| Objective Bone is the second most frequent target of distant metastases in DTC patients. The treatment of bone metastasis (BM) in association with differentiated thyroid cance(rDTC)represents a difficult challenge. Given the paucity of patients with BM and the difficulty of treating this disease, few studies have investigated BM from DTC. The aim of this study was to identify the clinical features of DTC patients with BM, to compare the value of various imageological methods in the detection of BM from DTC, to evaluate the efficacy of 131I treatment and identify its influencing factors, and to analyze the survival rates after 131I treatment and its influencing factors.Methods The clinlical data of 106 DTC patients with BM treated by 131I were retrospectively analyzed. The detection rate of 131I-WBS, bone scintigraphy X-ray, CT, MRI to detect BM were compared. Efficacy after 131I treatment was assessed based on the dynamic change of serum thyroglobulin, the palliation of bone pain and the changes of imageology. The variables affecting the response of 131I treatment were identified using univariate analysis. Survival rate after BM diagnosis were estimated using the life table method. The relationship between survival time and several variables were assessed using Kaplan-Meier method for univariates analysis.Results The incidence rate of BM was 8.4% (106/1258) in DTC patients in this study and most of them were osteolytic lesions. Ribs, ilium and thoracic vertebrate were the most common sites of BM in DTC. Twenty-one patients (19.8%) presented with BM as the initial presentation of DTC. BM was more common in patients over 45 years old, and was often multicentric. The detection rate of 131I-WBS, MRI, bone scintigraphy, X-ray,CT to detect BM were 93.8%,96.6%,47.3%,66.5%,38.2%, respectively. After multiple 131I treatment, serum thyroglobulin level were dropped markedly in 34.9% patients and keep stable in 52.8% patients. Bone pain was palliated in 39 (63.9%) of 61 patients with bone pain. By univariate analysis, age, tumor subtype and the presence of nonosseous distant metastases were significant factors with respect to the change of serum thyroglobulin after 131I treatment(P=0.040, 0.014, 0.034). However, no factor was significant for bone pain palliation after 131I treatment (P>0.05). Imageological changes of BM in 77.5% (82/106) patients after 131I treatment are stable. The overall 5-year and 10-year survival rate from the time of diagnosis of BM was 86.5% and 57.9%, respectively. Univariate analysis showed that single metastasis, no nonosseous distant metastases at the time of BM diagnosis, and surgery combined with 131I therapy were significant factors for the survival time of DTC patients with BM (P=0.040, 0.014, 0.039).Conclusions Detailed information regarding the clinical features of BM from DTC were summarized in this study. BM in DTC are often multiple osteolytic lesions. The sensitivities to detect BM from high to low in turn were MRI, 131I-WBS, CT, bone scintigraphy and X-ray. 131I treatment for BM from DTC can make serum thyroglobulin decrease or keep it stable, palliate bone pain and keep BM lesions stable. Therefore, 131I treatment is effective for BM from DTC. Single metastasis, no nonosseous distant metastases at the time of BM diagnosis and surgery combined with 131I therapy significantly contribute the survival rate of DTC patients with BM.
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