title: Elevated level of serum carbohydrate antigen 19.9 as predictor of mortality in patients with advanced medullary thyroid cancer.
abstract: BACKGROUND
  Medullary thyroid cancer (MTC) is capable of secreting several proteins, such as calcitonin (Ct), carcinoembryonic antigen (CEA), chromogranin and others. Recently, we observed an aggressive MTC with high levels of serum carbohydrate antigen 19.9 (Ca 19.9) and a rapid evolution to death.
  
  
  OBJECTIVE
  The aim of this study was to evaluate whether high levels of serum Ca 19.9 could be a prognostic factor of death in patients with advanced MTC.
  
  
  METHODS
  We measured Ca 19.9, CEA and Ct in 100 advanced structural recurrent/persistent MTC patients and in 100 cured or biochemically affected MTC patients. Clinical and pathological data were also collected.
  
  
  RESULTS
  Sixteen percent of the patients with advanced MTC had high levels of Ca 19.9. The group with abnormal Ca 19.9 levels had significantly higher levels of CEA and Ct compared with the group with normal values of Ca 19.9 (P<0.0001 for both Ct and CEA). At variance, all 100 patients in the MTC control group showed normal levels of Ca 19.9. Moreover, among the advanced cases, the Ca 19.9-positive group showed a higher mortality rate than the group with normal levels. A logistic regression analysis demonstrated that an elevated level of Ca 19.9 is a predictor of mortality (OR=3.78, P=0.04), independent from Ct doubling time.
  
  
  CONCLUSIONS
  These results demonstrated that an elevated value of serum Ca 19.9 appears to be a predictive factor of poor prognosis in advanced MTC patients and identifies those cases with a higher risk of mortality in the short term.
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy rossella.elisei@med.unipi.it.
authors.forename: Rossella
authors.initials: R
authors.lastname: Elisei
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Lorusso
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Piaggi
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Liborio
authors.initials: L
authors.lastname: Torregrossa
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellegrini
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Molinaro
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Agate
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Bottici
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Pani
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Cacciato Insilla
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Casella
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ciampi
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Tognetti
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Materazzi
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Basolo
authors.affiliation: Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Romei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D002116:Calcitonin / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D018278:Carcinoma, Neuroendocrine; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D002116:Calcitonin