Updated Thresholds of Basal Calcitonin Level and Extent of Lymph Node Metastasis in Initially Treated Medullary Thyroid Cancer

作者：Yuxin Du, Cenkai Shen, Kehan Song, Chuqiao Liu, Zimeng Li, Zhiyan Liu, Yijun Wu, Liang Guo, Yan Zhang, Hao Zhang, Chuang Chen, Min Yin, Haitao Tang, Qinghai Ji, Wenjun Wei, Xiao Shi, Yu Wang · 发表于：JAMA Otolaryngology–Head & Neck Surgery · 年份：2025 · DOI：10.1001/jamaoto.2025.0542 · 被引用次数：16 · 研究领域：Thyroid Cancer Diagnosis and Treatment、Thyroid and Parathyroid Surgery、S100 Proteins and Annexins

Importance: Calcitonin is the most sensitive and specific biomarker for medullary thyroid cancer (MTC). Basal serum calcitonin levels are strongly associated with the burden of lymph node metastasis (LNM) and can help guide the extent of neck dissection. However, the predictive thresholds for varying degrees of LNM are based on laboratory testing methods no longer in use. Objective: To update the optimal thresholds of basal serum calcitonin levels for predicting the extent of LNM. Design, Setting, and Participants: This retrospective cohort study included initially treated patients with MTC who had their preoperative basal calcitonin levels tested using electrochemiluminescence or chemiluminescence from a Chinese multicenter cohort of 13 hospitals between 2011 and 2024. The patients were randomly divided into a training and a validation cohort in a 2:1 ratio. The data were analyzed between June 2024 and September 2024. Exposures: Preoperative basal serum calcitonin using electrochemiluminescence or chemiluminescence. Main Outcomes and Measures: The main outcome is Structural recurrence-free survival (SRFS) based on the group partitioned by the proposed thresholds predicting different LNMs. Results: A total of 509 patients were included in the study with a median (interquartile range [IQR]) follow-up of 52 (27-84) months. The median (IQR) age at diagnosis was 50 (40-59) years, and 279 patients (54.8%) were female individuals. Patients were categorized into 4 groups based on th...