The importance of age over radioiodine avidity as a prognostic factor in differentiated thyroid carcinoma with distant metastases.
ABSTRACT Differentiated thyroid carcinoma (DTC) usually has a good prognosis and rarely develops distant metastases. Although it might be expected that avid radioiodine uptake in distant metastases would be associated with a favorable outcome, there are few long-term studies regarding this. The present study was performed to evaluate the influence of radioiodine uptake in distant metastases on the disease-specific survival (DSS) in DTC patients.
This retrospective study included 77 DTC patients with distant metastases (M1) who were treated with (131)I therapy from 1977 to the end of 2000 in our institution. The median follow-up of patients was 6.1 years. Univariate and multivariate analysis were performed using the Kaplan-Meier method and log rank test, and Cox Regression model, respectively.
Seventy-seven patients with M1 included 51 (66.2%) women and 26 (33.8%) men; 32 (41.6%) patients were <45 years old and 45 (58.4%) patients were >or=45 years old (range: 8-70 years; mean age: 45.4 years); histologically, there were 54 (70.1%) papillary carcinomas, 22 (28.6%) follicular carcinomas, and one case (1.3%) with an inconclusive histological report. The probability of DSS after appearance of M1 was 57.95% after 5 years, 48.31% after 10 years, and 39.46% after 15 and 20 years. In patients with iodine-avid distant metastases the 5-year DSS was 66.54%, the 10-year DSS was 55.09%, and the 15- and 20-year DSS were 44.99%. In contrast, patients with non-iodine-avid lesions had a 5- and 10-year DSS of 18.33%. This difference relating to the relationship between (131)I uptake in distant metastases and survival was significant (p = 0.0006). The proportion of patients with non-iodine-avid distant metastases that were >or=45 years old was significantly greater than the proportion of patients with non-iodine-avid distant metastases that were <45 years old (p < 0.01). If patients were matched for age, iodine non-avidity significantly shortened the survival in patients <45 years old (p < 0.001). According to multivariate analysis age had significantly greater influence on survival compared with iodine avidity (p < 0.001, p = 0.078, respectively).
Patients with distant metastases have a long-term survival that depends, in addition to other factors, on age and the degree of radioiodine uptake in distant metastases.
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ABSTRACT: Targeted therapy pinpointing specific alteration in cancer cells has gained an important role in the treatment of cancer. Compounds that re-induce thyroid-specific functions could be particularly useful in differentiated thyroid cancers by rendering them susceptible to radioiodine treatment, which is relatively specific and has few adverse effects. This review describes the rationale for radioiodine treatment, considering the targets of compounds with differentiation-inducing effects, and the impact of these drugs on the expression of thyroid-specific proteins and on iodine-uptake. We survey the results from the clinical trials thus far performed. We conclude that although retinoids, thiazolidinediones, histone deacetylase inhibitors and DNA methyltransferase inhibitors do increase the expression of thyroid-specific proteins, their clinical efficacy is limited. The relatively low rate of remissions in clinical trials with re-differentiating compounds could be due to low levels of the target, heterogeneity of iodine uptake into the tumor, poor correlation of radioiodine uptake and clinical remission, and/or the slow onset of the therapeutic effect. Although the mode of action is not clear, the combination of tyrosine kinase inhibitors and RAI treatment could improve clinical responses in non-radioiodine avid metastatic thyroid carcinoma.Cancer Treatment Reviews 01/2014; · 6.02 Impact Factor
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ABSTRACT: Although differentiated thyroid carcinoma (DTC) rarely develops distant metastases, the present study was performed to evaluate factors that affect the survival of patients with DTC who present with distant metastasis. Among 4,989 patients who underwent thyroid surgery for DTC, 82 presenting with distant metastasis were analyzed. Based on radioiodine ((131)I) avidity and the thyroid-stimulating hormone-stimulated serum thyroglobulin (sTg) level at the time of metastasis, patients were divided into three groups: group 1 ((131)I uptake + sTg ≤ 215 ng/mL, n = 46), group 2 ((131)I uptake + sTg > 215 ng/mL, n = 24), group 3 (no (131)I uptake, n = 12). Disease-specific survival (DSS) was estimated using the Kaplan-Meier method. Factors predicting the outcome were evaluated using Cox proportional hazard regression analysis. The age of patients (p = 0.04), frequency of follicular thyroid carcinoma (p = 0.002), tumor size (p < 0.001), and number of multiple metastatic sites (p = 0.004) differed significantly among the groups. With a median follow-up after surgery of 72 months, the 5- and 10-year DSSs for all patients were 84 and 69 %, respectively. The predictors of survival were age (p = 0.004), symptoms at the time of presentation (p = 0.045), histology (p = 0.01), sites of metastasis (p = 0.03), and (131)I avidity and sTg level at the time of metastasis (p = 0.002). In the multivariate analysis, age, histology, and (131)I avidity and sTg level at the time of metastasis remained significant factors for survival. Certain DTC patients with distant metastasis demonstrate favorable outcomes dependent on age, histology, and (131)I avidity and sTg level at the time of metastasis.World Journal of Surgery 10/2013; · 2.23 Impact Factor
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ABSTRACT: The purpose of this study was to compare the diagnostic capabilities of magnetic resonance imaging (MRI) and ultrasonography (US) for cervical lymph nodal metastases in differentiated thyroid carcinoma (DTC) before reoperation. From June 2011 to May 2013, preoperative MRI and ultrasound data were collected from differentiated thyroid cancer patients who underwent a reoperation. The following characteristics were assessed: the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI and US. The MRI and ultrasound findings were correlated with the histological diagnosis after reoperation. One hundred and thirty-eight cases were included in the analysis. 88.4% (122/138) of which had evidence of residual thyroid cancer tissue or metastatic nodal involvement at final histology. Lymph nodal metastases were confirmed in the central compartment in 76.42% (81/106) of patients and in lateral compartment in 73.28% (85/116) of patients. The sensitivity, specificity and accuracy of MRI VS US for detecting central compartment metastases was 75% VS 41.67% (P=0.04), 90.91% VS 100% (P=1) and 80% VS 60% (P=0.618), respectively; For detecting lateral compartment metastases was 83.33% VS 77.78% (P=1), 25% VS 50% (P=0.606) and 65.38% VS 69.23% (P=1), respectively. There was statistically significant difference between the sensitivity of MRI and ultrasound for diagnose of central compartment metastases. The MRI features with the greatest correlation with positive lymph nodal metastases were fusion and enhancing lesions. The ultrasound features with the greatest correlation with positive lymph nodal metastases were hypoechoic and microcalcifications. MRI is more sensitive than ultrasonography in detecting central compartment metastases in papillary thyroid carcinoma. There is no significant difference in diagnosis of lateral neck node metastases between MRI and US.American Journal of Translational Research 01/2014; 6(2):147-54.