Xu Ming-Lu, Wang Yang-Yang, Xie Li-Ping, Ding Ning, Hui Jia-Jun
Department of Medical Oncology, Wuxi Huishan District People's Hospital, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi, China.
Department of Otolaryngology, Wuxi Huishan District People's Hospital, Affiliated Huishan Hospital of Xinglin College, Nantong University, Wuxi, China.
Front Immunol. 2025 Jul 25;16:1624181. doi: 10.3389/fimmu.2025.1624181. eCollection 2025.
Liver metastases in thyroid cancer are rare but fatal, with poorly defined risk profiles and survival outcomes. This study aimed to characterize epidemiology, risk factors and outcomes of this disease using a population-based approach, further explore the potential impact of the immunotherapy era on the prognosis of these patients.
Data on 116,801 thyroid cancer cases from SEER program (2010-2021) were analyzed. The clinicopathological features of patients with and without liver metastases were compared. Logistic regression analyses were employed to identify the predictors for liver metastases, while survival determinants were determined using Cox regression models. The predictive nomogram was developed for liver metastasis risk assessment, validated using concordance index, calibration curves, receiver operating characteristic (ROC) curves, and decision curve analysis (DCA). In addition, we further compared the prognostic outcomes of these patients in the immunotherapy era.
The prevalence of liver metastasis in thyroid cancer was 0.22% (95%CI 0.20%-0.25%), predominantly in medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC). MTC exhibited the highest risk of metastasis (OR=35.7, 95%CI 24.1-52.8). The nomogram for liver metastasis risk (C-index=0.98) demonstrated robust discriminatory ability and clinical utility. The median overall survival (OS) was 6.0 months (95%CI 4.0-8.0), with survival rates of 38.1% at 1 year, 28.3% at 3 years, and 16.5% at 5 years. Patients with ATC and rare histology types experienced significantly shorter survival. No statistically significant difference in mOS and median cancer-specific survival (mCSS) of these patients between the pre- and post-immunotherapy eras were observed (P>0.05 for both).
This study establishes the first population-based predictive framework for liver metastases in thyroid cancer, underscoring risk stratification and survival. These findings also highlight the critical need to optimize survival outcomes for this aggressive metastatic phenotype in immunotherapy era.
甲状腺癌肝转移罕见但致命，其风险特征和生存结果尚不明确。本研究旨在采用基于人群的方法描述该疾病的流行病学、危险因素和结局，进一步探讨免疫治疗时代对这些患者预后的潜在影响。
分析了监测、流行病学和最终结果（SEER）项目（2010 - 2021年）中116,801例甲状腺癌病例的数据。比较了有和无肝转移患者的临床病理特征。采用逻辑回归分析确定肝转移的预测因素，同时使用Cox回归模型确定生存决定因素。开发了预测列线图用于肝转移风险评估，并使用一致性指数、校准曲线、受试者操作特征（ROC）曲线和决策曲线分析（DCA）进行验证。此外，我们进一步比较了这些患者在免疫治疗时代的预后结果。
甲状腺癌肝转移的患病率为0.22%（95%CI 0.20% - 0.25%），主要见于甲状腺髓样癌（MTC）和未分化甲状腺癌（ATC）。MTC表现出最高的转移风险（OR = 35.7，95%CI 24.1 - 52.8）。肝转移风险列线图（C指数 = 0.98）显示出强大的区分能力和临床实用性。中位总生存期（OS）为6.0个月（95%CI 4.0 - 8.0），1年生存率为38.1%，3年生存率为28.3%，5年生存率为16.5%。ATC和罕见组织学类型的患者生存期明显较短。在免疫治疗时代之前和之后，这些患者的中位总生存期（mOS）和中位癌症特异性生存期（mCSS）均未观察到统计学显著差异（两者P>0.05）。
本研究建立了首个基于人群的甲状腺癌肝转移预测框架，强调了风险分层和生存情况。这些发现还凸显了在免疫治疗时代优化这种侵袭性转移表型生存结果的迫切需求。
