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Long-term Outcomes and Prognostic Factors in Patients with Differentiated Thyroid Cancer and Distant Metastases
- Source :
- Endocrine Practice. 23:1193-1200
- Publication Year :
- 2017
- Publisher :
- Elsevier BV, 2017.
-
Abstract
- Distant metastatic spread is the most frequent cause of thyroid cancer-related death. The objective of this study was to evaluate overall and disease-related survival of patients with differentiated thyroid cancer (DTC) and distant metastases (DM) attending a single medical center and to investigate variables predictive of better long-term outcomes.The Rabin Medical Center Thyroid Cancer Registry was searched for patients with DM from DTC.The cohort included 138 patients (58.7% female) diagnosed at age 54.7 ± 19.5 years. Mean primary tumor size was 33.9 ± 26 mm. Most patients (57.7%) were stage T3/T4; 48.7% had extrathyroidal extension; 53.5% had lymph node metastases. Histopathology yielded papillary and follicular thyroid carcinoma in 66.7% and 13.8%, respectively, and intermediate/poorly differentiated carcinoma in 19.6%. All but 2 patients underwent total thyroidectomy, and 133/138 (96.4%) received radioactive iodine (RAI) therapy. DM were synchronous in 55.1%. The mean follow-up was 8.2 years from detection of metastases. The common sites of metastases were the lungs (85.6% of patients), bones (39.9%), brain (5.8%) and liver (3.6%). At last follow-up, resolution was documented in 24.6% of patients, improvement/stable disease in 31.6%, and structurally progressive disease in 43.4%. By the end of the study, 40.6% of patients died, 23.2% of DTC. Improved overall survival and disease progression were associated with younger age, lung-only DM, and metastatic RAI avidity.Patients with DTC and DM treated by standard-of-care approaches frequently achieve favorable long-term outcomes. Novel therapies might be necessary in only a minority of these patients, and the reported prognostic factors can aid in their identification.CR = complete response; DM = distant metastases; DTC = differentiated thyroid cancer; ETE = extra-thyroidal extension; M0 = detected during follow-up; M1 = detected at diagnosis; MSKCC = Memorial Sloan Kettering Cancer Center; NED = no evidence of disease; OS = overall survival; PFS = progression free survival; PTC = papillary thyroid cancer; RAI = radioactive iodine; Tg = thyroglobulin.
- Subjects :
- Adult
Male
Oncology
medicine.medical_specialty
Endocrinology, Diabetes and Metabolism
030209 endocrinology & metabolism
Carcinoma, Papillary, Follicular
Disease-Free Survival
Thyroid carcinoma
Young Adult
03 medical and health sciences
0302 clinical medicine
Endocrinology
Internal medicine
medicine
Carcinoma
Humans
Thyroid Neoplasms
Neoplasm Metastasis
Stage (cooking)
Lymph node
Thyroid cancer
Survival analysis
Aged
business.industry
Thyroid
General Medicine
Middle Aged
Prognosis
medicine.disease
Survival Analysis
medicine.anatomical_structure
030220 oncology & carcinogenesis
Disease Progression
Female
Histopathology
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 1530891X
- Volume :
- 23
- Database :
- OpenAIRE
- Journal :
- Endocrine Practice
- Accession number :
- edsair.doi.dedup.....c110969c28de8db21730f40641936895