A Review of the Significance in Measuring Preoperative and Postoperative Carcinoembryonic Antigen (CEA) Values in Patients with Medullary Thyroid Carcinoma (MTC)

Efficacy and safety of XELOX combined with neoadjuvant radiotherapy versus neoadjuvant chemotherapy in locally advanced gastric cancer

BACKGROUND

The work aimed to compare the efficacy and safety of chemotherapy regimen (oxaliplatin + capecitabine, XELOX) combined with neoadjuvant radiotherapy (NART) and neoadjuvant chemotherapy (NACT) in locally advanced gastric cancer.

METHODS

We retrospectively analyzed clinical data from patients with locally advanced gastric cancer who underwent radical gastrectomy with D2 lymph node dissection at our center between January 2019 and December 2020. The study compared tumor markers, postoperative pathology, short-term efficacy, postoperative complications, and hospital stay between the chemoradiotherapy (CRT, XELOX + NART) group and the NACT-only group. Pearson correlation coefficients was used to analyze the correlations between clinical variables and tumor biomarkers. Inverse probability weighting (IPW) was used to adjust for confounding factors.

RESULTS

A total of 409 patients were included, with 369 (90.2%) in the NACT group and 40 (9.8%) in the CRT group. Significant correlations were found between clinical variables and tumor biomarkers, which may help identify potential prognostic factors for gastric cancer treatment. After IPW adjustment, baseline characteristics were similar between groups. The negative conversion rate of CEA-positive patients was significantly higher in the CRT group (38.1% vs. 11.8%, P < 0.001). The rate of pathological complete response was also higher in the CRT group (15.8% vs. 4.7%, P = 0.017). Postoperative pathological stages ypT0 and T1 were observed in 35.5% of the CRT group compared to 13.5% in the NACT group (P = 0.031). The CRT group had a lower average number of lymph nodes dissected (17 vs. 24, P < 0.001) but a higher ypN0 rate (60.3% vs. 39.8%, P = 0.024). The proportion of patients with tumor regression grade (TRG) 0-1 was higher in the CRT group (60.3% vs. 24.3%, P = 0.003). The R0 resection rate after IPW was 100% in the CRT group versus 96.5% in the NACT group (P = 0.001). No significant differences were found between the CRT and NACT groups in nerve invasion, vascular embolus, peritoneal invasion, bone marrow suppression, nausea, vomiting, esophagitis, diarrhea, other adverse reactions, postoperative complications, or average hospitalization time. The CRT group showed superior disease-free survival while no overall survival advantage (P < 0.05).

CONCLUSIONS

The XELOX regimen combined with neoadjuvant chemoradiotherapy provided superior downstaging, short-term pathological response, and local control benifits compared to perioperative chemotherapy alone, with similar surgical safety profiles.

Prognostic effect of CEA, AFP, CA19‑9 and CA242 for recurrence/metastasis of gastric cancer following radical gastrectomy

The present study aimed to determine the potential of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen (CA)19-9 and CA242 in predicting recurrence/metastasis of gastric cancer in patients following radical gastrectomy. The clinical data of 368 patients with stage I-III gastric cancer who underwent radical gastrectomy were analyzed, and CEA, AFP, CA19-9 and CA242 levels were detected prior to surgery and 6-12 months following surgery. Univariate and multivariate analyses were used to evaluate the potential risk factors for post-operative recurrence/metastasis of gastric cancer, and the predictive value of CEA, AFP, CA19-9 and CA242 levels was evaluated using receiver operating characteristic (ROC) curve and area under the curve (AUC). Cumulative survival rates were calculated using Kaplan-Meier analysis, and statistical significance was evaluated using a log-rank test. Results of the univariate analysis demonstrated that open surgery, age ≥70, total gastrectomy, disease stage III, and pre-operative CA19-9 and CA242 positivity were risk factors for recurrence/metastasis. ROC curve analysis revealed that the AUC values of postoperative CA19-9 were higher than other values. According to the Kaplan-Meier survival analysis, patients with negative CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a higher five-year survival rate than those who exhibited positive levels of these tumor markers. In addition, patients with positive CEA, AFP, CA19-9 and CA242 levels prior to surgery exhibited a significantly worse prognosis. Collectively, the results of the present study indicated that CEA, AFP, CA19-9 and CA242 exhibited potential as predictive biomarkers for recurrence/metastasis following radical gastrectomy in patients with gastric cancer. Notably, CA19-9 and CA242 may exhibit the highest potential in predicting recurrence/metastasis.

