Patient and tumor factors contributing to distant metastasis in well-differentiated thyroid cancer: A retrospective cohort study

• Published in: Journal of otolaryngology-head and neck surgery Vol. 49; no. 1; pp. 1 - 8
• Main Authors: Khan, Usman, Al Afif, Ayham, Aldaihani, Abdullah, MacKay, Colin, Rigby, Matthew H., Rajaraman, Murali, Imran, Syed Ali, Bullock, Martin J., Taylor, S. Mark, Trites, Jonathan R. B., Hart, Robert D.
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 16-11-2020; BioMed Central; SAGE Publications
• Subjects: Analysis; Cancer metastasis; Cancer patients; Cancer research; Distant metastasis; Metastatic thyroid cancer; Original; Thyroid cancer; Thyroid cancer survival; Well differentiated thyroid cancer
• ISSN: 1916-0216; 1916-0208; 1916-0216
• DOI: 10.1186/s40463-020-00469-8

Background Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC. Methods A retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups. Results Distant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS [greater than or equai to] 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC. Conclusions TS [greater than or equai to] 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients. Graphical abstract Keywords: Distant metastasis, Thyroid cancer, Well differentiated thyroid cancer, Metastatic thyroid cancer, Thyroid cancer survival