Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Front Endocrinol (Lausanne). 2024 Jun 4;15:1344795. doi: 10.3389/fendo.2024.1344795. eCollection 2024.
OBJECTIVE: While bone metastases (BMs) are present in a minority of thyroid cancer (TC) patients at the time of initial diagnosis, there has been growing concern regarding their impact on life expectancy and quality of life. The aim of this study was to identify prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS) in these patients and provide therapeutic recommendations based on the findings. METHODS: In this retrospective cohort study, we included 82 patients diagnosed as TC with BM received treatment in our department from 2011.03 to 2023.03 (average follow-up duration was 3.02 years). The retrospective study was performed according to the inclusion and exclusion criteria. Kaplan-Meier analysis was used to estimate the OS and CSS, while the univariate and multivariate Cox proportional hazard models were employed to determine prognostic factors associated with OS and CSS. Also, 287 patients' data were collected from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 to confirm the prognostic factors identified in the retrospective study. RESULTS: The average survival time of the 82 patients was estimated to be 5.818 years (with a 95% confidence interval (CI) of 4.767 to 6.868 years). The cox regression analysis showed that older age (hazard ratio (HR) = 1.045, 95% CI: 1.001-1.092, P = 0.047), larger tumor size (>5cm, HR = 11.087, 95% CI: 3.728 - 32.976, P = 0.000), and the presence of extraosseous metastasis (HR = 3.247, 95% CI: 1.376 - 7.665, P = 0.007) were statistically significant factors associated with worse CSS. The results were furtherly confirmed in 287 SEER-sourced patients (age (HR = 1.020, 95% CI: 1.006 - 1.034, P = 0.006), tumor size (HR = 2.917, 95% CI: 2.044 - 4.161, P = 0.000), and extraosseous metastasis (HR = 3.726, 95% CI: 2.571 - 5.398, P = 0.000)). CONCLUSIONS: These results offer a population-based assessment of prognostic factors for patients with TC and BMs, revealing that age, primary tumor size (>5cm), and presence of extraosseous metastases are independent prognostic factors that correlate with worse survival. Accordingly, treatment for such patients ought to concentrate on systemic integrative therapy instead of surgical intervention.
目的：虽然在甲状腺癌（TC）患者初始诊断时，仅有少数患者存在骨转移（BMs），但人们越来越关注它们对预期寿命和生活质量的影响。本研究旨在确定与这些患者的总生存期（OS）和癌症特异性生存期（CSS）相关的预后因素，并根据研究结果提供治疗建议。
方法：在这项回顾性队列研究中，我们纳入了 2011.03 年至 2023.03 年在我院接受治疗的 82 例诊断为 TC 伴 BM 的患者（平均随访时间为 3.02 年）。回顾性研究是根据纳入和排除标准进行的。Kaplan-Meier 分析用于估计 OS 和 CSS，单因素和多因素 Cox 比例风险模型用于确定与 OS 和 CSS 相关的预后因素。此外，我们还从国家癌症研究所的监测、流行病学和最终结果（SEER）数据库中收集了 2010 年至 2015 年的 287 例患者的数据，以确认回顾性研究中确定的预后因素。
结果：82 例患者的平均生存时间估计为 5.818 年（95%置信区间为 4.767 年至 6.868 年）。Cox 回归分析显示，年龄较大（风险比（HR）=1.045，95%置信区间：1.001-1.092，P=0.047）、肿瘤较大（>5cm，HR=11.087，95%置信区间：3.728-32.976，P=0.000）和存在骨外转移（HR=3.247，95%置信区间：1.376-7.665，P=0.007）是与 CSS 较差相关的统计学显著因素。在 287 例来自 SEER 的患者中，这些结果得到了进一步证实（年龄（HR=1.020，95%置信区间：1.006-1.034，P=0.006）、肿瘤大小（HR=2.917，95%置信区间：2.044-4.161，P=0.000）和骨外转移（HR=3.726，95%置信区间：2.571-5.398，P=0.000））。
结论：这些结果为 TC 和 BMs 患者的预后因素提供了基于人群的评估，揭示了年龄、原发肿瘤大小（>5cm）和骨外转移的存在是与生存较差相关的独立预后因素。因此，此类患者的治疗应集中于系统综合治疗而非手术干预。
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