Department of Otolaryngology Head and Neck Surgery, Okayama Saiseikai General Hospital, Okayama, Japan.
Surgery. 2010 Mar;147(3):424-31. doi: 10.1016/j.surg.2009.10.009.
The treatment of bone metastasis in association with thyroid cancer represents a difficult challenge. Given the paucity of patients with bone metastasis and the difficulty of treating this disease, few studies have investigated the clinical features and prognostic factors of bone metastasis from differentiated thyroid cancer.
During the 31-year-period from 1976 to 2006, a total of 1,398 patients underwent initial thyroidectomy at Cancer Institute Hospital for differentiated thyroid carcinomas, including standard papillary thyroid carcinoma, papillary microcarcinoma (primary tumor diameter < or =1.0 cm), and follicular thyroid carcinoma. Among these, 25 (2%) patients displayed bone metastasis at initial presentation (synchronous) and 27 patients showed bone metastasis during follow-up (metachronous). The records for these 52 patients were reviewed retrospectively to identify prognostic factors and analyze treatment strategies.
Univariate analysis for disease-specific survival indicated metachronous bone metastasis and the presence of distant metastasis at sites other than bone as indicators of significantly worse prognosis. The type of cancer (papillary thyroid carcinoma versus follicular thyroid carcinoma) was not a significant indicator of prognosis; however, patients with papillary microcarcinoma showed significantly worse survival than patients with standard papillary and follicular thyroid carcinoma. A significant survival advantage was observed among patients who underwent radioactive iodine therapy, and better prognosis seemed to be obtained with greater doses of radioactive iodine. Operative resection of metastatic bone lesions also seemed to be associated with better prognosis. A multivariate analysis for disease-specific survival identified the coexistence of distant metastasis at sites other than bone as the only independent variable indicative of poor prognosis.
In the absence of definitive, effective treatments for this disease, radioactive iodine therapy combined with resection of bone metastasis, wherever possible, seems to represent the most potent therapy available. Although bone metastasis is a strong sign of poor prognosis, early detection and administration of appropriate therapy using radioactive iodine seems likely to improve the survival rate and quality of life in patients with bone metastasis from differentiated thyroid carcinoma.
甲状腺癌伴骨转移的治疗是一个棘手的挑战。由于骨转移患者数量较少，且该疾病的治疗难度较大，因此很少有研究探讨分化型甲状腺癌骨转移的临床特征和预后因素。
在 1976 年至 2006 年的 31 年期间，共有 1398 例分化型甲状腺癌患者在癌症研究所医院接受了初始甲状腺切除术，包括标准的乳头状甲状腺癌、乳头状微小癌（原发肿瘤直径≤1.0cm）和滤泡状甲状腺癌。其中，25 例（2%）患者在初始表现时出现骨转移（同步性），27 例患者在随访期间出现骨转移（异时性）。回顾性分析这 52 例患者的记录，以确定预后因素并分析治疗策略。
单因素分析显示，疾病特异性生存率与异时性骨转移和远处转移至骨以外部位有关，是预后不良的显著指标。癌症类型（乳头状甲状腺癌与滤泡状甲状腺癌）不是预后的显著指标；然而，与标准的乳头状和滤泡状甲状腺癌相比，微小乳头状癌患者的生存情况明显较差。放射性碘治疗的患者生存优势明显，且较大剂量的放射性碘似乎能获得更好的预后。转移性骨病变的手术切除也似乎与更好的预后相关。多因素分析显示，远处转移至骨以外部位以外的其他部位并存是预后不良的唯一独立变量。
在没有针对该疾病的明确、有效的治疗方法的情况下，放射性碘治疗联合尽可能切除骨转移病灶似乎是最有效的治疗方法。尽管骨转移是预后不良的强烈标志，但早期发现并使用放射性碘进行适当治疗，可能会提高分化型甲状腺癌骨转移患者的生存率和生活质量。
