Hirsch Dania, Levy Sigal, Tsvetov Gloria, Gorshtein Alexander, Slutzky-Shraga Ilana, Akirov Amit, Robenshtok Eyal, Shimon Ilan, Benbassat Carlos A
Endocr Pract. 2017 Oct;23(10):1193-1200. doi: 10.4158/EP171924.OR. Epub 2017 Jul 13.
Distant metastatic spread is the most frequent cause of thyroid cancer-related death. The objective of this study was to evaluate overall and disease-related survival of patients with differentiated thyroid cancer (DTC) and distant metastases (DM) attending a single medical center and to investigate variables predictive of better long-term outcomes.
The Rabin Medical Center Thyroid Cancer Registry was searched for patients with DM from DTC.
The cohort included 138 patients (58.7% female) diagnosed at age 54.7 ± 19.5 years. Mean primary tumor size was 33.9 ± 26 mm. Most patients (57.7%) were stage T3/T4; 48.7% had extrathyroidal extension; 53.5% had lymph node metastases. Histopathology yielded papillary and follicular thyroid carcinoma in 66.7% and 13.8%, respectively, and intermediate/poorly differentiated carcinoma in 19.6%. All but 2 patients underwent total thyroidectomy, and 133/138 (96.4%) received radioactive iodine (RAI) therapy. DM were synchronous in 55.1%. The mean follow-up was 8.2 years from detection of metastases. The common sites of metastases were the lungs (85.6% of patients), bones (39.9%), brain (5.8%) and liver (3.6%). At last follow-up, resolution was documented in 24.6% of patients, improvement/stable disease in 31.6%, and structurally progressive disease in 43.4%. By the end of the study, 40.6% of patients died, 23.2% of DTC. Improved overall survival and disease progression were associated with younger age, lung-only DM, and metastatic RAI avidity.
Patients with DTC and DM treated by standard-of-care approaches frequently achieve favorable long-term outcomes. Novel therapies might be necessary in only a minority of these patients, and the reported prognostic factors can aid in their identification.
CR = complete response; DM = distant metastases; DTC = differentiated thyroid cancer; ETE = extra-thyroidal extension; M0 = detected during follow-up; M1 = detected at diagnosis; MSKCC = Memorial Sloan Kettering Cancer Center; NED = no evidence of disease; OS = overall survival; PFS = progression free survival; PTC = papillary thyroid cancer; RAI = radioactive iodine; Tg = thyroglobulin.
远处转移扩散是甲状腺癌相关死亡最常见的原因。本研究的目的是评估在单一医疗中心就诊的分化型甲状腺癌（DTC）伴远处转移（DM）患者的总生存率和疾病相关生存率，并调查预测更好长期预后的变量。
在拉宾医疗中心甲状腺癌登记处搜索DTC伴DM的患者。
该队列包括138例患者（58.7%为女性），诊断时年龄为54.7±19.5岁。原发肿瘤平均大小为33.9±26mm。大多数患者（57.7%）为T3/T4期；48.7%有甲状腺外侵犯；53.5%有淋巴结转移。组织病理学显示分别为乳头状和滤泡状甲状腺癌的患者占66.7%和13.8%，中/低分化癌占19.6%。除2例患者外，所有患者均接受了甲状腺全切除术，138例中有133例（96.4%）接受了放射性碘（RAI）治疗。55.1%的DM为同时性转移。从发现转移起的平均随访时间为8.2年。转移的常见部位是肺（85.6%的患者）、骨（39.9%）、脑（5.8%）和肝（3.6%）。在最后一次随访时，24.6%的患者记录有缓解，31.6%为病情改善/稳定，43.4%为结构上的疾病进展。在研究结束时，40.6%的患者死亡，23.2%死于DTC。总生存率提高和疾病进展与年龄较小、仅肺转移以及转移灶对RAI摄取有关。
采用标准治疗方法治疗的DTC伴DM患者通常能获得良好的长期预后。只有少数患者可能需要新的治疗方法，所报告的预后因素有助于识别这些患者。
CR = 完全缓解；DM = 远处转移；DTC = 分化型甲状腺癌；ETE = 甲状腺外侵犯；M0 = 随访期间发现；M1 = 诊断时发现；MSKCC = 纪念斯隆凯特琳癌症中心；NED = 无疾病证据；OS = 总生存率；PFS = 无进展生存率；PTC = 乳头状甲状腺癌；RAI = 放射性碘；Tg = 甲状腺球蛋白
