The prognostic value of lymph node ratio in Medullary thyroid carcinoma: A multi-center study

Eur J Surg Oncol. 2020 Nov;46(11):2023-2028. doi: 10.1016/j.ejso.2020.04.016. Epub 2020 Apr 18.


Introduction: The lymph node ratio (LNR), which represents the proportion of metastatic lymph nodes resected, has been found to be a prognostic variable in several cancers, but data for Medullary thyroid carcinoma (MTC) are sparse. The aim of this study was to determine the value of the LNR in predicting outcome in patients with MTC.

Materials and methods: A retrospective multicenter study design of 107 patients with MTC who underwent total thyroidectomy with neck dissection between 1984 and 2016. The association of LNR with patient and tumor characteristics and prognostic factors was evaluated.

Results: Study population consisted of 53.3% female, mean age at diagnosis was 50.3 ± 18.4 years; 16.8% had inherited MTC. LNR was positively correlated with tumor size (p = 0.018) and inversely correlated with age at diagnosis (p = 0.024). A higher LNR was associated with extrathyroidal extension (p < 0.001), multifocality (p = 0.001), bilateral tumor (p = 0.002), distant metastases (p < 0.001), and tumor recurrence (OR = 14.7, p < 0.001). LNR was also correlated to postoperative calcitonin levels (p < 0.001) and carcinoembryonic antigen (p = 0.011). LNR >0.1 was associated with shorter disease-specific survival in patients at risk: tumor larger than 20 mm at diagnosis (p = 0.013), sporadic MTC (p = 0.01), and age above 40 years at diagnosis (p = 0.004). Cox multivariate survival analysis revealed LNR as the only significant independent factor for disease free survival (p = 0.005).

Conclusions: This study showed that LNR correlates well with patient and tumor characteristics and prognostic variables. We suggest that LNR should be considered an important parameter for predicting outcome in MTC.

Keywords: Cervical lymph node metastasis; Lymph node ratio; Medullary thyroid carcinoma; Survival; Thyroid cancer.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Calcitonin / blood
  • Carcinoembryonic Antigen / blood
  • Carcinoma, Neuroendocrine / blood
  • Carcinoma, Neuroendocrine / mortality
  • Carcinoma, Neuroendocrine / pathology*
  • Carcinoma, Neuroendocrine / surgery
  • Disease-Free Survival
  • Female
  • Humans
  • Lymph Nodes / pathology*
  • Male
  • Middle Aged
  • Neck Dissection*
  • Prognosis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Thyroid Neoplasms / blood
  • Thyroid Neoplasms / mortality
  • Thyroid Neoplasms / pathology*
  • Thyroid Neoplasms / surgery
  • Thyroidectomy*
  • Tumor Burden


  • Carcinoembryonic Antigen
  • Calcitonin

Supplementary concepts

  • Thyroid cancer, medullary