Early prognostic factors at the time of diagnosis of bone metastasis in patients with bone metastases of differentiated thyroid carcinoma

Abstract

Objective: Bone is the second most common site of distant metastases from differentiated thyroid cancer (DTC). Patients with bone metastases were associated with poor clinical outcomes; however, their clinical courses are heterogeneous. The aim of this study is to evaluate early prognostic factors of patients with bone metastases from DTC at the time of diagnosis of bone metastasis. Methods: This retrospective study included 93 patients with bone metastases from DTC. We defined 'Pre-RAIT group' as patients whose bone metastases were detected before initial RAIT. The 'post-RAIT group' was defined as patients whose bone metastases were detected after initial RAIT or during the follow-up period. Results: Median age was 55.4 years, and 55 patients (59%) had papillary thyroid cancer. Patients in the pre-RAIT group (n = 32) demonstrated significantly poorer overall survival (OS) (HR = 1.86, P = 0.04) than those in the post-RAIT group. There was no significant difference in the OS according to the initial RAI avidity among all patients (P = 0.18). RAI-avid bone metastases had better OS only in the pre-RAIT group (HR = 0.23, P = 0.01) but not in the post-RAIT group. In the post-RAIT group, older age (>45 years), elevated serum thyroglobulin (Tg) level (>250 ng/mL), and the presence of skeletal-related events (SREs) were significantly associated with poor OS. RAI avidity was not a significant prognostic factor in the post-RAIT group (P = 0.33). Conclusions: Patients whose bone metastases were diagnosed before initial RAIT demonstrate a poorer prognosis. RAI avidity is an early prognostic indicator in the pre-RAIT group. Old age, higher serum Tg levels, and SRE are associated with poor survival outcomes in the post-RAIT group.

INAVA promotes aggressiveness of papillary thyroid cancer by upregulating MMP9 expression

“…PTC is known for its early spread to regional lymph nodes and growing evidence has demonstrated that central lymph node metastasis is adversely associated with survival [ 29 , 30 ]. Distant metastasis occurs in only < 1% of thyroid cancer, but strongly associates with poor clinical outcomes [ 31 – 33 ]. Delineating the molecular aspects of the LN metastasis and distant metastasis in PTC will lead to a better understanding of the disease.…”

Differentiated thyroid cancer theranostics: radioiodine and beyond

“…Majority of patients having metastatic disease are diagnosed using WBS along with SPECT-CT with high specificity along with other ancillary findings in structural imaging. 99 This also aids in the assessment of therapeutic benefit by the theranostic concept. The survival drops to 14% in patients older than 40 years old with macronodular lung metastasis or multiple bone metastasis.…”

Seemingly Harmless Differentiated Thyroid Carcinoma Presenting as Bone Metastasis

“…When distant metastases occur, the bone is the second most frequently affected site [ 6 ]. The incidence of bone metastases is about 1 to 7% in papillary carcinoma and 7 to 20% in follicular carcinoma.…”

“…When present, the lesions are mostly osteolytic in nature [ 2 , 7 ]. Bone metastases can result in clinically significant morbidity, coursing with important pain, pathological fractures, and neurological dysfunction [ 2 , 6 ]. However, clinically silent presentation of bone metastases can also occur [ 2 ].…”