Trimboli Pierpaolo, Lauretta Rosa, Barnabei Agnese, Valabrega Stefano, Romanelli Francesco, Giovanella Luca, Appetecchia Marialuisa
1 Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona - Switzerland.
2 Endocrinology Unit, Regina Elena National Cancer Institute, Rome - Italy.
Int J Biol Markers. 2018 May;33(2):156-160. doi: 10.1177/1724600817747518. Epub 2018 Apr 30.
Due to the limits of calcitonin, other markers are warranted to better manage medullary thyroid carcinoma patients, and procalcitonin has been reported as promising. Here we aimed to evaluate procalcitonin as a marker of medullary thyroid carcinoma in the post-treatment follow-up.
Medullary thyroid carcinoma patients previously treated by thyroidectomy were enrolled. After complete imaging work-up (i.e. ultrasonography, computed tomography, magnetic resonance and FDG-PET-CT) we identified patients with structural recurrent/persistent medullary thyroid carcinoma (active medullary thyroid carcinoma) and subjects with no evidence of disease. Then, both calcitonin and procalcitonin were measured and their performance analyzed.
The final series included 55 medullary thyroid carcinoma patients treated and followed-up for about five years. Of these, 43 were assessed as no evidence of disease, and 12 as active medullary thyroid carcinoma. The median value of procalcitonin was significantly higher ( P < 0.0001) in active medullary thyroid carcinoma patients (3.10 ng/mL) than in those with no evidence of disease (0.10 ng/mL). Also, calcitonin levels of active medullary thyroid carcinoma (96.7 pg/mL) were significantly ( P < 0.0001) higher than that of no evidence of disease (2.0 pg/mL). At the receiver operating characteristic curve analysis, the optimal cut-off of procalcitonin was ≥0.32 ng/mL with 92% sensitivity and 98% specificity, while the most accurate threshold of calcitonin was ≥12.0 pg/mL with 100% sensitivity and 91% specificity. There was no active medullary thyroid carcinoma with simultaneously negative results of procalcitonin and calcitonin.
Procalcitonin is reliable in discriminating medullary thyroid carcinoma patients with active disease from those with no evidence of disease. We suggest using procalcitonin as complementary to calcitonin to follow-up medullary thyroid carcinoma patients.
由于降钙素存在局限性，需要其他标志物来更好地管理甲状腺髓样癌患者，而降钙素原已被报道具有潜力。在此，我们旨在评估降钙素原作为甲状腺髓样癌治疗后随访标志物的价值。
纳入先前接受甲状腺切除术治疗的甲状腺髓样癌患者。在完成全面的影像学检查（即超声、计算机断层扫描、磁共振成像和氟代脱氧葡萄糖正电子发射断层显像计算机断层扫描）后，我们确定了患有结构性复发/持续性甲状腺髓样癌（活动性甲状腺髓样癌）的患者以及无疾病证据的受试者。然后，检测降钙素和降钙素原，并分析它们的性能。
最终队列包括55例接受治疗并随访约5年的甲状腺髓样癌患者。其中，43例被评估为无疾病证据，12例为活动性甲状腺髓样癌。活动性甲状腺髓样癌患者的降钙素原中位数（3.10 ng/mL）显著高于（P < 0.0001）无疾病证据患者（0.10 ng/mL）。此外，活动性甲状腺髓样癌的降钙素水平（96.7 pg/mL）也显著高于（P < 0.0001）无疾病证据患者（2.0 pg/mL）。在受试者工作特征曲线分析中，降钙素原的最佳截断值为≥0.32 ng/mL，敏感性为92%，特异性为98%，而降钙素的最准确阈值为≥12.0 pg/mL，敏感性为100%，特异性为91%。没有降钙素原和降钙素结果同时为阴性的活动性甲状腺髓样癌患者。
降钙素原在区分患有活动性疾病的甲状腺髓样癌患者和无疾病证据的患者方面是可靠的。我们建议将降钙素原作为降钙素的补充用于甲状腺髓样癌患者的随访。
