The prognostic value of tumor markers doubling time in medullary thyroid carcinoma - preliminary report

Abstract

IntroductionCalcitonin (Ct) and carcinoembrional antigen (CEA) are widely used as tumor markers for the post-operative follow-up of patients with medullary thyroid carcinoma (MTC).In patients with elevated serum Ct and CEA their dynamics can be described by calculating the doubling time (DT) - the time, they need to double the serum concentration. Previous reports concluded that the Ct and CEA DT have prognostic value in MTC patients.Patients and methodsWe retrospectively analyzed data of 70 MTC patients with elevated serum Ct or CEA. In total, doubling times were calculated and the DT of the less favorable marker was used to stratify the patients into the low- and high-risk group with the cut-off value of 2 years. The survival analysis was performed using Cox proportional hazard method.ResultsThe doubling time < = 2 years of the less-favorable marker had significant prognostic impact for recurrence-free survival, HR = 2.61 (1.43-4.71) and overall survival, HR = 8.99 (3.51-23.04).ConclusionsThe calcitonin and carcinembrional antigen doubling times of less than two years are negative prognostic factors for MTC recurrence-free and total survival in patients with persistent or recurrent disease. They may be used as predictive factors for more intensive search of disease localization in asymptomatic hypercalcitoninemia and for therapy choice in symptomatic disease.

Elevated level of serum carbohydrate antigen 19.9 as predictor of mortality in patients with advanced medullary thyroid cancer

“…In agreement with this finding is the The Kaplan-Meier curve of survival in patients with normal and abnormal levels of Ca 19.9. A rapid increase of the Ct and CEA Dt is considered a strong prognostic indicator for MTC recurrence and death, as demonstrated in several studies and metanalyses (16,17,18). This study showed that in our group of advanced MTC, not only the Ct Dt but also abnormal serum levels of Ca 19.9 were prognostic factors of death.…”

“…In particular, the doubling time (Dt) of both Ct (Ct Dt) and CEA is a strong prognostic indicator for MTC recurrence and death (15,16,17,18).…”

Dynamic risk stratification in the follow-up of thyroid cancer: what is still to be discovered in 2017?

“…Likewise in DTC, TNM classification allows a better prediction of cancer-related death than the risk of MTC relapse. Moreover, multiple studies, recently published demonstrated a role of calcitonin and carcinoembryonic antigen (CEA) doubling time as an important prognostic factor (Gawlik et al 2010, Wells et al 2015. Therefore, changes in our approach to risk stratification in MTC seem to be necessary, although they have not been recommended yet by the newest MTC ATA GL published in 2015 (Wells et al 2015).…”

Radioactive iodine in the treatment of medullary thyroid carcinoma: a controlled multicenter study

“…Besides calcitonin doubling time (9,10,11,12), TNM stage is the most important prognostic factor with 10-year survival rates for stages I, II, III, and IV of 100, 93, 71, and 21% respectively (13).…”