Diagnostic value of preoperative systemic inflammatory markers and carcinoembryonic antigen in medullary thyroid carcinoma and the risk factors affecting its prognosis

Background

Medullary thyroid carcinoma (MTC) is a rare malignancy originating from aggressive parafollicular C cells that causes 8-13% of thyroid cancer-related deaths despite its low incidence. Calcitonin and carcinoembryonic antigen (CEA) are considered to be important indicators for the diagnosis of MTC, while serum inflammatory markers have been shown to be valuable in the diagnosis and evaluation of a variety of malignant tumors, but the amount of research literature on MTC is still limited. This article aims to assess the value of serum inflammatory markers, CEA and calcitonin in the differential diagnosis of MTC from papillary thyroid carcinoma (PTC), and to explore the risk factors affecting lateral zone lymph node metastasis of MTC and the clinical features that can be predictive of disease-free survival (DFS).

Methods

We retrospectively analyzed 883 patients with PTC and 128 patients with MTC who received care at West China Hospital Sichuan University. The data of clinical characteristics and follow-up results were collected.

Results

In our cohort, after performing propensity score matching (PSM), there were 117 patients in the MTC group and 436 in the PTC group. Compared with PTC, MTC patients had higher neutrophil-lymphocyte ratio (NLR) (P=0.008), neutrophil-monocyte-platelet-to-lymphocyte ratio (NMPLR) (P=0.03), and CEA values (P<0.001), and no significant differences were found between the remaining baseline characteristics, with CEA having the largest area under the curve (AUC) in the differential diagnosis of PTC and MTC at 0.898 [95% confidence interval (CI): 0.862-0.934, P<0.001]. Univariate and multivariate logistic regression analyses showed that the occurrence of extrathyroidal extension (ETE) [P=0.002, odds ratio (OR): 4.159, 95% CI: 2.734-5.584], calcitonin level >1,000 pg/mL (P=0.002, OR: 4.785, 95% CI: 3.220-6.350) and CEA level (P=0.04, OR: 1.005, 95% CI: 1.000-1.010) were significantly correlated with lateral zone lymph node metastasis in MTC, while platelet-to-lymphocyte ratio (PLR) was a predictor of DFS.

Conclusions

Preoperative blood inflammatory indexes, CEA, and calcitonin level may be able to initially identify MTC and PTC. Meanwhile, ETE, CEA, and calcitonin levels are independent risk factors for lymph node metastasis in the lateral zone of the MTC; therefore, surgeons should consider more carefully planning surgery in conjunction with imaging in patients who have these risk factors at the initial visit.

Long-Term Follow-Up in Medullary Thyroid Carcinoma Patients

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.

Histopathology of C Cells and Medullary Thyroid Carcinoma

C cells are the neuroendocrine cell component of the thyroid gland that embryologically arise from the pharyngeal endoderm. Normal C cells are concentrated in the upper two-thirds of both lateral lobes, appear singly or in small groups dispersed in, among or peripherally to the follicles, and are involved in the production of calcitonin. Reactive C-cell hyperplasia should be differentiated from proliferation of atypical C cells (neoplastic C-cell hyperplasia) which is considered an intraepithelial neoplasia of C cells/medullary carcinoma in situ, a precursor lesion associated to familial medullary thyroid carcinoma (MTC). MTC typically exhibits a lobular and/or trabecular growth pattern with amyloid deposits; however, due to its great histological variability, immunohistochemical positivity for calcitonin, carcinoembryonic antigen, calcitonin-gene-related peptide, insulinoma-associated protein 1, and/or other markers is necessary to confirm diagnosis. Investigation of germline RET proto-oncogene mutation is mandatory to identify familial MTC. Somatic RET mutations or fusions as well as RAS mutations in cytological and/or biopsy samples may represent therapeutic targets. Mixed medullary and follicular-derived cell carcinoma is a heterogeneous group of tumors which needs to be distinguished from collision tumors.

