title: Local recurrence in the neck and survival after thyroidectomy for metastatic renal cell carcinoma.
abstract: BACKGROUND
  Most investigations of thyroidectomy for metastatic renal cell carcinoma (RCC) are case studies or small series. This study was conducted to determine the contribution of clinical and histopathologic variables to local recurrence in the neck and overall survival after thyroidectomy for RCC metastases.
  
  
  METHODS
  The medical records of 140 patients with thyroidectomy for metastatic RCC performed between 1979 and 2012 at 25 institutions in Germany and Austria were analyzed.
  
  
  RESULTS
  The median interval between nephrectomy and thyroidectomy was 120 months. Concurrence of thyroid and pancreatic metastases was present in 23 % of the patients and concurrence of thyroid and adrenal metastases in 13 % of the patients. Clinical outcome data were available for 130 patients with a median follow-up period of 34 months. The 5-year overall survival rate was 46 %, and 28 % of patients developed a local neck recurrence at a median of 12 months after thyroidectomy. Multivariate analysis showed that invasion of adjacent cervical structures (hazard ratio [HR] 3.2; p = 0.001), patient age exceeding 70 years (HR 2.5; p = 0.004), and current or past evidence of metastases to nonendocrine organs (HR 2.4; p = 0.003) were independent determinants of inferior overall survival. Conversely, invasion of adjacent cervical structures (HR 12.1; p < 0.0001) and year of thyroidectomy (HR 5.7 before 2000; p < 0.0001) were shown to be independently associated with local recurrence in the neck by multivariate analysis.
  
  
  CONCLUSIONS
  Although significant improvement of local disease control in patients with thyroid metastases of RCC has been achieved during the last decade, overall outcome continues to be poor for patients with locally invasive thyroid metastases.
authors.affiliation: Department of Surgery, University of Regensburg, Regensburg, Germany, iesalnieks_igors@hotmail.com.
authors.forename: Igors
authors.initials: I
authors.lastname: Iesalnieks
authors.forename: Andreas
authors.initials: A
authors.lastname: Machens
authors.forename: Claudia
authors.initials: C
authors.lastname: Bures
authors.forename: Detlef
authors.initials: D
authors.lastname: Krenz
authors.forename: Hauke
authors.initials: H
authors.lastname: Winter
authors.forename: Christian
authors.initials: C
authors.lastname: Vorländer
authors.forename: Evelyne
authors.initials: E
authors.lastname: Bareck
authors.forename: Pier F
authors.initials: PF
authors.lastname: Alesina
authors.forename: Thomas
authors.initials: T
authors.lastname: Musholt
authors.forename: Thomas
authors.initials: T
authors.lastname: Steinmüller
authors.forename: Matthias
authors.initials: M
authors.lastname: Anthuber
authors.forename: Peter
authors.initials: P
authors.lastname: Goretzki
authors.forename: Arnold
authors.initials: A
authors.lastname: Trupka
authors.forename: Max
authors.initials: M
authors.lastname: Mayr
authors.forename: Theresia
authors.initials: T
authors.lastname: Weber
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: Henning
authors.initials: H
authors.lastname: Dralle
authors.forename: Michael
authors.initials: M
authors.lastname: Hermann
authors.forename: Ayman
authors.initials: A
authors.lastname: Agha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology* / Q000601:surgery; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*