title: DEATH RELATED TO PULMONARY METASTASIS IN PATIENTS WITH DIFFERENTIATED THYROID CANCER.
abstract: OBJECTIVE
  The purpose of the present study was to investigate the predictive factors for shorter disease-specific survival in patients with pulmonary disease secondary to differentiated thyroid cancer (DTC).
  
  
  METHODS
  This was a retrospective cohort study conducted over a 5-year period that included 54 patients with pulmonary disease secondary to DTC during the follow-up. Among these patients, 13 (24.1%) died from the disease. Dedifferentiation characteristics were identified at pathological examination of the metastatic disease (lymph node or distant metastases) and was defined as the abrupt transformation of a well-differentiated tumor into high-grade morphology lacking the original distinct histologic characteristics.
  
  
  RESULTS
  Tumor dedifferentiation marked by cellular aberrations and radioiodine (RAI) therapy resistance occurred in 5 (9.3%) patients. Four of them died due to pulmonary progression (80.0%), and the median survival of this group was 30 months compared to 279 months in the patients without dedifferentiation. The cumulative disease-specific survival was 20.0% in the patients with dedifferentiation during the follow-up versus 46.1% among the cases without this condition (P = .003, log-rank test). Moreover, dedifferentiation was independently associated with shorter disease-specific survival (hazard ratio [HR] = 31.607; 95% confidence interval [CI]: 4.815-207.478; P<.0001, Cox regression model) as were age over 45 years (HR = 10.904; 95% CI: 1.145-103.853; P = .038) and male sex (HR = 4.210; 95% CI: 1.056-16.783; P = .042).
  
  
  CONCLUSIONS
  DTC patients with pulmonary disease exhibited shorter disease-specific survival, particularly those who developed tumor dedifferentiation, and these patients require special attention during follow-up.
  
  
  BACKGROUND
  CI = confidence interval DTC = differentiated thyroid cancer FTC = follicular thyroid carcinoma HR = hazard ratio IQR = interquartile range LN = lymph node LR = likelihood ratio PTC = papillary thyroid carcinoma RAI = radioiodine pTNM = pathologic tumor-node-metastasis stage system.
authors.forename: Ana Kober Nogueira
authors.initials: AK
authors.lastname: Leite
authors.forename: Marco Aurélio Vamondes
authors.initials: MA
authors.lastname: Kulcsar
authors.forename: Beatriz
authors.initials: B
authors.lastname: de Godoi Cavalheiro
authors.forename: Evandro Sobroza
authors.initials: ES
authors.lastname: de Mello
authors.forename: Venâncio Avancini F
authors.initials: VA
authors.lastname: Alves
authors.forename: Claudio Roberto
authors.initials: CR
authors.lastname: Cernea
authors.forename: Leandro Luongo
authors.initials: LL
authors.lastname: Matos
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D000328:Adult; D000367:Age Factors; D002277:Carcinoma / Q000401:mortality* / Q000556:secondary / Q000628:therapy; D002291:Carcinoma, Papillary; D054337:Cell Dedifferentiation; D018450:Disease Progression; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000401:mortality* / Q000556:secondary; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009362:Neoplasm Metastasis; D016016:Proportional Hazards Models; D011836:Radiation Tolerance; D012189:Retrospective Studies; D015996:Survival Rate; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000628:therapy; D013965:Thyroidectomy
chemical_list: D007457:Iodine Radioisotopes