The Efficacy of Positron Emission Tomography/Computed Tomography Scan (PET CT Scan) in the Diagnosis of Local Recurrence and Metastases in Surgical Patients with Medullary Thyroid Carcinoma: A Systematic Review and Meta-Analysis of the Last 5 Years (2020-2024)

BACKGROUND/OBJECTIVES

Medullary thyroid carcinoma (MTC) is a highly aggressive tumor, as it is characterized by a high probability of local recurrence and distant metastases, even after surgical treatment. Early detection of disease recurrence is critical for improving long-term treatment outcomes and overall patient survival. By comparing different radiopharmaceuticals, this analysis aimed to strengthen existing guidelines and help bridge the gap between the recommendations of the ESMO and the ATA, highlighting the importance of PET/CT scanning in the postoperative follow-up of patients with MTC.

METHODS

This research was carried out using three searchable databases, PubMed, ScienceDirect, and ResearchGate, resulting in 575 bibliographic studies up to the date of 20 June 2024. A meta-analysis of diagnostic accuracy was performed using the software Meta-DiSc, Version: 2.0 (Universidad Complutense, Barcelona, Spain), which led to aggregate assessments and the design of the SROC.

RESULTS

A quality assessment of the eligible studies was conducted, and the key findings were summarized.

CONCLUSIONS

Regardless of methodology, PET/CT scanning exhibits high sensitivity and specificity values in the diagnosis of local recurrence and metastases in surgical patients with medullary thyroid carcinoma. Furthermore, based on a comparative analysis of18F-FDG and GA68-DOTATE, it appears that these misunderstood radiopharmaceuticals are particularly sensitive and reliable for highlighting MTC, and it was found that there were no statistical differences in terms of sensitivity and specificity. Therefore, these two modalities appear to be complementary in monitoring MTC patients.

Management of medullary thyroid cancer based on variation of carcinoembryonic antigen and calcitonin

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.

Primary Neuroendocrine Carcinoma of the Ileum With Markedly Elevated Carcinoembryonic Antigen (CEA) Levels: A Case Report

Neuroendocrine carcinomas (NECs) are rare and highly malignant tumors with a generally poor prognosis. Carcinoembryonic antigen (CEA) is often associated with adenocarcinoma, but its significant elevation in NEC cases is unusual. A 69-year-old man was admitted to our hospital in January 2016 due to syncope induced by anemia. The patient had a hemoglobin level of 8.0 g/dL and an ileocecal mass causing small bowel obstruction on computed tomography. His CEA level was markedly elevated at 3625.4 ng/mL. A colonoscopy revealed a neoplastic lesion in the terminal ileum, leading to an emergency ileocecal resection. Pathology confirmed a NEC, positive for synaptophysin and CEA, with a Ki-67 index of 30%. The patient was diagnosed with stage IIIb NEC (pT3N2M0). A postoperative increase in CEA to 4124.6 ng/mL and metastases in the right lung and multiple lymph nodes were detected. Initial chemotherapy with irinotecan, cisplatin (IP), and octreotide acetate proved ineffective. Subsequent octreoscans showed disease progression. Switching to everolimus as second-line therapy temporarily decreased CEA levels and tumor size, but the disease progressed with cervical lymph node involvement. The patient underwent palliative radiotherapy but succumbed to disease progression in May 2018, with a final CEA level of 36,643 ng/mL. Necropsy of the cervical lymph nodes was consistent with the original surgical findings. This case highlights the aggressive nature and challenging management of NEC with significantly elevated CEA levels.

