Woliński Kosma, Kaznowski Jarosław, Klimowicz Aleksandra, Maciejewski Adam, Łapińska-Cwojdzińska Dagny, Gurgul Edyta, Car Adrian D, Fichna Marta, Gut Paweł, Gryczyńska Maria, Ruchała Marek
Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, Poland.
Endokrynol Pol. 2017;68(4):434-437. doi: 10.5603/EP.a2017.0038. Epub 2017 Jun 6.
Medullary thyroid cancer (MTC) is a malignancy of the thyroid gland, which derives from parafollicular C cells. Periodic measurement of biochemical markers of MTC remains a crucial part of patient follow-up and disease monitoring. The aim of the study was to compare the diagnostic value of four selected markers - calcitonin (Ct), procalcitonin (PCT), chromogranin A (CgA), and carcinoembryonic antigen (CEA).
Patients with histopathologically confirmed MTC hospitalised in a single department between January 2015 and December 2015 were included in the study. Patients were subdivided into two groups: a remission group and an active disease group, based upon serum markers of MTC and imaging. Levels of Ct, PCT, CgA, and CEA were compared between the groups.
Forty-four patients were included; 20 patients presented active disease and 24 were in remission. All patients with active disease had Ct exceeding the upper limit of normal range (10 pg/mL) - for that threshold the sensitivity was 100.0% and the specificity was 73.9%; for the best-fit threshold of 121.0 pg/mL the specificity was 95.8% with sensitivity 100.0%. There was significant correlation between Ct and PCT - p < 0.000001, r = 0.93. All patients with active disease exceeded the upper limit of the normal range (0.5 ng/mL) - for that threshold the sensitivity was 100.0% and the specificity was 83.3%; for the best-fit threshold of 0.95 ng/mL the specificity was 95.8% with sensitivity 100.0%. In case of CEA for the best-fit threshold of 12.66 ng/mL the specificity was 100.0% with sensitivity 57.9%; for CgA the best-fit threshold was 75.66 ng/mL with specificity 83.3% and sensitivity 75.0%.
Our study confirms that PCT can be considered as an equivalent alternative for measurement of calcitonin. On the other hand, it is also worth noting that MTC can be a rare cause of very high levels of PTC not resulting from infectious diseases. The diagnostic value of CEA and chromogranin A is much lower and can be within the normal range even in patients with advanced, metastatic MTC. They should be used only as accessory markers.
甲状腺髓样癌（MTC）是一种起源于甲状腺滤泡旁C细胞的甲状腺恶性肿瘤。定期检测MTC的生化标志物仍然是患者随访和疾病监测的关键部分。本研究的目的是比较四种选定标志物——降钙素（Ct）、降钙素原（PCT）、嗜铬粒蛋白A（CgA）和癌胚抗原（CEA）的诊断价值。
纳入2015年1月至2015年12月在单一科室住院且经组织病理学确诊为MTC的患者。根据MTC的血清标志物和影像学检查，将患者分为两组：缓解组和疾病活动组。比较两组患者Ct、PCT、CgA和CEA的水平。
共纳入44例患者；20例患者疾病活动，24例处于缓解期。所有疾病活动的患者Ct均超过正常范围上限（10 pg/mL）——该阈值下敏感性为100.0%，特异性为73.9%；最佳拟合阈值为121.0 pg/mL时，特异性为95.8%，敏感性为100.0%。Ct与PCT之间存在显著相关性——p < 0.000001，r = 0.93。所有疾病活动的患者PCT均超过正常范围上限（0.5 ng/mL）——该阈值下敏感性为100.0%，特异性为83.3%；最佳拟合阈值为0.95 ng/mL时，特异性为95.8%，敏感性为100.0%。对于CEA来说，最佳拟合阈值为12.66 ng/mL时，特异性为100.0%，敏感性为57.9%；对于CgA，最佳拟合阈值为75.66 ng/mL，特异性为83.3%，敏感性为75.0%。
我们的研究证实PCT可被视为降钙素检测的等效替代方法。另一方面，还值得注意的是，MTC可能是导致PTC水平极高且并非由传染病引起的罕见原因。CEA和嗜铬粒蛋白A的诊断价值要低得多，即使在晚期转移性MTC患者中也可能处于正常范围内。它们仅应用作辅助标志物。
