Role of metastasectomy in the management of thyroid carcinoma: The NIH experience

Pak, Ho; Gourgiotis, Loukas; Chang, Wen I.; Guthrie, Lori C.; Skarulis, Monica C.; Reynolds, James C.; Merino, María J.; Schrump, David S.; Libutti, Steven K.; Alexander, H. Richard; Sarlis, Nicholas J.

doi:10.1002/jso.10189

Cited by 53 publications

(29 citation statements)

References 63 publications

(60 reference statements)

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“…After aggressive treatment, the 5 and 10 year survival were 68.5%, and 54.0%, respectively. These results were close to recent studies after metastasectomy in the management of thyroid carcinoma [20]. There were discrepancies in the criteria of lung metastases, different follow-up procedures, and the varying ethnic, and geographic factors.…”

Section: Discussionsupporting

confidence: 83%

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Follicular Thyroid Carcinomas with Lung Metastases: A 23-Year Retrospective Study

Lin

Chao

2004

Endocr J

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Abstract. Limited clinical information is specified in the presentations, results of treatment and prognostic factors of follicular thyroid carcinoma with lung metastases. In order to better characterize the information, we retrospectively analyzed the data of 2,003 thyroid cancer patients who received treatment and follow-up at the Chang Gung Memorial Hospital during the period from January 1979 to December 2002. There were 1,516 cases of papillary and 272 cases of follicular thyroid carcinomas. In the study, lung metastases of the follicular thyroid carcinomas were defined as postoperative or follow-up chest X-ray, diagnostic or therapeutic 131 I scan with positive finding of lung metastases. Serum thyroglobulin (Tg) levels under thyroxine treatment of patients with lung metastases had to be over 1.5 ng/mL. Of the follicular thyroid carcinomas, there were 70 (25.7%) with lung metastases including 50 females (mean age 54.1 ± 12.6 years old) and 20 males (mean age 59.4 ± 12.0 years old). Of the 70 patients, there were 53 patients (75.7%) who presented with lung metastases at the time of diagnosis. Of the 70 patients of follicular thyroid carcinoma with lung metastases, 30 patients (42.9%) died at the end of the follow-up, and only 4 patients improved to disease free status. The 5, 10, 15, and 20 year survival rates in these patients were 68.5%, 54.0%, 41.6%, 27.7%, respectively. Age, post-operative Tg level and tumor size are important prognostic factors which are demonstrated to be significantly different statistically between lung metastases group and the group of the patients without distant metastasis. Otherwise, only the tumor size and accumulative dose of 131 I therapy demonstrate a significant difference between survival and mortality groups. Seventeen of the 70 patients developed lung metastases during the follow-up period. Mean period between diagnosis and recurrence of these patients was 3.6 ± 0.9 years. Over 75% of follicular thyroid carcinoma with lung metastases was diagnosed at the time of presentation. Forty percent (28/70 cases) of the follicular thyroid carcinoma with lung metastases had history of thyroid surgery in this study. If lung metastases are diagnosed in follicular thyroid carcinoma, it will be followed by a poor prognosis. Older patients, higher postoperative Tg, and larger tumor size in follicular thyroid carcinoma need aggressive postoperative treatment. MOST well differentiated thyroid cancer cases progress slowly in their clinical courses [1][2][3]. Around 8 to 33% of the follicular thyroid carcinoma patients presented with distant metastases at the time of diagnosis [4][5][6]. In our recent study, 33.7% of the follicular thyroid cancer cases presented with distant metastases during the follow-up period [7]. When comparing the clinical presentations of the follicular thyroid cancer with other series, a relatively high incidence of the distant metastases was noted [3,6,7]. Hematogenous spreading had been known as the main way of distant metastases in follicular thyroid carcinoma. T...

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Section: Discussionsupporting

confidence: 83%

“…Surgical treatment for the metastatic lesions has been mentioned in the management of thyroid carcinoma [20,21]. Intrathoracic metastatic thyroid malignancy is the main site of these patients.…”

Section: Discussionmentioning

confidence: 99%

Follicular Thyroid Carcinomas with Lung Metastases: A 23-Year Retrospective Study

Lin

Chao

2004

Endocr J

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“…Their initial tumor burden of the lung was comparably bigger than that of the others; however, they were currently in an NED status with surgical management (lobectomy) of the lung lesions, following 131 I therapy for the remaining lesions. Although this is a very small number of patients, in combination with other studies (16,45), we could carefully deduce that large lung lesions could achieve good prognosis with optimal surgical intervention.…”

Section: Discussionmentioning

confidence: 85%

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

Cho

Choi²,

Yeom³

et al. 2014

Thyroid

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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.

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“…3. In the absence of demonstrated survival benefit, certain interventions can provide significant palliation or reduce morbidity (216,(250)(251)(252). 4.…”

Section: What Is the Most Appropriate Management Of Patients With Metmentioning

confidence: 99%

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

Cooper

Doherty

Haugen

et al. 2006

Thyroid

1,915

938

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Role of metastasectomy in the management of thyroid carcinoma: The NIH experience

Abstract: Our data show that extensive targeted metastasectomy in the setting of a tertiary center can be beneficial to patients with disseminated ThyrCa with persistent or recurrent distant disease, when used in conjunction with nonsurgical treatment modalities.

Cited by 53 publications

References 63 publications

Follicular Thyroid Carcinomas with Lung Metastases: A 23-Year Retrospective Study

Follicular Thyroid Carcinomas with Lung Metastases: A 23-Year Retrospective Study

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

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

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