It is unknown whether familial non-medullary thyroid cancer (FNMTC) has more aggressive clinical features and a worse prognosis than sporadic non-medullary thyroid cancer (SNMTC).
We retrospectively reviewed 2894 patients with differentiated thyroid cancer who underwent primary thyroidectomy, identified 391 FNMTC cases, and compared the prevalence, surgical extension, and clinicopathologic features of FNMTC and SNMTC.
A family history of thyroid cancer was noted in 391 patients (13.5%), with 85% having two affected relatives and 15% with ≥3 affected relatives. A sibling was affected in 52.9% of cases, and in 47.1%, both parent and child were affected. There were no significant between-group differences in sex, age, tumor size, extrathyroidal extension, or central lymph node metastases. Significantly more patients with FNMTC exhibited multifocal disease (p = 0.020) or benign nodules (p = 0.015). Lateral neck lymph node metastases were noted in 6.6% (SNMTC) and 9.7% (FNMTC, p = 0.021) of patients. Multifocality and combined benign masses were more frequently observed in patients with FNMTC in multivariate analysis. In the FNMTC group, seven experienced disease recurrence, with no mortality noted during follow-up.
FNMTC is not more aggressive than SNMTC; however, FNMTC should be treated with total thyroidectomy because of the increased disease multifocality and the presence of benign nodules. Lateral neck lymph node metastases were more likely in patients with FNMTC, although we could not estimate prognosis. All patients with thyroid cancer should be checked for family disease history and undergo preoperative ultrasonography to determine the extent of node dissection and the need for total thyroidectomy.
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Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA 295:2164–2167
Ahn HS, Kim HJ, Welch HG (2014) Korea's thyroid-cancer “epidemic”—screening and overdiagnosis. N Engl J Med 371:1765–1767
Mazeh H, Sippel RS (2013) Familial nonmedullary thyroid carcinoma. Thyroid 23:1049–1056
Sippel RS, Caron NR, Clark OH (2007) An evidence-based approach to familial nonmedullary thyroid cancer: screening, clinical management, and follow-up. World J Surg 31:924–933. https://doi.org/10.1007/s00268-006-0847-1
Robinson DW, Orr TG (1955) Carcinoma of the thyroid and other diseases of the thyroid in identical twins. AMA Arch Surg 70:923–928
Sturgeon C, Clark OH (2005) Familial nonmedullary thyroid cancer. Thyroid 15:588–593
Park YJ, Ahn HY, Choi HS et al (2012) The long-term outcomes of the second generation of familial nonmedullary thyroid carcinoma are more aggressive than sporadic cases. Thyroid 22:356–362
Sung TY, Lee YM, Yoon JH et al (2015) Surgical management of familial papillary thyroid microcarcinoma: a single institution study of 94 cases. World J Surg 39:1930–1935. https://doi.org/10.1007/s00268-015-3064-y
Alsanea O, Clark OH (2001) Familial thyroid cancer. Curr Opin Oncol 13:44–51
Ito Y, Kakudo K, Hirokawa M et al (2009) Biological behavior and prognosis of familial papillary thyroid carcinoma. Surgery 145:100–105
Maxwell EL, Hall FT, Freeman JL (2004) Familial non-medullary thyroid cancer: a matched-case control study. Laryngoscope 114:2182–2186
Moses W, Weng J, Kebebew E (2011) Prevalence, clinicopathologic features, and somatic genetic mutation profile in familial versus sporadic nonmedullary thyroid cancer. Thyroid 21:367–371
Uchino S, Noguchi S, Kawamoto H et al (2002) Familial nonmedullary thyroid carcinoma characterized by multifocality and a high recurrence rate in a large study population. World J Surg 26:897–902. https://doi.org/10.1007/s00268-002-6615-y
Wang X, Cheng W, Li J et al (2015) Endocrine tumours: familial nonmedullary thyroid carcinoma is a more aggressive disease: a systematic review and meta-analysis. Eur J Endocrinol 172:R253–262
Charkes ND (2006) On the prevalence of familial nonmedullary thyroid cancer in multiply affected kindreds. Thyroid 16:181–186
McDonald TJ, Driedger AA, Garcia BM et al (2011) Familial papillary thyroid carcinoma: a retrospective analysis. J Oncol 2011:948786
Triponez F, Wong M, Sturgeon C et al (2006) Does familial non-medullary thyroid cancer adversely affect survival? World J Surg 30:787–793. https://doi.org/10.1007/s00268-005-0398-x
Charkes ND (1998) On the prevalence of familial nonmedullary thyroid cancer. Thyroid 8:857–858
Tavarelli M, Russo M, Terranova R et al (2015) Familial non-medullary thyroid cancer represents an independent risk factor for increased cancer aggressiveness: a retrospective analysis of 74 families. Front Endocrinol (Lausanne) 6:117
Alsanea O, Wada N, Ain K et al (2000) Is familial non-medullary thyroid carcinoma more aggressive than sporadic thyroid cancer? A multicenter series. Surgery 128:1043–1050 (discussion 1050–1041)
Robenshtok E, Tzvetov G, Grozinsky-Glasberg S et al (2011) Clinical characteristics and outcome of familial nonmedullary thyroid cancer: a retrospective controlled study. Thyroid 21:43–48
Loh KC, Lo JC, Greenspan FS et al (1997) Familial papillary thyroid cancer: a case report. Ann Acad Med Singap 26:503–506
Zhang Q, Yang S, Meng XY et al (2016) Clinical analysis of familial nonmedullary thyroid carcinoma. World J Surg 40:570–573. https://doi.org/10.1007/s00268-015-3342-8
Mazeh H, Benavidez J, Poehls JL et al (2012) In patients with thyroid cancer of follicular cell origin, a family history of nonmedullary thyroid cancer in one first-degree relative is associated with more aggressive disease. Thyroid 22:3–8
Capezzone M, Marchisotta S, Cantara S et al (2008) Familial non-medullary thyroid carcinoma displays the features of clinical anticipation suggestive of a distinct biological entity. Endocr Relat Cancer 15:1075–1081
Grossman RF, Tu SH, Duh QY et al (1995) Familial nonmedullary thyroid cancer. An emerging entity that warrants aggressive treatment. Arch Surg 130:892–897 (discussion 898–899)
Hay ID (1990) Papillary thyroid carcinoma. Endocrinol Metab Clin N Am 19:545–576
Mazzaferri EL (1987) Papillary thyroid carcinoma: factors influencing prognosis and current therapy. Semin Oncol 14:315–332
Pal T, Vogl FD, Chappuis PO et al (2001) Increased risk for nonmedullary thyroid cancer in the first degree relatives of prevalent cases of nonmedullary thyroid cancer: a hospital-based study. J Clin Endocrinol Metab 86:5307–5312
This work was funded by Ulsan University Hospital (Biomedical Research Center Promotion Fund 11-03).
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Kim, Y.S., Seo, M., Park, S.H. et al. Should Total Thyroidectomy Be Recommended for Patients with Familial Non-medullary Thyroid Cancer?. World J Surg (2020). https://doi.org/10.1007/s00268-020-05473-7