Metastasis number and ratio in regional lymph nodes as predictive indicators for distant metastasis in medullary thyroid cancer: beyond American Joint Committee on Cancer nodal staging

Q: What is the main aim of the study in medullary thyroid cancer?

To estimate the risk of distant metastasis in patients with medullary thyroid cancer using the metastasis number and ratio of regional lymph nodes, beyond the predictive ability of the 8th edition AJCC nodal staging.

Q: Which data source and analytic approach were used?

The study used 744 participants from the SEER STAT 8.4.3 database (2018–2022). Multivariate logistic regression was performed to assess predictive value and report odds ratios with 95% confidence intervals.

Q: How did lymph-node number and ratio relate to distant metastasis risk?

Higher numbers of positive regional lymph nodes (e.g., 1–10, 11–20, and >20) and a ratio above a cut-off value (0.176) were associated with significantly increased odds of distant metastasis.

Sep 29, 2026

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Medullary thyroid cancer with distant metastasis is associated with poor outcomes, and current nodal risk assessment relies mainly on the 8th edition AJCC tumor-node-metastasis (TNM) staging. This cross-sectional SEER-based analysis from 2018–2022 evaluates whether the number and ratio of metastatic regional lymph nodes improve prediction of distant metastasis beyond AJCC N staging. Multivariable logistic regression estimates odds ratios and identifies lymph-node metrics as effective predictors, supporting potential refinement of AJCC N stage.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Background

Methods

Results

Conclusions

Introduction

Calcitonin in MTC evaluation

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Key findings

Metastasis number and ratio in regional lymph nodes as predictive indicators for distant metastasis in medullary thyroid cancer: beyond American Joint Committee on Cancer nodal staging Zihan Chen1\#^, Jiesheng Su2\#, Naishi Li1,3,4^, Weibo Xia1^ 1Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China; 2Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; 3Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; 4WHO Family of International Classifications Collaborating Center of China, Beijing, China Contributions: (I) Conception and design: All authors; (II) Administrative support: N Li, W Xia; (III) Provision of study materials or patients: Z Chen, J Su; (IV) Collection and assembly of data: Z Chen, J Su; (V) Data analysis and interpretation: Z Chen, J Su; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work. Correspondence to: Naishi Li, MD, PhD. Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China; Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; WHO Family of International Classifications Collaborating Center of China, Beijing, [China. Email: LNS@medmail.com.cn](China. Email: LNS@medmail.com.cn); Weibo Xia, MD. Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory for Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, [China. Email: xiaweibo8301@163.com](China. Email: xiaweibo8301@163.com). Background: It has been reported that medullary thyroid cancer (MTC) with distant metastasis may result in poor prognosis. The aim of the study was to estimate the risk of distant metastasis in patients with MTC based on metastasis number and ratio of regional lymph nodes, more than just according to the 8th edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. Methods: This cross-sectional study involved 744 participants from the Surveillance Epidemiology and End Results (SEER) STAT 8.4.3 database from 2018 to 2022. Multivariate logistic regression was performed to determine the predictive value of the condition of positive regional lymph nodes for identifying distant metastasis. The estimates are presented as odds ratios (ORs) with 95% confidence intervals (CIs) . Results: In patients with MTC, the 8th edition of the AJCC node (N) stage could traditionally predict the risk of distant metastasis, with N1a (OR 6.21; 95% CI: 1.46–42.42; P=0.03), and N1b (OR 23.20; 95% CI: 6.69–146.54; P<0.001), compared with the stage of N0 . However, the upward trend was relatively more significant in the model with the number of metastatic regional lymph nodes. The number of positive regional lymph nodes could predict the risk of distant metastasis, with 1–10 (OR 9.13; 95% CI: 2.47–59.11; P=0.004), 11–20 (OR 25.72; 95% CI: 6.52–171.29; P<0.001), and >20 (OR 26.44; 95% CI: 6.50–178.95; P<0.001) metastatic regional lymph nodes, compared with no metastasis of regional lymph nodes. Similar results could be found in predicting bone metastasis. The cut-off value of metastatic regional lymph node ra

FAQs

What is the main aim of the study in medullary thyroid cancer?

To estimate the risk of distant metastasis in patients with medullary thyroid cancer using the metastasis number and ratio of regional lymph nodes, beyond the predictive ability of the 8th edition AJCC nodal staging.

Which data source and analytic approach were used?

The study used 744 participants from the SEER STAT 8.4.3 database (2018–2022). Multivariate logistic regression was performed to assess predictive value and report odds ratios with 95% confidence intervals.

How did lymph-node number and ratio relate to distant metastasis risk?

Higher numbers of positive regional lymph nodes (e.g., 1–10, 11–20, and >20) and a ratio above a cut-off value (0.176) were associated with significantly increased odds of distant metastasis.

Sep 29, 2026

Uploaded by Aditya