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Zheng G, Liu J, Xu H, Dong C, Cao X, He Q, Zhang G, Wang W, Wang L, Yang X, Liu J, Hao M, Xue K, Li G, Liu X, Ding C, Wang X, Zheng H. Prognostic factors for progression free survival in patients with medullary thyroid cancer: a multicenter cohort study. Updates Surg 2025:10.1007/s13304-025-02193-2. [PMID: 40392415 DOI: 10.1007/s13304-025-02193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 03/27/2025] [Indexed: 05/22/2025]
Abstract
Many patients with medullary thyroid cancer (MTC) experience recurrent or persistent disease after surgery due to its aggressive nature. However, the prognostic factors for progression-free survival (PFS) have been poorly investigated. This study aimed to explore prognostic factors associated with PFS in patients with MTC. Patients with MTC were enrolled from 15 medical centers in Shandong Province, China, between January 2010 and December 2021. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors for PFS in patients with MTC. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff value of the metastatic lymph node ratio (LNR) in predicting PFS. Patients with MTC from the Surveillance, Epidemiology, and End Results (SEER) database were used to test the predictive value of the LNR cutoff for overall survival (OS) and disease-specific survival (DSS). In the Shandong cohort, extrathyroidal extension (HR, 1.622; 95% CI 1.022-2.575, P = 0.040), LNR (HR, 2.806; 95% CI 1.121-7.025, P = 0.028), and T3 stage (HR, 2.060; 95% CI 1.074-3.952, P = 0.030) were independent risk factors for PFS in patients with MTC. The optimal cutoff value of the LNR for predicting PFS was 0.19. Compared to patients with LNR < 0.19, those with LNR ≥ 0.19 suffered worse PFS (Log-rank P < 0.0001) in the Shandong cohort, and worse OS (Log-rank P < 0.0001) and DSS (Log-rank P < 0.0001) in the SEER cohort. This study identified prognostic factors for PFS in patients with MTC. LNR ≥ 0.19 could be used as an adverse prognostic factor for patients with MTC.
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Affiliation(s)
- Guibin Zheng
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, Shandong, China
| | - Jianing Liu
- Department of Thyroid Surgery, The Second Hospital of Shandong University, Jinan, 250033, Shandong, China
| | - Hao Xu
- Department of Breast and Thyroid Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Chaopeng Dong
- Department of Breast and Thyroid Surgery, Heze Municipal Hospital, Heze, 274000, Shandong, China
| | - Xianjiao Cao
- Department of Thyroid and Breast Surgery, The 960th Hospital of People'S Liberation Army, Jinan, 250031, Shandong, China
| | - Qingqing He
- Department of Thyroid and Breast Surgery, The 960th Hospital of People'S Liberation Army, Jinan, 250031, Shandong, China
| | - Guanyu Zhang
- Department of Breast and Thyroid Surgery, Jining No. 1 People's Hospital, Jining, 272002, Shandong, China
| | - Wei Wang
- Department of Breast and Thyroid Surgery, Jining No. 1 People's Hospital, Jining, 272002, Shandong, China
| | - Liquan Wang
- Department of Breast and Thyroid Surgery, Weifang People's Hospital, Weifang, 261000, Shandong, China
| | - Xiaoqing Yang
- Department of Thyroid Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shangdong University, Weihai, 264200, Shandong, China
| | - Jiaqi Liu
- Breast and Thyroid Surgery Department, Zibo Central Hospital, Zibo, 255000, Shandong, China
| | - Min Hao
- Department of Breast and Thyroid Surgery, Dongying People's Hospital, Dongying, 257091, Shandong, China
| | - Kecheng Xue
- Department of Thyroid Surgery, Linyi People's Hospital, Linyi, 276003, Shandong, China
| | - Guolou Li
- Department of Thyroid and Breast Surgery, Weifang Hospital of Traditional Chinese Medicine, Weifang, 261000, Shandong, China
| | - Xianqiang Liu
- Department of Thyroid and Breast Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, Shandong, China
| | - Changyuan Ding
- Department of Thyroid Surgery, General Surgery, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
| | - Xufu Wang
- Department of Nuclear Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 26603, Shandong, China.
| | - Haitao Zheng
- Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, 264000, Shandong, China.
