分化型甲状腺癌骨转移：西班牙多中心研究的临床特征、生存和预后因素。

Bone metastasis in differentiated thyroid cancer: Spanish multicenter study of clinical characteristics, survival and prognostic factors.

机构信息

Department of Endocrinology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.

Department of Endocrinology, Hospital Universitario de Toledo, Toledo, Spain.

出版信息

Front Endocrinol (Lausanne). 2024 Nov 7;15:1466245. doi: 10.3389/fendo.2024.1466245. eCollection 2024.

DOI:10.3389/fendo.2024.1466245

PMID:39574953

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11578728/

Abstract

OBJECTIVE

This study describes the characteristics, survival and prognostic factors in a cohort of patients with bone metastases (BM) from differentiated thyroid carcinoma (DTC).

METHODS

This was a multicenter retrospective observational study conducted in Spain, including patients diagnosed with DTC and BM between 1980 and 2022. A Cox regression analysis was performed to examine prognostic factors for survival. Kaplan-Meier and log-rank tests were performed for survival analysis and comparison between groups.

RESULTS

A total of 133 patients were included with a median follow-up of 40 (17-70) months. Seventy patients (52.6%) had BM at the initial diagnosis. Fifty-two (39.1%) had follicular carcinoma. Sixty-six (49.6%) presented multiple BM. The most frequent location was the spine (63.2%). Other metastases were present at diagnosis in 88 (66.2%), mainly lung (60.9%). BM were treated with I131 in 91 (68.4%) patients, with BM uptake in 63 (47.4%). Fifty-six (42.1%) received treatment with multikinase inhibitors. Fifty-three (3.9%) had skeletal-related events. Seventy-two (54.1%) died. The 3-, 5- and 10-year survival was 53.5, 39.5% and 28.5%, respectively. Significant prognostic factors in the multivariate analysis were the presence of lymph node metastases (N1) HR 1.71 (95% CI 1.005-2.098; p=0.048), BM treatment with I131 HR 0.532 (95% CI 0.304-0.931; p=0.027) and age ≥67 years at BM diagnosis HR 1.991 (95% CI 1.142-3.47; p=0.015).

CONCLUSIONS

Survival of DTC patients with BM treated in a Spanish cohort was 39.5% at 5 years and 28.5% at 10 years. Patients with BM treated with I131 appear to have a better outcome in terms of mortality and the presence of lymph node involvement and age over 67 years were associated with higher mortality.

摘要

目的

本研究描述了分化型甲状腺癌（DTC）患者骨转移（BM）患者的特征、生存和预后因素。

方法

这是一项在西班牙进行的多中心回顾性观察性研究，纳入了 1980 年至 2022 年间诊断为 DTC 并发生 BM 的患者。采用 Cox 回归分析探讨生存的预后因素。进行 Kaplan-Meier 和对数秩检验进行生存分析和组间比较。

结果

共纳入 133 例患者，中位随访时间为 40（17-70）个月。70 例（52.6%）在初始诊断时发生 BM。52 例（39.1%）为滤泡状癌。66 例（49.6%）有多处 BM。最常见的部位是脊柱（63.2%）。其他部位在诊断时存在转移 88 例（66.2%），主要是肺部（60.9%）。91 例（68.4%）患者接受 I131 治疗，其中 63 例（47.4%）有 BM 摄取。56 例（42.1%）接受多激酶抑制剂治疗。53 例（3.9%）发生骨骼相关事件。72 例（54.1%）死亡。3、5、10 年生存率分别为 53.5%、39.5%和 28.5%。多变量分析中，有意义的预后因素包括存在淋巴结转移（N1）HR 1.71（95%CI 1.005-2.098；p=0.048）、BM 接受 I131 治疗 HR 0.532（95%CI 0.304-0.931；p=0.027）和 BM 诊断时年龄≥67 岁 HR 1.991（95%CI 1.142-3.47；p=0.015）。