Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle (Saale), Germany.
J Clin Endocrinol Metab. 2010 Jun;95(6):2655-63. doi: 10.1210/jc.2009-2368. Epub 2010 Mar 25.
Preoperative neck ultrasonography may yield false-negative findings in more than one-third of medullary thyroid cancer (MTC) patients. If not cleared promptly, cervical lymph node metastases may emerge subsequently. Reoperations entail an excess risk of surgical morbidity and may be avoidable.
This comprehensive investigation aimed to evaluate in a head-to-head comparison the clinical utility of pretherapeutic biomarker serum levels (basal calcitonin; stimulated calcitonin; carcinoembryonic antigen) for indicating extent of disease and providing biochemical stratification of pretherapeutic MTC risk.
This was a retrospective analysis.
The setting was a tertiary referral center.
Included were 300 consecutive patients with previously untreated MTC.
The intervention was compartment-oriented surgery.
Stratified biomarker levels were correlated with histopathologic extent of disease.
Higher biomarker levels reflected larger primary tumors and more lymph node metastases. Stratified basal calcitonin serum levels correlated better (r = 0.59) with the number of lymph node metastases than carcinoembryonic antigen (r = 0.47) or pentagastrin-stimulated calcitonin (r = 0.40) levels. Lymph node metastases were present in the ipsilateral central and lateral neck, contralateral central neck, contralateral lateral neck, and upper mediastinum, respectively, beyond basal calcitonin thresholds of 20, 50, 200, and 500 pg/ml. Bilateral compartment-oriented neck surgery achieved biochemical cure in at least half the patients with pretherapeutic basal calcitonin levels of 1,000 pg/ml or less but not in patients with levels greater than 10,000 pg/ml.
Most newly diagnosed MTC patients, i.e. those with pretherapeutic basal calcitonin levels greater than 200 pg/ml, may need bilateral compartment-oriented neck surgery to reduce the number of reoperations.
术前颈部超声检查可能导致超过三分之一的甲状腺髓样癌（MTC）患者出现假阴性结果。如果不能及时清除，随后可能出现颈部淋巴结转移。再次手术会增加手术并发症的风险，而且可能是可以避免的。
本研究旨在对头对头比较术前生物标志物血清水平（基础降钙素；刺激降钙素；癌胚抗原）在指示疾病范围和提供术前 MTC 风险的生化分层方面的临床实用性进行评估。
这是一项回顾性分析。
研究地点为三级转诊中心。
纳入了 300 例先前未经治疗的 MTC 连续患者。
采用分区定向手术。
分层生物标志物水平与组织病理学疾病范围相关。
更高的生物标志物水平反映了更大的原发肿瘤和更多的淋巴结转移。分层基础降钙素血清水平与淋巴结转移数的相关性更好（r = 0.59），而癌胚抗原（r = 0.47）或五肽胃泌素刺激降钙素（r = 0.40）水平则不然。淋巴结转移分别位于同侧中央和侧颈部、对侧中央颈部、对侧侧颈部和上纵隔，基础降钙素阈值分别为 20、50、200 和 500 pg/ml。在术前降钙素水平为 1000 pg/ml 或更低的患者中，至少有一半接受双侧分区定向颈部手术可达到生化治愈，但在降钙素水平大于 10000 pg/ml 的患者中则不然。
大多数新诊断的 MTC 患者，即那些术前降钙素水平大于 200 pg/ml 的患者，可能需要双侧分区定向颈部手术以减少再次手术的数量。