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Hansen AW, Vestergaard P, Poulsen MM, Rasmussen ÅK, Feldt-Rasmussen U, Madsen M, Næraa RW, Hansen D, Main K, Pedersen HB, Londero SC, Rolighed L, Hahn CH, Rask KB, Maare C, Nielsen HH, Gaustadnes M, Rossing M, Hermann P, Mathiesen JS. RET C611Y Germline Variant in Multiple Endocrine Neoplasia Type 2A in Denmark 1930-2021: A Nationwide Study. Cancers (Basel) 2025; 17:374. [PMID: 39941743 PMCID: PMC11816337 DOI: 10.3390/cancers17030374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 01/08/2025] [Accepted: 01/20/2025] [Indexed: 02/16/2025] Open
Abstract
Background: Multiple endocrine neoplasia type 2A (MEN 2A) is a rare hereditary cancer syndrome caused by pathogenic variants in the rearranged during transfection (RET) gene and is characterized by medullary thyroid carcinoma (MTC), pheochromocytoma (PHEO), primary hyperparathyroidism (PHPT), cutaneous lichen amyloidosis (CLA), and Hirschsprung's disease. Phenotypic data on the RET C611Y variant remain sparse. Consequently, we aimed to establish a clinical risk profile. Methods: We conducted a nationwide study of all cases (n = 128) born after 1 January 1930 and recognized as carrying the RET C611Y variant in Denmark before 1 April 2021. Results: The median follow-up after birth was 47 years (range, 3-92). Age-related penetrance at age 70 years for MTC was 98% (CI, 91-100), for PHEO 24% (CI, 16-37), and for PHPT 10% (CI, 5-20). None had CLA or Hirschsprung's disease. The age-related progression of MTC was significant (p < 0.001). The median age at T0N0M0 was 11 years (2-62), at T1-4N0M0 was 37 years (12-65), at TxN1M0 was 47 years (16-79), and at TxNxM1 was 50 years (28-70). At the last follow-up, 56% of thyroidectomized cases (n = 103) were biochemically cured. Overall survival at 70 years was 74% (CI, 59-84). Conclusions: RET C611Y is associated with a very high penetrance of MTC and a low penetrance of PHEO and PHPT. CLA and Hirschsprung's disease almost never occur. MTC seems moderately aggressive, but large variability can be seen. Overall survival may be comparable to that of the general population.
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Affiliation(s)
- Anders Würgler Hansen
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, 5000 Odense, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.V.); (M.M.)
- Department of Clinical Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Morten Møller Poulsen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Åse Krogh Rasmussen
- Department of Nephrology and Endocrinology, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (Å.K.R.); (U.F.-R.)
| | - Ulla Feldt-Rasmussen
- Department of Nephrology and Endocrinology, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (Å.K.R.); (U.F.-R.)
| | - Mette Madsen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, 9000 Aalborg, Denmark; (P.V.); (M.M.)
- Department of Clinical Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
- Department of Pediatrics and Adolescent Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Rune Weis Næraa
- Department of Pediatrics, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Dorte Hansen
- Department of Pediatrics, Odense University Hospital, 5000 Odense, Denmark;
| | - Katharina Main
- Department of Growth and Reproduction, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
| | | | - Stefano Christian Londero
- Department of ORL Head & Neck Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark; (S.C.L.); (L.R.)
| | - Lars Rolighed
- Department of ORL Head & Neck Surgery, Aarhus University Hospital, 8200 Aarhus, Denmark; (S.C.L.); (L.R.)
| | - Christoffer Holst Hahn
- Department of ORL Head & Neck Surgery, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (C.H.H.); (K.B.R.)
| | - Klara Bay Rask
- Department of ORL Head & Neck Surgery, Copenhagen University Hospital, 2100 Copenhagen, Denmark; (C.H.H.); (K.B.R.)
