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Prognostic Implications of Radioiodine Avidity and Serum Thyroglobulin in Differentiated Thyroid Carcinoma with Distant Metastasis

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Abstract

Background

Although differentiated thyroid carcinoma (DTC) rarely develops distant metastases, the present study was performed to evaluate factors that affect the survival of patients with DTC who present with distant metastasis.

Methods

Among 4,989 patients who underwent thyroid surgery for DTC, 82 presenting with distant metastasis were analyzed. Based on radioiodine (131I) avidity and the thyroid-stimulating hormone-stimulated serum thyroglobulin (sTg) level at the time of metastasis, patients were divided into three groups: group 1 (131I uptake + sTg ≤ 215 ng/mL, n = 46), group 2 (131I uptake + sTg > 215 ng/mL, n = 24), group 3 (no 131I uptake, n = 12). Disease-specific survival (DSS) was estimated using the Kaplan–Meier method. Factors predicting the outcome were evaluated using Cox proportional hazard regression analysis.

Results

The age of patients (p = 0.04), frequency of follicular thyroid carcinoma (p = 0.002), tumor size (p < 0.001), and number of multiple metastatic sites (p = 0.004) differed significantly among the groups. With a median follow-up after surgery of 72 months, the 5- and 10-year DSSs for all patients were 84 and 69 %, respectively. The predictors of survival were age (p = 0.004), symptoms at the time of presentation (p = 0.045), histology (p = 0.01), sites of metastasis (p = 0.03), and 131I avidity and sTg level at the time of metastasis (p = 0.002). In the multivariate analysis, age, histology, and 131I avidity and sTg level at the time of metastasis remained significant factors for survival.

Conclusions

Certain DTC patients with distant metastasis demonstrate favorable outcomes dependent on age, histology, and 131I avidity and sTg level at the time of metastasis.

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Acknowledgments

This study was supported by 2012 SMC Clinical Research grant (CR0112101), the Korean Foundation for Cancer Research (CB-2011-03-02), and the Samsung Biomedical Research Institute grant (SBRI C-B0-233-3).

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Author notes

  1. Hye Jeong Kim

    Present address: Division of Endocrinology and Metabolism, Department of Internal Medicine, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea

  2. Ji In Lee

    Present address: Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, #50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea

    Hye Jeong Kim, Ji In Lee, Na Kyung Kim, Yong-Ki Min, Sun Wook Kim & Jae Hoon Chung

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  1. Hye Jeong Kim
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  2. Ji In Lee
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Correspondence to Jae Hoon Chung.

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Kim, H.J., Lee, J.I., Kim, N.K. et al. Prognostic Implications of Radioiodine Avidity and Serum Thyroglobulin in Differentiated Thyroid Carcinoma with Distant Metastasis. World J Surg 37, 2845–2852 (2013). https://doi.org/10.1007/s00268-013-2213-4

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  • DOI: https://doi.org/10.1007/s00268-013-2213-4

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