Early calcitonin levels in medullary thyroid carcinoma: Prognostic role in patients without distant metastases at diagnosis

Abstract

IntroductionCalcitonin is the most specific marker for medullary thyroid carcinoma, thus, low detectable calcitonin values after surgery can conceal persistent disease. The present study aimed to explore the prognostic role of pre-operative and early calcitonin levels in patients without distant metastases at diagnosis.MethodsA retrospective cohort of patients suffering from medullary thyroid carcinoma was considered (N=55). The final disease status, i.e. complete response (undetectable calcitonin levels and negative radiological assessments) or persistent disease (detectable calcitonin levels and/or positive radiological assessments), was deduced from the last available follow-up. Pre-operative and early calcitonin levels (i.e. six months after surgery) have been correlated to several clinical and histological features, according to the final disease status.ResultsPersistent disease patients showed higher pre-operative and early calcitonin values (p=0.028 and p<0.001, respectively), compared to complete response sub-cohort. Cox-regression models show that early detectable calcitonin increases up to 18-fold the risk of persistent disease, independently from tumour size and pre-operative calcitonin levels (p=0.006). Of note, when considering only patients who finally developed distant metastasis, ROC curve analysis shows that an early calcitonin level ≥16 pg/ml predicts the final disease status with a sensitivity of 89% and a specificity of 82% (AUC=0.911, CI95%: 0.819-1000, p<0.001).ConclusionCalcitonin levels six months after surgery represents an easy and effective predictor of persistent disease for medullary thyroid carcinoma without distant metastasis at diagnosis.

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“…After surgery, he didn’t reach the biochemical cure. Due to a higher risk of recurrence [ 9 ], he underwent strict radiological and biochemical monitoring and a progressive increase of plCT up to 5864 pg/mL and CEA up to 104.7 ng/mL was observed. A neck ultrasound revealed the presence of right lateral-cervical round lymph nodes suspicious for MCT locoregional metastases.…”

Time Kinetics and prognosis roles of calcitonin after surgery for medullary thyroid carcinoma

“…Long-term postoperative Ctn normalization, as biochemical cure, is a favorable prognostic factor related to a better outcome, predicting a 10-year survival rate of 97.7% [ 14 , 15 ]. Any detectable Ctn level value after six months from surgery increased up to 18-fold the risk of persistent disease, independently from tumour size and pre-operative calcitonin levels [ 16 ]. High persistent Ctn serum levels represent residual tumor and disease progression.…”