Metastatic differentiated thyroid carcinoma: clinical management and outcome of disease in patients with initial and late distant metastases

• Published in: Nuclear medicine communications Vol. 30; no. 7; pp. 558 - 564
• Main Authors: Mihailovic, Jasna M, Stefanovic, Ljubomir J, Malesevic, Milica D, Erak, Marko D, Tesanovic, Dusanka D
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins, Inc 01-07-2009
• Subjects: Age Factors; Female; Humans; Iodine Radioisotopes - therapeutic use; Male; Middle Aged; Neoplasm Metastasis; Retrospective Studies; Survival Rate; Thyroid Neoplasms - pathology; Thyroid Neoplasms - radiotherapy; Thyroid Neoplasms - therapy; Time Factors; Treatment Outcome
• ISSN: 0143-3636; 1473-5628
• DOI: 10.1097/MNM.0b013e32832cc2ab

OBJECTIVEOur objective was to analyze the clinical management and the outcome of disease in differentiated thyroid carcinoma with initial and late distant metastases (M1).
PATIENTS AND METHODSRadioiodine (I) therapy was applied in 77 differentiated thyroid carcinoma patients with M1 (31 patients with M1-initial and 46 patients with M1-late). The median follow-up of patients was 72.7 months. Probability of disease-specific survival (DSS) was analyzed by the Kaplan–Meier method and the log rank test, while the significance of differences between groups was calculated by the t-test of proportions.
RESULTSFollicular carcinomas were more frequent in patients with M1-late (P<0.05). During the follow-up, 58% of the patients died39% of cases had disease related deaths, while 42% had complete remission of disease. Stable disease and progressive disease were significantly influenced by age only (P = 0.0122), while I uptake, histological type, and sex had no influence (P = 0.1235; P = 0.340; P = 0.8540, respectively). Remission of disease (complete and partial) was not significantly influenced by age, sex, histological type, and I accumulation (P = 0.0644; P = 0.8452; P = 0.6308; P = 0.7675, respectively). DSS in patients with M1-initial and M1-late at 5 years was 71 and 50%, respectively and 62 and 41% at 10 years, respectively, without significant difference (P = 0.2582). Disease related deaths appeared more frequent in patients at 45 years of age or older, significantly caused by distant metastases (P<0.001).
CONCLUSIONDistant metastases occur late more often in patients with follicular carcinoma while M1-initial is detected more often in patients with papillary carcinoma. DSS was not significantly different among patients with M1-intial and M1-late. The risk of death from M1 increased after the age of 45 years.