Background
The presence of distant metastases is the most important predictive factor of poor
outcomes in patients with papillary thyroid carcinoma (PTC). Some patients have very
slow-growing distant metastases with relatively favorable outcomes, so predicting
prognosis is not easy. Furthermore, many patients with distant metastases show locally
advanced disease, and no consensus is available for operative control of cervical
tumor in this situation.
Methods
Among 1023 patients with PTC who underwent primary thyroidectomy from 1976 to 2002,
42 patients displayed distant metastases at initial presentation and 44 patients developed
distant metastases during follow-up. We reviewed the records retrospectively of these
86 patients. Mean duration of follow-up after detection of distant metastases was
7 years. Our treatment approach for patients with locally advanced neoplasms was radical
resection including extensive neck dissection and extended resection of the involved
organs, even when distant metastases were present.
Results
Disease-specific survival of the 86 patients with distant metastases at 5 and 10 years
was 65% and 45%, respectively. Using multivariate analysis, older age at time of distant
metastases detection, distant metastases involving sites other than the lung, distant
metastases diameter ≥2 cm, presence of large nodal metastases (≥3 cm), and a primary
neoplasm with poorly differentiated components were all predictive of worse prognosis.
Our aggressive approach allowed curative resection in all but 1 patient, and only
5 patients (6%) succumbed to local disease. Patients with cervical recurrences displayed
worse prognosis than those without.
Conclusions
Although the currently employed modalities of therapy for distant metastases do not
have definitive impact on survival, some PTC patients with distant metastases, including
younger patients with well-differentiated, small lung metastases appear to have relatively
favorable outcomes. Local operative control of PTC is important even in patients with
distant metastases, particularly when the distant metastases appear to be slow-growing.
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Article info
Publication history
Published online: November 30, 2007
Accepted:
June 5,
2007
Identification
Copyright
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
