Treatment、Head and Neck Anomalies

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 wer...