Clinical outcomes of a cohort of 271 patients with lung metastases from differentiated thyroid carcinoma

Abstract

Context Lung is the most common site of distant metastases from differentiated thyroid carcinoma (DTC). Objective To investigate the outcomes of a cohort of patients with DTC and lung metastases (LM). Methods A retrospective analysis of a cohort of 271 patients with LM was performed. Results The female‐to‐male ratio was 1:1 and the median follow‐up time was 5.9 (1.1–38.4) years. Papillary thyroid carcinoma (PTC) was the most frequent type (83.4%), mainly the classic variant, followed by follicular thyroid carcinoma (FTC, 10.3%) and Hürthle cell carcinoma (HTC, 6.3%). The prevalence of PTC, FTC and HCC was different between the micronodular and macronodular LM groups [87.4%, 6.3% and 6.3% vs. 74.6%, 19.0% and 6.3%, respectively (p = .013)]. Only 5.0% of the patients had LM diagnosed after a period of remission. LM were submitted to radioactive iodine treatment (RAIT) in 84.5% (52.8% showed 131iodine avid metastases). Complete remission was only achieved in 12.2%. Micronodular disease and age <55 years at LM diagnosis were associated with a better prognosis (p < .05). We found no difference in survival between patients with LM treated or not with RAIT. However, in patients submitted to RAIT, there was a tendency for longer survival in the group of patients with 131I avid lesions. Conclusion: The classic variant of PTC was the most frequent histology found in LM of DTC. LM are rarely diagnosed in the follow‐up when complete remission is achieved after surgery and 131I. Younger age at LM diagnosis and a micronodular pattern are associated with a better prognosis.

The Effect of Radioiodine Therapy on the Prognosis of Differentiated Thyroid Cancer with Lung Metastases

“…The overall prognosis for patients with DTC is favorable, while patients with distant metastases have a significantly poorer prognosis [ 7 , 8 ]. The lung is the most commonly affected site of distant metastases for DTC metastases, with an incidence rate of 2–20% [ 9 , 10 ]. Indeed, research indicated a higher incidence of lung metastasis compared to other organs in thyroid cancer patients with distant metastasis [ 11 , 12 , 13 ], likely due to the lungs’ extensive vascularization and tumor-friendly microenvironment [ 14 ].…”

“…Indeed, research indicated a higher incidence of lung metastasis compared to other organs in thyroid cancer patients with distant metastasis [ 11 , 12 , 13 ], likely due to the lungs’ extensive vascularization and tumor-friendly microenvironment [ 14 ]. Of those with lung metastases, 50% of patients die within 10 years [ 9 , 15 , 16 ]. Several factors, including age, serum thyroglobulin levels, cumulative dose of radioiodine therapy (RAI), and tumor size, have been shown to influence the prognosis of patients with DTC correlated with pulmonary metastases [ 17 , 18 ].…”

Development and validation of a nomogram to predict cancer-specific survival in middle-aged patients with papillary thyroid cancer: A SEER database study

“…The prognosis of PTC is generally good, with a 10-year survival rate of 80%–95% [ 9 ]. However, middle-aged PTC is prone to local lymphatic metastasis and distant metastasis.…”