Samaan N A, Schultz P N, Hickey R C
Section of Endocrinology, University of Texas M. D. Anderson Cancer Center, Houston.
Horm Metab Res Suppl. 1989;21:21-5.
A retrospective study of 202 patients with medullary thyroid carcinoma (MTC) diagnosed between 1943 and 1987 was done to compare the prognosis of patients with sporadic disease and those with the familial form of multiple endocrine neoplasia type II (MEN-II) and to study the effect of radiotherapy. The relationship between serum calcitonin (iCT), carcinoembryonic antigen (CEA), and calcitonin gene-related peptide (CGRP) to the extent of disease and prognosis was also studied. Patients with MEN-II had significantly longer survival rates than did patients with the sporadic variety (P less than 0.005), but most patients with sporadic disease were older and had more advanced disease. No differences in survival rates were found when patients from these two groups were matched for age and extent of disease (P greater than 0.7). When patients who received radiotherapy were matched for age, extent of disease, and surgery with patients who had had no radiotherapy, the latter group was found to live significantly longer (P less than 0.05). Our studies suggested (1) that the apparently poor prognosis of patients with sporadic MTC may be related to the patients' older age at detection rather than to inherent differences in the two forms of disease, (2) radiotherapy has little effect on MTC, (3) calcitonin gene-related peptide measurement was not helpful in determining the extent of disease or prognosis, (4) patients with liver metastasis had the highest iCT levels, (5) patients with bone metastasis had the highest CEA levels, and (6) patients with diarrhea had poor prognosis and had high iCT levels.
对1943年至1987年间确诊的202例甲状腺髓样癌（MTC）患者进行了一项回顾性研究，以比较散发性疾病患者与家族性II型多发性内分泌腺瘤病（MEN-II）患者的预后，并研究放疗的效果。还研究了血清降钙素（iCT）、癌胚抗原（CEA）和降钙素基因相关肽（CGRP）与疾病范围和预后之间的关系。MEN-II患者的生存率明显高于散发性患者（P<0.005），但大多数散发性疾病患者年龄较大且疾病进展更严重。当将这两组患者按年龄和疾病范围进行匹配时，未发现生存率有差异（P>0.7）。当将接受放疗的患者与未接受放疗的患者按年龄、疾病范围和手术情况进行匹配时，发现未接受放疗的组存活时间明显更长（P<0.05）。我们的研究表明：（1）散发性MTC患者明显较差的预后可能与患者检测时年龄较大有关，而非两种疾病形式的内在差异；（2）放疗对MTC几乎没有影响；（3）降钙素基因相关肽测量对确定疾病范围或预后没有帮助；（4）有肝转移的患者iCT水平最高；（5）有骨转移的患者CEA水平最高；（6）有腹泻的患者预后较差且iCT水平较高。