| | - Christian Maare
- Department of Oncology, Copenhagen University Hospital-Herlev and Gentofte, 2730 Herlev, Denmark;
| | - Heidi Hvid Nielsen
- Department of Clinical Biochemistry, Zealand University Hospital, 4000 Roskilde, Denmark;
| | - Mette Gaustadnes
- Department of Molecular Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark;
| | - Maria Rossing
- Department of Genomic Medicine, Copenhagen University Hospital, 2100 Copenhagen, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Pernille Hermann
- Department of Endocrinology, Odense University Hospital, 5000 Odense, Denmark;
| | - Jes Sloth Mathiesen
- Department of ORL Head & Neck Surgery and Audiology, Odense University Hospital, 5000 Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Raue F, Frank-Raue K. Long-Term Follow-Up in Medullary Thyroid Carcinoma Patients. Recent Results Cancer Res 2025; 223:267-291. [PMID: 40102262 DOI: 10.1007/978-3-031-80396-3_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
After surgery, patients with MTC (medullary thyroid carcinoma) should be assessed for the presence of residual disease, the localization of metastases, and the identification of progressive disease. Postoperative staging is used to separate low-risk patients from high-risk patients with MTC. In addition to the TNM system, further histological staging with Ki67, mitotic count, tumor necrosis, and molecular analysis of somatic RET mutations is helpful for the stratification of patients in different prognostic categories. The number of lymph node metastases and involved compartments as well as postoperative Ctn (calcitonin) and CEA (carcinoembryonic antigen) levels should also be documented. Postoperative nonmeasurable Ctn levels are associated with a favorable outcome. In patients with basal serum Ctn levels less than 150 pg/ml following thyroidectomy, persistent or recurrent disease is almost always confined to lymph nodes in the neck. If the postoperative serum Ctn level exceeds 150 pg/ml, patients should be evaluated by imaging procedures, including neck and chest CT (computed tomography), contrast-enhanced MRI, US of the liver, bone scintigraphy, MRI of the bone and positron emission tomography (PET)/CT. One can estimate the growth rate of MTC metastases from sequential imaging studies using response evaluation criteria in solid tumors (RECIST) that document increases in tumor size over time and by measuring serum levels of Ctn or CEA over multiple time points to determine the tumor marker doubling time. One of the main challenges remains finding effective adjuvant and palliative options for patients with metastatic disease. Patients with persistent or recurrent MTC localized to the neck and slightly elevated Ctn levels following thyroidectomy might be candidates for neck reoperations depending on the extent of the tumor. Once metastases appear, the clinician must decide which patients require therapy, balancing the frequently slow rate of tumor progression associated with a good quality of life and suggesting active surveillance against the limited efficacy and potential toxicities of local and systemic therapies. Considering that metastatic MTC is incurable, the management goals are to provide locoregional disease control, palliate symptoms such as diarrhea, palliate symptomatic metastases causing pain or bone fractures, and control metastases that threaten life through bronchial obstruction or spinal cord compression. This can be achieved by palliative surgery, EBRT (external beam radiation therapy) or systemic therapy using multikinase inhibitors (MKIs) targeting RET or selective RET inhibitors requiring genetic testing prior to the initiation of therapy.
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Affiliation(s)
- Friedhelm Raue
- Endocrine Practice, Heidelberg, Germany.
- Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | - Karin Frank-Raue
- Endocrine Practice, Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
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Machens A, Dralle H. Surgical Treatment of Medullary Thyroid Cancer. Recent Results Cancer Res 2025; 223:247-266. [PMID: 40102261 DOI: 10.1007/978-3-031-80396-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
Medullary thyroid cancer (MTC) is an infrequent calcitonin-secreting thyroid malignancy that can vary a great deal in tumor biology and progression. The most important determinant of distant metastases, which represents the single greatest risk factor of poor cancer-specific survival, is lymph node metastasis in the neck and mediastinum. In patients with node-positive MTC, systematic compartment-oriented dissection of central and lateral neck nodes at the initial operation promotes biochemical cure and decreases the risk of locoregional recurrence in previously dissected lymph node compartments. Routine calcitonin screening in nodular thyroid disease and genomic screening, flanked by advances in ultrasound and functional imaging modalities, have been pivotal in making the diagnosis early and enabling risk-reducing surgical interventions in patients with sporadic and hereditary MTC, without compromising clinical outcome. To assess a RET carrier's risk of medullary thyroid cancer, all that is needed is patient age, underlying RET mutation, and biomarker levels. Recently, risk-reducing surgery, consisting in hemithyroidectomy with or without diagnostic ipsilateral central lymph node dissection, has been advocated for sporadic MTC clinically confined to one thyroid lobe that is desmoplasia negative on intraoperative frozen sectioning. These recent developments reflect the current shift from reactive to increasingly preemptive, risk-reducing surgery for MTC.
