Meijer JA, le Cessie S, van den Hout WB, Kievit J, Schoones JW, Romijn JA, Smit JW
Calcitonin and CEA doubling times as prognostic factors in medullary thyroid carcinoma, a structured meta-analysis. [JOURNAL ARTICLE]
Clin Endocrinol (Oxf) 2009 Jun 26.
Context: In the management of patients with medullary thyroid carcinoma, calcitonin doubling time (dt) has gained interest as an independent predictor of recurrence and survival.
Objective: To perform a structured meta-analysis of the diagnostic value of calcitonin dt, CEA dt and the combination, and to define dt strata with the highest predictive power.
Design: The study was a meta-analysis using individual data.
Methods: Ten studies containing data on the postoperative kinetics of tumour marker(s) and (recurrence free) survival were included.
Results: Calcitonin- and CEA-dt are significant indicators for survival (Hazard Ratios (HR) 21.52 respectively infinite for dt 0-1 year compared to dt > 1 year) and recurrence (HR 5.33 respectively 6.80 for dt 0-1 year compared to dt > 1 year). The highest predictive power was found for the dt classification 0 - 1 year vs. > 1 year. CEA dt has a higher predictive value than calcitonin dt in the subgroup of patients for which both parameters were available.
Conclusion: The doubling times of both calcitonin and CEA are strong prognostic indicators for MTC recurrence and death. CEA dt has a higher predictive value than calcitonin dt, therefore, measuring both tumour markers is essential for proper risk stratification.
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