The potential role of MMP-9 and VEGF-C as predictors of lymph node involvement in papillary thyroid carcinoma

Introduction: Most thyroid malignancy is papillary thyroid carcinoma (PTC). However, lymph node metastases occur in 30-40% of PTC patients. Biomarkers to predict cervical lymph node metastases have now begun to be widely varied, such as matrix metalloproteinase (MMP) and vascular endothelial growth factor (VEGF). There has not been any diagnostic agreement on MMP-9 and VEGF-C as predictors of lymph node metastasis in PTC. Hence, this study aims to determine the association of MMP-9 and VEGF-C to cervical lymph node metastases in PTC patients. Methods: A cross-sectional study was conducted at Cipto Mangunkusumo General Hospital, Jakarta. Patients diagnosed with PTC based on histopathological examination were included in this study. Patients with distant metastases were excluded from the study. The expression of MMP-9 and VEGF-C was investigated at the Anatomical Pathology Laboratory. Results: Sixty-two patients were included in this study, 80.6% female and 19.4% male. The MMP-9 expression was higher in the metastatic group (p<0.001). The same results were also found in VEGF-C expression, where the median expression of this marker in the metastatic group was higher than in the non-metastatic group (p<0.001). We found a significant positive correlation between the MMP-9 and VEGF-C expressions (correlation coefficient of 0.618). Conclusions: There is a significant relationship between the expression of MMP-9 and VEGFC with cervical lymph node metastases in PTC patients. The MMP-9 and VEGF-C expression was higher in the metastatic group. The increased MMP-9 expression is also positively correlated with increased VEGF-C expression.