1 Department of Internal Medicine, Seoul National University , Seoul, Korea.
Thyroid. 2014 Feb;24(2):277-86. doi: 10.1089/thy.2012.0654. Epub 2013 Sep 11.
Distant metastasis, generally to lung and bone, is rare in differentiated thyroid carcinoma (DTC) and the prognosis is still elusive. We investigated long-term outcomes of lung metastasis in DTC patients and its prognostic factors.
A retrospective review was performed of 4572 patients who underwent surgery for DTC from 1962 to 2009 at Seoul National University Hospital. Among them, 164 patients were identified with lung metastasis and 152 patients were enrolled in the final analysis. Poor prognosis was defined as progressive disease or death.
Of these 152 patients, 10- and 20-year survival rates were 85.0% and 71.0%, respectively. No evidence of disease, stable disease, progressive disease, and death was identified in 22.4%, 28.3%, 35.5%, and 13.8%, respectively, after 11 years of median follow-up (range 2-41 years). Older age at diagnosis (≥45 years), primary tumor size ≥2 cm, follicular thyroid cancer, metastasis diagnosed after initial evaluation or (131)I remnant ablation (late metastasis), multiple metastases other than lung, (131)I nonavidity, and the presence of macronodules (≥1 cm) were more frequent in poor prognoses. Cox proportional hazard ratio for progression-free survival showed that (131)I nonavidity was the only independent predictive factor for poor prognosis.
The prognosis of lung metastasis from DTC in Korea within this study was favorable. (131)I nonavidity, observed more frequently in late metastasis, was the only independent factor predicting poor prognosis.
远处转移，通常转移至肺部和骨骼，在分化型甲状腺癌（DTC）中较为罕见，且预后仍难以捉摸。我们研究了 DTC 患者肺部转移的长期结果及其预后因素。
对 1962 年至 2009 年在首尔国立大学医院接受 DTC 手术的 4572 例患者进行了回顾性分析。其中，有 164 例患者被诊断为肺部转移，152 例患者被纳入最终分析。预后不良定义为疾病进展或死亡。
在这 152 例患者中，10 年和 20 年的生存率分别为 85.0%和 71.0%。在中位数为 11 年的随访时间（范围 2-41 年）后，分别有 22.4%、28.3%、35.5%和 13.8%的患者无疾病证据、稳定疾病、疾病进展和死亡。诊断时年龄较大（≥45 岁）、原发肿瘤大小≥2cm、滤泡性甲状腺癌、初始评估后或（131）I 残余消融（晚期转移）时诊断转移、除肺部以外的多处转移、（131）I 非摄取和存在大结节（≥1cm）的患者预后较差。无进展生存的 Cox 比例风险比显示，（131）I 非摄取是不良预后的唯一独立预测因素。
本研究中韩国 DTC 肺部转移的预后良好。（131）I 非摄取在晚期转移中更为常见，是唯一预测不良预后的独立因素。
