Factors Related to the Survival of Papillary and Follicular Thyroid Carcinoma Patients with Distant Metastases

Abstract

There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.

Long-Term Prognosis of Differentiated Thyroid Cancer with Lung Metastasis in Korea and Its Prognostic Factors

“…These similarities in the survival rates from two different ethnic groups suggest that histologic type should be a critical factor in determining the survival of DTC patients with lung metastasis. PTC has been known to be more commonly associated with lung metastasis than with FTC (36% vs. 25%), and inversely, FTC has been identified to be more frequent in bone metastasis than in PTC (44% vs. 19%) (34). In association with the higher frequency of PTC (82%), the present study also showed higher rates of metastasis limited to the lungs (86.2%) compared to other studies (45-51%) (9,14,16), while patients with both lung and bone metastases had a relatively higher frequency of FTC than patients with lung metastasis only (55.6% vs. 11.1%).…”

Follicular Thyroid Carcinomas with Lung Metastases: A 23-Year Retrospective Study

“…Around 8 to 33% of the follicular thyroid carcinoma patients presented with distant metastases at the time of diagnosis [4][5][6]. In our recent study, 33.7% of the follicular thyroid cancer cases presented with distant metastases during the follow-up period [7]. When comparing the clinical presentations of the follicular thyroid cancer with other series, a relatively high incidence of the distant metastases was noted [3,6,7].…”

“…In our recent study, 33.7% of the follicular thyroid cancer cases presented with distant metastases during the follow-up period [7]. When comparing the clinical presentations of the follicular thyroid cancer with other series, a relatively high incidence of the distant metastases was noted [3,6,7]. Hematogenous spreading had been known as the main way of distant metastases in follicular thyroid carcinoma.…”

Antivascular Therapy of Human Follicular Thyroid Cancer Experimental Bone Metastasis by Blockade of Epidermal Growth Factor Receptor and Vascular Growth Factor Receptor Phosphorylation

“…Although patients with FTC rank second in survival rates behind those with papillary thyroid cancer, patients with FTC face an increased risk of developing metastases in the lung and bone (8). In fact, metastases from FTC occur earlier and are more aggressive than those from papillary thyroid cancer (5). At diagnosis, bone metastasis is present in f10% to 30% of patients with FTC (9).…”