Tan Li-Cheng, Huang Nai-Si, Yu Peng-Cheng, Han Pei-Zhen, Liu Wan-Lin, Lu Zhong-Wu, Shi Rong-Liang, Shi Xiao, Wang Yu, Ji Qing-Hai, Qu Ning, Wei Wen-Jun, Wang Yu-Long
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Clin Endocrinol (Oxf). 2022 Mar;96(3):402-412. doi: 10.1111/cen.14602. Epub 2021 Sep 30.
Limited studies have focused on the associated clinicopathologic features and short-term prognostic impacts of metastatic patterns at initial diagnosis in differentiated thyroid cancer (DTC).
Overall, 530 individuals with distant DTC diagnosed between 2010 and 2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database. Multinomial logistic regression model was used to assess the clinicopathologic factors influencing the pattern of distant metastasis. Kaplan-Meier method and multivariable Cox regression were used to estimate the short-term effects of metastatic patterns on overall (OS) and thyroid cancer-specific survival (TCSS).
Fifty, 111, 263, 59 and 47 patients presented with distant lymph node (LN)-only, bone-only, lung-only, bone plus lung, and liver and/or brain metastases (Mets), respectively. Regional lymph node metastasis (LNM) and follicular histotype were the only confirmed risk factors for distant LN-only Mets and bone-only Mets, respectively. Larger tumour size, extrathyroidal extension (ETE) and papillary histotype were associated with lung-only Mets. Synchronous bone and lung Mets were more likely to occur in older patients. In addition, patients with distant LN-only Mets had hardly any negative effect on OS and TCSS, whereas those with synchronous bone and lung or liver/brain Mets predicted unfavourable short-term outcomes, regardless of whether they received total thyroidectomy and radioisotopes.
Different clinicopathologic factors predispose to different patterns of metastases with profound short-term survival differences among DTC patients. Our findings may help to determine effective pretreatment screening for aggressive metastatic patterns at initial diagnosis, and thus to provide additional treatment or access of clinical trials for these patients.
关于分化型甲状腺癌（DTC）初诊时转移模式的相关临床病理特征及短期预后影响的研究有限。
总体而言，从监测、流行病学和最终结果（SEER）数据库中识别出2010年至2014年间诊断为远处转移DTC的530例患者。采用多项逻辑回归模型评估影响远处转移模式的临床病理因素。采用Kaplan-Meier法和多变量Cox回归估计转移模式对总生存期（OS）和甲状腺癌特异性生存期（TCSS）的短期影响。
分别有50例、111例、263例、59例和47例患者出现仅远处淋巴结转移（LN）、仅骨转移、仅肺转移、骨加肺转移以及肝和/或脑转移。区域淋巴结转移（LNM）和滤泡组织学类型分别是仅远处LN转移和仅骨转移的唯一确定危险因素。肿瘤体积较大、甲状腺外侵犯（ETE）和乳头状组织学类型与仅肺转移有关。同步骨和肺转移更可能发生在老年患者中。此外，仅远处LN转移的患者对OS和TCSS几乎没有负面影响，而同步骨和肺或肝/脑转移的患者则预示着短期预后不良，无论他们是否接受了甲状腺全切术和放射性同位素治疗。
不同的临床病理因素易导致不同的转移模式，DTC患者之间存在明显的短期生存差异。我们的研究结果可能有助于确定初诊时侵袭性转移模式的有效预处理筛查，从而为这些患者提供额外的治疗或临床试验机会。
