Prognostic Thresholds for Lymph Node Metastasis in Medullary Thyroid Cancer: A Restricted Cubic Splines Analysis
Authors' conclusion
Using population-level data, we identified robust LN thresholds associated with MTC-specific mortality. Compared with a threshold of 8 positive LNs, a LNR threshold ≥14% was associated with a greater increase in hazard of MTC-specific mortality.
Study context
- Population
- Medullary thyroid cancer (MTC) patients in SEER database (2004–20); testing cohort of 149 MTC patients at a single institution (1996–2025); mean age 54.1 years, 59.1% femalederivation cohort
- Participants
- 2,709 patients
- Exposure
- ≥8 vs <8 positive lymph node (LNs); LN ratio (LNR) ≥14% vs <14%
- Outcome
- MTC-specific mortality
Methodological detailsrestricted cubic splines, derivation (SEER) and single-institution testing cohort, 2098 (77.4%) had LNs examined; 52.7% of these had ≥1 positive LN
- Restricted cubic splines
- Derivation (SEER) and single-institution testing cohort
- 2098 (77.4%) had LNs examined; 52.7% of these had ≥1 positive LN
Main finding
As reported in the abstract
Hazard ratio (CI)P value
≥8 positive LNsvs <8 positive LNsadjusted; model AUC 86.7%
1.54(1.09–2.17)
P = 0.014LNR ≥14%vs LNR <14%adjusted; model AUC: 87.9%
3.308(2.096–5.222)
P < 0.001- Threshold values identified: positive LNs
- 7.8
- Threshold values identified: LNR
- 13.8%
- Nonlinearity p for both
- P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | ≥8 positive LNs | <8 positive LNs | LNR ≥14% | LNR <14% | P value |
|---|---|---|---|---|---|
| Recurrence-free survival, testing cohort (positive LN count) · 5-year≥8 positive LNs vs <8 positive LNs | 56.5% (CI 39.5–70.4) | 90.5% (CI 82.5–94.9) | — not stated in the abstract | — not stated in the abstract | log-rank p < 0.001 |
| Recurrence-free survival, testing cohort (LNR) · 5-yearLNR ≥14% vs LNR <14% | — not stated in the abstract | — not stated in the abstract | 67.9% (CI 55–77.9) | 92.8% (CI 83.6–97) | log-rank p < 0.001 |
— not stated in the abstract
MTC-specific survival, derivation cohort · 5-year
- 5-year MTC-specific survival
- 93.3%
Original publication
Prognostic Thresholds for Lymph Node Metastasis in Medullary Thyroid Cancer: A Restricted Cubic Splines Analysis. Thyroid. Published 20 October 2025. doi:10.
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