Prognostic factors in medullary thyroid carcinomas.Survival in relation to age, sex, stage, histology, immunocytochemistry, and DNA content

Abstract

Patients with medullary thyroid carcinomas (MTC) were analyzed according to age, sex, and tumor stage. In addition, the MTC were screened for the predominant histologic pattern, immunocytochemical spectrum (60 tumors), and DNA content (DNA cytophotometry and DNA flow cytometry, 25 tumors). These findings were correlated with follow‐up data available for 45 of these patients. Forty‐eight percent of the tumors revealed a polygonal cell pattern, whereas 22% showed spindle‐cell predominance. All tumors contained cytokeratin, chromogranin A, and calcitonin (CT). Calcitonin gene‐related peptide (CGRP) was present in 92%, carcinoembryonic antigen (CEA) in 77%, neuron‐specific enolase (NSE) in 75%, and vimentin in 53% of cases. Positivity for neurotensin, somatostatin, neurofilaments, bombesin, and alpha human chorionic gonadotropin (a‐hCG) and serotonin ranged between 3% and 27%. All MTC were negative for substance P, adrenocorticotropic hormone (ACTH), thyroglobulin (TG), or S‐100 protein. Local recurrences and regional lymph node metastases revealed identical staining patterns as the primaries. Prognosis of MTC was found not to be related to histologic features (dominant architectural pattern, cellular shape, presence of amyloid deposits) or immunocytochemical pattern. Instead, survival was significantly correlated to age, sex, and stage of disease. The best prognosis was seen in women younger than 40 years and revealing an early stage of disease. DNA measurements added valuable information in assessing the prognosis of MTC.