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Affiliation(s)
- Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Halle, Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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Raue F, Frank-Raue K. What Is New in Diagnostics and Management of Medullary Thyroid Carcinoma. Recent Results Cancer Res 2025; 223:1-8. [PMID: 40102252 DOI: 10.1007/978-3-031-80396-3_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
Medullary thyroid carcinoma (MTC) is a rare neoplasm originating from parafollicular C cells. It secretes calcitonin (Ctn), a highly sensitive and specific tumor marker, which allows for early diagnosis and defines postoperative cure or persistence/recurrence of MTC. Germline mutations in the RET proto-oncogene are responsible for the development of MTC in MEN2. Somatic RET mutations modify the behavior of MTC and are a target for systemic therapy with selective RET inhibitors. Recent advances in preoperative immunohistochemistry and molecular diagnostics in biopsies achieved by fine needle aspiration significantly improves diagnosis and allows classification in low and high risk MTC with important implications for treatment and prognosis. This personalized approach enables a less aggressive surgery in low risk MTC patients, reduces the incidence of complications and improves quality of life. Risk stratification in MEN2 patients based on genotype-phenotype correlation of the different RET mutations allows cure by personalized thyroidectomy. Postoperative imaging in patients with persistent or recurrent MTC with PET/CT using different radiopharmaceuticals proved to be sensitive and accurate in detecting MTC recurrences/metastases and assesses their biological and clinical aggressiveness. Molecular genetic classification of tumors enables personalized systemic therapies with multikinase inhibitors or selective RET inhibitors in patients with advanced metastasized and progressive disease. Despite the recent progress in diagnosis and treatment, confirmation of these new procedures and standardization of these approaches in MTC are required.
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Affiliation(s)
- Friedhelm Raue
- Endocrine Practice, Heidelberg, Germany.
- Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | - Karin Frank-Raue
- Endocrine Practice, Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
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Raue F, Frank-Raue K. Epidemiology, Clinical Presentation, and Diagnosis of Medullary Thyroid Carcinoma. Recent Results Cancer Res 2025; 223:93-127. [PMID: 40102255 DOI: 10.1007/978-3-031-80396-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2025]
Abstract
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating from thyroid C cells that produces mainly calcitonin (Ctn) and is used as a tumor marker. MTC can occur either sporadically (75%) or in a hereditary variant (multiple endocrine neoplasia type 2, MEN2) due to germline mutations in the RET proto-oncogene. The discovery of MTC in a patient has several diagnostic implications involving a specific strategy, preoperative evaluation of the tumor marker Ctn and the extent of the disease, classification of MTC as sporadic or hereditary using germline RET testing, screening for associated endocrinopathies in hereditary MTC, and somatic RET testing in sporadic MTC. Elevated Ctn is a highly sensitive and specific tumor marker for the diagnosis and follow-up of MTC. Ctn is directly related to the tumor mass. In patients with nodular thyroid disease, MTC can be diagnosed by Ctn determination. Ctn is an indicator of tumor burden. Patients with confirmed sporadic or hereditary MTC should undergo total thyroidectomy. Depending on the preoperative Ctn value, additional dissection of the lymph nodes in the central and lateral neck compartments should be performed. In MEN 2 patients diagnosed by RET mutation analysis, the timing of prophylactic thyroidectomy depends on the specific RET mutation and Ctn level.
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Affiliation(s)
- Friedhelm Raue
- Endocrine Practice, Heidelberg, Germany.
- Medical Faculty, University of Heidelberg, Heidelberg, Germany.
| | - Karin Frank-Raue
- Endocrine Practice, Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
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Yin Y, Sun F, Jin Y. A real-world pharmacovigilance study of FDA Adverse Event Reporting System events for pralsetinib. Front Oncol 2024; 14:1491167. [PMID: 39600647 PMCID: PMC11588741 DOI: 10.3389/fonc.2024.1491167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 10/21/2024] [Indexed: 11/29/2024] Open
Abstract
Background Pralsetinib, a selective oral inhibitor of rearranged during transfection (RET) fusion proteins and oncogenic RET mutants, has shown significant efficacy in treating RET fusion-positive non-small cell lung cancer and thyroid cancer. However, since pralsetinib was approved in the United States in September 2020, there have been limited reports of post-marketing adverse events (AEs). In this study, we aimed to analyze the AE signals with pralsetinib on the basis of the United States Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) to provide instructions in clinical practice. Methods All AE reports were obtained from the FAERS database from the first quarter (Q3) of 2020 to the second quarter (Q2) of 2024. Various signal quantification techniques were used for analysis, including reporting odds ratios, proportional reporting ratios, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker (MGPS)-based empirical Bayesian geometric mean. Results Out of 8,341,673 case reports in the FAERS database, 1,064 reports of pralsetinib as the "primary suspected (PS)" AEs were recorded, covering 26 system organ classes and 256 preferred terms. Of the reports, 62.5% were from consumers rather than healthcare professionals. The most common systems were general disorders and administration site conditions (n = 704), investigations (n = 516), and gastrointestinal disorders (n = 405). A total of 95 significant disproportionality preferred terms (PTs) conformed to the four algorithms simultaneously. AEs that ranked the top three at the PT level were hypertension (n = 80), asthenia (n = 79), and anemia (n = 65). Of the 95 PTs with significant disproportionation, unexpected significant AEs such as increased blood calcitonin, increased myocardial necrosis marker, and bacterial cystitis were observed, which were not mentioned in the drug's instructions. The median onset time of pralsetinib-associated AEs was 41 days [interquartile range (IQR) 14-86 days]. The majority of the AEs occurred in 30 days (42.86%). Conclusion Our pharmacovigilance analysis of real-world data from the FEARS database revealed the safety signals and potential risks of pralsetinib usage. These results can provide valuable evidence for further clinical application of pralsetinib and are important in enhancing clinical medication safety.
