Zhang Han, Zhang Daqi, Sui Chengqiu, Li Jingting, Li Canxiao, He Qiao, Du Rui, Zhao Yishen, Fu Yantao, Zhou Le, Wang Tie, Dionigi Gianlorenzo, Liang Nan, Sun Hui
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China.
Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy.
Ann Transl Med. 2022 Jun;10(12):709. doi: 10.21037/atm-22-2737.
Medullary thyroid carcinoma (MTC) patients have poor survival, tumor/node/metastasis (TNM) stage and biochemical prognosis are the most important factors. We investigated the clinical significance of calcitonin (Ctn) to assess the biochemical prognosis of MTC.
This retrospective observational study enrolled 77 MTC patients with complete information and primary surgery at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University between 2009 and 2020. Patient and MTC characteristics were recorded. All patients were divided into remission, stable, and progression according to biochemical prognosis. We analyzed the correlation between preoperative serum Ctn, TNM stage and biochemical prognosis.
Elevated preoperative serum Ctn was positively correlated with TNM stage. Patients with higher Ctn, multifocality, and bilateral tumors were associated with a higher TNM stage. Multivariate logistic regression analysis showed that preoperative serum Ctn level was an independent risk factor for TNM stage. Receiver operating characteristic (ROC) analysis found the best Ctn cut-off value for predicting TNM III was 45.88 pg/mL, which had a sensitivity of 87.2% and a specificity of 65.8%. The best Ctn cut-off value for predicting TNM IV was 167.00 pg/mL, with a sensitivity of 92.9% and a specificity of 77.6%. In univariate analysis, patients with higher preoperative serum Ctn, multifocality, bilateral tumors, and higher TNM stage were more likely to progress. The optimal cut-off value for progression was 195.5 pg/mL, which had a sensitivity of 80.0% and a specificity of 70.2%. For every 1-unit increase in preoperative serum Ctn levels, the risk of progression increased by 1.004 times (P=0.008), and patients with TNM stage III [hazard ratio (HR) =9.663; 95% confidence interval (CI): 1.411, 66.156] were nearly 9.7-fold more likely to progress than those in TNM stage I/II.
Elevated preoperative serum Ctn predicted poor clinical outcomes in MTC.
甲状腺髓样癌（MTC）患者生存率较低，肿瘤/淋巴结/转移（TNM）分期和生化预后是最重要的因素。我们研究了降钙素（Ctn）评估MTC生化预后的临床意义。
这项回顾性观察性研究纳入了2009年至2020年期间在吉林大学中日联谊医院甲状腺外科接受初次手术且信息完整的77例MTC患者。记录患者和MTC的特征。根据生化预后将所有患者分为缓解、稳定和进展三组。我们分析了术前血清Ctn、TNM分期与生化预后之间的相关性。
术前血清Ctn升高与TNM分期呈正相关。Ctn水平较高、多灶性和双侧肿瘤的患者TNM分期较高。多因素logistic回归分析显示，术前血清Ctn水平是TNM分期的独立危险因素。受试者工作特征（ROC）分析发现，预测TNM III期的最佳Ctn临界值为45.88 pg/mL，灵敏度为87.2%，特异度为65.8%。预测TNM IV期的最佳Ctn临界值为167.00 pg/mL，灵敏度为92.9%，特异度为77.6%。单因素分析中，术前血清Ctn水平较高、多灶性、双侧肿瘤和TNM分期较高的患者更易进展。进展的最佳临界值为195.5 pg/mL，灵敏度为80.0%，特异度为70.2%。术前血清Ctn水平每升高1个单位，进展风险增加1.004倍（P=0.008），TNM III期患者[风险比（HR）=9.663；95%置信区间（CI）：1.411，66.156]进展的可能性比TNM I/II期患者高近9.7倍。
术前血清Ctn升高预示MTC临床结局较差。
