Context: The clinical response after surgery is a determinant in the management of patients with medullary thyroid carcinoma (MTC). In case of excellent or structural incomplete response, the follow-up strategies are well designed. Conversely, in case of biochemical incomplete response (BiR) the management is not clearly defined. Purpose: To evaluate the overall and per-site prevalence of structural disease detection in sporadic MTC patients with BiR and to assess the predictive value of various clinical, biochemical, and genetics features. Methods: We evaluated data of 599 consecutive patients surgically treated for sporadic MTC (2000-2018) and followed-up at Endocrine Unit of the University Hospital of Pisa. Results: After a median of 5 months from surgery, 145/599 (24.2%) patients were classified as BiR. Structural disease was detected in 64/145 (44.1%), after a median time of 3.3 years. In 73.6% structural disease was detected at a single site, prevalently cervical lymph nodes. Among several others, at the time of first evaluation after surgery, only basal calcitonin (bCTN) and stage IVa/b were independent predictive factors. Also, structural disease was more frequent in patients with shorter CTN doubling time and somatic RET mutation. Conclusions: In sporadic MTC patients with BiR the risk of detection of structural disease was about 50% at 10 years. Higher bCTN levels and staging predicted the risk of detecting structural disease. According to these findings, a stricter follow-up should be reserved to MTC with BiR and elevated values of bCTN and to those with an advanced stage. Long follow-up should anyway be considered for all BiR patients since 50% of them develop structural disease within 10 years.
Clinical evolution of sporadic medullary thyroid carcinoma with biochemical incomplete response after initial treatment
Prete, Alessandro;Gambale, Carla;Torregrossa, Liborio;Ciampi, Raffaele;Romei, Cristina;Ramone, Teresa;Agate, Laura;Bottici, Valeria;Cappagli, Virginia;Molinaro, Eleonora;Materazzi, Gabriele;Elisei, Rossella;Matrone, Antonio
2023-01-01
Abstract
Context: The clinical response after surgery is a determinant in the management of patients with medullary thyroid carcinoma (MTC). In case of excellent or structural incomplete response, the follow-up strategies are well designed. Conversely, in case of biochemical incomplete response (BiR) the management is not clearly defined. Purpose: To evaluate the overall and per-site prevalence of structural disease detection in sporadic MTC patients with BiR and to assess the predictive value of various clinical, biochemical, and genetics features. Methods: We evaluated data of 599 consecutive patients surgically treated for sporadic MTC (2000-2018) and followed-up at Endocrine Unit of the University Hospital of Pisa. Results: After a median of 5 months from surgery, 145/599 (24.2%) patients were classified as BiR. Structural disease was detected in 64/145 (44.1%), after a median time of 3.3 years. In 73.6% structural disease was detected at a single site, prevalently cervical lymph nodes. Among several others, at the time of first evaluation after surgery, only basal calcitonin (bCTN) and stage IVa/b were independent predictive factors. Also, structural disease was more frequent in patients with shorter CTN doubling time and somatic RET mutation. Conclusions: In sporadic MTC patients with BiR the risk of detection of structural disease was about 50% at 10 years. Higher bCTN levels and staging predicted the risk of detecting structural disease. According to these findings, a stricter follow-up should be reserved to MTC with BiR and elevated values of bCTN and to those with an advanced stage. Long follow-up should anyway be considered for all BiR patients since 50% of them develop structural disease within 10 years.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
