Clark Jonathan R, Lai Philip, Hall Francis, Borglund Anna, Eski Spiro, Freeman Jeremy L
Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
Laryngoscope. 2005 Apr;115(4):661-7. doi: 10.1097/01.mlg.0000161337.46892.e0.
Distant metastases from thyroid cancer are uncommon and have a variable prognosis. We present a series of patients with distant metastases to determine which patients are at risk of developing distant disease and to examine the significant prognostic variables.
Retrospective chart review of 30 patients with distant metastases compared with 633 controls from the Mount Sinai Thyroid Cancer Database and literature review.
The prevalence of distant metastases was 4.5%, and median follow-up of survivors was 12.7 years. Histologic type was Hurthle cell carcinoma in 3, follicular in 3, papillary in 19, and 5 patients had focal anaplasia either in the primary site or regional metastases. Predictors for distant metastases, locoregional control, and survival were analyzed.
Cumulative survival for patients with distant metastases was 49.5% at 10 years and 12.9% at 20 years. Site of metastases was lung in 26, bone in 11 and brain in 1 patient, with 8 patients having multiple sites. The median time to diagnosis of distant metastases was 3 months. Variables that predicted for development of distant disease were male sex, age, size, extrathyroidal extension, regional metastases, and elevated thyroglobulin. Survival in patients without distant disease was significantly better than those with distant metastases (P < .001). Variables that predicted poor outcome in patients with distant metastases on analysis were age greater than 45 years (P = .003) and histologic type of thyroid cancer (P = .009).
Although patients with thyroid cancer and distant metastases may live prolonged periods with disease, it does significantly impact on patient survival. Age remains an important variable in both predicting for development of distant metastases and also influences long-term survival in patients with existing distant metastases.
甲状腺癌远处转移并不常见，预后各异。我们报告一组有远处转移的患者，以确定哪些患者有发生远处疾病的风险，并研究重要的预后变量。
对来自西奈山甲状腺癌数据库的30例有远处转移的患者与633例对照进行回顾性病历审查，并进行文献综述。
远处转移的发生率为4.5%，幸存者的中位随访时间为12.7年。组织学类型为Hurthle细胞癌3例，滤泡状癌3例，乳头状癌19例，5例患者在原发部位或区域转移灶有局灶性间变。分析远处转移、局部区域控制和生存的预测因素。
有远处转移患者的10年累积生存率为49.5%，20年为12.9%。转移部位为肺26例，骨11例，脑1例，8例为多部位转移。远处转移的中位诊断时间为3个月。预测远处疾病发生的变量为男性、年龄、大小、甲状腺外侵犯、区域转移和甲状腺球蛋白升高。无远处疾病患者的生存率明显高于有远处转移的患者（P <.001）。分析显示，预测有远处转移患者预后不良的变量为年龄大于45岁（P =.003）和甲状腺癌的组织学类型（P =.009）。
虽然甲状腺癌有远处转移的患者可能带瘤生存较长时间，但这确实会对患者生存产生显著影响。年龄仍然是预测远处转移发生以及影响现有远处转移患者长期生存的重要变量。
