文章：

治疗前基础降钙素截断值对甲状腺髓样癌患者治疗策略及长期预后预测的价值——一项30年单中心经验

The Value of Pretherapeutic Basal Calcitonin Cut-Offs for the Therapeutic Strategy and Prediction of Long-Term Outcome of Patients with Medullary Thyroid Cancer—A 30-Year Single-Center Experience

原文发布日期：29 September 2024

DOI: 10.3390/cancers16193343

类型: Article

开放获取: 是

英文摘要：

Background: The clinical relevance of clearly defined pretherapeutic basal calcitonin (bCt) cut-offs for predicting lymph node metastases (LNMs) and long-term outcomes (LOs) has so far not been tested in a large cohort of patients with medullary thyroid cancer included in a Ct screening program during the initial diagnostic workup of thyroid nodules. Material and Methods: Female (f) patients with a bCt level of ≤23 pg/mL and male (m) patients with a level of ≤43 pg/mL were assigned to Group 1 (minimal oncologic risk), patients with a bCt between 24 and 84 pg/mL (f) and 44–99 pg/mL (m) to Group 2 (low oncologic risk), and those with a bCt of ≥85 pg/mL (f) and ≥100 pg/mL (m) to Group 3 (high oncologic risk). All patients underwent surgery applying a uniform surgical protocol. The median follow-up was 100 months. Results: The study included 306 patients. In 3/115 (2.6%) patients in Group 1 and in 3/50 (6.0%) in Group 2, LNM in the central but not lateral neck and no distant metastases (DMet) were documented. In both groups, the biochemical long-term cure rate was 95.7% and the disease-specific-survival (DSS) rate was 100% at 10, 15 and 20 years. Lateral LNM and DMet were diagnosed only in Group 3. The bCt levels of N0 and N1 patients showed broadly overlapping ranges, thus impeding the differentiation between those patients through bCt. Both the cure rate and DSS were significantly worse in Group 3. The overall biochemical long-term cure rate was 78.2%. Conclusions: Within a Ct screening program, grouping patients upon pretherapeutic bCt provides a simple risk classification system for indicating surgery, predicting LN involvement, and LOs.

摘要翻译： 

背景：在甲状腺结节初始诊断评估中纳入降钙素（Ct）筛查项目的甲状腺髓样癌患者大型队列中，明确界定的治疗前基础降钙素（bCt）截断值对预测淋巴结转移（LNMs）及长期结局（LOs）的临床相关性尚未得到验证。材料与方法：将bCt水平≤23 pg/mL的女性患者及≤43 pg/mL的男性患者归入第1组（极低肿瘤风险），bCt水平在24-84 pg/mL（女性）及44-99 pg/mL（男性）的患者归入第2组（低肿瘤风险），bCt水平≥85 pg/mL（女性）及≥100 pg/mL（男性）的患者归入第3组（高肿瘤风险）。所有患者均接受统一手术方案治疗，中位随访时间为100个月。结果：研究共纳入306例患者。第1组115例患者中有3例（2.6%）、第2组50例患者中有3例（6.0%）记录到中央区（而非侧颈区）淋巴结转移，且均无远处转移。两组患者的10年、15年及20年生化长期治愈率均为95.7%，疾病特异性生存率均为100%。仅第3组患者出现侧颈区淋巴结转移及远处转移。淋巴结阴性（N0）与阳性（N1）患者的bCt水平存在广泛重叠区间，导致无法通过bCt水平有效区分这两类患者。第3组患者的治愈率与疾病特异性生存率均显著降低，总体生化长期治愈率为78.2%。结论：在Ct筛查项目中，依据治疗前bCt水平进行患者分组可建立简易的风险分级系统，用于指导手术决策、预测淋巴结受累情况及长期预后。

原文链接：

The Value of Pretherapeutic Basal Calcitonin Cut-Offs for the Therapeutic Strategy and Prediction of Long-Term Outcome of Patients with Medullary Thyroid Cancer—A 30-Year Single-Center Experience