Serum Carcinoembryonic Antigen as a Biomarker for Medullary Thyroid Cancer
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Background and Objectives: The lack of known elevated biomarkers in cancer surveillance is a challenge fordiagnostics. However, few studies have assessed the proportion of patients with medullary thyroid cancer (MTC)that presented with elevated serum carcinoembryonic antigen (CEA) level. Materials and Methods: This was aretrospective study of 115 patients treated for MTC at Samsung Medical Center between 1995 and 2017. Serumcalcitonin and CEA levels that were available at one of the following time points were included: (a) within 3months before the initial surgery, (b) when a structural recurrence was confined to the neck, or (c) when a distantmetastasis was identified during follow-up. Considering the high false-positive rate of serum CEA testing, 5 ng/mLwas selected as the cut-off threshold. Results: The sensitivity of CEA at the time of diagnosis was 54%, but itsignificantly increased with anatomical stage, from 20% in stage I to 88% in stage IV (p for trend ＜0.001). At the time of diagnosis, larger tumor size, more frequent gross extra-thyroidal extension, more frequent N1b,and a higher number of metastatic lymph nodes were significantly observed in CEA-positive patients comparedwith CEA-negative patients (p＜0.05). The sensitivity of CEA at the time of recurrence was 56% for localrecurrence and 80% for distant recurrence. Conclusion: The CEA value was associated with anatomical stage asa biomarker for MTC and could be used to predict poor prognosis. However, serum CEA testing plays a limitedrole in diagnosis and follow-up of MTC because it can show normal values even in advanced disease.
Abstract
Background and Objectives: The lack of known elevated biomarkers in cancer surveillance is a challenge fordiagnostics. However, few studies have assessed the proportion of patients with medullary thyroid cancer (MTC)that presented with elevated serum carcinoembryonic antigen (CEA) level. Materials and Methods: This was aretrospective study of 115 patients treated for MTC at Samsung Medical Center between 1995 and 2017. Serumcalcitonin and CEA levels that were available at one of the following time points were included: (a) within 3months before the initial surgery, (b) when a structural recurrence was confined to the neck, or (c) when a distantmetastasis was identified during follow-up. Considering the high false-positive rate of serum CEA testing, 5 ng/mLwas selected as the cut-off threshold. Results: The sensitivity of CEA at the time of diagnosis was 54%, but itsignificantly increased with anatomical stage, from 20% in stage I to 88% in stage IV (p for trend ＜0.001). At the time of diagnosis, larger tumor size, more frequent gross extra-thyroidal extension, more frequent N1b,and a higher number of metastatic lymph nodes were significantly observed in CEA-positive patients comparedwith CEA-negative patients (p＜0.05). The sensitivity of CEA at the time of recurrence was 56% for localrecurrence and 80% for distant recurrence. Conclusion: The CEA value was associated with anatomical stage asa biomarker for MTC and could be used to predict poor prognosis. However, serum CEA testing plays a limitedrole in diagnosis and follow-up of MTC because it can show normal values even in advanced disease.
참고문헌 (30)
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