A Cohort of 134 Patients with Differentiated Thyroid Cancer and Distant Metastases Treated at a Single Tertiary Medical Center in Israel

Program: Abstracts - Orals, Poster Previews, and Posters
Session: SAT 270-310-Thyroid Neoplasia (posters)
Saturday, April 2, 2016: 1:15 PM-3:15 PM
Exhibit/Poster Hall (BCEC)

Poster Board SAT 306
Carlos Benbassat*1, Alex Gorshtein2, Eyal Robenshtok3, Gloria Tzvetov2, Amit Akirov2, Ilan Shimon2 and Dania Kolerman Hirsch3
1Assaf Harofe Medical Center and Tel Aviv University, Israel, 2Rabin Medical Center, Israel, 3Rabin Medical Center and Tel Aviv University, Israel
Introduction: Cervical lymph node metastases (LNM) is a strong predictor for persistent disease; however, the poorest prognosis in differentiated thyroid cancer (DTC) is associated with distant metastases (DM) and/or extensive local invasion. Aims: To investigate clinical characteristics and factors associated with improved outcome in patients with DTC and DM. Methods: From the Rabin Medical Center Thyroid Cancer Registry we identified 134 patients with DTC and DM operated during 1970-2014 having sufficient data for analysis. Anaplastic cancer was excluded. Data on clinical characteristics, treatment modalities and disease outcome were obtained from medical records. Most patients were treated with total thyroidectomy and I-131, while TKIs were given to 15 patients. Median follow-up was 9 yrs (range 1-54). Results: Mean age at diagnosis was 58.8±18, 60% were females, primary tumor size was 33.1±26 mm, 57% were T3T4, 51.3% presented extrathyroidal extension (ETE) and 53.2% had LNM. Histopathology was PTC/PTCFV 70%, FTC 10.5% and intermediate differentiated 19.5%. In 53% DM was synchronous (M1). The cumulative I-131 dose was 404 ± 245 mCi (median 380, range 30-1550). Disease outcome at last follow-up was: resolved 28.4%, improved/stable 28.6% and progressive 43%, and the overall survival was 65.7%. Disease progression was higher in metachronous (53% vs 34%) and intermediate type (64% vs 46% FTC and 34% PTC). Distribution by site was: lung-only 77, bone-only 17, lungs and bones 35, brain 9 liver 4 uterus 1.  Compared to all patients with bones metastases, those with lung-only were younger (48 vs 59 yrs) more female (63 vs 51%) with smaller primary (29 vs 36 mm) more PTC/PTCFV type (80 vs 47%) and less disease progression (21 vs 42%). There were no differences in ETE and LNM rates. Only one patient with liver and none with brain metastases were disease free at last follow up. Conclusion: There is a wide spectrum of clinical characteristics in thyroid cancer patients with distant metastases that can be used to predict disease outcome. Factors associated with better outcome are more differentiated cancer, synchronous DM and lung-only disease.

Nothing to Disclose: CB, AG, ER, GT, AA, IS, DKH

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