Several immunologic markers may predict the presence of aggressive medullary thyroid carcinoma (MTC), according to a study recently published in Endocrinología, Diabetes y Nutrición.

“Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) are prognostic factors in several tumors, though little is known in medullary thyroid cancer (MTC),” the authors wrote.

Read more about MTC prognosis

Continue Reading

This observational, retrospective study included 75 patients previously diagnosed with MTC who underwent surgical resection of the tumor. The majority of the participants (57%) were females, and the age at diagnosis ranged from 44 to 69 years of age. Median age was 57 years. 

The authors studied the association between NLR, PLR, and SII to several variables.

The tumor diameter ranged from 15 mm to 50 mm, with a median of 25 mm. Less than a fourth (21.3%) of the cases were multifocal, while over a third (34.7%) had an extrathyroidal disease. Almost half (48%) of the patients had lymph node involvement, and only 10.7% further showcased distant metastasis.

Increased NLR correlated with extrathyroidal extension, angioinvasion, preoperative calcitonin, and moderate to severe fibrosis. On the other hand, higher PLR is associated with extrathyroidal disease extension and higher T stages. Moreover, lower NLR and SII are related to biochemical cures following surgery. All 3 of the inflammatory parameters (NLR, SII, and PLR) correlated with advanced MTC stages. 

Notably, only NLR was associated with lymph node involvement after the univariate analysis, despite not showcasing this relationship in the multivariate analysis. Finally, none of the 3 markers predicted distant or lymph node metastasis, as reported by Abrantes and colleagues.

“In conclusion, NLR, PLR, and SII may be useful biomarkers to indicate increased clinicopathological aggressiveness in the MTC setting, but their usefulness in independently predicting lymph node or distant metastasis appears to be limited,” the authors wrote. 


Abrantes A, Esteves S, Moura M, et al. Preoperative serum inflammation-based scores inmedullary thyroid cancer. Endocrinol Diabetes Nutr. Published online January 2023. doi:10.1016/j.endien.2022.06.015