Predictive and prognostic value of aurora kinase A combined with tumor-infiltrating lymphocytes in medullary thyroid carcinoma

Background

Aurora kinase A (AURKA) and tumor-infiltrating lymphocytes (TILs) are both known to play an essential role in tumorigenesis. However, the expression and prognostic value of the AURKA and TILs in medullary thyroid carcinoma (MTC) have not yet been investigated.

Patients and methods

Surgical specimens and clinical data of 137 patients diagnosed with MTC were collected. AURKA expression and TILs infiltration were quantified by immunohistochemistry and hematoxylin-eosin staining. Subsequently, the prognostic value of AURKA expression and TIL infiltration in MTC was evaluated.

Results

AURKA was highly expressed in patients with multifocal tumor, cervical lymph node metastasis, and an advanced TNM stage, indicating a high probability of recurrence. AURKA further exhibited a positive correlation with TILs (R = 0.44, P < 0.001). High expression of AURKA combined with a low numbers of TILs (AURKAhigh/TILslow) was identified as an independent prognostic factor for biochemical recurrence (odds ratio: 4.57, 95% confidence interval: 1.54-14.66, P < 0.01) and recurrence-free survival (hazard ratio: 3.64, 95% confidence interval: 1.52-8.71, P < 0.001). The combination of AURKA and TILs apparently improves the prognostic value for biochemical recurrence (area under the curve: 0.751) and structural recurrence (area under the curve: 0.836) of MTC. Notably, AURKAhigh/TILslow demonstrated a high value for prediction of distant or unresectable locoregional recurrence, with an overall accuracy of 86.9%.

Conclusion

AURKAhigh is associated with the MTC malignancy. The combination of AURKAhigh/TILslow was identified as novel independent prognostic marker in MTC, predicting incurable disease recurrence with high accuracy.

FABP6 serves as a new therapeutic target in esophageal tumor

BACKGROUND

Esophageal cancer is one of the most common malignant tumors with high incidence and mortality rates. Despite the continuous development of treatment options, the prognosis for esophageal cancer patients remains poor. Therefore, there is an urgent need for new diagnostic and therapeutic targets in clinical practice to improve the survival of patients with esophageal cancer.

METHODS

In this study, we conducted a comprehensive scRNA-seq analysis of the tumor microenvironment in primary esophageal tumors to elucidate cell composition and heterogeneity. Using Seurat, we identified eight clusters, encompassing non-immune cells (fibroblasts, myofibroblasts, endothelial cells, and epithelial cells) and immunocytes (myeloid-derived cells, T cells, B cells, and plasma cells). Compared to normal tissues, tumors exhibited an increased proportion of epithelial cells and alterations in immune cell infiltration. Analysis of epithelial cells revealed a cluster (cluster 0) with a high differentiation score and early distribution, suggesting its importance as a precursor cell.

RESULTS

Cluster 0 was characterized by high expression of FABP6, indicating a potential role in fatty acid metabolism and tumor growth. T cell analysis revealed shifts in the balance between Treg and CD8+ effector T cells in tumor tissues. Cellular communication analysis identified increased interactions between FABP6+ tumor cells and T cells, with the involvement of the MIF-related pathway and the CD74-CD44 interaction. This study provides insights into the cellular landscape and immune interactions within esophageal tumors, contributing to a better understanding of tumor heterogeneity and potential therapeutic targets.

Circulating miR-26b-5p and miR-451a as diagnostic biomarkers in medullary thyroid carcinoma patients

PURPOSE/METHODS

The determination of tumour biomarkers is paramount to advancing personalized medicine, more so in rare tumours like medullary thyroid carcinoma (MTC), whose diagnosis is still challenging. The aim of this study was to identify non-invasive circulating biomarkers in MTC. To achieve this goal, paired MTC tissue and plasma extracellular vesicle samples were collected from multiple centres and microRNA (miRNA) expression levels were evaluated.

RESULTS

The samples from a discovery cohort of 23 MTC patients were analysed using miRNA arrays. Lasso logistic regression analysis resulted in the identification of a set of circulating miRNAs as diagnostic biomarkers. Among them, miR-26b-5p and miR-451a, were highly expressed and their expression decreased during follow-up in disease-free patients in the discovery cohort. Circulating miR-26b-5p and miR-451a were validated using droplet digital PCR in a second independent cohort of 12 MTC patients.

