Incidence and Predictors of Synchronous Bone Metastasis in Newly Diagnosed Differentiated Thyroid Cancer: A Real-World Population-Based Study

Abstract

BackgroundClinical and sociodemographic characteristics of differentiated thyroid cancer (DTC) patients with synchronous bone metastasis (SBM) remain unclear. This real-world study aimed to elucidate the incidence and prognosis of DTC patients with SBM using population-based data.MethodsData of patients with newly diagnosed DTC from 2010 to 2016 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariable logistic regression analysis was utilized to identify predictors of developing SBM in patients with DTC and was further evaluated by receiver operator characteristics (ROC) analysis. Multivariable Cox regression was applied to identify prognostic factors associated with overall survival (OS) and cancer-specific survival (CSS).ResultsA total of 67,176 patients with DTC were screened from the database, with 0.36% (244/67,176) developed SBM. The age-adjusted incidence of SBM in patients with DTC was relatively stable during the study period with an average annual percentage change (AAPC) of 2.52. Multivariable logistic regression analysis recognized seven factors (older age, male gender, black race, other races, follicular histology, the American Joint Committee on Cancer (AJCC) T2, T3, T4 staging, and N1 staging) as predictors of developing SBM among the entire cohort, with the value of area under the curve (AUC) of 0.931 (95% CI: 0.915–0.947). The median survival time of DTC patients with SBM was 22 months (interquartile range, 7–47 months). The multivariable Cox regression analysis indicated multiple metastatic sites, surgical procedures, and chemotherapy as predictors for the survival of patients.ConclusionsPredictors and prognostic factors of SBM in patients with DTC were identified in this study. Patients with risk factors should be given more attention in clinical practice.

Bone metastases in newly diagnosed patients with thyroid cancer: A large population-based cohort study

“…In this SEER study, distant metastasis was found in 1.7% of thyroid cancer patients at the time of diagnosis, comparable to 2.03% (for PTC) as reported by Toraih et al (18) and 1.045% (for DTC) by Qi et al (6) However, an autopsy study conducted from the nationwide Duch pathology registry reported distant metastasis was present in up to 35.1% of thyroid cancer patients, and the majority of patients had more than one metastasis (19). BM occurred in 0.5% (347/ 64083) of all newly diagnosed thyroid cancer patients, which was lower than previous studies as reported ~4% (20).…”

“…Preemptive surveillance for the presence of lymph node and lung metastases is the standard-of-care in thyroid cancer patients (1,2). Although thyroid cancer is predisposed to bone metastases (BM), the existent data are limited to older, retrospective, single-institution studies with small cohorts (3-5) or large cohorts but mainly focused on differentiated thyroid cancer (DTC) (6). Additionally, the occurrence of BM is less well studied, which, in the literature varies widely (7,8), occurring in 2%-15% of pooled DTC series and 1.4%-7% in papillary thyroid cancer (PTC) patients.…”

“…Nevertheless, many of them lead to inconclusive results (8), since cohorts were often assembled over multiple decades during which both histopathologic evaluation and clinical management have evolved. More recently, Qi et al have identified predictors of developing BM in patients with DTC using population-based data, but regretfully, the rare ATC and MTC subtypes were not included (6).…”

Enhancing clinical decision-making: A novel nomogram for stratifying cancer-specific survival in middle-aged individuals with follicular thyroid carcinoma utilizing SEER data

“…Studies have shown that the OS of TC starts to decline steadily from age 40 [ 35 ]. A population study in Germany found that when comparing the all-cause mortality of well-differentiated TC patients with the general population, there was a moderate decline in survival in patients aged >45 years and a significant decrease in patients aged over 60 years [ 36 ]. Yang et al conducted a population-based study that evaluated and predicted the probability of death due to TC and other causes in patients with TC and found a continuous positive correlation between age and TC survival [ 37 ].…”

Development and validation of a nomogram to predict cancer-specific survival in middle-aged patients with papillary thyroid cancer: A SEER database study

“…Ho AS et al also came to the same conclusion after analyzing the TC patients and believed that the increase in age and tumour size led to a gradual increase in the mortality of non-surgical TC patients [ 26 ]. Studies have shown that thyroid cancer's overall survival (OS) begins to decline steadily from age 40 [ 27 ]. A German population-based study found a significant decrease in all-cause mortality in patients >60 years of age when DTC patients were compared with the general population [ 28 ].…”