University Hospital, University of Würzburg, Department of Internal Medicine I, Division of Endocrinology/Diabetology, Würzburg, Germany.
Endocrine Practice; Heidelberg, Germany.
J Clin Endocrinol Metab. 2020 Jun 1;105(6). doi: 10.1210/clinem/dgaa077.
The clinical relevance of bone metastases (BM) in advanced medullary thyroid carcinoma (MTC) is poorly described.
The objectives of this work are to describe the prevalence of BM, frequency of skeletal related events (SREs), and impact of BM morphology and SREs on prognosis, and to assess the role of antiresorptive treatment (ART).
A retrospective cohort study was conducted.
This study was conducted at 4 German referral centers.
A total of 1060 MTC patients were included.
Main outcome measures include descriptive statistics, overall survival (OS) by the Kaplan-Meier method, and risk factors by Cox proportional hazards modeling.
A total of 120 of 416 patients (29%) with metastatic MTC had BM, of which 97% had concurrent nonosseous metastases. BM occurred 2.1 years (median, range -0.1 to 20.6 years) after initial diagnosis, were multifocal in 79%, and were located preferentially in the spine (86%) and pelvis (60%). BM morphology was osteolytic in 32%, osteoblastic in 25%, and mixed in 22% of cases (unknown: 21%). Within a median observation period of 26.6 months (range, 0-188 months) after BM diagnosis, 47% of patients experienced one or more SREs (bone radiation 50%, pathological fractures 32%), of which 42% occurred in osteolytic and 17% in osteoblastic BM (P = .047). Presence of osteolytic metastases (hazard ratio 3.85, 95% CI 1.52-9.77, P = .005) but not occurrence of SREs was associated with impaired OS. Among the 36 patients who received ART (no ART: n = 71), SREs were significantly less frequent than in untreated patients (P = .04).
BM are common in metastatic MTC and most often with an osteolytic morphology and an unfavorable prognosis. The majority of SREs occur in osteolytic metastases and may be prevented by ART.
骨转移（BM）在晚期甲状腺髓样癌（MTC）中的临床意义描述甚少。
本研究旨在描述 BM 的发生率、骨骼相关事件（SREs）的频率以及 BM 形态和 SREs 对预后的影响，并评估抗吸收治疗（ART）的作用。
回顾性队列研究。
这项研究在德国的 4 个转诊中心进行。
共纳入 1060 例 MTC 患者。
主要观察指标包括描述性统计、Kaplan-Meier 法的总生存率（OS）和 Cox 比例风险模型的危险因素。
416 例转移性 MTC 患者中有 120 例（29%）发生 BM，其中 97%的患者同时存在非骨转移。BM 发生在初始诊断后 2.1 年（中位数，范围 0.1-20.6 年），97%为多灶性，86%位于脊柱，60%位于骨盆。32%的 BM 形态为溶骨性，25%为成骨性，22%为混合性（未知：21%）。在 BM 诊断后中位 26.6 个月（范围 0-188 个月）的观察期内，47%的患者发生了 1 次或多次 SREs（骨放疗 50%，病理性骨折 32%），其中 42%发生在溶骨性 BM，17%发生在成骨性 BM（P=0.047）。存在溶骨性转移（风险比 3.85，95%CI 1.52-9.77，P=0.005）而不是 SREs 与 OS 受损相关。在接受 ART（无 ART：n=71）的 36 例患者中，SREs 的发生率明显低于未接受治疗的患者（P=0.04）。
BM 在转移性 MTC 中很常见，且大多数为溶骨性形态，预后不良。大多数 SREs 发生在溶骨性转移中，ART 可能会预防这些 SREs 的发生。
