Cohen R, Campos J M, Salaün C, Heshmati H M, Kraimps J L, Proye C, Sarfati E, Henry J F, Niccoli-Sire P, Modigliani E
Service d'Endocrinologie, Hôpital Avicenne, Université Paris XIII, Bobigny, France.
J Clin Endocrinol Metab. 2000 Feb;85(2):919-22. doi: 10.1210/jcem.85.2.6556.
Medullary thyroid carcinoma (MTC) is a calcitonin (CT)-secreting endocrine tumor. Although plasma CT level is a specific and sensitive marker of MTC, its preoperative usefulness in predicting tumor size and postoperative CT normalization has not been documented. From a nationwide database set up by the French CT Tumor Study Group, 226 MTC patients were selected according to the following criteria: preoperative CT level determination by an immunoradiometric assay (normal value, < 10 pg/mL) within the 6 months prior to surgery, total thyroidectomy and diagnosis of MTC ascertained by histological report including tumor size. Patients were 129 females and 97 males (female/male ratio, 1.3). One hundred and twelve patients (49.6%) had the sporadic variety of the disease, 74 (32.7%) had multiple endocrine neoplasia 2A, three (1.3%) had multiple endocrine neoplasia 2B, and 37 (16.4%) had familial MTC. Median age at diagnosis was 44.8 yr (range, 4.9-80.1 yr). Complete neck dissection was performed in 159 patients (70.4%). Postoperative CT normalization was ascertained by negative response of CT to pentagastrin stimulation (< 10 pg/mL) in 94 patients. Seventy-one patients were considered as not cured because of residual tumor tissue and/or elevated CT levels. Median tumor size was 11.0 mm (range, 0.2-80.0 mm), significantly larger in females (15.0 vs. 8.0 mm, P < 0.05), and in sporadic forms (15.0 vs. 7.0 mm, P < 0.05). Tumor size was significantly correlated (r2 = 0.52, P < 0.01) with preoperative CT levels, the relationship being more straight in familial (r2 = 0.71) than in sporadic (r2 = 0.36) forms. Furthermore, preoperative CT levels under 50 pg/mL appeared to be predictive of postoperative CT normalization (44 of 45 patients). However, higher CT levels did not mean absence of postoperative CT normalization (50 of 120 patients). We conclude that low preoperative CT levels are predictive of tumor size and postoperative CT normalization.
甲状腺髓样癌（MTC）是一种分泌降钙素（CT）的内分泌肿瘤。尽管血浆CT水平是MTC的一种特异性和敏感性标志物，但其术前在预测肿瘤大小及术后CT恢复正常方面的作用尚未见文献报道。从法国CT肿瘤研究组建立的全国性数据库中，根据以下标准选取了226例MTC患者：术前6个月内采用免疫放射分析测定CT水平（正常值，<10 pg/mL），行甲状腺全切除术，且经组织学报告确诊为MTC并包括肿瘤大小。患者中女性129例，男性97例（女/男比例为1.3）。112例患者（49.6%）为散发性MTC，74例（32.7%）为多发性内分泌腺瘤病2A，3例（1.3%）为多发性内分泌腺瘤病2B，37例（16.4%）为家族性MTC。诊断时的中位年龄为44.8岁（范围4.9 - 80.1岁）。159例患者（70.4%）行颈部完全清扫术。94例患者术后CT对五肽胃泌素刺激反应阴性（<10 pg/mL），确定CT恢复正常。71例患者因残留肿瘤组织和/或CT水平升高被认为未治愈。中位肿瘤大小为11.0 mm（范围0.2 - 80.0 mm），女性肿瘤明显更大（15.0 vs. 8.0 mm，P < 0.05），散发性MTC肿瘤也更大（15.0 vs. 7.0 mm，P < 0.05）。肿瘤大小与术前CT水平显著相关（r2 = 0.52，P < 0.01），家族性MTC的相关性（r2 = 0.71）比散发性MTC（r2 = 0.36）更显著。此外，术前CT水平低于50 pg/mL似乎可预测术后CT恢复正常（45例患者中的44例）。然而，较高的CT水平并不意味着术后CT不能恢复正常（120例患者中的50例）。我们得出结论，术前低CT水平可预测肿瘤大小及术后CT恢复正常。
