Abstract
BackgroundDistant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC.MethodsA retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups.ResultsDistant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC.ConclusionsTS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients.Graphical abstract
Highlights
Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC)
While several studies have reported the prognosticators of survival [5,6,7,8,9,10], local recurrence and mortality [6, 11, 12] in WDTC, there remains a lack of information regarding the pathological predictors of distant metastasis (DM) in this population
There is limited information regarding the contributions of aggressive pathological subtypes of WDTC [5, 6] in the development of DM, such as non-classical subtypes of papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) and Hurthle cell carcinoma (HCC)
Summary
Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC. Distant metastasis (DM) in WDTC remains uncommon, it is associated with a significantly lower disease-specific survival (DSS), estimated at 30–50% (5–10 years), compared to patients with no DM [3,4,5]. There is limited information regarding the contributions of aggressive pathological subtypes of WDTC [5, 6] in the development of DM, such as non-classical subtypes of papillary thyroid carcinoma (PTC) (tall cell, oncocytic variants), follicular thyroid carcinoma (FTC) and Hurthle cell carcinoma (HCC). While some studies have investigated DM in WDTC, there are limited studies utilizing a statistical model that evaluates the development of DM over time for clinically-relevant pathological features
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