Elevated levels of serum calcitonin predicted poor clinical outcomes in medullary thyroid carcinoma (MTC), according to a new study published in the Annals of Translational Medicine. The researchers found that serum calcitonin levels were positively correlated with tumor/node/metastasis (TNM) stage.

“We found preoperative serum [calcitonin] levels could be potentially used as an important parameter to supplement TNM stage to predict biochemical prognosis,” they wrote. “The findings of this study suggest that preoperative serum [calcitonin] level plays a key role in preliminary clinical diagnosis, surgical decision making, and prognosis prediction.”

The research team conducted a retrospective observational study of 77 patients with MTC at a single center in China between 2010 and 2020. All enrolled patients had complete data including serum calcitonin levels, clinical and histopathological information, and a follow-up of longer than 6 months.

They were divided into 3 groups based on postoperative calcitonin levels: remission (normal levels), stable (steady but above normal), and progression (increased levels to 150 pg/ml or doubled within less than 12 months.

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The analysis revealed that calcitonin levels were clearly correlated with outcomes and TNM stage. Furthermore, postoperative calcitonin levels increased as preoperative calcitonin or carcinoembryonic antigen (CEA) levels increased.

Those patients with more lymph node dissection also had poorer biochemical prognoses, perhaps reflecting that patients with higher tumor burden require more aggressive surgical treatment. However, there was no correlation found between preoperative CEA level and TNM stage.

The researchers note that in previous studies, TNM staging alone has been insufficient to guide the prognosis and treatment decisions needed in patients with MTC. The authors propose that including preoperative levels of calcitonin in the TNM staging process could provide additional useful and accurate diagnostic and prognostic information. Furthermore, postoperative calcitonin levels add important data to guide clinicians in making treatment decisions.


Zhang H, Zhang D, Sui C, et al. Does pretreatment elevated calcitonin level cause the poor prognosis in patients with medullary thyroid cancer? Ann Transl Med. 2022;10(12):709. doi:10.21037/atm-22-2737