Semenov, Arseny1,2; Chernikov, Roman1; Buzanakov, Dmitry2; Makarin, Viktor1; Slepcov , Ilya1; Chinchuk, Igor1; Novokshonov, Konstantin1; Karelina, Julia1; Uspenskaya , Anna1; Timofeeva , Nataly1; Vorobev, Sergey3; Kulyash, Alexey3; Fedorov, Elisey1; Malyugov, Yuriy1; Bubnov, Aleksandr1,2,4; Fedotov, Yuriy4
1 Northwest center of endocrinology and endocrine surgery, University clinic, SPbSU, Saint-Petersburg, Russia
2 Faculty of Medicine,SPbSU, Saint-Petersburg, Russia
3 Department of morphology, University clinic, SPbSU, Saint-Petersburg, Russia
4 Department of operative surgery and clinical anatomy, North-Western State Medical University named after I.I.Mechnikov Saint-Petersburg, Russia
During 2010-2015 in university clinic 154 patients with medullary cancer received primary surgical care. 119 were women (77,3%), 35 – men. Age at the time of operation – women were older: 54,5±16,6 years, than men 50,1±16 but difference was insignificant (p=0,075). Basal calcitonin was 1521,6±5069,4 pg/ml. Multifocal lesions were found in 18,3% cases, of them 85,7% had germline RET-mutations.
18,0% of tumors had “positive border” of resection, surrounding tissue invasion was observed in 4,6% cases. Vascular invasion was found 9,8%, neural – in 2,0% of cases. Lymph node metastasis in central compartment had 27,5% of patients, 12,4% had lateral neck metastasis. Distant metastasis rate found at the time of diagnosis was 5,9%.
According to calcitonin doubling time based follow-up all patients were divided to 4 groups: Patients with “0” calcitonin level; patients with slow Ctn growth; patients with rapid Ctn growth or remained symptomatic; patients who died of progression.
Lymph node metastasis, their size, and amount on preoperative US proven with FNAB with Ctn measurement have more influence on prognosis then basal calcitonin. But adjusted to the primary tumor size level of calcitonin can predict aggressive tumor behavior in both cases, of extent of tumor and in loss of production ability.
In cases with mean adjusted Ctn without evidence of lymph node involvement prognosis was always good and seemed not to be affected by high basal calcitonin even if it was greater than 2000 pg/ml.