CONCLUSION

This study allowed the identification and validation of a signature of two circulating miRNAs, miR-26b-5p and miR-451a, in two independent cohorts reporting a significant diagnostic performance for MTC. The results of this study offer advancements in molecular diagnosis of MTC proposing a novel non-invasive tool to use in precision medicine.

The dual-crosslinked prospective values of RAI14 for the diagnosis and chemosurveillance in triple negative breast cancer

OBJECTIVE

The exploration of non-invasive biomarkers for assessing tumor response is critical to optimize treatment decisions. In this study, we aimed at determining the potential role of RAI14 in the early diagnosis and evaluation of chemotherapy efficacy in triple-negative breast cancer (TNBC).

METHODS

We recruited 116 patients newly diagnosed with breast cancer, 30 patients with benign breast disease and 30 healthy controls. In addition, 57 TNBC patients were collected in serum at different time points (C0, C2 and C4) for chemotherapy monitoring. The expression of serum RAI14 and CA15-3 were quantified by Elisa and electrochemiluminescence assay, respectively. Then we compared the performances of markers with the chemotherapy efficacy assessed by imaging.

RESULTS

RAI14 is significantly overexpressed in TNBC and is linked to adverse clinicopathological features such as tumor burden, CA15-3 levels and the ER, PR, and HER2 status of the patients. ROC curve analysis showed that RAI14 improves the diagnostic performance for CA15-3(AUCRAI14 = 0.934 vs. AUCCA15-3 = 0.836), especially embodied in early-stage breast cancer diagnosis and patients with CA15-3 negativity. Furthermore, RAI14 behaves well in reproducing treatment response which was consistent with clinical Imaging assessment.

CONCLUSIONS

Recent studies showed that RAI14 has a complementary effect to CA15-3 and a test combining the two parameters can improve the detection rate of early triple-negative breast cancer. At the same time, RAI14 plays a more important role in chemotherapy monitoring than CA15-3 as the change in its concentration is in line with the tumor volume variation. Taken together, RAI14 is a reliable novel marker in the early diagnosis and chemotherapy monitoring of triple-negative breast cancer.

A dynamic study of the postoperative management of thyroid cancer from 2003 to 2022: a bibliometric analysis

Background

Over the past 20 years, the global incidence of thyroid cancer has continued to increase. The volume of literature on the postoperative management of thyroid cancer comprises 1,040 articles, from 64 countries, with 1,400 journals publishing the relevant literature, and several guidelines on the treatment of thyroid cancer. This study used bibliometric methods to identify research hotspots and explore future directions in this field.

Methods

We comprehensively searched the Science Citation Index Expanded (SCI-E) database of the Web of Science Core Collection (WOSCC) for articles published from 2003 to 2022 on the postoperative management of thyroid cancer. Using CiteSpace 6.1.R6 and Microsoft Office Excel 2010, we evaluated and visualized the search results. Using R Studio, we generated a network of spatial geographic distribution maps and cooperative network.

Results

A total of 1,040 publications were included in the study. The results revealed an overall upward trend in the number of publications and citations over the past 20 years. The United States of America (USA) had the largest number of publications and the highest centrality (n=282, centrality =0.28). Johns Hopkins University had highest centrality (centrality =0.15) and was the academic center of the field. Thyroid was the journal with the highest number of citations (n=826), and the American Journal of Surgical Pathology was the journal with the highest centrality (centrality =0.08). The top 10 citations in the literature were mainly guidelines and consensus statements on the management of thyroid cancer. A keyword-based clustering analysis revealed the prominence of clusters of keywords, such as follow-up, recurrent laryngeal nerve, and medullary thyroid carcinoma (MTC). A keyword burst detection analysis showed that the term papillary had the highest burst intensity (strength =8.02), while management guidelines, association guidelines, active surveillance (AS), microcarcinoma, and differentiated thyroid cancer were the current burst words.

