降钙素和癌胚抗原倍增时间作为甲状腺髓样癌的预后因素：一项结构化荟萃分析。
Calcitonin and carcinoembryonic antigen doubling times as prognostic factors in medullary thyroid carcinoma: a structured meta-analysis.
机构信息
Department of Endocrinology, Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands.
出版信息
Clin Endocrinol (Oxf). 2010 Apr;72(4):534-42. doi: 10.1111/j.1365-2265.2009.03666.x. Epub 2009 Jun 26.
CONTEXT
In the management of patients with medullary thyroid carcinoma (MTC), calcitonin doubling time (dt) has gained interest as an independent predictor of recurrence and survival.
OBJECTIVE
To perform a structured meta-analysis of the diagnostic value of calcitonin dt, carcinoembryonic antigen (CEA) dt and the combination and to define dt strata with the highest predictive power. Design The study was a meta-analysis using individual data.
METHODS
Ten studies containing data on the post-operative kinetics of tumour marker(s) and (recurrence free) survival were included.
RESULTS
Calcitonin- and CEA-dt are significant indicators for survival (hazard ratios (HR) 21.52 respectively infinite for dt 0-1 year compared to dt >1 year) and recurrence (HR 5.33 respectively 6.80 for dt 0-1 year compared to dt >1 year). The highest predictive power was found for the dt classification 0-1 year vs. >1 year. CEA dt has a higher predictive value than calcitonin dt in the subgroup of patients for which both parameters were available.
CONCLUSION
The dts of both calcitonin and CEA are strong prognostic indicators for MTC recurrence and death. CEA dt has a higher predictive value than calcitonin dt and therefore measuring both tumour markers is essential for proper risk stratification.
背景
在甲状腺髓样癌（MTC）患者的管理中，降钙素倍增时间（dt）作为复发和生存的独立预测指标引起了关注。
目的
对降钙素 dt、癌胚抗原（CEA）dt 及其联合的诊断价值进行系统的荟萃分析，并定义具有最高预测能力的 dt 分层。
设计
这是一项使用个体数据进行的荟萃分析研究。
方法
纳入了 10 项包含术后肿瘤标志物（s）动力学和（无复发生存）数据的研究。
结果
降钙素和 CEA-dt 是生存（风险比（HR）分别为 21.52 和无限，dt 0-1 年与 dt>1 年相比）和复发（HR 分别为 5.33 和 6.80，dt 0-1 年与 dt>1 年相比）的显著指标。dt 分类为 0-1 年与>1 年之间的预测能力最高。在可获得这两个参数的患者亚组中，CEA-dt 的预测价值高于降钙素 dt。
结论
降钙素和 CEA 的 dt 均是 MTC 复发和死亡的强烈预后指标。CEA-dt 的预测价值高于降钙素 dt，因此测量这两种肿瘤标志物对于正确的风险分层至关重要。
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