Howaidi Ali, Alswailem Anwar, Hakami Abdulrhman, Hadadi Afnan, Alturki Deema, Abothenain Fayha, Alobaid Lulu, Ewain Najla Saleh, Murugan Avaniyapuram Kannan, Alzahrani Ali S
Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia.
Department of Pathology, King Fahad Medical City, Riyadh 11525, Saudi Arabia.
J Endocr Soc. 2025 Feb 24;9(4):bvaf034. doi: 10.1210/jendso/bvaf034. eCollection 2025 Mar 3.
Distant metastases (DM) are the major cause of death in patients with differentiated thyroid cancer (DTC). This study aimed to investigate the predictors of DM-associated mortality.
We identified 154 thyroid cancer (TC) patients with DM from our institution's tumor registry. We excluded anaplastic (n = 21) and medullary TC (n = 32) and patients with inadequate data (n = 15). The remaining 86 patients with DTC were studied. These include 57 females (66.3%) and 29 males (33.7%) with a median age of 53.5 years [interquartile range (IQR) 45-65]. All patients underwent thyroidectomy; 58 (67.4%) had neck dissection, and 81 (94.2%) received radioactive iodine (I-131) ablation/therapy.
Lung metastases were the most common, occurring in 91.9%; skeletal metastases occurred in 58.1%, brain metastases in 9.3%, and multiple-organ DM in 58%. The management of DM included surgery, 1 or more doses of I-131, external beam radiotherapy, and multikinase inhibitors. Over a median follow-up of 84 months (IQR 35.5-118) for the whole cohort, 47 patients succumbed to their disease (disease-specific mortality 54.7%). Factors associated with mortality were increasing age ( = .001) and bone metastases ( < .0001). These factors remained significant in multivariate analyses [for age, = .009, hazard ratio (HR) 1.030, 95% confidence interval (CI) 1.007-1.053] and for bone metastases ( = .017, HR 2.58, 95% CI 1.19-5.6).
DM from DTC are associated with ∼ 55% mortality at a median survival of 47 months. Increasing age and skeletal metastases are predictors of an increased risk of mortality.
远处转移（DM）是分化型甲状腺癌（DTC）患者死亡的主要原因。本研究旨在调查DM相关死亡率的预测因素。
我们从本机构的肿瘤登记处识别出154例患有DM的甲状腺癌（TC）患者。我们排除了未分化型（n = 21）和髓样TC（n = 32）以及数据不完整的患者（n = 15）。对其余86例DTC患者进行了研究。其中包括57名女性（66.3%）和29名男性（33.7%），中位年龄为53.5岁[四分位间距（IQR）45 - 65]。所有患者均接受了甲状腺切除术；58例（67.4%）进行了颈部清扫术，81例（94.2%）接受了放射性碘（I - 131）消融/治疗。
肺转移最为常见，发生率为91.9%；骨转移发生率为58.1%，脑转移发生率为9.3%，多器官DM发生率为58%。DM的治疗包括手术、1剂或多剂I - 131、外照射放疗和多激酶抑制剂。对整个队列进行中位84个月（IQR 35.5 - 118）的随访后，47例患者死于该病（疾病特异性死亡率54.7%）。与死亡率相关的因素是年龄增加（P = 0.001）和骨转移（P < 0.0001）。在多变量分析中，这些因素仍然具有显著性[年龄方面，P = 0.009，风险比（HR）1.030，95%置信区间（CI）1.007 - 1.053]以及骨转移方面（P = 0.017，HR 2.58，95% CI 1.19 - 5.6）。
DTC的DM在中位生存期47个月时与约55%的死亡率相关。年龄增加和骨转移是死亡率增加风险的预测因素。
