Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Endocr Relat Cancer. 2009 Dec;16(4):1291-8. doi: 10.1677/ERC-09-0136. Epub 2009 Sep 2.
Men and women differ in thyroidal C-cell mass and calcitonin secretion. This difference may have implications for the definition of calcitonin thresholds to distinguish sporadic C-cell hyperplasia from occult medullary thyroid cancer. This retrospective study examined the hypothesis that gender-specific calcitonin thresholds predict occult medullary thyroid cancer more accurately among patients with increased basal calcitonin levels than unisex thresholds. A total of 100 consecutive patients were evaluated with occult sporadic C-cell disease no larger than 10 mm who were referred for increased basal calcitonin levels and underwent pentagastrin stimulation preoperatively at this institution. Altogether, gender-specific calcitonin thresholds predicted medullary thyroid cancer better than unisex thresholds. At lower (<or=50 pg/ml basally; <or=500 pg/ml after stimulation), but not higher, calcitonin serum levels, women revealed medullary thyroid cancer four to eight times more often than men. Most discriminatory between C-cell hyperplasia and medullary thyroid cancer was a basal calcitonin threshold of 15 pg/ml (corrected 20 pg/ml) for women and 80 pg/ml (corrected 100 pg/ml) for men, based on the greatest accuracy at the lowest possible calcitonin level. The respective gender-specific stimulated peak calcitonin thresholds were 80 pg/ml (corrected 100 pg/ml) and 500 pg/ml. Corresponding positive predictive values for medullary thyroid cancer at these calcitonin thresholds were 89 and 90% for women, as opposed to 100% for men. To increase the positive predictive value for women to 100%, the respective calcitonin thresholds would have to be raised to 40 pg/ml (corrected 50 pg/ml) and 250 pg/ml. These findings indicate that gender-specific calcitonin thresholds predict sporadic occult medullary thyroid cancer better than unisex thresholds.
男性和女性的甲状腺 C 细胞质量和降钙素分泌存在差异。这种差异可能对定义区分散发性 C 细胞增生和隐匿性甲状腺髓样癌的降钙素阈值具有重要意义。本回顾性研究检验了这样一个假设，即性别特异性降钙素阈值比通用阈值更能准确预测基础降钙素水平升高的患者中的隐匿性甲状腺髓样癌。共有 100 名连续患者因基础降钙素水平升高且在此机构术前进行五肽胃泌素刺激而被评估患有隐匿性散发性 C 细胞疾病，其大小不超过 10 毫米。总的来说，性别特异性降钙素阈值比通用阈值更能预测甲状腺髓样癌。在较低（基础水平 <或=50 pg/ml；刺激后 <或=500 pg/ml）但不高的降钙素血清水平下，女性比男性更常发现甲状腺髓样癌。基于最低可能的降钙素水平的最高准确性，最能区分 C 细胞增生和甲状腺髓样癌的是女性基础降钙素阈值为 15 pg/ml（校正后为 20 pg/ml），男性为 80 pg/ml（校正后为 100 pg/ml）。相应的女性刺激后最大降钙素峰值阈值为 80 pg/ml（校正后为 100 pg/ml），男性为 500 pg/ml。在这些降钙素阈值下，甲状腺髓样癌的相应阳性预测值分别为女性 89%和 90%，而男性为 100%。为了将女性的阳性预测值提高到 100%，相应的降钙素阈值将不得不提高到 40 pg/ml（校正后为 50 pg/ml）和 250 pg/ml。这些发现表明，性别特异性降钙素阈值比通用阈值更能预测散发性隐匿性甲状腺髓样癌。
