Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, 4-57 Urafunecho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan.
Endocrine. 2022 Dec;78(3):543-551. doi: 10.1007/s12020-022-03183-9. Epub 2022 Sep 7.
This study aimed to analyze the clinical course of patients with differentiated thyroid cancer (DTC) who were treated by lenvatinib and investigate the specific criteria for the initiation of lenvatinib in lung metastasis.
A total of 111 patients with DTC treated by lenvatinib were included in the study. Patients were divided into two groups based on the target lesion for the initiation of lenvatinib: lung metastasis group and other metastases group.
In the univariate analysis, the tumor size for the lung metastasis (p = 0.002) and the factor of lung metastasis group (p < 0.001) were significantly associated with overall survival (OS). Multivariate analysis revealed that the factor of lung metastasis group [hazard ratio, 0.408; 95% confidence interval (CI), 0.206-0.810; p = 0.010] was the only independent prognostic factor of OS. Of the 53 patients in the lung metastasis group, 12 (23%) had lung metastasis-related finding such as pleural effusion (n = 12), hemoptysis (n = 2), and dyspnea (n = 1) at the initiation of lenvatinib treatment. The median OS in patients with or without lung metastasis-related findings were 41.0 [95% CI, 10.4-not available (NA)] months and 62.9 (95% CI, 53.0-NA) months, respectively (p = 0.022).
Patients with lung metastasis-related finding at the initiation of lenvatinib treatment had a poorer prognosis among the lung metastasis group. It is important to consider not only the tumor size but also the presence of lung metastasis-related findings when initiating lenvatinib treatment for DTC patients with lung metastasis.
本研究旨在分析接受仑伐替尼治疗的分化型甲状腺癌（DTC）患者的临床病程，并探讨肺转移起始时应用仑伐替尼的具体标准。
共纳入 111 例接受仑伐替尼治疗的 DTC 患者。根据起始仑伐替尼的靶病灶将患者分为两组：肺转移组和其他转移组。
单因素分析显示，肺转移的肿瘤大小（p=0.002）和肺转移组的因素（p<0.001）与总生存期（OS）显著相关。多因素分析显示，肺转移组的因素[风险比，0.408；95%置信区间（CI），0.206-0.810；p=0.010]是 OS 的唯一独立预后因素。在肺转移组的 53 例患者中，12 例（23%）在起始仑伐替尼治疗时存在与肺转移相关的发现，如胸腔积液（n=12）、咯血（n=2）和呼吸困难（n=1）。有或无肺转移相关发现的患者的中位 OS 分别为 41.0[95%CI，10.4-未达到（NA）]个月和 62.9[95%CI，53.0-NA]个月，差异有统计学意义（p=0.022）。
在肺转移组中，起始仑伐替尼治疗时存在与肺转移相关发现的患者预后较差。对于 DTC 肺转移患者，起始仑伐替尼治疗时不仅要考虑肿瘤大小，还要考虑是否存在与肺转移相关的发现。
