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- Title
Clinical Evolution of Sporadic Medullary Thyroid Carcinoma With Biochemical Incomplete Response After Initial Treatment.
- Authors
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
- 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. Objective: This work aimed 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 genetic features. Methods: We evaluated data of 599 consecutive patients surgically treated for sporadic MTC (2000-2018) and followed-up at the endocrine unit of the University Hospital of Pisa. Results: After a median of 5 months from surgery, 145 of 599 (24.2%) patients were classified as BiR. Structural disease was detected in 64 of 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. Conclusion: 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, stricter follow-up should be reserved for MTC with BiR and elevated values of bCTN and to those with an advanced stage. Long follow-up should be considered for all BiR patients since 50% of them develop structural disease within 10 years.
- Subjects
MEDULLARY thyroid carcinoma; CLINICAL trials
- Publication
Journal of Clinical Endocrinology & Metabolism, 2023, Vol 108, Issue 8, pe613
- ISSN
0021-972X
- Publication type
Academic Journal
- DOI
10.1210/clinem/dgad061