Publicaciones científicas
Initial Clinical and Treatment Patterns of Advanced Differentiated Thyroid Cancer. ERUDIT Study
Juan Antonio Vallejo Casas 1 , Marcel Sambo 2 , Carlos López López 3 , Manuel Durán-Poveda 4 , Julio Rodríguez-Villanueva García 5 , Rita Joana Santos 6 , Marta Llanos 7 , Elena Navarro-González 8 , Javier Aller 9 , Virginia Pubul 10 , Sonsoles Guadalix 11 , Guillermo Crespo 12 , Cintia González 13 , Carles Zafón 14 , Miguel Navarro 15 , Javier Santamaría-Sandi 16 , Ángel Segura 17 , Pablo Gajate 18 , Marcelino Gómez-Balaguer 19 , Javier Valdivia 20 , Manel Puig-Domingo 21 , Juan Carlos Galofré 22 , Beatriz Castelo 23 , María José Villanueva 24 , Iñaki Argüelles 25 , Lorenzo Orcajo Rincón 26
Background: Up to 30% of differentiated thyroid cancer (DTC) will develop advanced-stage disease (aDTC) with reduced overall survival (OS).
Objective: To characterize initial diagnosis of aDTC, its therapeutic management, and prognosis in Spain and Portugal.
Methods: Multicentre, longitudinal, retrospective study of adult patients diagnosed with aDTC in Iberian Peninsula between Jan'2007 and Dec'2012. Analyses of baseline characteristics and results to 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: 213 patients (median age 63 years; 57% female) were eligible from 23 hospitals. Advanced disease presented at first diagnosis (de novo aDTC) in 54% of patients, while 46% had relapsed from early disease (recurrent/progressive eDTC). At initial stage, most patients received surgery (98%) and/or 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 <55 years was associated with lower risk of death (Wald chi-square [Wc-s] p<0.0001), while 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.
CITA DEL ARTÍCULO Eur Thyroid J. 2022 Jul 1;ETJ-21-0111. doi: 10.1530/ETJ-21-0111
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