Abstract
Serum calcitonin (CT) is pivotal in medullary thyroid cancer (MTC) management. Recently, progastrin releasing peptide (ProGRP) has been proposed as a candidate complementary tumor marker of MTC. As current data are sparse our study was undertaken to evaluate the distribution of ProGRP in patients with MTC and its relationship with the tumor burden. Additionally, serial measurement of CT, carcinoembryonic antigen (CEA) and ProGRP was evaluated in three patients undergoing tyrosine kinase inhibitors (TKI). Seventy-eight, 125 and 62 sera from patients with MTC, non-medullary malignant and benign thyroid diseases were collected, respectively. ProGRP measurement was performed by Elecsys® assays on Cobas e601 platform (Roche Diagnostics). Significantly higher ProGRP levels were found in MTC compared to non-MTC patients. Among MTC patients ProGRP levels accurately discriminate patients with active from those with cured disease and, respectively, patients with loco-regional active disease from those with distant metastasis. Finally, ProGRP performed better than CT and CEA in monitoring the response to TKI therapy in three patients monitored serially. Serum ProGRP is promising as a complementary tumor marker in MTC patients. Further studies will be required, mainly focused on monitoring ProGRP during TKI treatment for early detection of resistance and assessing its usefulness to avoid the observed false positive fluctuations that occur with CT and carcinoembryonic antigen.
Highlights
Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor caused by a malignant transformation in the parafollicular C cells of the thyroid and constitutes between 5 and 10% of all thyroid carcinomas
Serum progastrin releasing peptide (ProGRP) concentrations were significantly higher in patients with active medullary thyroid cancer (MTC) compared with those with cured MTC and nonmedullary thyroid diseases, respectively (p=0.0066)
No differences were found between patients with cured MTC (NESD) and those with non-medullary thyroid disease, respectively
Summary
Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor caused by a malignant transformation in the parafollicular C cells of the thyroid and constitutes between 5 and 10% of all thyroid carcinomas. CT measurement suffers pre-analytic and analytic drawbacks which makes rapid processing of samples mandatory and potentially produce inaccurate results and poor comparability between different assays [4]. In this instance, procalcitonin, a precursor of CT, has been studied with interesting features and some advantages when compared to CT [5]. MTC is known to produce carcinoembryonic antigen (CEA) in about 50% of cases. It serves well as marker for disease progression in relapsed/advanced MTCs but it is insensitive
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