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.
背景/目的：远处转移是甲状腺髓样癌（MTC）患者死亡的主要原因。然而，由于该癌症较为罕见，目前少有研究深入分析影响远处转移发生的相关因素。本研究旨在评估MTC患者中与同步性和异时性远处转移发生相关的因素。 方法：在一家三级医院进行了一项分析性、观察性、回顾性队列研究。研究对象包括经组织学确诊的散发性及家族性（MEN2综合征）MTC患者。评估了流行病学变量、遗传性、辅助检查、手术因素、组织学特征、分期及疾病进展的影响。首先进行单变量比较分析，随后采用逻辑回归进行多变量分析。 结果：本研究共纳入146例患者，其中75%（n=109）为家族性MTC。诊断时发现淋巴结转移者占36%（n=52）。随访期间，14%（n=21）的患者发生远处转移，其中5例在诊断时即存在转移。中位随访时间为214个月（四分位距106-289个月）。远处转移的存在与死亡风险增加相关。与远处转移相关的因素包括年龄、降钙素水平、遗传状态、淋巴结受累情况及总体分期。在多变量分析中，淋巴结转移率（LNR）是唯一保持显著性的预测因子（比值比29.124）。 结论：多个变量与远处转移的存在相关。其中，淋巴结转移率（LNR）是同步性和异时性远处转移的独立预测因子。
Predictors of Distant Metastasis in Patients with Medullary Thyroid Carcinoma
肿瘤(癌症)患者之家