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Affiliation(s)
- Yi Yin
- Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fengli Sun
- Department of Pediatric Intensive Care Unit, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Youpeng Jin
- Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Wang B, Huang J, Chen L. Management of medullary thyroid cancer based on variation of carcinoembryonic antigen and calcitonin. Front Endocrinol (Lausanne) 2024; 15:1418657. [PMID: 39449744 PMCID: PMC11499115 DOI: 10.3389/fendo.2024.1418657] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 09/25/2024] [Indexed: 10/26/2024] Open
Abstract
Carcinoembryonic antigen (CEA) and calcitonin (Ctn) are pivotal biomarkers in the diagnosis and management of medullary thyroid carcinoma (MTC). However, their diagnostic reliability in perioperative period remains a topic of ongoing debate. This review synthesizes researches on perioperative fluctuations in CEA and Ctn levels, and evaluates the impact of their different combinations on MTC diagnosis, treatment decisions, and prognosis. Our findings highlight it is crucial to understand and interpret the various combinations of CEA and Ctn fluctuations within a clinical context. Furthermore, to reduce diagnostic errors and improve patient outcomes, we recommend follow-up diagnostic and treatment protocols designed to address the potential pitfalls associated with the use of these biomarkers.
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Affiliation(s)
- Bo Wang
- Department of Paediatric Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Huang
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Chen
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilian University of Munich, Munich, Germany
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Raue F, Bruckner T, Frank-Raue K. The Long-Term Cure of Patients With Hereditary Medullary Thyroid Carcinoma: 40 Years of Follow-Up in a Single Center. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:657-664. [PMID: 39285761 PMCID: PMC11966136 DOI: 10.3238/arztebl.m2024.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 08/09/2024] [Accepted: 08/09/2024] [Indexed: 01/14/2025]
Abstract
BACKGROUND The cure rate of patients with hereditary medullary thyroid carcionoma (MTC) can be decisively improved by screening for elevated calcitonin (Ctn) levels and RET gene mutations in patients from families affected by multiple endocrine neoplasia type 2 (MEN2), followed by prophylactic thyroidectomy in persons with mutated RET genes. In this long-term observational study, we investigated whether postoperative cures are indeed maintained decades after the procedure. METHODS From 1979 to 2021, 277 patients with MEN2 who underwent thyroidectomy were observed postoperatively for 14.4 ± 10.3 years (mean, standard deviation). They were classified as either cured or not cured depending on the last measured serum Ctn level (cured, Ctn < 10 pg/mL or < 2 pg/mL; not cured, Ctn ≥ 10 pg/mL). Depending on their RET mutation status, they were categorized as moderate, high, or highest risk (121, 130, and 26 patients, respec - tively). RESULTS 154 patients (55.6%) obtained a long-term cure (Ctn <10 pg/mL). The median age at surgery was 27, 14, and 4 years in patients at moderate, high, and highest risk. All 52 patients who had undergone prophylactic thyroidectomy before the age of 6 years, 9 years, or 6 months had a Ctn level below 2 pg/mL and were cured at the end of the follow-up period. In a multivariable analysis, prognostic factors for a long-term cure were a lower tumor stage and, by tendency, classification as belonging to the moderate as opposed to the highest-risk group. CONCLUSION In patients receiving an early diagnosis of MEN2 via family screening, prophylactic thyroidectomy taking into account the RET mutation risk group can achieve a long-term cure of MTC with undetectable serum Ctn levels.
