title: Prognostic factors in patients with well-differentiated thyroid cancer presenting with pulmonary metastasis.
abstract: OBJECTIVE
  Survival outcomes in patients presenting with well-differentiated thyroid cancer with pulmonary metastasis are variable. The aim of this study was to evaluate prognostic factors for outcome in this patient population.
  
  
  METHODS
  A prospective registry database was searched to identify patients presenting with pulmonary metastasis from well-differentiated thyroid cancer. All patients underwent total thyroidectomy and postoperative I-131 therapy. Cox proportional hazards modeling was performed to evaluate prognostic factors for survival outcomes.
  
  
  RESULTS
  Forty (40) patients were identified with well-differentiated thyroid cancer involving the thyroid and metastatic to cervical lymph nodes and lung at initial diagnosis. The median follow-up was 9.7 years for those alive at last follow-up. Cox proportional hazards modeling evaluated age at diagnosis, gender, primary tumor size, and vascular invasion on cause-specific and progression-free survivals. Age at diagnosis was the only significant independent prognostic factor (p = 0.0035). The 10-year cause-specific survivals were 100% in patient's < or =40 years, compared to 36% for those >40 years (p < 0.0001). The corresponding 10-year progression-free survivals were 69% and 12% (p = 0.0003).
  
  
  CONCLUSIONS
  Patients < or =40 years of age presenting with pulmonary metastasis from well-differentiated thyroid cancer had an excellent prognosis. Older patients have a poor survival outcome. Postoperative I-131 therapy is recommended in all patients.
authors.affiliation: Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
authors.forename: Barry A
authors.initials: BA
authors.lastname: Siegel
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Moley
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Baranski
authors.forename: Perry W
authors.initials: PW
authors.lastname: Grigsby
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000473:pathology* / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D016016:Proportional Hazards Models; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology*
chemical_list: D007457:Iodine Radioisotopes