降钙素在甲状腺髓样癌手术后的时间动力学和预后作用。
Time Kinetics and prognosis roles of calcitonin after surgery for medullary thyroid carcinoma.
机构信息
Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, China.
出版信息
World J Surg Oncol. 2024 May 6;22(1):121. doi: 10.1186/s12957-024-03397-3.
BACKGROUND
Medullary thyroid carcinoma (MTC) is a malignant tumor with low incidence. Currently, most studies have focused on the prognostic risk factors of MTC, whatever, time kinetic and risk factors related to calcitonin normalization (CN) and biochemical persistence/recurrence (BP) are yet to be elucidated.
METHODS
A retrospective study was conducted for 190 MTC patients. Risk factors related to calcitonin normalization (CN) and biochemical persistence/recurrence (BP) were analyzed. The predictors of calcitonin normalization time (CNT) and biochemical persistent/recurrent time (BPT) were identified. Further, the prognostic roles of CNT and BPT were also demonstrated.
RESULTS
The 5- and 10-year DFS were 86.7% and 70.2%, respectively. The 5- and 10-year OS were 97.6% and 78.8%, respectively. CN was achieved in 120 (63.2%) patients, whereas BP was presented in 76 (40.0%) patients at the last follow up. After curative surgery, 39 (32.5%) and 106 (88.3%) patients achieved CN within 1 week and 1 month. All patients who failed to achieve CN turned to BP over time and 32/70 of them developed structural recurrence. The median time of CNT and BPT was 1 month (1 day to 84 months) and 6 month (3 day to 63months), respectively. LNR > 0.23 and male gender were independent predictors for CN and BP. LNR > 0.23 (Hazard ratio (HR), 0.24; 95% CI,0.13-0.46; P < 0.01) and male gender (HR, 0.65; 95% CI, 0.42-0.99; P = 0.045) were independent predictors for longer CNT. LNR > 0.23 (HR,5.10; 95% CI,2.15-12.11; P < 0.01) was still the strongest independent predictor followed by preoperative serum Ctn > 1400ng/L (HR,2.34; 95% CI,1.29-4.25; P = 0.005) for shorter BPT. In survival analysis, primary tumor size > 2 cm (HR, 5.81; 95% CI,2.20-15.38; P < 0.01), CNT > 1 month (HR, 5.69; 95% CI, 1.17-27.61; P = 0.031) and multifocality (HR, 3.10; 95% CI, 1.45-6.65; P = 0.004) were independent predictor of DFS.
CONCLUSION
Early changes of Ctn after curative surgery can predict the long-term risks of biochemical and structural recurrence, which provide a useful real-time prognostic information. LNR significantly affect the time kinetic of biochemical prognosis. Tumor burden and CNT play a crucial role in MTC survival, the intensity of follow-up must be tailored accordingly.
背景
甲状腺髓样癌（MTC）是一种发病率较低的恶性肿瘤。目前，大多数研究都集中在 MTC 的预后风险因素上，但有关降钙素正常化（CN）和生化持续性/复发（BP）的时间动力学和风险因素仍有待阐明。
方法
对 190 例 MTC 患者进行回顾性研究。分析了与降钙素正常化（CN）和生化持续性/复发（BP）相关的危险因素。确定了降钙素正常化时间（CNT）和生化持续/复发时间（BPT）的预测因子。此外，还展示了 CNT 和 BPT 的预后作用。
结果
5 年和 10 年的无病生存率（DFS）分别为 86.7%和 70.2%。5 年和 10 年的总生存率（OS）分别为 97.6%和 78.8%。120 例（63.2%）患者达到 CN，76 例（40.0%）患者在最后一次随访时出现 BP。在根治性手术后，39 例（32.5%）和 106 例（88.3%）患者在 1 周和 1 个月内达到 CN。所有未能达到 CN 的患者随着时间的推移都转为 BP，其中 32/70 例出现结构复发。CNT 和 BPT 的中位时间分别为 1 个月（1 天至 84 个月）和 6 个月（3 天至 63 个月）。LNR＞0.23 和男性是 CN 和 BP 的独立预测因素。LNR＞0.23（风险比（HR），0.24；95%置信区间，0.13-0.46；P＜0.01）和男性（HR，0.65；95%置信区间，0.42-0.99；P=0.045）是 CNT 延长的独立预测因素。LNR＞0.23（HR，5.10；95%置信区间，2.15-12.11；P＜0.01）仍然是最短 BPT 的最强独立预测因子，其次是术前降钙素水平＞1400ng/L（HR，2.34；95%置信区间，1.29-4.25；P=0.005）。在生存分析中，原发肿瘤大小＞2cm（HR，5.81；95%置信区间，2.20-15.38；P＜0.01）、CNT＞1 个月（HR，5.69；95%置信区间，1.17-27.61；P=0.031）和多灶性（HR，3.10；95%置信区间，1.45-6.65；P=0.004）是 DFS 的独立预测因素。
结论
根治性手术后降钙素的早期变化可以预测生化和结构复发的长期风险，为患者提供有用的实时预后信息。LNR 显著影响生化预后的时间动力学。肿瘤负荷和 CNT 在 MTC 生存中起着至关重要的作用，必须相应调整随访强度。
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