Factors Influencing Prognosis

As discussed in the previous section, the age of onset and clinical course of MTC are different in FMTC, MEN 2A, and MEN 2B. As is the case in most cancers, nodal status and tumor stage are associated with outcome.19 21 MTC often has an indolent clinical course, with approximately 75% 10-year overall survival and 50% 15-year overall survival.2223 Patients with high levels of calcitonin secondary to MTC may experience symptoms of flushing and diarrhea. The presence of such symptoms is associated with a poor prognosis.24 Other features that may correlate with clinical outcome include plasma calcitonin levels, CEA levels, DNA ploidy, and calcitonin and somatostatin immunohistochem-istry. In a study of 94 patients, a high preoperative stimulated calcitonin level (>10,000 pg/mL) was associated with a worse outcome.25 Those who presented with lower calcitonin levels were less likely to have nodal metastatic disease at operation than patients with high levels. CEA is elevated in more than 50% of patients with MTC.26 Elevated levels of CEA have been reported to be associated with the presence of metastatic disease, although this is not always the case.27 28

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