title: Long-term course of patients with persistent hypercalcitoninemia after apparent curative primary surgery for medullary thyroid carcinoma.
abstract: Thirty-one patients with persistent hypercalcitoninemia after seemingly adequate primary operation for medullary thyroid carcinoma (MTC) were followed for a mean period of 11.9 years after operation. Ten patients had sporadic MTC and the remaining patients were members of families with multiple endocrine neoplasia (MEN)--either MEN 2A (15 patients) or MEN 2B (six patients). Overall 5- and 10-year survival rates were 90% and 86%, respectively. Only four patients died at the completion of the study: two of MTC and two of unrelated causes. Eleven patients (35.5%) underwent surgical re-exploration after demonstration of recurrent disease clinically or radiologically. In no patient did the calcitonin level return to normal after re-exploration. The presence of more than three metastatic nodes at the time of initial operation was a statistically significant (p = 0.003) predictor for disease recurrence. Factors approaching statistical significance were patients younger than age 35 (p = 0.06) and the percentage of cells in the S phase of cell division (0.07). This data supports a conservative surgical philosophy in the management of the patient with persistent hypercalcitoninemia after resection of MTC.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: J A
authors.initials: JA
authors.lastname: van Heerden
authors.forename: C S
authors.initials: CS
authors.lastname: Grant
authors.forename: H
authors.initials: H
authors.lastname: Gharib
authors.forename: I D
authors.initials: ID
authors.lastname: Hay
authors.forename: D M
authors.initials: DM
authors.lastname: Ilstrup
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002116:Calcitonin / Q000097:blood*; D002277:Carcinoma / Q000097:blood* / Q000235:genetics / Q000401:mortality / Q000601:surgery*; D002648:Child; D004273:DNA, Neoplasm / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011003:Ploidies; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000097:blood* / Q000235:genetics / Q000401:mortality / Q000601:surgery*
chemical_list: D004273:DNA, Neoplasm; D002116:Calcitonin