Procalcitonin measured by three different assays is an excellent tumor marker for the follow-up of patients with medullary thyroid carcinoma

Objectives: Procalcitonin (PCT) has been suggested as a tumor marker in patients with medullary thyroid carcinoma (MTC). Clinical application data in long term followup are missing. Methods: 210 serum samples of 169 consecutive patients with MTC (92 sporadic, 77 hereditary, 158 postoperative follow-up, 11 preoperative) were collected between 2018 and 2020. Postoperative patients were stratified into three groups according to their disease status at the end of follow-up: cured (n=51, calcitonin (CT) levels < limit of quantitation), minimal residual disease (n=55, detectable CT and no metastases provable by imaging methods), metastatic disease (n=52). In five patients CT and PCT were measured while on therapy with tyrosine kinase inhibitors (TKI). CT was analyzed by the Roche ECLIA, PCT by three assays from Roche, PES, Abbott. Results: The mean +/- SD values seen with the three PCT assays in the MTC response groups, cured: <0.06, 0.016 +/- 0.007, 0.014 +/- 0.007 ng/mL, minimal residual disease: 0.511 +/- 0.800, 0.389 +/- 0.687, 0.341 +/- 0.614 ng/mL, metastatic disease 109 +/- 202, 60.4 +/- 110, 63.3 +/- 115 ng/mL correlate well with the CT results in these groups: cured <1.0 pg/mL, minimal residual disease 91.3 +/- 121.5 pg/mL, metastatic disease 14,489 +/- 30,772 pg/mL. There was a significant correlation (p<0.001) between the three PCT assays (Roche/PES r=0.970, Roche/Abbott r=0.976, Abbott/PES r=0.995). In the course of treatment with TKI both CT and PCT reflected clinical state. Preoperative PCT in hereditary MTC has the same diagnostic validity than CT. Conclusions: PCT measured with three different immunoassays is as good as the standard tumor marker CT in the follow-up of MTC but has a superior analytical stability.

Automated summary

In this study, three different immunoassays for PCT were used to monitor MTC patients in long-term follow-up, showing that PCT correlates well with disease status and CT results. Both CT and PCT reflected clinical state during treatment with TKI. Preoperative PCT in hereditary MTC was found to have the same diagnostic validity as CT.