Outcomes and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Carcinomas |
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| Authors: | Johanna Wassermann Marie‐Odile Bernier Jean‐Philippe Spano Charlotte Lepoutre‐Lussey Camille Buffet Jean‐Marc Simon Fabrice Ménégaux Frédérique Tissier Monique Leban Laurence Leenhardt |
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| Institution: | 1. Department of Medical Oncology, Pitié‐Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France;2. Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié‐Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France;3. Department of Epidemiology, Institute of Nuclear safety and radioprotection, Fontenay aux Roses, France;4. Department of Radiotherapy, Pitié‐Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France;5. Department of Endocrine Surgery, Pitié‐Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France;6. Department of Pathology, Pitié‐Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France;7. Department of Biochemistry, Pitié‐Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France |
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| Abstract: | Background.Outcomes vary among patients with radioiodine refractory (RR) differentiated thyroid cancer (DTC). The prognostic factors for survival are not well-known, resulting in difficulty in selecting patients for new targeted therapies. We assessed overall survival (OS) and cancer-specific survival (CSS) from RR-DTC to identify prognostic factors associated with survival.Patients and Methods.The data on all cases of metastatic RR-DTC treated in our center from 1990 to 2011 were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method; associated prognostic factors were assessed using Cox’s model.Results.Of 153 cases of metastatic DTC, 59% (n = 91) met a criterion for RR: that is, 60% (n = 55) had at least 1 metastasis without 131I uptake; 21% (n = 19) had progressive disease (PD) despite 131I; 19% (n = 17) had persistent disease despite a cumulative activity of 131I of ≥600 mCi. After the diagnosis of RR, median OS was 8.9 years (95% confidence interval CI]: 5.4-NR); median CSS was 9.6 years (95% CI: 6.01-NR). In multivariate analyses, PD despite 131I as a criterion for RR disease and the time from initial diagnosis of DTC to diagnosis of RR <3 years were the only independent prognostic factors for poor OS and CSS. Thyroglobulin doubling time (Tg-DT) was assessed in 31 of 91 cases. Among the 11 patients with Tg-DT for <1 year or undetectable Tg, 6 deaths occurred, whereas only 3 died of 20 patients with Tg-DT >1 year or negative Tg-DT.Conclusion.The identification of prognostic factors for decreased survival in RR-DTC may improve the selection of patients for targeted agents.Implications for Practice:This study shows a great heterogeneity in terms of prognosis in radioiodine refractory differentiated thyroid carcinoma. Poorer prognosis is observed in patients with tumor progression or with a diagnosis of radioiodine resistance within 3 years after the initial diagnosis of thyroid cancer. Those findings could lead to improvements in the selection of patients for targeted therapies. |
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| Keywords: | Thyroid neoplasm Survival analysis Thyroglobulin Iodine radioisotopes Molecular targeted therapy |
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