Endocr Pract. 2019 May;25(5):427-437. doi: 10.4158/EP-2018-0465. Epub 2019 Jan 18.
This institutional study sought to retrospectively evaluate disease progression and survival of patients with differentiated thyroid cancer (DTC) and bone metastases (BM) and to investigate variables predictive of better long-term outcomes. The Rabin Medical Center Thyroid Cancer Registry was searched for patients with bone-metastatic DTC. Variables including a patient's gender and age, pathology of the thyroid tumor, and characteristics of BM were retrieved and analyzed in association with disease progression and mortality. The cohort included 64 patients (48.4% female). Mean age at diagnosis was 62.1 ± 14.3 years; mean primary tumor size was 41 ± 30 mm. Overall, 60.4% had stage T3/T4 disease; 46.3% had extrathyroidal extension; 40% had lymph-node metastases. Histopathology yielded papillary and follicular DTC in 40.6% and 32.8% of patients, respectively, and poorly/intermediately differentiated carcinoma in 26.6%. BM were synchronous in 50%. Mean follow-up was 11 ± 9.6 years from DTC detection. The common first sites of BM detection were spine (46.9% of patients), pelvis (37.5%) and ribs (21.9%). Nineteen patients (29.7%) presented with multiple-site BM, of whom 15 (78.9%) had spinal metastases. After initial treatment, 62/64 patients had structural persistence, and at last follow-up, 57.8% had progressive disease. Overall, 54.7% of patients died, 71.4% of DTC. Improved long-term outcomes were associated with younger age, lower tumor stage, no extrathyroidal extension, bone-only metastases, and non-spinal BM. Younger age and non-spinal BM were the only independent predictors for improved survival. Selected patients with bone-metastatic DTC may achieve fair long-term outcomes. Spinal metastases are associated with disseminated skeletal spread and increased mortality. = bone metastases; = multivariate analyses; = distant metastases; = disease-specific mortality; = disease-specific survival; = differentiated thyroid carcinoma; = extrathyroidal extension; = lymph node metastases; = overall mortality; = overall survival; = papillary thyroid carcinoma; = radioactive iodine; = spinal metastases; = skeletal-related event; = whole-body scan after RAI therapy.
本回顾性研究旨在评估分化型甲状腺癌（DTC）伴骨转移（BM）患者的疾病进展和生存情况，并探讨预测长期预后更好的相关因素。本研究从拉宾医学中心甲状腺癌登记处检索了患有骨转移 DTC 的患者。收集患者的性别和年龄、甲状腺肿瘤的病理类型以及 BM 的特征等变量，并与疾病进展和死亡率相关联进行分析。该队列共纳入 64 例患者（48.4%为女性）。诊断时的平均年龄为 62.1 ± 14.3 岁；原发肿瘤平均大小为 41 ± 30mm。总体而言，60.4%的患者为 T3/T4 期疾病；46.3%的患者有甲状腺外侵犯；40%的患者有淋巴结转移。组织病理学显示，40.6%的患者为乳头状 DTC，32.8%的患者为滤泡状 DTC，26.6%的患者为低/中分化癌。50%的 BM 为同步性转移。从 DTC 检出到随访结束的平均时间为 11 ± 9.6 年。BM 首次检测到的常见部位为脊柱（46.9%的患者）、骨盆（37.5%）和肋骨（21.9%）。19 例（29.7%）患者出现多部位 BM，其中 15 例（78.9%）有脊柱转移。初始治疗后，62/64 例患者存在结构残留，末次随访时 57.8%的患者疾病进展。总体而言，54.7%的患者死亡，71.4%的患者死于 DTC。长期预后较好与年龄较小、肿瘤分期较低、无甲状腺外侵犯、单纯骨转移和非脊柱 BM 有关。年龄较小和非脊柱 BM 是改善生存的唯一独立预测因素。对于患有骨转移 DTC 的患者，可能会取得良好的长期预后。脊柱转移与广泛的骨骼扩散和死亡率增加有关。
