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Procalcitonin levels predict clinical course and progression‐free survival in patients with medullary thyroid cancer
Author(s) -
Walter Martin A.,
Meier Christian,
Radimerski Tanja,
Iten Fabienne,
Kränzlin Marius,
MüllerBrand Jan,
de Groot Jan Willem B.,
Kema Ido P.,
Links Thera P.,
Müller Beat
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24738
Subject(s) - medicine , procalcitonin , calcitonin , medullary thyroid cancer , thyroid cancer , thyroidectomy , cancer , confidence interval , thyroid , gastroenterology , oncology , sepsis
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.