Kinetic analysis of the growth rate of sporadic and hereditary medullary thyroid carcinoma: Comparing the postoperative calcitonin-doubling rate with the hypothetical preoperative tumor volume-doubling rate
Background
Our previous kinetic analyses of changes in the tumor volume (TV) of papillary thyroid microcarcinomas during active surveillance revealed that the tumors' growth varied over time from rather rapid growth to shrinkage and that the hypothetical TV-doubling rates (DRs) before the patients' presentation were much larger than their observed TV-DRs, indicating that rapid growth phases preceded their presentation. Whether this phenomenon also occurs in medullary thyroid carcinoma (MTC) was unknown.
Methods
We retrospectively analyzed the cases of 46 MTC patients (18 hereditary, 28 sporadic; 9–80 years old at surgery, median 53.5 years; 19 males and 27 females) with elevated postoperative calcitonin (Ct) suggesting persistent disease. We calculated each patient's Ct-DR and his/her hypothetical TV-DR, using the tumor size and age at surgery.
Results
Ct-DRs (/year) after surgery were >0.5, 0.1–0.5, −0.1–0.1, and <−0.1 in 9, 21, 12, and 4 patients, respectively (median 0.17). The hypothetical TV-DRs (/year) before surgery were >1, 0.5–1.0, 0.1–0.5 and <0.1 in 11, 21, 14, and 0 patients, respectively (median 0.60). The hypothetical TV-DR was higher than the observed Ct-DR in 41 of the 46 MTC patients and all 18 patients with hereditary MTC, suggesting that a rapid growth phase preceded surgery in these patients.
Conclusions
In this series of MTC patients, the pre-surgery calculated hypothetical TV-DRs were significantly higher than the Ct-DRs observed post-surgery, suggesting that there were rapid growth periods before surgery in the vast majority of these MTC patients, especially those with hereditary MTC.
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Posted 24 Jun, 2020
On 21 Jul, 2020
On 07 Jul, 2020
Received 01 Jul, 2020
On 26 Jun, 2020
Invitations sent on 24 Jun, 2020
On 24 Jun, 2020
On 23 Jun, 2020
On 23 Jun, 2020
On 20 Jun, 2020
Received 03 Jun, 2020
Received 31 May, 2020
Received 31 May, 2020
On 27 May, 2020
On 25 May, 2020
On 12 May, 2020
Invitations sent on 11 May, 2020
On 10 May, 2020
On 10 May, 2020
On 09 May, 2020
On 09 May, 2020
Kinetic analysis of the growth rate of sporadic and hereditary medullary thyroid carcinoma: Comparing the postoperative calcitonin-doubling rate with the hypothetical preoperative tumor volume-doubling rate
Posted 24 Jun, 2020
On 21 Jul, 2020
On 07 Jul, 2020
Received 01 Jul, 2020
On 26 Jun, 2020
Invitations sent on 24 Jun, 2020
On 24 Jun, 2020
On 23 Jun, 2020
On 23 Jun, 2020
On 20 Jun, 2020
Received 03 Jun, 2020
Received 31 May, 2020
Received 31 May, 2020
On 27 May, 2020
On 25 May, 2020
On 12 May, 2020
Invitations sent on 11 May, 2020
On 10 May, 2020
On 10 May, 2020
On 09 May, 2020
On 09 May, 2020
Background
Our previous kinetic analyses of changes in the tumor volume (TV) of papillary thyroid microcarcinomas during active surveillance revealed that the tumors' growth varied over time from rather rapid growth to shrinkage and that the hypothetical TV-doubling rates (DRs) before the patients' presentation were much larger than their observed TV-DRs, indicating that rapid growth phases preceded their presentation. Whether this phenomenon also occurs in medullary thyroid carcinoma (MTC) was unknown.
Methods
We retrospectively analyzed the cases of 46 MTC patients (18 hereditary, 28 sporadic; 9–80 years old at surgery, median 53.5 years; 19 males and 27 females) with elevated postoperative calcitonin (Ct) suggesting persistent disease. We calculated each patient's Ct-DR and his/her hypothetical TV-DR, using the tumor size and age at surgery.
Results
Ct-DRs (/year) after surgery were >0.5, 0.1–0.5, −0.1–0.1, and <−0.1 in 9, 21, 12, and 4 patients, respectively (median 0.17). The hypothetical TV-DRs (/year) before surgery were >1, 0.5–1.0, 0.1–0.5 and <0.1 in 11, 21, 14, and 0 patients, respectively (median 0.60). The hypothetical TV-DR was higher than the observed Ct-DR in 41 of the 46 MTC patients and all 18 patients with hereditary MTC, suggesting that a rapid growth phase preceded surgery in these patients.
Conclusions
In this series of MTC patients, the pre-surgery calculated hypothetical TV-DRs were significantly higher than the Ct-DRs observed post-surgery, suggesting that there were rapid growth periods before surgery in the vast majority of these MTC patients, especially those with hereditary MTC.
Figure 1
Figure 2
Figure 3