Demographical, clinical, and tumor characteristics may predict the risk of metastasis in patients with medullary thyroid carcinoma (MTC), according to a study recently published in Endocrine Pathology.

“Our risk table can be an adjuvant tool in the interpretation of tumor aggressiveness by using basic clinical information,” the authors wrote.

This scoring system consists of a table with the following variables: gender, age, tumor size, external tissue extension (ETE), and lymph node metastasis. The female gender does not add points, while males receive 5. Age adds 1.2 points for every 10 years, and tumor size adds 1 for every centimeter. Apparent ETE equals 4 points while no or unknown adds 0. Finally, lymph node metastasis sums 11 points.

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Total score cut-offs are 0 to 13, >13 to <22, and 22 or above, classifying patients into either low, intermediate, or high risk, respectively.

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A K-means clustering analysis divided a total of 2526 patients previously diagnosed with MTC into 3 risk cohorts with different survivals to determine the usefulness of this method. Low-risk patients had a 0.88%, 1.3%, and 0.5% risk of metastasis, while those cataloged as high risk showcased 19.7%, 15.8%, and 17.8% risk of metastasis.

Current guidelines recommend using calcitonin plasma levels to evaluate the metastatic risk. Nonetheless, the actual relation between these 2 variables has yet to be objectively described. This study suggests complementing tumor biomarkers, histopathologic features, imaging characteristics, and genetic results with this table, as explained by Le et al.

Assessing the risk of distant metastasis determines the therapeutic scheme and could even influence decision-making regarding the surgical approach, emphasizing the importance of predicting it prior to the intervention.

Targeted therapy with tyrosine kinase inhibitors is strongly recommended in metastatic MTC, and lymph node resection is advised upon findings in imaging studies and calcitonin levels.


Le M, Kawai M, Odate T, Vuong H, Oishi N, Kondo T. Metastatic risk stratification of 2526 medullary thyroid carcinoma patients: a study based on surveillance, epidemiology, and end results database. Endocr Pathol. Published online July 19, 2022. doi:10.1007/s12022-022-09724-2