Abstract
Introduction: Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII) are prognostic factors in several tumours, however little is known in medullary thyroid cancer (MTC). Objective: To evaluate the association between preoperative NLR, PLR and SII with MTC clinicopathological and molecular features, and their predictive value for lymph-node and distant metastasis. Methods: We retrospectively analysed 75 patients with MTC who underwent surgery at our institution. Results: In our cohort, 56% were females, the median age at diagnosis was 57 years (44–69), the median tumour diameter was 25mm (15–50); 21.3% were multifocal and 34.7% had extrathyroidal extension. Fibrosis was present in 30 of the 37 analysed samples; RET somatic status was assessed in 35 cases and 21 harboured a mutation. Lymph-node and distant metastasis were observed in 36 (48.0%) and 8 (10.7%), respectively. Higher NLR was associated with preoperative calcitonin, angioinvasion, extrathyroidal extension, moderate/severe fibrosis; higher PLR was associated to extrathyroidal extension and advanced T stages; lower SII and NLR were associated with biochemical cure after surgery. Increased PLR, NLR and SII were associated with advanced MTC stages. In the univariate analysis, only NLR was associated with lymph-node metastasis (odds ratio (OR) = 2.69, 95% confidence interval (CI): 1.50–5.84; p = 0.004); however, in the multivariate model, NLR was no longer a predictive factor for lymph-node metastasis. Conclusion: None of these serum inflammatory markers predicted the occurrence of distant metastasis. In conclusion, NLR, PLR and SII may indicate aggressive MTC disease, but do not predict lymph-node or distant metastasis.
Evaluation of neutrophil‑to‑lymphocyte ratio and calcitonin concentration for predicting lymph node metastasis and distant metastasis in patients with medullary thyroid cancer
