{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T09:07:59Z","timestamp":1793869679061,"version":"4.6.1"},"reference-count":14,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec id=\"ab-ooi250014-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Calcitonin is the most sensitive and specific biomarker for medullary thyroid cancer (MTC). Basal serum calcitonin levels are strongly associated with the burden of lymph node metastasis (LNM) and can help guide the extent of neck dissection. However, the predictive thresholds for varying degrees of LNM are based on laboratory testing methods no longer in use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250014-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To update the optimal thresholds of basal serum calcitonin levels for predicting the extent of LNM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250014-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective cohort study included initially treated patients with MTC who had their preoperative basal calcitonin levels tested using electrochemiluminescence or chemiluminescence from a Chinese multicenter cohort of 13 hospitals between 2011 and 2024. The patients were randomly divided into a training and a validation cohort in a 2:1 ratio. The data were analyzed between June 2024 and September 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250014-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Preoperative basal serum calcitonin using electrochemiluminescence or chemiluminescence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250014-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The main outcome is Structural recurrence-free survival (SRFS) based on the group partitioned by the proposed thresholds predicting different LNMs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250014-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 509 patients were included in the study with a median (interquartile range [IQR]) follow-up of 52 (27-84) months. The median (IQR) age at diagnosis was 50 (40-59) years, and 279 patients (54.8%) were female individuals. Patients were categorized into 4 groups based on the extent of LNM: no LNM, central LNM, lateral LNM, and upper mediastinal LNM. A positive correlation was found between preoperative calcitonin levels and the extent of LNM (\u03b7\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.28). Using the training cohort, preoperative basal calcitonin thresholds associated with different extents of LNM were identified as follows: 241.9 pg\/mL for central LNM, 693.9 pg\/mL for ipsilateral lateral LNM, 2787.1 pg\/mL for upper mediastinal LNM, and 2378.5 pg\/mL for bilateral and\/or contralateral lateral LNM. In both the training and validation cohorts, the proposed thresholds outperformed those recommended by the American Thyroid Association guidelines not only in the prediction of LNM, but also in the discrimination of SRFS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ooi250014-10\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this cohort study, updated threshold values of preoperative serum calcitonin predicted different extents of LNM, which may provide optimal cutoffs for future prospective studies on biomarker-guided selective neck dissection in patients with MTC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaoto.2025.0542","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T11:31:10Z","timestamp":1750937470000},"page":"761","source":"Crossref","is-referenced-by-count":17,"title":["Updated Thresholds of Basal Calcitonin Level and Extent of Lymph Node Metastasis in Initially Treated Medullary Thyroid Cancer"],"prefix":"10.1001","volume":"151","author":[{"given":"Yuxin","family":"Du","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cenkai","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kehan","family":"Song","sequence":"additional","affiliation":[{"name":"Hubei Provincial Research Center for Precision Medicine of Cancer, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuqiao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zimeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Thyroid Surgery, the First Hospital of China Medical University, Shenyang, Liaoning, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitao","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghai","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjun","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"1","key":"ooi250014r1","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1111\/j.1365-2796.2009.02106.x","article-title":"Medullary thyroid carcinoma and biomarkers: past, present and future.","volume":"266","author":"van Veelen","year":"2009","journal-title":"J Intern Med"},{"issue":"2","key":"ooi250014r2","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1007\/s12020-019-02183-6","article-title":"Calcitonin as a biomarker of C cell disease: recent achievements and current 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