Integration of a postoperative calcitonin measurement into an anatomical staging system improves initial risk stratification in medullary thyroid cancer

医学 降钙素 甲状腺髓样癌 甲状腺癌 癌症 AJCC分段系统 内科学 病态的 甲状腺 疾病 髓腔 肿瘤科 登台系统
作者
Ji Hyun Yang,Susan C. Lindsey,Cleber Camacho,Flávia O. F. Valente,Fausto Germano-Neto,Aline Fernanda Perez Machado,Maria Conceição Mamone,Fábio Brodskyn,Rosa Paula M. Biscolla,R. Michael Tuttle,Magnus R. Dias da Silva,Rui M. B. Maciel
出处
期刊:Clinical Endocrinology [Wiley]
卷期号:83 (6): 938-942 被引量:34
标识
DOI:10.1111/cen.12657
摘要

Summary Objective Staging systems applied to medullary thyroid cancer ( MTC ) rely on initial clinical and pathological features and do not consider the response to treatment. To determine whether MTC staging can be improved by incorporating the first postoperative calcitonin measurement. Patients and measurements Eighty‐five patients being monitored for MTC (median follow‐up 5 years) were retrospectively classified according to both the American Joint Committee on Cancer ( AJCC ) and the proposed combined risk stratification system (low, intermediate and high risk), which incorporates the first postoperative calcitonin measurement, using the outcomes no evidence of disease ( NED ), biochemical evidence of disease, structurally identifiable disease and death. Results Ninety per cent of AJCC I patients were classified as NED at final follow‐up. When we added a postoperative calcitonin measurement, 95% low‐risk patients were classified as NED at final follow‐up. AJCC stages I and IV were associated, respectively, with no occurrence and a high rate (63%) of structurally identifiable disease. Stages II and III yielded similar predictions of structurally identifiable disease, 13% and 14%, respectively. When we included the postoperative calcitonin level, the patients with structural evidence of disease included none from the low‐risk group, 10% from the intermediate group and 63% from the high‐risk group. The proportion of variance explained analysis ( PVE ) was better for the combined risk stratification system (54%) than for the AJCC system alone (32%). Conclusion Including the first postoperative calcitonin measurement with the anatomical staging system can better predict the clinical outcome of patients with MTC and refine the follow‐up of these patients.
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