Abstract
Advanced differentiated thyroid carcinoma (aDTC), herein defined as locally unresectable or metastatic disease, frequently develops into RR-DTC, one of the most common late-stage endocrine tumours. However, available data about its evolution is limited. ERUDIT is a multicentre, observational, retrospective study of patients diagnosed with aDTC in Spain and Portugal. The study describes its natural history from the initial diagnosis until the advanced stages of disease. This communication is focused on the RR-DTC subpopulation, its diagnosis, treatment patterns, and specialties involved in its management. Clinical records from patients ≥18 y-o diagnosed with aDTC (including poorly differentiated DTC) with first evidence of advanced disease documented between January 2007 and August 2017 were retrospectively reviewed until death or lost to follow-up. 213 patients were identified in 23 centres. Median age at initial diagnosis was 63 y-o, 59% were females. aDTC presented de novo in 54% of the cases. In all, 77.5% were initially diagnosed or developed into RR-DTC along study follow-up. Median (Q1-Q3) time to RR-DTC from first radioiodine dose was 27.6 (9.5-50.6) months. Computed (CT) and fluorodeoxygucose positron emission tomography (FDG PET-CT) were the most used methods to follow refractory disease (41% and 27%, respectively). Management was multimodal, with surgery (15%), watchful waiting (48%), locoregional (35%), and systemic therapies (ST) (37%) being used. Median (Q1-Q3) time from RR-DTC diagnosis to start of ST was 8.9 (1.4-34.7) months, while median overall survival (95%CI) reached 4.7 (3.4-8.0) years in this subpopulation. Endocrinology (59%) and Oncology (33%) were the leading medical specialties responsible for patient monitoring, while two thirds of the patients were evaluated by multidisciplinary committees. Most of aDTC tumours either present or become RR-DTC in around 2.3 years and are treated multidisciplinarily. Survival expectancy of this group nears 5 years, confirming an unfavourable evolution of most aDTC at their late treatment stages.
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