诊断时伴有远处转移的乳头状和滤泡状（分化型）甲状腺癌的临床管理与预后

Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis.

作者信息

Sampson Elliot, Brierley James D, Le Lisa W, Rotstein Lorne, Tsang Richard W

机构信息

Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Canada.

出版信息

Cancer. 2007 Oct 1;110(7):1451-6. doi: 10.1002/cncr.22956.

DOI:10.1002/cncr.22956

PMID:17705176

Abstract

BACKGROUND

Differentiated thyroid cancer has a good prognosis and only rarely presents with distant metastasis at diagnosis. The clinical outcome of this presentation was assessed with respect to survival and factors that may determine prognosis.

METHODS

A retrospective review was undertaken of patients with stage M1 differentiated thyroid cancer at presentation (n = 49), referred from 1980-2000 at a single institution.

RESULTS

The median age was 68 (range, 17-90), with 69% females. The initial site(s) of metastasis were lung only, 45%, bone only, 39%, other single site, 4%, and multiple sites, 12%.

HISTOLOGY

papillary, 51%, follicular, 49%. Initial treatment(s) included: thyroidectomy, 82%, radioactive iodine (RAI), 88%, excision of metastasis, 29%, radiotherapy, 47%, and chemotherapy, 6%. With a median follow-up time of 3.5 years, 25 patients are alive (51%) and 24 died (49%), with 3-year and 5-year actuarial survivals of 69% and 50%, respectively. Only a minority of patients (4/25, 16%) had no clinical evidence of disease at last follow-up. Most deaths (17/24, 71%) were due to progressive cancer. Prognosis was associated with age, site of metastasis, histology, and iodine avidity of the metastasis. Patients aged </=45 (n = 8) had a 3-year survival of 100%, versus 62% for those age > 45 years (P = .001). The 3-year survival for lung only versus bone only metastasis was 77% versus 56% (P = .02); for papillary versus follicular carcinoma, 75% versus 62% (P = .006); for iodine-avid disease (n = 29) versus not avid (n = 14), 82% versus 57% (P = .02), respectively. In multivariate analysis after adjusting for age, only histology and iodine avidity remained significant for survival. The hazard ratio for follicular histology was 3.7 (95% confidence interval [CI], 1.1-12.1, P = .03), and for tumors not avid for iodine, 3.4 (95% CI, 1.2-9.2, P = .02).

CONCLUSIONS

The data support the aggressive management of patients presenting with stage M1 thyroid cancer, with thyroidectomy and RAI. Complete clinical eradication of disease was rarely seen, and 50% of patients survived for more than 5 years. Young patients with papillary tumors and/or iodine-avid disease have an even better prognosis.

摘要

背景

分化型甲状腺癌预后良好，诊断时很少出现远处转移。本文评估了该疾病的临床结局以及可能决定预后的因素。

方法

对1980年至2000年间在单一机构就诊的M1期分化型甲状腺癌患者（n = 49）进行回顾性研究。

结果

患者中位年龄为68岁（范围17 - 90岁），女性占69%。转移的初始部位仅为肺部的占45%，仅为骨骼的占39%，其他单一部位的占4%，多个部位的占12%。

组织学类型

乳头状癌占51%，滤泡状癌占49%。初始治疗包括：甲状腺切除术82%，放射性碘（RAI）治疗88%，转移灶切除术29%，放射治疗47%，化疗6%。中位随访时间为3.5年，25例患者存活（51%），24例死亡（49%），3年和5年精算生存率分别为69%和50%。最后一次随访时，只有少数患者（4/25，16%）没有疾病的临床证据。大多数死亡病例（17/24，71%）是由于癌症进展。预后与年龄、转移部位、组织学类型以及转移灶的碘摄取情况有关。年龄≤45岁的患者（n = 8）3年生存率为100%，而年龄>45岁的患者为62%（P = .001）。仅肺部转移与仅骨骼转移患者的3年生存率分别为77%和56%（P = .02）；乳头状癌与滤泡状癌患者分别为75%和62%（P = .006）；碘摄取阳性疾病患者（n = 29）与碘摄取阴性患者（n = 14）分别为82%和57%（P = .02）。多因素分析在调整年龄后，仅组织学类型和碘摄取情况对生存仍有显著意义。滤泡状组织学类型的风险比为3.7（95%置信区间[CI]，1.1 - 12.1，P = .03），碘摄取阴性肿瘤的风险比为3.4（95%CI，1.2 - 9.2，P = .02）。