Procalcitonin levels predict clinical course and progression-free survival in patients with medullary thyroid cancer

Authors

  • Martin A. Walter MD,

    Corresponding author
    1. Institute of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
    2. Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
    • Institute of Nuclear Medicine, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland
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    • Fax: (011) 41 61 265 4897

  • Christian Meier MD,

    1. Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
    2. Endocrine Clinic and Laboratory, Basel, Switzerland
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  • Tanja Radimerski MSc, MD,

    1. Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
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  • Fabienne Iten MD,

    1. Institute of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
    2. Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
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  • Marius Kränzlin MD,

    1. Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
    2. Endocrine Clinic and Laboratory, Basel, Switzerland
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  • Jan Müller-Brand MD,

    1. Institute of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
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  • Jan Willem B. de Groot MD,

    1. Department of Endocrinology, University Medical Center, University of Groningen, Groningen, the Netherlands
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  • Ido P. Kema MD, PhD,

    1. Department of Pathology, University Medical Center, University of Groningen, Groningen, the Netherlands
    2. Department of Laboratory Medicine, University Medical Center, University of Groningen, Groningen, the Netherlands
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  • Thera P. Links MD,

    1. Department of Endocrinology, University Medical Center, University of Groningen, Groningen, the Netherlands
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  • Beat Müller MD

    1. Division of Endocrinology, Diabetology, and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
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Abstract

BACKGROUND:

Procalcitonin has been well established as an important marker of sepsis and systemic infection. The authors evaluated the diagnostic and predictive value of calcitonin and its prohormone procalcitonin in medullary thyroid cancer.

METHODS:

The authors systematically explored the ability of calcitonin and procalcitonin to identify medullary thyroid cancer and predict the endpoints local recurrence and distant metastases, as well as the progression-free survival. Patients with C-cell hyperplasia; patients after thyroidectomy for differentiated thyroid cancer, goiter, or Graves disease; and healthy subjects served as controls. The study was performed in accordance with the Reporting Recommendations for Tumor Marker Prognostic Studies of the National Cancer Institute.

RESULTS:

Sixty-nine medullary thyroid cancer patients and 96 controls were included (median observed interval: 10.9 years [range, 1.4-47.5 years]; 981.8 patient-years). The 1-year, 5-year, 10-year, and 20-year recurrence rates were 9%, 34%, 45%, and 56%, respectively. Calcitonin had a higher diagnostic accuracy for detecting medullary thyroid cancer than procalcitonin (area under the curve [AUC], 0.94; 95% confidence interval [95% CI], 0.90-0.99 vs AUC, 0.89; 95% CI, 0.83-0.95 [P = .038]). The procalcitonin:calcitonin ratio predicted disease progression (AUC, 0.63; 95% CI, 0.51-0.75 [P = .036]) and progression-free survival (hazards ratio, 1.49; 95% CI, 1.09-2.04 [P = .013]).

CONCLUSIONS:

The results of the current study indicate a superior diagnostic accuracy of calcitonin and an independent predictive value of the procalcitonin:calcitonin ratio. These findings may lead to improved diagnostic and therapeutic strategies for medullary thyroid cancer patients. Cancer 2010. © 2010 American Cancer Society.

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