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Clinical and prognostic role of detection timing of distant metastases in patients with differentiated thyroid cancer

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Abstract

Purpose

Distant metastases (DM) from DTC occur in 5–25% of cases and are correlated to lower survival; the prognostic significance of the temporal onset of DM is unclear. Our aim was to retrospectively analyze the prevalence of DM and to assess the prognostic role of the timing of manifestation of DM regarding the outcome.

Materials and methods

We included 174 patients (mean age 64 years). According to the time of manifestation, DM were divided in two groups: synchronous DM (SDM, n = 108) defined as metastases present at initial diagnosis and metachronous DM (MDM, n = 66) as diagnosed during follow-up. SDM were further sub grouped in pre-RAIT when diagnosed during pre-surgery work-up (n = 35) and baseline-RAIT when detected by first whole body scan after RAIT (n = 73). Disease-specific survival (DSS) was analyzed using the Kaplan–Meier method.

Results

Total RAI activities and number of treatments were significantly higher in MDM, also loss of RAI avidity was more frequent in MDM. Forty-four patients died during follow-up, of which 41 were DTC-related deaths, 5-year and 10-year DSS were 80% and 56%. On univariate analysis MDM had significantly shorter DSS; also histotype and RAI avidity were significant risk factors of impaired survival. On multivariate analysis, only loss of RAI avidity remained as independent negative predictor (p = 0.043). Considering SDM, DSS was significantly shorter in pre-RAIT group than baseline-RAIT (p = 0.004). Instead there was no significant difference between pre-RAIT-SDM and MDM in survival outcome (p = 0.875).

Conclusions

In DTC with DM, loss of RAI uptake has an important role in survival. No significant difference in survival outcome was discovered between SDM and MDM; but, among SDM, pre-RAIT had significant shorter DSS than baseline-RAIT.

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Authors and Affiliations

  1. Nuclear Medicine, Spedali Civili Brescia, Brescia, Italy

    Domenico Albano, Maria Beatrice Panarotto & Rexhep Durmo

  2. Health Physics Department, Spedali Civili, Brescia, Italy

    Carlo Rodella

  3. Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy

    Francesco Bertagna & Raffaele Giubbini

Authors
  1. Domenico Albano
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  2. Maria Beatrice Panarotto
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  3. Rexhep Durmo
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  4. Carlo Rodella
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  5. Francesco Bertagna
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  6. Raffaele Giubbini
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Correspondence to Domenico Albano.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Albano, D., Panarotto, M.B., Durmo, R. et al. Clinical and prognostic role of detection timing of distant metastases in patients with differentiated thyroid cancer. Endocrine 63, 79–86 (2019). https://doi.org/10.1007/s12020-018-1713-2

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  • DOI: https://doi.org/10.1007/s12020-018-1713-2

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