Clinical Characteristics, Prognostic Factors, and Outcomes of Patients With Medullary Thyroid Carcinoma: A Retrospective Review From a Tertiary Care Hospital

Introduction: Medullary thyroid carcinoma (MTC) is an uncommon neuroendocrine tumor of the thyroid with a highly variable clinical course. Epidemiological and outcome data on MTC from South Asian countries are limited. This study was conducted to assess the clinical features, treatment approaches, and outcomes of patients with MTC managed at a tertiary care hospital in Pakistan. Methods: We performed a retrospective observational study including adult patients with histologically confirmed MTC treated between December 2008 and December 2019. Data collected included demographics, tumor characteristics, multiple endocrine neoplasia type 2 (MEN2) status, biochemical markers, treatment modalities, and survival outcomes. Postoperative serum calcitonin and carcinoembryonic antigen (CEA) levels, along with calcitonin doubling time (DT), were evaluated as prognostic indicators. Statistical analyses were performed using Statistical Package for the Social Sciences version 26.0 (IBM Corp., Armonk, NY). Results: We found a total of 90 patients having MTC during our study period, as the prevalence is scarce, so all the patients found were included (mean age = 39.3 ± 12.3 years (17-67); 43.3% male). MEN2A-associated disease was present in 13.3%. Cervical lymph node involvement and distant metastases were observed in 37.8% and 13.3% of patients, respectively. Disease-free status strongly correlated with improved overall survival (p < 0.001). Elevated post-treatment calcitonin and CEA levels, as well as shorter calcitonin DT, were associated with poorer survival. Patients with distant metastases, particularly bone involvement, had significantly worse outcomes (p < 0.001). Conclusion: Early disease detection, achievement of disease-free status, and favorable postoperative biochemical markers are key predictors of survival in MTC. These findings underscore the importance of timely diagnosis and comprehensive management.