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.
Br J Surg. 2019 Mar;106(4):412-418. doi: 10.1002/bjs.11071. Epub 2019 Feb 6.
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.
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.
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.
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.
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。
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。
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。
降钙素水平通常在 1 周内恢复正常；在淋巴结阳性 MTC 患者和术前降钙素水平为 500.1-1000pg/ml 的患者中，降钙素水平在两周内恢复正常。在淋巴结阳性 MTC 患者和术前降钙素水平超过 1000pg/ml 以及淋巴结转移超过 10 个的患者中，降钙素恢复正常需要更长的时间。
