Bone metastases in newly diagnosed patients with thyroid cancer: A large population-based cohort study

Ruiguo Zhang; Wenxin Zhang; Cailan Wu; Qiang Jia; Jinyan Chai; Zhaowei Meng; Wei Zheng; Jian Tan

doi:10.3389/fonc.2022.955629

Bone metastases in newly diagnosed patients with thyroid cancer: A large population-based cohort study

Front Oncol. 2022 Aug 12:12:955629. doi: 10.3389/fonc.2022.955629. eCollection 2022.

Authors

Ruiguo Zhang¹, Wenxin Zhang¹, Cailan Wu², Qiang Jia¹, Jinyan Chai¹, Zhaowei Meng¹, Wei Zheng¹, Jian Tan¹

Affiliations

¹ Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China.
² Department of Nuclear Medicine, Tianjin Fourth Central Hospital, Tianjin, China.

Abstract

Background: Population-based estimates of the incidence and prognosis of bone metastases (BM) stratified by histologic subtype at diagnosis of thyroid cancer are limited.

Methods: Using multivariable logistic and Cox regression analyses, we identified risk factors for BM and investigated the prognostic survival of BM patients between 2010 and 2015 via the Surveillance, Epidemiology, and End Results (SEER) database.

Results: Among 64,083 eligible patients, a total of 347 patients with BM at the time of diagnosis were identified, representing 0.5% of the entire cohort but 32.4% of the subset with metastases. BM incidence was highest (11.6%) in anaplastic thyroid cancer (ATC), which, nevertheless, was highest (61.5%) in follicular thyroid cancer (FTC) among the subset with metastases. The median overall survival among BM patients was 40.0 months, and 1-, 3-, and 5-year survival rates were 65.2%, 51.3%, and 38.7%, respectively. Compared with papillary thyroid cancer (PTC), FTC (aOR, 6.33; 95% CI, 4.72-8.48), medullary thyroid cancer (MTC) (aOR, 6.04, 95% CI, 4.09-8.92), and ATC (aOR, 6.21; 95% CI, 4.20-9.18) significantly increased the risk of developing BM. However, only ATC (aHR, 6.07; 95% CI, 3.83-9.60) was independently associated with worse survival in multivariable analysis. Additionally, patients with BM alone (56.5%) displayed the longest median survival (66.0 months), compared with those complicated with one extraskeletal metastatic site (lung, brain, or liver) (35.2%; 14.0 months) and two or three sites (8.3%; 6.0 months). The former 5-year overall survival rate was 52.6%, which, however, drastically declined to 23.0% in patients with one extraskeletal metastatic site and 9.1% with two or three sites.

Conclusion: Closer bone surveillance should be required for patients with FTC, MTC, and ATC, and extraskeletal metastases at initial diagnosis frequently predict a poorer prognosis.

Keywords: SEER (Surveillance Epidemiology and End Results) database; bone metastases; epidemiology; histologic subtype; population-based study; thyroid cancer.