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Affiliation(s)
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
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Liu S, Zhao H, Li X. Serum Biochemical Markers for Medullary Thyroid Carcinoma: An Update. Cancer Manag Res 2024; 16:299-310. [PMID: 38617188 PMCID: PMC11011642 DOI: 10.2147/cmar.s440477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC), a rare malignancy, requires early diagnosis for optimal patient outcomes. An important aspect of MTC diagnosis is the assessment of serum biomarkers. This review aimed to evaluate the use of serum biomarkers in the diagnosis, prognosis, and follow-up of MTC. METHODS A thorough search of PubMed covering 1975 to 2022 was conducted to identify English-language articles on MTC serum biomarkers. RESULTS The review revealed that calcitonin (Ctn) and carcinoembryonic antigen (CEA) remain the most important serum biomarkers for MTC diagnosis and management. Despite limited studies on procalcitonin (PCT), its stability and ability to exclude interference from inflammation make it a valuable potential marker of MTC. Although the positive rate of serum CA19-9 levels in MTC patients was not high, it can be used as an indicator of poor prognosis in advanced MTC. Other serum markers, including chromogranin A, gastrin-releasing peptide precursor, and neurospecific enolase, did not show any unique value in MTC diagnosis and management. CONCLUSION Taken together, this review emphasized the importance of serum biomarkers, particularly Ctn and CEA, in the diagnosis and management of MTC. PCT shows promise as a valuable potential marker, whereas CA19-9 can be used as a prognostic indicator of advanced MTC. Further research is needed to validate the significance of these serum biomarkers in MTC and determine the effects of confounding factors on their levels. Clinicians should consider using these markers in MTC diagnosis, prognosis, and follow-up, particularly for patients with advanced disease.
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Affiliation(s)
- Shuzhou Liu
- Department of Head & Neck Surgery, Hainan General Hospital, Haikou, 570311, People’s Republic of China
| | - Hao Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100010, People’s Republic of China
| | - Xiaoyi Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100010, People’s Republic of China
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Guo M, Sun Y, Wei Y, Xu J, Zhang C. Advances in targeted therapy and biomarker research in thyroid cancer. Front Endocrinol (Lausanne) 2024; 15:1372553. [PMID: 38501105 PMCID: PMC10944873 DOI: 10.3389/fendo.2024.1372553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
Driven by the intricacy of the illness and the need for individualized treatments, targeted therapy and biomarker research in thyroid cancer represent an important frontier in oncology. The variety of genetic changes associated with thyroid cancer demand more investigation to elucidate molecular details. This research is clinically significant since it can be used to develop customized treatment plans. A more focused approach is provided by targeted therapies, which target certain molecular targets such as mutant BRAF or RET proteins. This strategy minimizes collateral harm to healthy tissues and may also reduce adverse effects. Simultaneously, patient categorization based on molecular profiles is made possible by biomarker exploration, which allows for customized therapy regimens and maximizes therapeutic results. The benefits of targeted therapy and biomarker research go beyond their immediate clinical impact to encompass the whole cancer landscape. Comprehending the genetic underpinnings of thyroid cancer facilitates the creation of novel treatments that specifically target aberrant molecules. This advances the treatment of thyroid cancer and advances precision medicine, paving the way for the treatment of other cancers. Taken simply, more study on thyroid cancer is promising for better patient care. The concepts discovered during this investigation have the potential to completely transform the way that care is provided, bringing in a new era of personalized, precision medicine. This paradigm shift could improve the prognosis and quality of life for individuals with thyroid cancer and act as an inspiration for advances in other cancer types.
