Matta-Coelho Claudia, Simões-Pereira Joana, Vilar Helena, Leite Valeriano
Serviço de Endocrinologia, Hospital de Braga, Braga, Portugal.
Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.
Eur Thyroid J. 2019 Apr;8(2):96-101. doi: 10.1159/000494719. Epub 2018 Dec 12.
BACKGROUND/AIMS: Overall, 2-13% of patients with thyroid cancer develop bone metastases (BM). In addition to decreased survival, patients with BM may present skeletal-related events (SRE) that impair the quality of life. Our objectives were to characterize clinical features, treatment approaches, and outcomes of patients with thyroid cancer and BM.
We identified patients diagnosed with thyroid carcinoma of follicular origin and BM followed at the Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Lisbon, Portugal, from 1991 to 2017. SRE were defined as the need for bone irradiation, bone surgery, spinal cord compression, or pathologic fractures.
The final cohort consisted of 86 patients, with a median follow-up time of 54 months (IQR 22.8-82.8), mainly women (67.4%), and a median age of 64 years (IQR 53.6-71.2). BM was the initial presentation of thyroid cancer in 36.0% of the patients. Bone involvement was multiple in 59.3% of the cases. Papillary carcinoma was the most frequent histological type, present in 47.7% of the patients, of which 56.1% presented the follicular variant. SRE were found in 76.7% of the patients. The most frequent SRE was radiotherapy (66.3%). Treatment with bisphosphonates was initiated in 19.8% of the patients. The 5-year specific survival was 60%, whereas the 10-year specific survival decreased to 50%. There were no differences in 5- or 10-year specific survival regarding gender, the occurrence of SRE, or histological type. However, patients with initial radioiodine non-avid lesions had a lower 5- and 10-year specific survival ( = 0.002).
The high frequency of patients with SRE was notable. The follicular variant of papillary thyroid cancer was the variant most commonly associated with BM, reflecting a more similar behavior to follicular carcinoma than the classic variant.
背景/目的：总体而言，2%至13%的甲状腺癌患者会发生骨转移（BM）。除了生存期缩短外，发生骨转移的患者可能会出现影响生活质量的骨相关事件（SRE）。我们的目的是描述甲状腺癌合并骨转移患者的临床特征、治疗方法及预后。
我们确定了1991年至2017年在葡萄牙里斯本弗朗西斯科·根蒂尔葡萄牙肿瘤研究所（IPOLFG）随访的诊断为滤泡起源甲状腺癌并发生骨转移的患者。骨相关事件定义为需要进行骨照射、骨手术、脊髓压迫或病理性骨折。
最终队列包括86例患者，中位随访时间为54个月（四分位间距22.8 - 82.8），主要为女性（67.4%），中位年龄64岁（四分位间距53.6 - 71.2）。36.0%的患者骨转移是甲状腺癌的首发表现。59.3%的病例骨受累为多发。乳头状癌是最常见的组织学类型，占患者的47.7%，其中56.1%为滤泡变异型。76.7%的患者出现骨相关事件。最常见的骨相关事件是放疗（66.3%）。19.8%的患者开始使用双膦酸盐治疗。5年特异性生存率为60%，而10年特异性生存率降至50%。在5年或10年特异性生存率方面，性别、骨相关事件的发生情况或组织学类型并无差异。然而，初始放射性碘不摄取病变的患者5年和10年特异性生存率较低（P = 0.002）。
骨相关事件患者的高频率值得关注。甲状腺乳头状癌的滤泡变异型是最常与骨转移相关的变异型，这反映出其行为比经典变异型更类似于滤泡癌。
