Prognostic value of histological grade in Medullary Thyroid Cancer

• Research type

  Research Study

• Full title

  Does a grading system based on proliferation markers predict prognosis in Medullary Thyroid Cancer?

• IRAS ID

  224621

• Contact name

  Daniel Morganstein

• Contact email

  daniel.morganstein@chelwest.nhs.uk

• Sponsor organisation

  The Royal Marsden NHS Foundation Trust

• Duration of Study in the UK

  1 years, 0 months, 1 days

• Research summary

  Medullary thyroid cancer (MTC) is a rare form of thyroid cancer, arising from neuroendocrine cells in the thyroid gland. It accounts for around 5% of all thyroid malignancies, and is associated with a high level of serum calcitonin. Although often metastatic at presentation, and therefore incurable, the prognosis is still relatively good with 10 year survival rates in the range of 80%. However many patients develop progressive disease, and will be considered for systemic therapies such as tyrosine kinase inhibitors eg vandetanib or cabozantinib which have been shown to increase progression free survival (PFS) (refs: Elisei et al JCO 2013; Wells et al JCO 2012). When to initiate systemic therapies remains controversial and an area of much debate. Both prognostic and predictive biomarkers are therefore increasingly important, inform discussion between patients and clinicians to guide intensity of follow up and decision about treatment interventions.
  Validated prognostic indicators include the stage of disease(1) and the level of, or rate of change, of calcitonin and CEA (doubling time).
  Neuroendocrine tumours from the gastrointestinal tract or pancreas (GEP) are graded according to a European system, according to the number of dividing cells or level of expression of Ki-67, a marker of cell proliferation(3). The grade strongly predicts survival. Recent reports have suggested that similar grading on the basis of proliferation markers also holds prognostic value in lung neuroendocrine tumours. Although two small studies have reported variability in Ki-67 in medullary thyroid cancer. it is not known if utilising Ki-67 or mitotic count to grade medullary thyroid cancer will help to refine the prognosis. This study will utilise a retrospective cohort of over 100 patients with medullary thyroid cancer to determine if grading of MTC can predict progression free or overall survival

• REC name

  London - Stanmore Research Ethics Committee

• REC reference

  17/LO/1854

• Date of REC Opinion

  3 Nov 2017

• REC opinion

  Further Information Favourable Opinion