DISTANT METASTASES IN PAPILLARY THYROID-CARCINOMA - 100 CASES OBSERVED AT ONE INSTITUTION DURING 5 DECADES

The present study was designed to define the factors that predict surv ival in patients with distant metastases (DM) from papillary thyroid c arcinoma. We performed a retrospective review of the records of 100 co nsecutive patients (45 females and 55 males; age range, 8-91 yr) who d eveloped DM after primary treatment at our institution from, 1940-1989 . Median follow-up for the 20 survivors was 21 yr (range, 3-38). Cause -specific survival rates at L, 10, and 15 yr were 40%, 27%, and 24%, r espectively, and were not significantly different between the eras 194 0-1954, 1955-1969, and 1970-1969 (P = 0.74). By univariate analysis, a ge at diagnosis of DM was the most important predictor of survival (P < 0.0001), with improved survival occurring in younger patients. Tumor -related factors associated with improved survival included complete r esection of the primary tumor (P < 0.005), histological grade 1(P = 0. 006), diploid nuclear DNA(P = 0.03), and lung as first site of DM (P = 0.018). By univariate analysis, use of radioiodine therapy was associ ated with improved survival (vs. other forms of therapy, P < 0.001). H owever, by multivariate analysis only age, site of DM. and degree of e xtrathyroidal invasion of the primary tumor were identified as signifi cant predictors of survival. None of the four treatment variables (ext ernal radiation, surgery, chemotherapy, or radioiodine) was a signific ant predictor of survival in the Cox model. Our retrospective data ind icate that 1) outcome has changed little over 5 decades for patients w ith DM from papillary thyroid carcinoma; and 2) current forms of thera py do not appear to impact on survival.