Differentiated Thyroid Cancer With Liver Metastases: Lessons Learned From Managing a Series of 14 Patients

Liver metastases from differentiated thyroid carcinoma (LMDTC) are rare and usually occur in disseminated metastatic disease. The aim of this study was to review the diagnosis and management of LMDTC. Between 1995 and 2011, 14 patients with a mean age of 59.7 years (+/-10.2) were treated for LMDTC. Data were retrospectively reviewed and analyzed. Seven patients had distant metastases at diagnosis, including 2 with synchronous liver lesions. The average time of onset of LMDTC from initial diagnosis was 52.2 months (+/49.5). All LMDTC were discovered during routine radiologic monitoring. Histologic analysis confirmed LMDTC in 5 patients. Eight patients received tyrosine kinase inhibitors, 1 patient underwent resection of their LMDTC after chemotherapy. Six patients (disseminated metastases, significant comorbidities) did not receive any specific treatment. The median survival after diagnosis of LMDTC was 17.4 months (+/-3.3): 23.6 months (+/-2.9) for patients who underwent chemotherapy versus 3.9 months (+/-0.9) for patients who did not receive any specific treatment (P < 0.001). Developing DTC liver metastasis is a very poor prognostic sign. Chemotherapy by TKIs, especially, hold promise in the cure of LMDTC for selected patients.Key words: Liver metastasis, Thyroid carcinomaDifferentiated thyroid carcinoma, encompassing follicular and papillary carcinomas, has a good prognosis and long-term survival rates. Indeed, the 10-year survival rate is 80–95%. The incidence of distant metastases at the time of initial presentation of differentiated thyroid carcinoma (DTC) is 4%. During the course of treatment and follow-up, the prevalence of distant metastases ranges from 2% in low-risk patients, to 33% in high-risk patients. Distant metastases occur primarily in the lungs and, to a lesser extent, in bones. The presence of distant metastases is the most significant prognostic factor and is associated with poor outcomes. Only 50% of patients survive 10 years after a diagnosis of the metastatic DTC.^1–3Liver metastases from differentiated thyroid carcinoma (LMDTC) are rare, with a reported frequency of 0.5%. They tend to occur during the terminal phase of the disease are a grave event. Survival ranges from 1 to 60 months after diagnosis of LMDTC in the largest series of 11 cases.⁴Because of this rarity, there is little information available on the diagnosis and management of LMDTC. We have therefore undertaken a retrospective, multicenter study on LMDTC and analyzed factors affecting survival.