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

Abstract

Background: Distant metastasis, generally to lung and bone, is rare in differentiated thyroid carcinoma (DTC) and the prognosis is still elusive. We investigated long-term outcomes of lung metastasis in DTC patients and its prognostic factors. Methods: A retrospective review was performed of 4572 patients who underwent surgery for DTC from 1962 to 2009 at Seoul National University Hospital. Among them, 164 patients were identified with lung metastasis and 152 patients were enrolled in the final analysis. Poor prognosis was defined as progressive disease or death. Results: Of these 152 patients, 10-and 20-year survival rates were 85.0% and 71.0%, respectively. No evidence of disease, stable disease, progressive disease, and death was identified in 22.4%, 28.3%, 35.5%, and 13.8%, respectively, after 11 years of median follow-up (range 2-41 years). Older age at diagnosis ( ‡ 45 years), primary tumor size ‡ 2 cm, follicular thyroid cancer, metastasis diagnosed after initial evaluation or 131 I remnant ablation (late metastasis), multiple metastases other than lung, 131 I nonavidity, and the presence of macronodules ( ‡ 1 cm) were more frequent in poor prognoses. Cox proportional hazard ratio for progression-free survival showed that 131 I nonavidity was the only independent predictive factor for poor prognosis. Conclusions: The prognosis of lung metastasis from DTC in Korea within this study was favorable.

Outcomes and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Carcinomas

“…Other previous studies found an unfavorable prognosis associated with an absence of 131 I uptake or persistent disease despite 131 I treatments [25][26][27]. Our results do agree with clinical observations on prolonged survival in such patients [28].…”

Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors

“…Several studies have reported that DTC patients with 131 I-avidity have longer survival rates than those with non-131 I-avid pulmonary metastasis (15,16,17,18). In agreement with the previous studies, our patients with non-131 I-avid disease had a 10-year OS rate of 38.1% compared to 69.2% for 131 I-avid metastases (P!0.0001).…”

“…Survival time from diagnosis of lung metastases (years) Figure 3 Overall survival for patients with lung metastases by sites of metastasis. (8,15,22,23,24). Cox's regression analysis showed that the three variables, including age, combination with other distant metastases and pulmonary node size, were significant predictor for survival (P valves 0.00015, !0.0001 and !0.0001 respectively).…”

Prognostic factors in pediatric differentiated thyroid cancer patients with pulmonary metastases

“…In comparison to adults, DTC in children and adolescents is observed to have a favorable overall prognosis in spite of aggressive presentation. The incidence of pulmonary metastases at presentation is reported to be as high as 6%-33% in children (3,4,8), in contrast to only 3%-6% in adults (13)(14)(15) the tumor comes to clinical attention at a late stage when loco-regional spread has already taken place.…”