手术治疗阴性和阳性淋巴结髓样甲状腺癌后降钙素正常化的时间。

Time to calcitonin normalization after surgery for node-negative and node-positive medullary thyroid cancer.

机构信息

Medical Faculty, Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.

Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany.

出版信息

Br J Surg. 2019 Mar;106(4):412-418. doi: 10.1002/bjs.11071. Epub 2019 Feb 6.

DOI:10.1002/bjs.11071

PMID:30725475

Abstract

BACKGROUND

It remains unclear when postoperative serum calcitonin levels should be measured in patients with medullary thyroid cancer (MTC) and, specifically, whether this decision should be based on the preoperative calcitonin level or nodal status.

METHODS

A cohort of patients with previously untreated MTC was studied. Kaplan-Meier analyses, stratified by preoperative calcitonin level, nodal status and number of nodal metastases, were performed to determine time to calcitonin normalization after initial surgery, with statistical analysis by means of the log rank test.

RESULTS

Some 213 patients with node-negative and 182 with node-positive MTC were included in the study. Postoperative calcitonin levels normalized in a mean of 3·5 versus 3·7 days respectively among patients with preoperative calcitonin levels of 10-100 pg/ml (P = 0·815); 4·8 versus 5·3 days in those with preoperative calcitonin levels of 100·1-500 pg/ml (P = 0·026); 5·3 versus 9·9 days in patients with preoperative calcitonin levels of 500·1-1000 pg/ml (P = 0·004); and 6·6 versus 57·7 days among those with preoperative calcitonin levels exceeding 1000 pg/ml (P < 0·001). Calcitonin levels normalized in a mean of 4·7 days when nodal metastasis was not present, 5·2 days in those with one to five nodal metastases, 7·0 days in patients with six to ten nodal metastases, and 57·1 days among patients with more than ten nodal metastases. Postoperative calcitonin normalization curves paralleled each other in patients with node-negative MTC, but diverged in those with node-positive disease and with more nodal metastases.

CONCLUSION

Calcitonin levels typically normalize within 1 week; and within a fortnight in those with node-positive MTC and preoperative calcitonin levels of 500·1-1000 pg/ml. With node-positive MTC and preoperative calcitonin levels exceeding 1000 pg/ml, and with more than ten nodal metastases, calcitonin normalization takes longer.

摘要

背景

目前仍不清楚在甲状腺髓样癌（MTC）患者中应何时测量术后血清降钙素水平，具体而言，这一决定是否应基于术前降钙素水平或淋巴结状态。

方法

研究了一组未经治疗的 MTC 患者。通过 Kaplan-Meier 分析，按术前降钙素水平、淋巴结状态和淋巴结转移数分层，确定初始手术后降钙素正常化的时间，通过对数秩检验进行统计分析。

结果

研究纳入了 213 例淋巴结阴性和 182 例淋巴结阳性的 MTC 患者。术前降钙素水平为 10-100pg/ml 的患者术后降钙素水平分别在 3.5 天和 3.7 天内恢复正常（P=0.815）；术前降钙素水平为 100.1-500pg/ml 的患者分别在 4.8 天和 5.3 天内恢复正常（P=0.026）；术前降钙素水平为 500.1-1000pg/ml 的患者分别在 5.3 天和 9.9 天内恢复正常（P=0.004）；术前降钙素水平超过 1000pg/ml 的患者分别在 6.6 天和 57.7 天内恢复正常（P<0.001）。无淋巴结转移患者的降钙素水平平均在 4.7 天内恢复正常，有 1-5 个淋巴结转移的患者在 5.2 天内恢复正常，有 6-10 个淋巴结转移的患者在 7.0 天内恢复正常，有超过 10 个淋巴结转移的患者在 57.1 天内恢复正常。在淋巴结阴性 MTC 患者中，降钙素正常化曲线相互平行，但在淋巴结阳性疾病和淋巴结转移较多的患者中则有所偏离。