Abstract
BackgroundOur previous kinetic analyses of changes in the tumor volume (TV) of papillary thyroid microcarcinomas during active surveillance revealed that the tumors’ growth varied over time from rather rapid growth to shrinkage and that the hypothetical TV-doubling rates (DRs) before the patients’ presentation were much larger than their observed TV-DRs, indicating that rapid growth phases preceded their presentation. Whether this phenomenon also occurs in medullary thyroid carcinoma (MTC) was unknown.MethodsWe retrospectively analyzed the cases of 46 MTC patients (18 hereditary, 28 sporadic; 9–80 years old at surgery, median 53.5 years; 19 males and 27 females) with elevated postoperative calcitonin (Ct) measured with the electrochemiluminescence immunoassay suggesting persistent disease. We calculated each patient’s Ct-DR and his/her hypothetical TV-DR, using the tumor size and age at surgery.ResultsCt-DRs (/year) after surgery were > 0.5, 0.1–0.5, − 0.1–0.1, and < − 0.1 in 9, 21, 12, and 4 patients, respectively (median 0.17). The hypothetical TV-DRs (/year) before surgery were > 1, 0.5–1.0, 0.1–0.5 and < 0.1 in 11, 21, 14, and 0 patients, respectively (median 0.60). The hypothetical TV-DR was higher than the observed Ct-DR in 41 of the 46 MTC patients and all 18 patients with hereditary MTC, suggesting that a rapid growth phase preceded surgery in these patients.ConclusionsIn this series of MTC patients, the pre-surgery calculated hypothetical TV-DRs were significantly higher than the Ct-DRs observed post-surgery, suggesting that there were rapid growth periods before surgery in the vast majority of these MTC patients.
Highlights
Medullary thyroid carcinoma (MTC) is an uncommon malignant tumor derived from the C cells of the thyroid gland, and it presents in a sporadic or hereditary variant
We converted the tumor volume-doubling time (TV-Doubling time (DT)) to its inverse (i.e., 1/TV-DT), and we proposed that this value be called the ‘doubling rate (DR)’, because it is designed to indicate the number of doublings that occur per unit of time [3]
Our research revealed that in most of the patients, the hypothetical TV-DR was much larger than the TV-DR observed during active surveillance, suggesting that the tumors’ growth before the patients’ presentation had been much more rapid
Summary
Medullary thyroid carcinoma (MTC) is an uncommon malignant tumor derived from the C cells (calcitoninproducing cells) of the thyroid gland, and it presents in a sporadic or hereditary variant. Our previous kinetic analyses of changes in the tumor volume (TV) of papillary thyroid microcarcinomas during active surveillance revealed that the tumors’ growth varied over time from rather rapid growth to shrinkage and that the hypothetical TV-doubling rates (DRs) before the patients’ presentation were much larger than their observed TV-DRs, indicating that rapid growth phases preceded their presentation. Whether this phenomenon occurs in medullary thyroid carcinoma (MTC) was unknown
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