Integration of a postoperative calcitonin measurement into an anatomical staging system improves initial risk stratification in medullary thyroid cancer

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Yang, Ji H. ; Lindsey, Susan C. ; Camacho, Cleber P. ; Valente, Flavia O. F. ; Germano-Neto, Fausto ; Machado, Alberto L. ; Mamone, Maria Conceicao O. C. ; Brodskyn, Fabio ; Biscolla, Rosa Paula M. ; Tuttle, Robert Michael ; Dias-da-Silva, Magnus R. ; Maciel, Rui M. B.

• Tipo de documento: Artigo Científico
• Fonte: CLINICAL ENDOCRINOLOGY; v. 83, n. 6, p. 5-pg., 2015-12-01.

Resumo

Objective Staging systems applied to medullary thyroid cancer (MTC) rely on initial clinical and pathological features and do not consider the response to treatment. To determine whether MTC staging can be improved by incorporating the first postoperative calcitonin measurement. Patients and measurements Eighty-five patients being monitored for MTC (median follow-up 5 years) were retrospectively classified according to both the American Joint Committee on Cancer (AJCC) and the proposed combined risk stratification system (low, intermediate and high risk), which incorporates the first postoperative calcitonin measurement, using the outcomes no evidence of disease (NED), biochemical evidence of disease, structurally identifiable disease and death. Results Ninety per cent of AJCC I patients were classified as NED at final follow-up. When we added a postoperative calcitonin measurement, 95% low-risk patients were classified as NED at final follow-up. AJCC stages I and IV were associated, respectively, with no occurrence and a high rate (63%) of structurally identifiable disease. Stages II and III yielded similar predictions of structurally identifiable disease, 13% and 14%, respectively. When we included the postoperative calcitonin level, the patients with structural evidence of disease included none from the low-risk group, 10% from the intermediate group and 63% from the high-risk group. The proportion of variance explained analysis PVE) was better for the combined risk stratification system (54%) than for the AJCC system alone (32%). Conclusion Including the first postoperative calcitonin measurement with the anatomical staging system can better predict the clinical outcome of patients with MTC and refine the follow-up of these patients. (AU)

• Processo FAPESP: 09/50575-4 - Desenvolvimento de um modelo de tumorigênese in vivo para o Carcinoma Medular de Tiroide através da técnica de transgênese somática em embrião de galinha
• Beneficiário: Susan Chow Lindsey
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto
• Processo FAPESP: 06/60402-1 - Carcinoma medular da tiróide: revisitação à clínica, à biologia molecular, à bioquímica e à biologia do desenvolvimento depois dos achados da genética molecular
• Beneficiário: Rui Monteiro de Barros Maciel
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 10/51547-1 - Carcinoma medular de tiroide hereditario: percepcao e atitude de pacientes, familiares e profissionais de saude sobre questoes bioeticas.
• Beneficiário: Rui Monteiro de Barros Maciel
• Modalidade de apoio: Auxílio à Pesquisa - Regular