血清降钙素在甲状腺髓样癌诊治中应用研究进展

Advances in the application of serum calcitonin in the diagnosis and treatment of medullary thyroid carcinoma

甲状腺髓样癌(MTC)起源于甲状腺滤泡旁细胞(也称C细胞或明亮细胞),可分泌多种神经内分泌物质,属于神经内分泌肿瘤。血清降钙素(CTn)是MTC特异性标记物,主要由甲状腺滤泡旁细胞或MTC细胞分泌,对MTC的诊断和治疗发挥着重要的作用:(1)对甲状腺结节病人常规行血清CTn检测,有助于早期诊断MTC进而改善预后。(2)术前血清CTn水平与肿瘤临床病理学分期有关,可为MTC病人手术方式的选择和确定手术范围提供参考。(3)术后行CTn检测可评估预后,预测复发风险,早期发现并处理转移病灶。近年来,随着对MTC认识的不断深入以及检测手段的改善,CTn在国内外相关指南中的地位也在提升。但是,值得注意的是,目前检测血清CTn水平诊断MTC仍然缺乏有效的截断值、对微小病灶的诊断价值也不明确,同时也缺乏确切的卫生经济价值。因此,未来仍然需要进一步探究CTn在MTC诊疗中的价值。

Medullary thyroid carcinoma(MTC)originates from thyroid parafollicular cells(also known as C cells or bright cells),secretes a variety of neuroendocrine substances,and belongs to neuroendocrine tumor.Serum Calcitonin(CTn)is a specific marker of MTC,mainly secreted by thyroid parafollicular cells or MTC cells,and plays an important role in the diagnosis and treatment of MTC:(1)Routine detection of serum CTn in thyroid nodule patients is helpful for early diagnosis of MTC and improving prognosis.(2)Preoperative serum CTn level is related to the clinicopathological stage of the tumor,which can provide reference for the selection of surgical methods and the determination of surgical scope in MTC patients.(3)Postoperative CTn can evaluate the prognosis,predict the risk of recurrence,and detect and manage metastatic lesions early.In recent years,with the deepening understanding of MTC and the improvement of detection methods,the status of CTn in relevant guidelines at home and abroad has also been improving.However,it is worth noting that the detection of serum CTn level in the diagnosis of MTC still lacks an effective cut-off value,the diagnostic value of small lesions is not clear,and the exact health economic value is also lacking.Therefore,the value of CTn in the diagnosis and treatment of MTC needs to be further explored in the future.