European Thyroid Journal (Jan 2023)

Initial clinical and treatment patterns of advanced differentiated thyroid cancer: ERUDIT study

  • Juan Antonio Vallejo Casas,
  • Marcel Sambo,
  • Carlos López López,
  • Manuel Durán-Poveda,
  • Julio Rodríguez-Villanueva García,
  • Rita Joana Santos,
  • Marta Llanos,
  • Elena Navarro-González,
  • Javier Aller,
  • Virginia Pubul,
  • Sonsoles Guadalix,
  • Guillermo Crespo,
  • Cintia González,
  • Carles Zafón,
  • Miguel Navarro,
  • Javier Santamaría-Sandi,
  • Ángel Segura,
  • Pablo Gajate,
  • Marcelino Gómez-Balaguer,
  • Javier Valdivia,
  • Manel Puig-Domingo,
  • Juan Carlos Galofré,
  • Beatriz Castelo,
  • María José Villanueva,
  • Iñaki Argüelles,
  • Lorenzo Orcajo-Rincón

DOI
https://doi.org/10.1530/ETJ-21-0111
Journal volume & issue
Vol. 11, no. 5
pp. 1 – 13

Abstract

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Background: Up to 30% of differentiated thyroid cancer (DTC) will develop advanced-stage disease (aDTC) with reduced overall survival (OS). Objective: The aim of this study is to characterize initial diagnosis of aDTC, its therapeutic management, and prognosis in Spain and Portugal. Methods: A multicentre, longitudinal, retrospective study of adult patients diagnosed with aDTC in the Iberian Peninsula was conducted between January 2007 and December 2012. Analyses of baseline characteristics and results of initial treatments, relapse- or progression-free survival ((RP)FS) from first DTC diagnosis, OS, and prognostic factors impacting the evolution of advanced disease were evaluated. Results: Two hundred and thirteen patients (median age: 63 years; 57% female) were eligible from 23 hospitals. Advanced disease presented at first diagnosis (de novo aDTC) included 54% of patients, while 46% had relapsed from early disease (recurrent/progressive eDTC). At initial stage, most patients received surgery (98%) and/or radioiodine (RAI) (89%), with no differences seen between median OS (95% CI) (10.4 (7.3–15.3) years) and median disease-specific-survival (95% CI) (11.1 (8.7–16.2) years; log-rank test P = 0.4737). Age at diagnosis being <55 years was associated with a lower risk of death (Wald chi-square (Wc-s) P < 0.0001), while a poor response to RAI to a higher risk of death ((Wc-s) P < 0.05). In the eDTC cohort, median (RP)FS (95% CI) was of 1.7 (1.0–2.0) years after RAI, with R0/R1 surgeries being the only common significant favourable factor for longer (RP)FS and time to aDTC ((Wc-s) P < 0.05). Conclusion: Identification of early treatment-dependent prognostic factors for an unfavourable course of advanced disease is possible. An intensified therapeutic attitude may reverse this trend and should be considered in poor-performing patients. Prospective studies are required to confirm these findings.

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