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Affiliation(s)
- Mei Guo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuqi Sun
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuyao Wei
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jianxin Xu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chun Zhang
- Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Yao W, Peng X, Guan Y, Du X, Xia C, Liu F. Thyroid Nodules: Emerging Trends in Detection and Visualization based on Citespace. Endocr Metab Immune Disord Drug Targets 2024; 24:130-141. [PMID: 37608676 PMCID: PMC10909822 DOI: 10.2174/1871530323666230822143549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Thyroid nodule (TN) is a highly prevalent clinical endocrine disease. Many countries have formed guidelines on the prevention and treatment of TN based on extensive research. However, there is a scarcity of TN-related literature based on bibliometrics. OBJECTIVES This study aimed to evaluate the scientific achievements and progress of TN research from a global perspective by investigating the literature for 20 years through bibliometrics. METHODS We searched the literature on TN in the core collection of the Web of Science database from 2002 to 2021 and used the Citespace software to analyze the co-authorship, co-citation, and co-occurrence of countries, institutions, authors, keywords, and co-cited literature. RESULTS We retrieved 12319 documents related to TN. The literature on TN has been growing since 2002. The United States has contributed the largest proportion of TN papers (20.64%), followed by China, Italy, and South Korea. The United States ranked first in terms of centrality (0.38). Haugen BR, Gharib H, and Cibas ES are the top three most cited authors. The papers published in Thyroid were cited most frequently (7952 times). The most prominent keywords were management, cancer, fine needle aspiration, diagnosis, malignant tumor, thyroid cancer, ultrasound, biopsy, benign, surgery, ablation, and cytology. All keywords could be divided into three categories: diagnosis stratification, treatment, and cancer. As far as potential hot spots are concerned, the keywords that have recently burst strongly and are still continuing are: "Association Guideline" (2018-2021), "Radiofrequency Ablation" (2017-2021), "Classification" (2019-2021), and "Data System" (2017-2021). CONCLUSION Based on the current trends, the number of publications on TN will continue to increase. The United States is the most active contributor to research in this field. Previous literature focused on stratification, cancer, surgery, and ablation, and there were different opinions on the stratification of diagnosis. There were relatively few studies on pathogenesis and treatment using medicine. More focus will be placed on association guidelines, radiofrequency ablation, classification, and data system, which may be the next popular topics in TN research.
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Affiliation(s)
- Wenyan Yao
- Shaanxi Institute of International Trade & Commerce, Xianyang, 712046, China
- College of Pharmacy, Dali University, Dali, 671000, China
| | - Xiujuan Peng
- Shaanxi Institute of International Trade & Commerce, Xianyang, 712046, China
| | - Yunhui Guan
- College of Pharmacy, Dali University, Dali, 671000, China
| | - Xia Du
- Shaanxi Academy of Traditional Chinese Medicine, Xi'an 710003, China
| | - Conglong Xia
- College of Pharmacy, Dali University, Dali, 671000, China
| | - Feng Liu
- Shaanxi Institute of International Trade & Commerce, Xianyang, 712046, China
- Shaanxi Buchang Pharmaceutical Co., Ltd., Xi'an, 710075, China
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Dralle H, Brandenburg T, Weber F, Führer-Sakel D, Theurer S, Baba HA, Schmid KW, Machens A. Sporadic noninvasive medullary thyroid neoplasm: A desmoplasia-negative unifocal nonmetastatic tumor cured by hemithyroidectomy. Surgery 2023; 174:1356-1362. [PMID: 37821265 DOI: 10.1016/j.surg.2023.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/14/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The absence of primary tumor desmoplasia, a marker of node metastases, on frozen section may help reduce the extent of surgery without compromising the biochemical cure. We aimed to clarify whether hemithyroidectomy with diagnostic ipsilateral central neck dissection can replace total thyroidectomy with routine central neck dissection in patients with sporadic medullary thyroid cancer. METHODS We retrospectively evaluated data collected from patients who had undergone primary neck surgery for hypercalcitoninemic sporadic medullary thyroid cancer between January 2017 and December 2022 at one institution. RESULTS Of the 25 patients we examined, 19 had desmoplasia-negative and 6 desmoplasia-positive primary thyroid tumors on frozen section. The desmoplasia-negative patients had undergone less surgery with fewer nodes removed than the desmoplasia-positive patients (medians of 6 vs 31 nodes, P < .001). The desmoplasia-negative patients had predominantly undergone hemithyroidectomy with ipsilateral central neck dissection. None of the desmoplasia-negative tumors was multifocal (0 of 19 desmoplasia-negative vs 2 of 6 desmoplasia-positive or 0% vs 33%, P = .050) or node-positive (0 of 19 vs 6 of 6 patients or 0% vs 100%; medians of 0 vs 3.5 node metastases; both P < .001). Despite limited surgery, all desmoplasia-negative patients attained and maintained biochemical cure. CONCLUSION Hemithyroidectomy combined with diagnostic ipsilateral central neck dissection is a viable risk-reducing and curative strategy for desmoplasia-negative and node-negative, nonmetastatic unifocal tumors, for which we propose the term sporadic noninvasive medullary thyroid neoplasm (SNMTP).
