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Distinguishing synchronous from metachronous manifestation of distant metastases: a prognostic feature in differentiated thyroid carcinoma

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aim

Distant metastasis has a negative impact on survival in differentiated thyroid carcinoma (DTC). The timing of this manifestation, however, is of unknown prognostic relevance. The aim of this retrospective study was to investigate the potential significance of discriminating synchronous versus metachronous distant metastases (SDM vs. MDM) for the outcome of patients with DTC.

Methods

We retrospectively analyzed a consecutive cohort of n = 89 patients with distant metastases of DTC (43 with follicular, 46 with papillary DTC histology; mean age 52.6 ± 17.7 years) undergoing radioiodine treatment at our institution. All patients were treated with the same protocol consisting of ablative radioiodine therapy (RIT, 3.7 GBq) and one post-ablation treatment after 3 months (3.7–11.1 GBq). Further cycles of RIT were administered for recurrent, progressive or newly developed metastatic disease. We distinguished 2 types of distant metastases according to the time of manifestation: SDM (within ≤12 months after DTC diagnosis) and MDM (occurring >12 months after diagnosis). Tumor-related survival was analyzed using the Kaplan–Meier method. Uni- and multivariate analyses including the Cox proportional hazards model were performed with a significance level of p < 0.05.

Results

The mean follow-up period was 13.8 ± 1.2 years. SDM were present in 49 (55.1 %), MDM in 40 (44.9 %) patients. MDM were associated with shorter tumor-related survival (p = 0.002). 5-year and 10-year survival rates were 68.5 % and 34.8 % for MDM, and 84.3 % and 66.9 % for SDM, respectively. Within both age subgroups of <45 and ≥45 years, SDM were also linked with longer survival. No effect on tumor-related survival was found for the co-variables sex, lymph node metastases and histologic type.

Conclusion

Distinguishing synchronous from metachronous manifestation of distant metastases may add an important prognostic feature to risk stratification in DTC, as proven metachronous appearance is associated with impaired survival.

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Author notes

    Authors and Affiliations

    1. Department of Nuclear Medicine, University Duisburg-Essen, Essen, Germany

      Amir Sabet, Ina Binse, Andrea Koch & Sandra J. Rosenbaum-Krumme

    2. Department of Nuclear Medicine, Saarland University Hospital, Kirrbergerstr., Geb. 50, D-66421, Homburg, Germany

      Amir Sabet & Samer Ezziddin

    3. Department of Nuclear Medicine, University Hospital, Bonn, Germany

      Semih Dogan, Hans-Jürgen Biersack, Kim Biermann & Samer Ezziddin

    4. Department of Radiology and Nuclear Medicine, Confessional Hospital “Barmherzige Brüder”, Trier, Germany

      Kim Biermann

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    1. Amir Sabet
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    Correspondence to Samer Ezziddin.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals.

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    Amir Sabet and Ina Binse contributed equally to this work.

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    Sabet, A., Binse, I., Dogan, S. et al. Distinguishing synchronous from metachronous manifestation of distant metastases: a prognostic feature in differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging 44, 190–195 (2017). https://doi.org/10.1007/s00259-016-3485-3

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