Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Endocr Pract. 2020 Jul;26(7):738-747. doi: 10.4158/EP-2019-0404. Epub 2020 Nov 24.
In a cohort of medullary thyroid cancer (MTC) patients with biochemical incomplete responses, 37 to 48% developed structural persistent disease; however, few indictors were available to distinguish those patients who were more likely to develop structural disease. We hypothesized that the relationship between preoperative calcitonin (Ctn) and postoperative Ctn (within 3 days after surgery) could be used to predict early prognosis of these patients.
A total of 92 sporadic MTC patients were enrolled in this study. Our team proposed a novel indicator of structural persistent MTC called the calcitonin ratio (CR; CR = postoperative Ctn/preoperative Ctn). Cox regression models and the Kaplan-Meier method were used to evaluate the prognostic capability of CR. The area under the time-dependent receiver-operating characteristic curves (AUC) and the Harrell concordance index (C-index) were used for analysis.
The cutoff CR value used to determine MTC prognosis was 0.15. Multivariate Cox analysis revealed that CR (hazard ratio [HR]: 22.974, 95% confidence interval [CI]: 3.259 to 161.959, P = .002), tumor-node-metastasis (HR: 3.968, 95% CI: 1.360 to 21.857; P = .031), and multifocality (HR: 8.466, 95% CI: 1.286 to 55.716; P = .026) independently correlated with MTC prognosis. Kaplan-Meier survival curves demonstrated a lower proportion with structural persistent disease in patients with CR <0.15 (P<.001). The 3, 5, and 10-year AUC values were 0.798, 0.752, and 0.743, respectively. The C-index of CR was 0.788 (95% CI: 0.763 to 0.813).
In this study, CR was identified as a sensitive and specific risk stratification marker for patients with biochemical incomplete responses in sporadic MTC.
ATA = American Thyroid Association; AUC = area under curve; CEA = carcinoembryonic antigen; CR = calcitonin ratio; Ctn = calcitonin; HR = hazard ratio; MTC = medullary thyroid cancer; ROC = receiver operating characteristic; TNM = tumor-node-metastasis.
在一组生化不完全缓解的甲状腺髓样癌（MTC）患者中，有 37%至 48%发生了结构性持续性疾病；然而，很少有指标可以区分那些更有可能发生结构性疾病的患者。我们假设术前降钙素（Ctn）与术后 Ctn（术后 3 天内）之间的关系可以用于预测这些患者的早期预后。
本研究共纳入 92 例散发性 MTC 患者。我们团队提出了一种新的结构性持续性 MTC 标志物，称为降钙素比（CR；CR=术后 Ctn/术前 Ctn）。Cox 回归模型和 Kaplan-Meier 方法用于评估 CR 的预后能力。时间依赖性受试者工作特征曲线（ROC）下面积（AUC）和 Harrell 一致性指数（C-index）用于分析。
用于确定 MTC 预后的 CR 截断值为 0.15。多变量 Cox 分析显示，CR（风险比[HR]：22.974，95%置信区间[CI]：3.259 至 161.959，P=0.002）、肿瘤-淋巴结-转移（HR：3.968，95%CI：1.360 至 21.857；P=0.031）和多灶性（HR：8.466，95%CI：1.286 至 55.716；P=0.026）与 MTC 预后独立相关。Kaplan-Meier 生存曲线显示 CR<0.15 的患者中结构性持续性疾病的比例较低（P<0.001）。AUC 值在 3、5 和 10 年时分别为 0.798、0.752 和 0.743。CR 的 C-index 为 0.788（95%CI：0.763 至 0.813）。
在这项研究中，CR 被确定为散发性 MTC 中生化不完全缓解患者的一种敏感和特异的风险分层标志物。