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Tim Brandenburg
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Frank Weber
- Department of General, Visceral and Transplantation Surgery, Division of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- Department of Endocrinology, Diabetology and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Sarah Theurer
- Department of Pathology, University of Duisburg-Essen, Essen, Germany
| | - Hideo A Baba
- Department of Pathology, University of Duisburg-Essen, Essen, Germany
| | | | - Andreas Machens
- Department of Visceral, Vascular, and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Prete A, Gambale C, Torregrossa L, Ciampi R, Romei C, Ramone T, Agate L, Bottici V, Cappagli V, Molinaro E, Materazzi G, Elisei R, Matrone A. Clinical Evolution of Sporadic Medullary Thyroid Carcinoma With Biochemical Incomplete Response After Initial Treatment. J Clin Endocrinol Metab 2023; 108:e613-e622. [PMID: 36722192 DOI: 10.1210/clinem/dgad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/06/2023] [Accepted: 01/25/2023] [Indexed: 02/02/2023]
Abstract
CONTEXT The clinical response after surgery is a determinant in the management of patients with medullary thyroid carcinoma (MTC). In case of excellent or structural incomplete response, the follow-up strategies are well designed. Conversely, in case of biochemical incomplete response (BiR) the management is not clearly defined. OBJECTIVE This work aimed to evaluate the overall and per-site prevalence of structural disease detection in sporadic MTC patients with BiR and to assess the predictive value of various clinical, biochemical, and genetic features. METHODS We evaluated data of 599 consecutive patients surgically treated for sporadic MTC (2000-2018) and followed-up at the endocrine unit of the University Hospital of Pisa. RESULTS After a median of 5 months from surgery, 145 of 599 (24.2%) patients were classified as BiR. Structural disease was detected in 64 of 145 (44.1%), after a median time of 3.3 years. In 73.6%, structural disease was detected at a single site, prevalently cervical lymph nodes. Among several others, at the time of first evaluation after surgery, only basal calcitonin (bCTN) and stage IVa/b were independent predictive factors. Also, structural disease was more frequent in patients with shorter CTN doubling time and somatic RET mutation. CONCLUSION In sporadic MTC patients with BiR, the risk of detection of structural disease was about 50% at 10 years. Higher bCTN levels and staging predicted the risk of detecting structural disease. According to these findings, stricter follow-up should be reserved for MTC with BiR and elevated values of bCTN and to those with an advanced stage. Long follow-up should be considered for all BiR patients since 50% of them develop structural disease within 10 years.
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Affiliation(s)
- Alessandro Prete
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Carla Gambale
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University Hospital of Pisa, 56126, Pisa, Italy
| | - Raffaele Ciampi
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Cristina Romei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Teresa Ramone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Laura Agate
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Valeria Bottici
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Virginia Cappagli
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Eleonora Molinaro
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Unit of Endocrine Surgery, University Hospital of Pisa, 56124, Pisa, Italy
| | - Rossella Elisei
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
| | - Antonio Matrone
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, Pisa University Hospital, 56124, Pisa, Italy
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Yue W, Zhang Y. Oncologic outcomes of calcitonin-negative medullary thyroid carcinoma. Front Endocrinol (Lausanne) 2022; 13:1025629. [PMID: 36506082 PMCID: PMC9727137 DOI: 10.3389/fendo.2022.1025629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Calcitonin (Ct)-negative medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor. This study aimed to clarify its incidence, clinicopathologic characteristics, management, and treatment outcome. METHODS We retrospectively analyzed data of patients with primary MTC. Patients were divided into two groups according to the preoperative serum Ct level (Ct-negative and Ct-positive). The demographic, pathologic, and molecular characteristics, and treatment outcomes were compared between the two groups. In the Ct-negative group, we analyzed the association between the operation type and treatment outcome. RESULTS Of the total 312 patients, 24 were diagnosed with Ct-negative MTC. The rate of lymph node metastasis was significantly higher in the Ct-positive than in the Ct-negative group (47.9% vs. 0%, p<0.001). The proportion of patients with Ki-67 ≤10% was significantly higher in the Ct-negative than in the Ct-positive group (87.5% vs. 38.2%, p<0.001). Excellent response was achieved by 91.7% and 34.7% of patients in the Ct-negative and Ct-positive groups, respectively (p<0.001). In the Ct-negative group, excellent response was achieved by all female patients, but only 50% of male patients. CONCLUSIONS Ct-negative MTC is rare and unlikely to develop lymph node metastasis. Unilateral lobectomy tends to provide a satisfactory chance of excellent response; however, this requires further validation.
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