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Survival and Therapeutic Modalities in Patients with Bone Metastases of Differentiated Thyroid Carcinomas

Departments of Nuclear Medicine (M.-O.B., L.L., A.A.), Pathology (C.H.), General and Gastrointestinal Surgery (F.M.), Endocrinology (G.T.), Neuroradiology (J.C.), and Orthopedic Surgery (E.E., G.S.), Hôpital Pitié-Salpêtrière, 75013 Paris, France; Epidemiology and Information Science, INSERM, U-444, Université Paris 7 (J.-Y.M.), 75005 Paris, France; and Quantitative Medical Imaging Unit, INSERM, U-494, Hôpital Pitié-Salpêtrière (M.-O.B., L.L., G.H., A.A.), 75651 Paris, France

Address all correspondence and requests for reprints to: Dr. Marie O. Bernier, Service de Médecine Nucléaire, Hôpital Pitié-Salpêtrière, 47–83 boulevard de l’Hôpital, 75651 Paris Cedex 13, France. E-mail: gilles.hejblum{at}imed.jussieu.fr

Data for patients with bone metastases (BMs) of differentiated thyroid carcinoma (DTC) were retrospectively studied to identify factors associated with survival. We especially studied the impact of therapies. Among the 1977 patients followed for DTC in our department from 1958 to 1999, 109 (77 females and 32 males; age range, 20–87 yr) presented BMs. All patients except 1 underwent total thyroidectomy, followed by radioiodine therapy (3.7 gigabecquerels) in 95 cases. Survival rates at 5 and 10 yr were 41% and 15%, respectively. Univariate analyses indicated that a young age at BM discovery (P < 0.005) and the discovery of BM as a revealing symptom of DTC (P < 0.05) were features significantly associated with improved survival as well as radioiodine therapy (P < 10^-4) and BM complete surgery (P < 0.02). Using multivariate analysis, the detection of BMs as a revealing symptom of thyroid carcinoma (P < 0.0005), the absence of metastasis appearance in other organs than bones during the follow-up (P < 0.03), the cumulative dose of radioiodine therapy (P < 0.0001), and complete BM surgery in young patients (P < 0.04) appeared as independent prognostic features associated with an improved survival.

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