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Predictors of Distant Metastasis in Patients with Medullary Thyroid Carcinoma
by
, ,
Inmaculada Ros-Madrid
1,2
,
Beatriz Febrero
3,4,*,
Rosario Paloma Cano-Mármol
1
,
Mercedes Ferrer-Gómez
1 and
José M. Rodríguez
3,4 1
Endocrinology Service, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
2
Department of Digestive Surgery, Endocrinology and organ Transplantation, Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), 30120 Murcia, Spain
3
Endocrine Surgery Unit, General Surgery Service, Surgery, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
4
Pediatric, Obstetric and Gynecology Department, Biomedical Research Institute of Murcia Pascual Parrilla (IMIB), University of Murcia, 30120 Murcia, Spain
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(19), 3193; https://doi.org/10.3390/cancers17193193
Submission received: 22 August 2025
/
Revised: 28 September 2025
/
Accepted: 29 September 2025
/
Published: 30 September 2025
(This article belongs to the Special Issue New Advances and Approaches in Thyroid Cancer)
Simple Summary
The presence of distant metastases in patients with MTC determines their survival. However, the clinical behavior of MTC is heterogeneous, which raises the need to identify prognostic factors that allow the risk of metastatic spread to be stratified. The clinical, analytical, and histopathological characterization of patients with MTC is essential for optimizing diagnostic, therapeutic, and follow-up strategies.
Abstract
Background/Objectives: The presence of distant metastases is the main cause of death in medullary thyroid carcinoma (MTC). However, due to the rarity of this cancer, few studies have thoroughly analyzed the variables influencing the development of distant metastases. The objective of this study was to evaluate, in patients with MTC, the factors associated with the occurrence of synchronous and metachronous distant metastases. Methods: An analytical, observational, retrospective cohort study was conducted at a tertiary hospital. Patients with histologically confirmed MTC, both sporadic and familial (MEN2 syndrome), were included. The influence of epidemiological variables, heredity, complementary tests, surgical factors, histological features, staging, and disease progression was assessed. A univariate comparative analysis was first performed, followed by a multivariate analysis using logistic regression. Results: This study included 146 patients, of whom 75% (n = 109) had familial MTC. Lymph node involvement at diagnosis was observed in 36% (n = 52). During follow-up, distant metastases developed in 14% (n = 21) of patients, including five cases present at the time of diagnosis. The median follow-up was 214 months (IQR 106–289). The presence of distant metastases was associated with an increased risk of mortality. Factors associated with distant metastases included age, calcitonin level, hereditary status, lymph node involvement, and overall stage. In multivariate analysis, the lymph node ratio (LNR) remained the only significant predictor (OR 29.124). Conclusions: Several variables were related to the presence of distant metastases. Among them, the LNR emerged as the independent predictor of both synchronous and metachronous distant metastases.
