Trimboli Pierpaolo, Giovanella Luca
Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Endocrinol Metab (Seoul). 2018 Jun;33(2):204-210. doi: 10.3803/EnM.2018.33.2.204.
Calcitonin measurement is pivotal in the management of medullary thyroid carcinoma (MTC), but several pitfalls can affect its reliability. Other potential markers have been proposed, and procalcitonin (ProCT) has been reported as promising. The present study was undertaken to summarize the published data and provide more robust estimates on the reliability of ProCT as marker in the management of patients with MTC.
The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The sources comprised studies published through May 2018. Journal Articles that reported series of MTC patients undergone ProCT during postoperative follow-up were searched. A random-effects model was used for statistical pooling of the data. The I² index was used to quantify the consistency among the studies. The Egger test evaluated the possible presence of significant publication bias. Quality assessment of the studies was performed according to Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).
According to inclusion and exclusion criteria five papers, reporting 296 MTC patients undergone ProCT evaluation, were finally selected. The number of MTC with recurrence was 140. The pooled sensitivity of ProCT in detecting recurrence was 96% (95% confidence interval [CI], 92% to 99%), with neither heterogeneity (I²=0%) nor publication bias (Egger test, 3.16; P=0.99). The pooled specificity was 96% (95% CI, 87% to 100%) with mild heterogeneity (I²=66.6%), while Egger test was not calculable.
The present meta-analysis provides evidence that ProCT is reliable to manage MTC patients during their postoperative follow-up.
降钙素检测在甲状腺髓样癌（MTC）的管理中至关重要，但有几个陷阱会影响其可靠性。已经提出了其他潜在标志物，并且据报道降钙素原（ProCT）很有前景。本研究旨在总结已发表的数据，并对ProCT作为MTC患者管理标志物的可靠性提供更可靠的估计。
根据系统评价和Meta分析的首选报告项目（PRISMA）指南进行系统评价。资料来源包括截至2018年5月发表的研究。检索了报告术后随访期间接受ProCT检查的MTC患者系列的期刊文章。采用随机效应模型对数据进行统计合并。I²指数用于量化研究之间的一致性。Egger检验评估是否可能存在显著的发表偏倚。根据诊断准确性研究质量评估2（QUADAS-2）对研究进行质量评估。
根据纳入和排除标准，最终选择了5篇报告296例接受ProCT评估的MTC患者的论文。复发的MTC患者数量为140例。ProCT检测复发的合并敏感性为96%（95%置信区间[CI]，92%至99%），无异质性（I²=0%）和发表偏倚（Egger检验，3.16；P=0.99）。合并特异性为96%（95%CI，87%至100%），异质性轻度（I²=66.6%），而Egger检验无法计算。
本Meta分析提供的证据表明，ProCT在MTC患者术后随访管理中是可靠的。
