Analysis of some prognostic factors significance for medullary thyroid cancer metastasis

Abstract

Background. The urgency of the study is due to the need to find effective methods for the diagnosis and treatment of medullary thyroid cancer. Basal calcitonin is a biomarker that determines both the presence of this disease and the level of metastasis. Howe­ver, above-threshold calcitonin levels have a low prognostic value of the positive result. The study was aimed to analyze the importance of additional factors (besides calcitonin) in predicting the medullary thyroid cancer metastasis: age, sex, tumor focus, tumor volume (total volume). Materials and me­thods. A retrospective monocenter analysis was performed using the records of 194 patients treated for medullary thyroid cancer. The study involved 143 patients with primary forms of the di­sease. The required characteristics of the tumor were assessed in the postoperative period based on the pathomorphological exa­mination. Results. The association between age and metastasis was not found, but a moderate relationship between sex and metastasis has been shown. The ratio of the chances of metastases detected in male patients is estimated at 3 : 1. It is proved that in the presence of tumor multifocality, the likelihood of metastasis detection increa­ses. With an odds ratio of 2.368, the multifocal factor shows a weak but statistically significant strong association with the presence of metastases. Total tumor size is associated with metastasis. More than half (54.5 %) of cases are in the range of tumor sizes smaller than the selected cut-off threshold, with 16.7% metastasi­zing. On the other hand, the share of cases of exceeding the cut-off threshold (Cut-off = 1.9 cm; AUC = 0.703, Se = 0.745, Sp = 0.680) is 45.5 %, and metastasis is observed in 53.8 % of patients in this range. Conclusions. No association was found between age and metastasis. Male gender is a risk factor for metastasis. Multifocality is a risk factor for metastasis with a weak connection. The total size of the tumor is associated with metastasis with medium strength.