The overall survival of patients with mixed medullary-follicular thyroid carcinoma is significantly worse than that of patients with differentiated thyroid carcinoma, according to a new study published in The American Journal of Surgery.

“Our study adds to the growing body of literature characterizing the prognosis and clinicopathologic characteristics of mixed histology thyroid tumors,” the authors of the study wrote. 

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The team led by Maureen D. Moore, MD, from the Department of Surgery, Cooper University Hospital in Camden, New Jersey compared the demographics, clinicopathologic features, treatment, and overall survival of patients with mixed medullary-papillary and mixed medullary-follicular thyroid carcinomas to those of more common subtypes of thyroid cancer using data from the National Cancer Database (NCDB).

The database contains information on 296,101 patients. Of those, 421 had mixed medullary-papillary thyroid carcinoma, 133 had mixed medullary-follicular thyroid carcinoma, 263,140 had papillary thyroid carcinoma, 24,208 had follicular thyroid carcinoma, and 8199 had medullary thyroid carcinoma.

The researchers found that patients with mixed medullary-papillary and mixed medullary-follicular thyroid carcinomas were generally older than those with papillary thyroid cancer and had a higher Charlson-Deyo comorbidity index, which predicts the 10-year mortality of patients with a range of comorbid conditions.

They also found that mixed tumors had lower rates of nodal disease but more distant metastases than papillary thyroid carcinoma. 

Mixed medullary-papillary thyroid carcinoma showed a lower estimated 10-year overall survival than papillary thyroid carcinoma and follicular thyroid carcinoma, but it was higher than that of medullary thyroid carcinoma. Mixed medullary-follicular thyroid carcinoma, on the other hand, had worse overall survival than all other types of thyroid cancer.

“Subsequent studies . . . will be critical to better delineate disease-specific outcomes, mutational characteristics as well as the role of adjuvant radiotherapy in the treatment of these rare tumors needed to tailor treatment regimens,” the authors wrote. 


Sandilos G, Lou J, Butchy MV, et al. Features of mixed medullary thyroid tumors: an NCDB analysis of clinicopathologic characteristics and survival. Am J Surg. Published online February 10, 2023. doi:10.1016/j.amjsurg.2023.02.006