Conclusions

Over the past two decades, the number of relevant publications in the postoperative management of thyroid cancer field has continued to grow. Among the many research directions, follow-up, recurrent laryngeal nerve, and MTC are research hotspots. Future research is likely to revolve around guidelines and consensus statements on the management of thyroid cancer, AS, and microcarcinoma in differentiated thyroid cancer.

A prediction model for the 5-year, 10-year and 20-year mortality of medullary thyroid carcinoma patients based on lymph node ratio and other predictors

Aim

To explore the predictive value of lymph node ratio (LNR) for the prognosis of medullary thyroid carcinoma (MTC) patients, and constructed prediction models for the 5-year, 10-year and 20-year mortality of MTC patients based on LNR and other predictors.

Methods

This cohort study extracted the data of 2,093 MTC patients aged ≥18 years undergoing total thyroidectomy and neck lymph nodes dissection. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between LNR < 15% group and LNR ≥ 15% group. All data was divided into the training set (n = 1,465) and the testing set (n = 628). The random survival forest model was constructed in the training set and validated in the testing set. The area under the curve (AUC) was employed for evaluating the predictive ability of the model.

Results

The 5-year, 10-year and 20-year overall survival (OS) and cause-specific survival (CSS) of MTC patients with LNR <15% were higher than those with LNR ≥15%. The OS was 46% and the CSS was 75% after 20 years' follow-up. The AUC of the model for the 5-year, 10-year, and 20-year OS in MTC patients was 0.878 (95%CI: 0.856-0.900), 0.859 (95%CI: 0.838-0.879) and 0.843 (95%CI: 0.823-0.862) in the training set and 0.845 (95%CI: 0.807-0.883), 0.841 (95%CI: 0.807-0.875) and 0.841 (95%CI: 0.811-0.872) in the testing set. In the training set, the AUCs were 0.869 (95%CI: 0.845-0.892), 0.843 (95%CI: 0.821-0.865), 0.819 (95%CI: 0.798-0.840) for the 5-year, 10-year and 20-year CCS in MTC patients, respectively. In the testing set, the AUCs were 0.857 (95%CI: 0.822-0.892), 0.839 (95%CI: 0.805-0.873) and 0.826 (95%CI: 0.794-0.857) for the 5-year CCS, 10-year CCS and 20-year CCS in MTC patients, respectively.

Conclusion

The models displayed good predictive performance, which might help identify MTC patients might have poor outcomes and appropriate interventions should be applied in these patients.

Other markers of medullary thyroid cancer, not only calcitonin

BACKGROUND

Medullary thyroid cancer (MTC) is a rare neuroendocrine tumor originating from parafollicular C-cells. It represents 2% of all thyroid malignancies and 0.4-1.4% of all thyroid nodules. MTC has a variable clinical course, with complete remission often difficult to achieve. An early diagnosis is still crucial in MTC management, enabling a radical surgical treatment, the only chance for curing the patient. Calcitonin (Ct) is a very sensitive MTC tumor marker in patients with thyroid nodules, although Ct-negative MTCs have been described, but not all clinical guidelines recommend the Ct routine measurement in thyroid nodules because of the absolute low prevalence of MTC in the general population and the consequent scarce positive predictive value of Ct. Moreover, the specificity of moderately high Ct levels is not high. Thus, the scientific community has been investigating the possible role of other tumor markers for MTC diagnosis and prognosis.

AIM OF THE REVIEW

The present review is an attempt to summarize the knowledge available today on the role of other serum markers for MTC alternative to Ct.

CONCLUSIONS

At present, literature data does not seem solid enough yet to establish effective flowcharts in evaluating a thyroid nodule for MTC, involving alternative serum markers, particularly in cases of moderately high CT levels. MTC is a rare diagnosis in thyroid nodules, and this makes the evaluation of any tumor serum marker accuracy problematic. More extensive and prospective studies are needed to shed more light on this intriguing challenge.

Oncologic outcomes of calcitonin-negative medullary thyroid carcinoma

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.