Department of General, Digestive and Endocrine surgery, Lyon Sud Hospital Centre, Pierre Bénite, France.
Department of Thoracic and Endocrine Surgery and Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Br J Surg. 2021 Sep 27;108(9):1064-1071. doi: 10.1093/bjs/znab106.
Calcitonin (Ct) is a sensitive diagnostic biomarker and one of the most important prognostic factors in medullary thyroid cancer (MTC). This study aimed to evaluate progression-free survival and recurrence rates of MTC associated with undetectable compared with normalized serum Ct levels after surgery.
This retrospective observational study included patients operated for MTC at the Digestive and Endocrine Surgery Department of Lyon Sud Hospital Centre between 2000 and 2019. Clinical and pathological factors were correlated with postoperative Ct concentrations. Undetectable and normalized Ct concentrations were defined as below 2 pg/ml and 2-10 pg/ml respectively.
Overall, 176 patients were treated for MTC, and 127 were considered biochemically cured after surgery. Of these, 24 and 103 had normalized and undetectable Ct concentrations respectively. Patients with Ct level normalization had a 25 per cent risk of disease recurrence, compared with 3 per cent in patients with undetectable Ct levels after surgery. The presence of metastasis in two or more compartments was predictive of failure to achieve undetectable Ct concentrations after surgery and an increased risk of recurrence.
Among patients with biochemically cured MTC, those with undetectable or normalized Ct concentrations after surgery had different risks of recurrence. Simply assessing postoperative Ct normalization can be falsely reassuring, and long-term follow-up is needed.
Calcitonin (Ct) is a sensitive diagnostic biomarker and one of the most important prognostic factors for medullary thyroid cancer outcomes; however, the significance of postoperative Ct levels remains controversial. This study evaluated the differences between normal and undetectable postoperative Ct levels in patients who had undergone surgical treatment for medullary thyroid cancer. Patients who experienced postoperative Ct level normalization had a higher risk of disease recurrence than those with undetectable Ct levels after surgery.
降钙素（Ct）是一种敏感的诊断生物标志物，也是影响甲状腺髓样癌（MTC）预后的最重要的因素之一。本研究旨在评估手术后 Ct 血清水平无法检测与正常相比，对 MTC 无进展生存期和复发率的影响。
本回顾性观察性研究纳入了 2000 年至 2019 年期间在里昂南医院中心消化内分泌外科接受 MTC 手术的患者。将临床和病理因素与术后 Ct 浓度相关联。将无法检测到的和正常的 Ct 浓度定义为分别低于 2pg/ml 和 2-10pg/ml。
总体而言，176 例患者接受了 MTC 治疗，127 例患者术后被认为生化治愈。其中，24 例和 103 例患者的 Ct 浓度分别正常和无法检测到。术后 Ct 浓度正常的患者疾病复发的风险为 25%，而 Ct 浓度无法检测到的患者复发风险为 3%。两个或更多部位存在转移是预测术后无法达到 Ct 浓度无法检测到的因素，也是复发风险增加的因素。
在生化治愈的 MTC 患者中，手术后 Ct 浓度可检测或正常的患者复发风险不同。仅仅评估术后 Ct 浓度的正常化可能会产生错误的安全感，需要长期随访。
降钙素（Ct）是一种敏感的诊断生物标志物，也是甲状腺髓样癌预后最重要的因素之一；然而，术后 Ct 水平的意义仍存在争议。本研究评估了接受甲状腺髓样癌手术治疗的患者术后 Ct 水平正常和无法检测之间的差异。术后 Ct 浓度正常的患者比术后 Ct 浓度无法检测的患者疾病复发风险更高。
