Shoup Margo, Stojadinovic Alexander, Nissan Aviram, Ghossein Ronald A, Freedman Sam, Brennan Murray F, Shah Jatin P, Shaha Ashok R
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Am Coll Surg. 2003 Aug;197(2):191-7. doi: 10.1016/S1072-7515(03)00332-6.
Distant metastasis is uncommon in differentiated thyroid cancer and the prognosis is unclear. This study aims to evaluate outcomes and to define independent variables that are associated with tumor-related mortality in patients with distant metastasis from thyroid carcinoma.
A retrospective review of the thyroid cancer research database identified 336 patients with distant metastasis from differentiated thyroid carcinoma treated at a single institution between 1941 and 2000. After excluding patients with local or regional recurrence, distant disease was either the first site of recurrence or was detected at the time of diagnosis of the primary tumor in 242 patients (72%). Patient, tumor, and treatment-related factors were analyzed for their relation to disease-specific survival (DSS) using multivariate Cox regression and the log-rank test.
Median survival was 4.1 years and 10-year DSS was 26%. Distant disease was synchronous with the primary diagnosis in 97 of 242 (40%) patients. The site of metastasis was lung only in 103 (43%) patients, bone only in 80 (33%), other sites in 14 (6%), and more than one organ system in 45 (19%). Multivariate analysis identified age 45 years or more, symptoms, site other than lung only or bone only, and no radioactive iodine treatment for the metastasis as predictors of poor outcome with 13%, 11%, 16%, and 12% 10-year DSS, respectively. This compares with age less than 45 years, asymptomatic presentation, metastasis only in the lung or bone, and radioactive iodine treatment with 10-year DSS rates of 58%, 45%, 32%, and 33%, respectively (all p < 0.0001). Radioactive iodine treatment was more often given in patients who were less than 45 years of age, asymptomatic, and with metastasis only in the lung or bone only (p = 0.03, 0.11, 0.01).
Longterm survival is possible in patients with distant metastasis from differentiated thyroid cancer. This retrospective study found that age of 45 years or more, site other than lung only or bone only, and symptoms at the time of diagnosis are associated with poorer outcomes.
远处转移在分化型甲状腺癌中并不常见，其预后尚不清楚。本研究旨在评估远处转移的甲状腺癌患者的预后情况，并确定与肿瘤相关死亡率相关的独立变量。
对甲状腺癌研究数据库进行回顾性分析，共纳入1941年至2000年间在一家机构接受治疗的336例分化型甲状腺癌远处转移患者。排除局部或区域复发患者后，242例（72%）患者的远处疾病为首次复发部位或在原发性肿瘤诊断时被发现。采用多因素Cox回归和对数秩检验分析患者、肿瘤及治疗相关因素与疾病特异性生存（DSS）的关系。
中位生存期为4.1年，10年DSS为26%。242例患者中有97例（40%）远处疾病与原发性诊断同时出现。转移部位仅为肺部的患者有103例（43%），仅为骨转移的有80例（33%），其他部位转移的有14例（6%），多个器官系统转移的有45例（19%）。多因素分析确定年龄45岁及以上、有症状、转移部位不是仅为肺部或仅为骨转移、未对转移灶进行放射性碘治疗为预后不良的预测因素，其10年DSS分别为13%、11%、16%和12%。相比之下，年龄小于45岁、无症状表现、仅肺部或骨转移、接受放射性碘治疗的患者10年DSS率分别为58%、45%、32%和33%（所有p<0.0001）。年龄小于45岁、无症状且仅肺部或骨转移的患者更常接受放射性碘治疗（p = 0.03、0.11、0.01）。
分化型甲状腺癌远处转移患者有可能实现长期生存。这项回顾性研究发现，年龄45岁及以上、转移部位不是仅为肺部或仅为骨转移以及诊断时出现症状与较差的预后相关。
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