The Benefit of Primary Tumor Surgical Resection in Distant Metastatic Carcinomas of the Thyroid

Objectives/Hypothesis Thyroid cancer with distant metastasis (TCDM) at diagnosis has significantly worse survival rates when compared to localized/regional thyroid cancer. This study sought to report on the characteristics of patients presenting with TCDM and the potential survival advantage of surgical resection. Study Design Data were acquired from the Surveillance, Epidemiology, and End Results (SEER) database with cases from 2004 to 2015. Methods TCDM cases (n = 2,558) were identified from the SEER database. The Bonferroni correction was applied for multivariate analysis. Kaplan-Meier analysis was utilized to obtain disease-specific survival (DSS) rates. Cox regression analysis was utilized to identify independent factors significantly associated with survival. Results The average age of diagnosis of TCDM was 62.0 (+/- 17.5) years. Patients were predominantly white (74.6%), female (54.6%), in a relationship (56.0%), and between ages 36 and 80 years (76.4%). Cases consisted of papillary (57.2%), follicular (16.0%), medullary (8.9%), anaplastic (17.9%) TCDM histological variants. Overall 1-, 5-, and 10-year DSS rates were 72.0%, 56.8%, and 43.8%, respectively. Anaplastic and medullary variants had the worst 10-year DSS (0% and 25.5%, respectively). Patients who underwent surgical resection only and surgical resection with radiation were 49% and 59% less likely to die, respectively. Treatment, age, histology, T staging, relationship status, and metastasis site were determined to be significant predictors of survival. Conclusions Surgical resection with radiation was found to be a significant predictor of survival after applying the Bonferroni correction for all thyroid cancer variants except medullary. To increase survival, surgical intervention should be recommended in patients who are deemed to be medically tolerant of surgery. Level of Evidence 4Laryngoscope, 2020

Automated summary

Thyroid cancer with distant metastasis (TCDM) at diagnosis has worse survival rates compared to localized/regional thyroid cancer. Surgical resection with radiation was found to be a significant predictor of survival for TCDM patients, except for medullary variants. Surgical intervention should be recommended for medically tolerant patients to increase survival.