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A Multivariate Analysis

Andreas Machens, MD; Jörg Ukkat, MD; Steffen Hauptmann, MD; Henning Dralle, MD

Arch Surg. 2007;142(3):289-293.

Hypothesis  Medullary thyroid cancer cells are capable of secreting carcinoembyronic antigen (CEA). An abnormal preoperative CEA level may have important implications for the management of this condition.

Design  Retrospective analysis.

Setting  Tertiary referral center at a university hospital.

Patients  One hundred fifty patients with a histopathologic diagnosis of medullary thyroid cancer and preoperative CEA measurements using the same assay.

Main Outcome Measure  We used univariate and multivariate analyses to quantify the relationship between preoperative CEA level and tumor progression.

Results  On multivariate analysis, abnormal preoperative CEA levels were significantly associated with the initial operation rather than reoperation, larger primary tumors, positive lymph nodes, and distant metastasis. When analyses were limited to the 54 patients with increased CEA levels before the initial operation, there was a respective significant association between successive CEA levels (4.7-10.0, 10.1-30.0, 30.1-100.0, and >100.0 ng/mL) and lymph node metastases (>10 positive nodes: 0%, 9%, 53%, and 69% [P<.001]), involvement of cervical lymph node compartments (central: 33%, 36%, 73%, and 93% [P=.002]; lateral [ipsilateral]: 20%, 27%, 67%, and 88% [P=.001]; and lateral [contralateral]: 22%, 10%, 36%, and 73% [P=.008]), and distant metastasis (0%, 27%, 13%, and 75% [P<.001]). When CEA levels exceeded 30.0 ng/mL, surgical cure was exceptional.

Conclusions  In medullary thyroid cancer, an abnormal CEA level heralds advanced disease. Carcinoembryonic antigen levels greater than 30.0 ng/mL indicate central and lateral (ipsilateral) lymph node metastases, whereas CEA levels greater than 100.0 ng/mL signify lateral (contralateral) lymph node metastases and distant metastasis.

Author Affiliations: Departments of General, Visceral, and Vascular Surgery (Drs Machens, Ukkat, and Dralle) and Pathology (Dr Hauptmann), Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.

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