Background: In medullary thyroid cancer (MTC), lymph node metastases are often present at diagnosis and the extent of surgery is usually based upon pre-operative calcitonin and CEA levels as well as ultrasound findings. The aim of this study was to evaluate the role of pre-operative calcitonin and CEA levels as predictive markers of the burden of lymph node metastases at diagnosis.Methods: we conducted a retrospective study analyzing 87 MTC patients.Results: The median levels of calcitonin and CEA were 88.4 pg/mL and 7.0 ng/mL, respectively, in patients with no lymph nodes metastases; 108.0 pg/mL and 9.6 ng/mL, respectively, in patients with metastases to 1–5 lymph nodes; 520.5 pg/mL and 43.2 ng/mL, respectively, in patients with metastases to >5 lymph nodes. There were no significant differences in pre-operative calcitonin and CEA values between N0 and N1a patients, whereas they were significantly higher in N1b patients. Pre-operative cut-off levels distinguishing N0/N1a from N1b patients were 90 pg/mL for calcitonin (sensitivity 100%, specificity 59.3%, AUC = 0.82) and 17 ng/mL for CEA (sensitivity 100%, specificity 75%, AUC = 0.89).Conclusions: in patients with MTC, pre-operative serum calcitonin and CEA levels may drive the decision-making process to better define the extent of surgery.
背景：在甲状腺髓样癌（MTC）中，淋巴结转移在诊断时常已存在，手术范围通常基于术前降钙素和癌胚抗原（CEA）水平以及超声检查结果来确定。本研究旨在评估术前降钙素和CEA水平作为诊断时淋巴结转移负荷预测标志物的作用。 方法：我们进行了一项回顾性研究，分析了87例MTC患者。 结果：无淋巴结转移患者的降钙素和CEA中位水平分别为88.4 pg/mL和7.0 ng/mL；1-5个淋巴结转移患者分别为108.0 pg/mL和9.6 ng/mL；超过5个淋巴结转移患者分别为520.5 pg/mL和43.2 ng/mL。N0与N1a患者间的术前降钙素和CEA值无显著差异，而N1b患者的这两项指标均显著更高。区分N0/N1a与N1b患者的术前临界值：降钙素为90 pg/mL（敏感性100%，特异性59.3%，AUC=0.82），CEA为17 ng/mL（敏感性100%，特异性75%，AUC=0.89）。 结论：对于MTC患者，术前血清降钙素和CEA水平可指导临床决策，有助于更精准地确定手术范围。
肿瘤(癌症)患者之家