1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
2 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Republic of Korea.
Thyroid. 2017 Jul;27(7):915-922. doi: 10.1089/thy.2016.0676. Epub 2017 May 25.
The clinical course of patients with lung metastases of differentiated thyroid carcinoma (DTC) vary, and cancer-specific survival (CSS) can be associated with tumor burden. This study evaluated the growth kinetics of lung metastases from DTC using serial chest computed tomography for Response Evaluation Criteria in Solid Tumors assessment and its prognostic implications.
Forty-four patients with macronodular lung metastases (≥1 cm) of DTC were included. The time intervals to disease progression of lung metastases were measured and compared to CSS rates.
On the basis of the time to progression, 15 (34%), 17 (39%), and 12 (27%) patients were classified into the slow (≥3 years), moderate (1-3 years), and rapid groups (<1 year), respectively. The growth kinetics of lung metastases exhibited a linear pattern in the three groups. The doubling time of tumor burden was 1.8 years (R = 0.973, p = 0.013) in the rapid group, and the estimated doubling time of the tumor burden in the moderate and slow groups was 5.9 years and 19.3 years, respectively. No independent variable predicted the growth kinetics of lung metastases. In multivariate analysis, disease progression within the first year was an independent predictor of CSS (hazard ratio = 8.6; p = 0.003).
This is the first study to demonstrate objectively that tumor growth kinetics within the first year are an independent predictor of CSS in patients with macronodular lung metastases. Performing chest computed tomography at least twice a year in the early phase of the disease in patients with macronodular lung metastases may be helpful for identifying high-risk patients who are eligible for treatment with tyrosine kinase inhibitors.
分化型甲状腺癌（DTC）肺转移患者的临床病程各不相同，癌症特异性生存（CSS）可能与肿瘤负荷有关。本研究通过实体瘤反应评估标准的连续胸部计算机断层扫描（CT）评估 DTC 肺转移的生长动力学及其预后意义。
纳入 44 例 DTC 大结节性肺转移（≥1cm）患者。测量肺转移疾病进展的时间间隔，并与 CSS 率进行比较。
根据进展时间，15 例（34%）、17 例（39%）和 12 例（27%）患者分别归入缓慢（≥3 年）、中度（1-3 年）和快速（<1 年）组。三组的肺转移生长动力学呈线性模式。快速组肿瘤负荷的倍增时间为 1.8 年（R=0.973，p=0.013），中度和缓慢组肿瘤负荷的估计倍增时间分别为 5.9 年和 19.3 年。无独立变量可预测肺转移的生长动力学。多变量分析显示，第一年的疾病进展是 CSS 的独立预测因子（危险比=8.6；p=0.003）。
这是第一项证明大结节性肺转移患者肿瘤生长动力学在第一年是 CSS 的独立预测因子的研究。在疾病早期至少每年两次进行胸部 CT 检查，可能有助于识别有资格接受酪氨酸激酶抑制剂治疗的高危患者。
