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  • Author: Elena Navarro-González x
  • Thyroid cancer - clinical x
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Ana Piñar-Gutiérrez UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España

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Ana R Romero-Lluch UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España

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Suset Dueñas-Disotuar UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España

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Irene de Lara-Rodríguez UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España

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María Ángeles Gálvez-Moreno Servicio de Endocrinología, Hospital Universitario Reina Sofía, Córdoba, España

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Tomás Martín-Hernández Servicio de Endocrinología, Hospital Universitario Virgen Macarena, Sevilla, España

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Jorge García-Alemán Servicio de Endocrinología, Hospital Universitario Virgen de la Victoria, Málaga, España

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Guillermo Martínez-de Pinillos Servicio de Endocrinología, Hospital Universitario Virgen de Valme, Sevilla, España

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Elena Navarro-González UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, España

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Objective

The aim of this study is to describe the characteristics, survival and prognostic factors of a cohort of patients with bone metastases (BMs) from differentiated thyroid carcinoma (DTC).

Methods

This was a multicenter retrospective observational study including patients diagnosed with BMs from DTC between 1980 and 2021. A Cox regression was performed to study prognostic factors for 5- and 10-year survival. Kaplan–Meier and log-rank tests were performed for the survival analysis and comparison between groups.

Results

Sixty-three patients were evaluated. Median follow-up from BM diagnosis was 35 (15–68) months. About 30 (48.4%) patients presented with synchronous BMs. Regarding histology, 38 (60.3%) had the papillary variant. BMs were multiple in 32 (50.8%) patients. The most frequent location was the spine (60.3%). Other metastases were present in 77.8%, mainly pulmonary (69.8%). Concerning treatment, 54 (85.9%) patients received I131, with BM uptake in 31 (49.2%) and 25 (39.7%) received treatment with multikinase inhibitors. Regarding complications, 34 (54%) patients had skeletal-related events, 34 (54%) died and 5- and 10-year overall survival was 42.4% and 20.4%, respectively. Significant prognostic factors in the multivariate analysis were the presence of lymph node involvement (hazard ratio (HR): 2.916; 95% confidence interval (CI): 1.013–8.391; P = 0.047) and treatment with I131 (HR 0.214 (95% CI 0.069–0.665); P = 0.008) at 5 years, the presence of other metastases (HR 6.844. 95% CI 1.017–46.05; P = 0.048) and treatment with I131 (HR 0.23 (95% CI 0.058–0.913); P = 0.037) at 10 years.

Conclusions

Our study reflects the management of patients with bone metastases from differentiated thyroid carcinoma in real clinical practice in several centers in southern Spain. Overall survival at 5 and 10 years was lower in patients who were not treated with I131, had nodal involvement and/or had other metastases.

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Juan Antonio Vallejo Casas Department of Nuclear Medicine (UGC), Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain

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Marcel Sambo Department of Endocrinology, Gregorio Marañón University Hospital, Madrid, Spain

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Carlos López López Department of Medical Oncology, Marqués de Valdecilla University Hospital, IDIVAL, Santander, Spain

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Manuel Durán-Poveda Department of General and Digestive Surgery, Rey Juan Carlos University Hospital, Madrid, Spain

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Julio Rodríguez-Villanueva García Oncology Business Group – EISAI Farmacéutica SA, Madrid, Spain

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Rita Joana Santos Department of Endocrinology, Francisco Gentil Portuguese Institute of Oncology of Lisbon, Lisbon, Portugal

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Marta Llanos Department of Medical Oncology, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain

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Elena Navarro-González Department of Endocrinology, Virgen del Rocío University Hospital, Seville, Spain

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Javier Aller Department of Endocrinology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain

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Virginia Pubul Department of Nuclear Medicine, University Hospital and Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain

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Sonsoles Guadalix Department of Endocrinology and Nutrition, Hospital Universitario 12 de Octubre, Madrid, Spain

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Guillermo Crespo Department of Medical Oncology, Burgos University Hospital, Burgos, Spain

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Cintia González Department of Endocrinology, Santa Creu i Sant Pau University Hospital, CIBER-BBN, Barcelona, Spain

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Carles Zafón Department of Endocrinology and Nutrition, Vall Hebron University Hospital and Autonomous University of Barcelona (UAB), Barcelona, Spain

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Miguel Navarro Department of Medical Oncology, University Hospital of Salamanca, Salamanca, Spain

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Javier Santamaría-Sandi Department of Endocrinology, Cruces University Hospital, Vizcaya, Spain

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Ángel Segura Medical Oncology Unit, La Fe University Hospital, Valencia, Spain

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Pablo Gajate Department of Medical Oncology, Ramon y Cajal University Hospital, Madrid, Spain

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Marcelino Gómez-Balaguer Department of Endocrinology, Doctor Peset University Hospital, Valencia, Spain

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Javier Valdivia Department of Oncology, University Hospital Centre Virgen de las Nieves, Granada, Spain

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Manel Puig-Domingo Endocrine and Nutrition Service, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Badalona, Spain

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Juan Carlos Galofré Department of Endocrinology, Clínica Universidad de Navarra, University of Navarra, Lisbon, Spain

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Beatriz Castelo Department of Medical Oncology, La Paz University Hospital, Madrid, Spain

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María José Villanueva Department of Medical Oncology, Alvaro Cunqueiro University Hospital Complex, University of Vigo, Vigo, Spain

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Iñaki Argüelles Department of Endocrinology and Nutrition, Son Espases University Hospital, Palma de Mallorca, Spain

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Lorenzo Orcajo-Rincón Oncology Business Group – EISAI Farmacéutica SA, Madrid, Spain

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Background

Up to 30% of differentiated thyroid cancer (DTC) will develop advanced-stage disease (aDTC) with reduced overall survival (OS).

Objective

The aim of this study is to characterize initial diagnosis of aDTC, its therapeutic management, and prognosis in Spain and Portugal.

Methods

A multicentre, longitudinal, retrospective study of adult patients diagnosed with aDTC in the Iberian Peninsula was conducted between January 2007 and December 2012. Analyses of baseline characteristics and results of initial treatments, relapse- or progression-free survival ((RP)FS) from first DTC diagnosis, OS, and prognostic factors impacting the evolution of advanced disease were evaluated.

Results

Two hundred and thirteen patients (median age: 63 years; 57% female) were eligible from 23 hospitals. Advanced disease presented at first diagnosis (de novo aDTC) included 54% of patients, while 46% had relapsed from early disease (recurrent/progressive eDTC). At initial stage, most patients received surgery (98%) and/or radioiodine (RAI) (89%), with no differences seen between median OS (95% CI) (10.4 (7.3–15.3) years) and median disease-specific-survival (95% CI) (11.1 (8.7–16.2) years; log-rank test P = 0.4737). Age at diagnosis being <55 years was associated with a lower risk of death (Wald chi-square (Wc-s) P < 0.0001), while a poor response to RAI to a higher risk of death ((Wc-s) P < 0.05). In the eDTC cohort, median (RP)FS (95% CI) was of 1.7 (1.0–2.0) years after RAI, with R0/R1 surgeries being the only common significant favourable factor for longer (RP)FS and time to aDTC ((Wc-s) P < 0.05).

Conclusion

Identification of early treatment-dependent prognostic factors for an unfavourable course of advanced disease is possible. An intensified therapeutic attitude may reverse this trend and should be considered in poor-performing patients. Prospective studies are required to confirm these findings.

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