Publication Abstract

Authors: Choksi P, Papaleontiou M, Guo C, Worden F, Banerjee M, Haymart M

Title: Skeletal Complications and Mortality in Thyroid Cancer: A Population-Based Study.

Journal: J Clin Endocrinol Metab :-

Date: 2017 Jan 25

Abstract: Context: Although bone is a common site for tumor metastases, the burden of bone events (bone metastases and skeletal-related events (SREs)) in patients with thyroid cancer is not well known. Objective: To measure the prevalence of bone events and their impact on mortality in patients with thyroid cancer. Patients, Design, and Setting: We identified patients diagnosed with thyroid cancer between 1991-2011 from the linked Surveillance Epidemiology and End Results-Medicare (SEER-Medicare) dataset. Multivariable logistic regression was used to identify the risk factors for bone metastases and SREs. We used cox proportional hazards regressions to assess the impact of these events on mortality, after adjusting for patient and tumor characteristics. Results: Of the 30,063 patients with thyroid cancer, 1173 (3.9%) developed bone metastases and 1661 patients (5.5%) an SRE. Compared to papillary thyroid cancer, likelihood of developing bone metastases or skeletal-related event was higher in follicular thyroid cancer (OR 2.25, CI: 1.85-2.74 and OR 1.40 CI: 1.15-1.68 respectively) and medullary thyroid cancer (OR 2.16, CI: 1.60-2.86 and OR 1.62 CI: 1.23-2.11). The occurrence of a bone event was associated with greater risk of overall and disease-specific mortality (HR 2.14 CI: 1.94-2.36 and HR: 1.59 CI: 1.48-1.71). Bone events were a poor prognostic indicator even when compared to patients with other distant metastases (p < 0.001, p< 0.001 for overall and disease-specific mortality respectively). Conclusions: Bone events in patients with thyroid cancer are a poor prognostic indicator. Patients with follicular and medullary thyroid cancers are at especially high risk for skeletal complications.