| Objective: To summarize and analyze the clinical and follow-up data of patients with Medullary Thyroid Carcinoma,who were treated and followed up for 10 years,to explore the dynamic changes of tumor markers after operation and their correlation with clinical variables at the current monitoring level,and to evaluate the general information,ultrasound features,preoperative calcitonin levels and surgical conditions under the latest treatment guidelines.And the relationship between pathological characteristics and disease-free survival rate of MTC patients.Method: The clinical and follow-up data of medullary thyroid cancer patients treated in the Department of Thyroid Surgery of China-Japan Union Hospital of Jilin University,from June 2008 to October 2018 were retrospectively analyzed.The following factors were analyzed:(1)General data: sex ratio,age of onset;(2)Preoperative tumor markers: calcitonin and carcinoembryonic antigen levels,and their correlation with general data.Department;(3)Surgery and pathological features of tumors,including diameter,number,distribution and lymph node metastasis;(4)relationship between preoperative calcitonin and pathological features;(5)dynamic changes of tumor markers: changes of calcitonin and carcinoembryonic antigen levels after surgery and during follow-up;(6)analysis of relapse related factors: general information,ultrasound features,preoperative calcitonin The influence of vegetable level,surgical condition and pathological characteristics on recurrence.Result: 1.General data: From June 2008 to October 2018,101 patients with MTC were admitted to the Thyroid Surgery Department of Sino-Japanese Friendship Hospital of Jilin University,42 males(41.6%)and 59 females(58.4%).The ratio of males to females was 1:1.5.The average age of onset was 47.5±11.9 years,and 27 patients(26.7%)had family history of thyroid.2.Preoperative levels of tumor markers: preoperative mean calcitonin was 77.9±5.5 pg/ml,elevated calcitonin was found in 55 cases(74.3%)and normal range in 19 cases(25.7%),CEA was 14.0±5.6 ug/L,elevated CEA in 16 cases(55.2%)and normal range in 13 cases(44.8%).3.Calcitonin and pathological features: The average diameter of tumors was 1.1±0.6 cm,and there was a significant correlation between the diameter and the level of calcitonin(P=0.01).Tumors were usually single focus(83.5%)with the same proportion of left and right distribution,25.8% MTC combined with PTC.In the analysis of metastasis rate,there was a significant difference between the central group and the left and right cervical lymph nodes(P=0.003,P=0.014).There was no metastasis rate between left and right cervical lymph nodes.Calcitonin levels were linearly correlated with central group(P=0.019)and left and right cervical lymph node metastasis rates(P=0.050,P=0.032).4.Dynamic changes of tumor markers: The average level of serum Ctn on the first day after operation was 6.84±1.71pg/ml,8.19±2.64pg/ml on the sixth day,33.80±2.90ug/L on the first day and 74.30±4.30ug/L on the sixth day.Calcitonin returned to normal on the 6th day after operation,but decreased slightly in the short term after CEA,which was longer than that of Ctn,and returned to normal about 1 month after CEA.5.Relapse-related factors: 80 patients(82.2%)have been followed up so far.The average disease-free survival time is 46.07±30.2 months,11 patients(13.8%)have relapsed,and 3 patients(2.9%)have died.Age over 55 was a risk factor for recurrence(P=0.03).The risk factors of recurrence were calcitonin(>400 pg/ml)(P=0.036),the location of the lesion at the upper pole(P=0.020),and significant hypoechoic(P=0.024).Unilateral lobectomy(P=0.711),unilateral lobectomy + contralateral lobectomy/subtotal lobectomy(P=0.472),and neck lymph node dissection were not risk factors for recurrence.Conclusion: 1.The proportion of men and women in MTC is equal,and the age of onset is concentrated in 45-60 years old.2.There was no significant difference in the distribution of calcitonin in different MTC populations,and the sensitivity of calcitonin to MTC was higher than that of CEA.During the follow-up period,calcitonin returned to normal on the 6th day after operation,with a small decrease in the short term after CEA,longer than that of Ctn,and returned to normal about one month after operation.3.Preoperative calcitonin value has a linear relationship with tumor diameter and cervical lymph node metastasis rate.The higher the level of calcitonin,the larger the diameter of the tumor,the higher the cervical lymph node metastasis rate.4.Preoperative calcitonin may be normal.Diagnosis should be combined with various diagnostic methods to avoid missed diagnosis.5.Calcitonin level and echo characteristics under ultrasound are independent risk factors for MTC recurrence.6.Preoperative calcitonin(> 400 pg/ml)and markedly hypoechoic MTC have a high risk of recurrence,which should be paid special attention in the course of treatment and follow-up. |
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