title: Outcomes and Prognostic Factors in Radioiodine Refractory Differentiated Thyroid Carcinomas.
abstract: BACKGROUND
  Outcomes vary among patients with radioiodine refractory (RR) differentiated thyroid cancer (DTC). The prognostic factors for survival are not well-known, resulting in difficulty in selecting patients for new targeted therapies. We assessed overall survival (OS) and cancer-specific survival (CSS) from RR-DTC to identify prognostic factors associated with survival.
  
  
  METHODS
  The data on all cases of metastatic RR-DTC treated in our center from 1990 to 2011 were retrospectively reviewed. Survival was estimated using the Kaplan-Meier method; associated prognostic factors were assessed using Cox's model.
  
  
  RESULTS
  Of 153 cases of metastatic DTC, 59% (n = 91) met a criterion for RR: that is, 60% (n = 55) had at least 1 metastasis without (131)I uptake; 21% (n = 19) had progressive disease (PD) despite (131)I; 19% (n = 17) had persistent disease despite a cumulative activity of (131)I of ≥600 mCi. After the diagnosis of RR, median OS was 8.9 years (95% confidence interval [CI]: 5.4-NR); median CSS was 9.6 years (95% CI: 6.01-NR). In multivariate analyses, PD despite (131)I as a criterion for RR disease and the time from initial diagnosis of DTC to diagnosis of RR <3 years were the only independent prognostic factors for poor OS and CSS. Thyroglobulin doubling time (Tg-DT) was assessed in 31 of 91 cases. Among the 11 patients with Tg-DT for <1 year or undetectable Tg, 6 deaths occurred, whereas only 3 died of 20 patients with Tg-DT >1 year or negative Tg-DT.
  
  
  CONCLUSIONS
  The identification of prognostic factors for decreased survival in RR-DTC may improve the selection of patients for targeted agents.
  
  
  CONCLUSIONS
  This study shows a great heterogeneity in terms of prognosis in radioiodine refractory differentiated thyroid carcinoma. Poorer prognosis is observed in patients with tumor progression or with a diagnosis of radioiodine resistance within 3 years after the initial diagnosis of thyroid cancer. Those findings could lead to improvements in the selection of patients for targeted therapies.
authors.affiliation: Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Johanna
authors.initials: J
authors.lastname: Wassermann
authors.affiliation: Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France Department of Epidemiology, Institute of Nuclear safety and radioprotection, Fontenay aux Roses, France.
authors.forename: Marie-Odile
authors.initials: MO
authors.lastname: Bernier
authors.affiliation: Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Spano
authors.affiliation: Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lepoutre-Lussey
authors.affiliation: Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Buffet
authors.affiliation: Department of Radiotherapy, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Simon
authors.affiliation: Department of Endocrine Surgery, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Ménégaux
authors.affiliation: Department of Pathology, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Tissier
authors.affiliation: Department of Biochemistry, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Leban
authors.affiliation: Thyroid and Endocrine Tumors Unit, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris VI University, Cancer Institute, Paris, France laurence.leenhardt@aphp.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Leenhardt
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D011379:Prognosis; D011836:Radiation Tolerance; D012189:Retrospective Studies; D013954:Thyroglobulin / Q000378:metabolism; D013964:Thyroid Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D013954:Thyroglobulin
keywords: Iodine radioisotopes; Molecular targeted therapy; Survival analysis; Thyroglobulin; Thyroid neoplasm