Ni Jiajia, Zhang Xinyi, Liu Yalan, Ling Yan
Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
Clin Endocrinol (Oxf). 2025 May;102(5):589-599. doi: 10.1111/cen.15195. Epub 2025 Jan 3.
The International Medullary Thyroid Carcinoma Grading System (IMTCGS) was recently introduced in medullary thyroid carcinoma (MTC). This study aimed to assess the predictive value of the IMTCGS for disease response and survival, and compare its predictive ability with that of other traditional risk factors in a Chinese MTC cohort.
The data of 137 MTC patients undergoing initial surgery between January 2004 and June 2023 were included for analysis. Histologic features were reviewed by two pathologists. Kaplan-Meier survival analysis and Cox proportional hazard model were performed to analyse the association between risk factors (including IMTCGS high vs low grade) and progression-free survival (PFS) and disease-specific survival (DSS). ROC analysis and Delong's test were used to compare the predictive ability of IMTCGS with that of other risk factors.
Local recurrence, distant metastasis, and disease-specific death were observed in 14/134 (10.45%), 3/134 (2.24%), and 6/137 (4.38%) MTC patients, respectively. IMTCGS, TNM stage, postoperative calcitonin, postoperative CEA, and vascular invasion were associated with PFS in Kaplan-Meier survival analysis (all p < 0.05). Postoperative calcitonin was the only independent predictor for PFS in multivariate analysis (HR = 1.002, p = 0.002). ROC analysis and Delong's test showed that postoperative calcitonin had superior predictive value for structural recurrence than IMTCGS (AUC 0.90 vs. 0.64, p = 0.002). IMTCGS, TNM stage, and vascular invasion were associated with DSS in Kaplan-Meier survival analysis (both p < 0.05). In multivariate analysis, IMTCGS was the only independent predictor for DSS (HR = 11.23, p = 0.05). The AUC of IMTCGS was 0.81 (p = 0.01) for disease-specific death.
In this Chinese MTC cohort, IMTCGS was a powerful predictor of disease-specific death, while postoperative calcitonin was a powerful predictor of structural recurrence.
国际甲状腺髓样癌分级系统（IMTCGS）最近被引入甲状腺髓样癌（MTC）的研究中。本研究旨在评估IMTCGS对疾病反应和生存的预测价值，并在中国MTC队列中比较其与其他传统危险因素的预测能力。
纳入2004年1月至2023年6月期间接受初次手术的137例MTC患者的数据进行分析。由两名病理学家对组织学特征进行评估。采用Kaplan-Meier生存分析和Cox比例风险模型分析危险因素（包括IMTCGS高分级与低分级）与无进展生存期（PFS）和疾病特异性生存期（DSS）之间的关联。采用ROC分析和Delong检验比较IMTCGS与其他危险因素的预测能力。
134例MTC患者中分别有14例（10.45%）出现局部复发、3例（2.24%）出现远处转移、137例中有6例（4.38%）出现疾病特异性死亡。在Kaplan-Meier生存分析中，IMTCGS、TNM分期、术后降钙素、术后癌胚抗原和血管侵犯与PFS相关（均p<0.05）。多因素分析中，术后降钙素是PFS的唯一独立预测因素（HR=1.002，p=0.002）。ROC分析和Delong检验显示，术后降钙素对结构复发的预测价值优于IMTCGS（AUC 0.90对0.64，p=0.002）。在Kaplan-Meier生存分析中，IMTCGS、TNM分期和血管侵犯与DSS相关（均p<0.05）。多因素分析中，IMTCGS是DSS的唯一独立预测因素（HR=11.23，p=0.05）。IMTCGS对疾病特异性死亡的AUC为0.81（p=0.01）。
在这个中国MTC队列中，IMTCGS是疾病特异性死亡的有力预测因素，而术后降钙素是结构复发的有力预测因素。
