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: Objectives The aim of this study is to identify the prognostic factors predicting remission and subsequent disease relapse in patients with differentiated thyroid cancer (DTC) greater than 60 years of age. Materials and Methods The institute thyroid cancer database had 4370 patients with DTC, of which 447 (10%) were aged > 60. However, 9 patients were excluded due to follow-up less than 1 year. The prognostic factors in the remaining 438 patients were studied. Results Among the 438 patients, 311 (71%) had only loco-regional disease (M0) and 127 (29%) had distant metastases (M1) at the time of initial presentation. The host factors predictive of distant metastases at presentation were female gender, primary tumor size (> 4 cm), follicular histology, and extra-thyroidal extension. Among Mo patients, 195 (63%) achieved complete remission while only 12 (9%) M1 patients did so. Average number of radioactive iodine (131I) doses administered to achieve complete remission was 2.3 (range, 1–6) and the mean cumulative dose was 3404 MBq (range, 925–46,250 MBq). In multivariate logistic regression among M0 patients, follicular histology, nodal metastases, and surgical treatment lesser than total/near-total thyroidectomy and among M1 patients, site of distant metastases (skeletal and multiple sites) were independent factors predicting non-remission. Among the patients (both M0 and M1) who achieved remission, factors associated with disease recurrence were primary tumor size (> 4 cm), nodal metastases, pulmonary metastases, and non-remission after first dose of radioactive iodine and were associated with greater chances of disease relapse. Conclusion This study highlights that DTC in older patients behaves more aggressively than in adults age < 60 years, and identifies several prognostic factors for remission and subsequent relapse.Journal of Geriatric Oncology 10/2014; 6(1). DOI:10.1016/j.jgo.2014.09.182 · 1.12 Impact Factor
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ABSTRACT: Context: Large-sample studies with long-term follow-up data are limited for pediatric patients with thyroid cancer. Objective: Secular changes in clinicopathological characteristics and outcomes in pediatric patients with thyroid cancer were investigated and compared with those of adults. Design and Patients: A retrospective review of 150 pediatric patients with thyroid cancer managed between 1980 and 2013 was conducted. The long-term outcomes of 124 patients followed up for ≥12 months were evaluated. Predictors of recurrence-free survival (RFS) in pediatric patients with papillary thyroid cancer (ped-PTC group) were compared with those of 3071 adult patients. Results: The proportion of small tumors (<1 cm) increased from 9.0% before 2010 to 36.8% after 2010 (P < 0.001); however, neither pathologic presentations such as multifocality, extrathyroidal extension (ETE), lymph node (LN) metastasis, or lung metastasis nor the RFS rate changed over time. The 5- and 10-year recurrence rates (RRs) were 14.5% and 34.4% in pediatric patients, respectively. In respective analyses of the ped-PTC group and patients of all ages with PTC (all-ages group), rates of ETE, LN metastasis, and lung metastasis were higher with younger age (all P for trend < 0.05). RFS was lower in pediatric than adult patients aged 20-54 years (P < 0.005) and comparable with that of older patients (≥55 years). Only tumor multifocality and size predicted recurrence in the ped-PTC group (P < 0.05), whereas LN metastasis and ETE also predicted recurrence in the all-ages group (P < 0.01). Among patients in the all-ages group with multifocal tumors, pediatric patients had the lowest RFS (P < 0.05). Conclusions: The pathological characteristics and RRs of pediatric thyroid cancer have not changed over 33 years. Although younger patients present with more advanced disease, multifocality rather than age at diagnosis predicted recurrence. Recurrence was higher in pediatric than adult patients with multifocal PTC.
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ABSTRACT: Background: Well-differentiated thyroid carcinoma (WDTC) generally has a favorable prognosis. However, patients with distant metastatic disease experience progression of disease with higher mortality. A subset of patients not previously described may challenge the conventional dogma regarding the progressive nature of all metastatic WDTC. Methods: Through analysis of our database, we identified patients with distant metastatic WDTC and persistent, minimally-progressive disease. In all patients, persistent metastatic disease was confirmed via tissue biopsy, abnormal PET scan and/or biochemical elevations in thyroglobulin or antibody levels. Progression of disease was monitored clinically and with repeat imaging. Result: We describe 5 patients with WDTC and pulmonary metastases, ages 8 to 43 years old at diagnosis. All patients underwent initial surgery and radioactive iodine (RAI) ablation, with some receiving multiple treatments. Persistent pulmonary metastatic disease was confirmed over decades (mean 22 years, range 8-42 years) with minimal progression despite no further treatment beyond thyroid hormone suppression. Persistent disease was biopsy-proven in all patients at a mean 9.6 years from last RAI treatment. All patients had elevated thyroglobulin or anti-thyroglobulin antibody levels, while three demonstrated metabolically active disease with positive FDG uptake on PET scan, and one patient with persistent radioiodine avid pulmonary metastasis 36 years after her last RAI treatment. Conclusion: This case series demonstrates that some patients with distant metastases, even if metabolically active and radioiodine resistant, remain stable for decades without further treatment. Clinical awareness of such patients and continual reassessment of disease risk following initial therapy is crucial as aggressive treatment may not be necessary.10/2014; DOI:10.1530/EC-14-0097