■甲状腺髓样癌(MTC)是一种罕见的分泌降钙素(Ctn)的恶性肿瘤。我们旨在分析MTC患者在不同时间点的Ctn水平之间的关系,并评价其对复发的预测作用。
■在中国北方一家大型医疗中心对被诊断为MTC的患者进行了回顾性研究。术前Ctn之间的相互关系,术后第一个月血清Ctn(NPS)正常化,并评估了长期生化治愈及其对结构性复发的预测作用。
■本研究共纳入212例患者。中位随访时间为59.5个月。5年和10年累积无病生存率分别为81.5%和66.8%,分别。NPS(OR:216.33,95%CI:28.69-1631.09,P<0.001)和无结构性复发(OR:61.71,95%CI:3.90-975.31;P=0.003)与生化治愈有关。非生化治愈(OR:28.76;95%CI:2.84-290.86;P=0.004,HR:14.63,95%CI:2.27-94.07,P=0.005),肿瘤大小较大(OR:8.79,95%CI:2.12-36.40,P=0.003,HR:5.41,95%CI:2.04-14.37,P=0.001),多灶性(OR:4.02,95%CI:1.06-15.17,P=0.040,HR:3.00,95%CI:1.18-7.60,P=0.021)是结构性复发和无病生存的不利独立预测因子。对于局限于甲状腺叶的零星MTC,在亚组分析中,不同手术之间的生化或结构预后没有差异。
■NPS,而不是术前Ctn,预测MTC的长期生化治愈。非生化治疗,较大的肿瘤负荷,包括较大的肿瘤大小和初始手术时的多病灶,作为较差的预后预测因子。
UNASSIGNED: Medullary thyroid carcinoma (MTC) is a rare malignancy secreting calcitonin (Ctn). We aimed to analyze the relationship between Ctn levels at different time points in patients with MTC, and evaluate its predictive effect on recurrence.
UNASSIGNED: A retrospective study of patients diagnosed with MTC in a large medical center were conducted in northern China. The interrelationships between preoperative Ctn, normalization of postoperative serum Ctn at the first month (NPS), and long-term biochemical cure as well as their predicting roles on structural recurrence were assessed.
UNASSIGNED: A total of 212 patients were included in this study. The median follow-up time was 59.5 months. The 5- and 10-year cumulative disease-free survival rates were 81.5 % and 66.8 %, respectively. NPS (OR: 216.33, 95 % CI: 28.69-1631.09, P < 0.001) and absence of structural recurrence (OR: 61.71, 95 % CI: 3.90-975.31; P = 0.003) were associated with biochemical cure. Non-biochemical cure (OR: 28.76; 95 % CI: 2.84-290.86; P = 0.004, HR: 14.63, 95 % CI: 2.27-94.07, P = 0.005), larger tumor size (OR: 8.79, 95 % CI: 2.12-36.40, P = 0.003, HR: 5.41, 95 % CI: 2.04-14.37, P = 0.001), and multifocality (OR: 4.02, 95 % CI: 1.06-15.17, P = 0.040, HR: 3.00, 95 % CI: 1.18-7.60, P = 0.021) were unfavorable independent predictors of structural recurrence and disease-free survival. For sporadic MTC confined to the thyroid lobe, there was no difference in biochemical or structural prognosis between the different surgeries in the subgroup analysis.
UNASSIGNED: NPS, rather than preoperative Ctn, predicted long-term biochemical cure for MTC. Non-biochemical cure, larger tumor burden including larger tumor size and multifocality at initial surgery, served as worse prognostic predictors.