Initial clinical and treatment patterns of advanced differentiated thyroid cancer: ERUDIT study
Copyright policy )Initial clinical and treatment patterns of advanced differentiated thyroid cancer: ERUDIT study
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.
epidemiological study, Epidemiological study, DISEASES::Neoplasms::Neoplasms by Site::Endocrine Gland Neoplasms::Thyroid Neoplasms, patient monitoring, retrospective study, España, radioactive iodine, thyroglobulin, external beam radiotherapy, cardiovascular disease, thyroid cancer, advanced cancer, cancer survival, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico, neck dissection, thyroid papillary carcinoma, disease specific survival, progression free survival, adult, longitudinal study, Progression-free survival, Diagnóstico diferencial, radioiodine-refractory differentiated thyroid cancer, female, Otros calificadores::Otros calificadores::/terapia, risk factor, Survival prognostic factors, Advanced differentiated thyroid cancer, survival rate, recombinant thyrotropin, overall survival, log rank test, Other subheadings::Other subheadings::/therapy, Thyroid neoplasms, differentiated thyroid cancer, Tiroide - Càncer - Tractament, Adenocarcinoma, cancer prognosis, Diseases of the endocrine glands. Clinical endocrinology, Chronic disease, Article, decision making, histology, Iodine radioisotopes, remission, male, Relapsing differentiated thyroid cancer, Neoplasias de la Tiroides, follow up, relapsing differentiated thyroid cancer, human, Radioiodine-refractory differentiated thyroid cancer, Estadificación de neoplasias, Portugal, cancer staging, Research, echography, clinical assessment, advanced differentiated thyroid cancer, tumor invasion, RC648-665, major clinical study, mortality, Tiroide - Càncer - Prognosi, Relapsing prognostic factors, cancer recurrence, multicenter study, relapsing prognostic factors, Spain, ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias de las glándulas endocrinas::neoplasias de la tiroides, observational study, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis, prognosis, Prospective studies, survival prognostic factors
epidemiological study, Epidemiological study, DISEASES::Neoplasms::Neoplasms by Site::Endocrine Gland Neoplasms::Thyroid Neoplasms, patient monitoring, retrospective study, España, radioactive iodine, thyroglobulin, external beam radiotherapy, cardiovascular disease, thyroid cancer, advanced cancer, cancer survival, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico, neck dissection, thyroid papillary carcinoma, disease specific survival, progression free survival, adult, longitudinal study, Progression-free survival, Diagnóstico diferencial, radioiodine-refractory differentiated thyroid cancer, female, Otros calificadores::Otros calificadores::/terapia, risk factor, Survival prognostic factors, Advanced differentiated thyroid cancer, survival rate, recombinant thyrotropin, overall survival, log rank test, Other subheadings::Other subheadings::/therapy, Thyroid neoplasms, differentiated thyroid cancer, Tiroide - Càncer - Tractament, Adenocarcinoma, cancer prognosis, Diseases of the endocrine glands. Clinical endocrinology, Chronic disease, Article, decision making, histology, Iodine radioisotopes, remission, male, Relapsing differentiated thyroid cancer, Neoplasias de la Tiroides, follow up, relapsing differentiated thyroid cancer, human, Radioiodine-refractory differentiated thyroid cancer, Estadificación de neoplasias, Portugal, cancer staging, Research, echography, clinical assessment, advanced differentiated thyroid cancer, tumor invasion, RC648-665, major clinical study, mortality, Tiroide - Càncer - Prognosi, Relapsing prognostic factors, cancer recurrence, multicenter study, relapsing prognostic factors, Spain, ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias de las glándulas endocrinas::neoplasias de la tiroides, observational study, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis, prognosis, Prospective studies, survival prognostic factors
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