Causes And Treatment Of Differentiated Thyroid Carcinoma With Bone Metastasis

ObjectiveTo investigate the clinical features and risk factors of differentiated thyroid carcinoma(DTC)with bone metastases and summarize the causes of bone metastases.Pay more attention to patients with high risk factors,and standardize the management of postoperative follow-up.To explore the main treatment methods and curative effect of DTC with bone metastases,and provide reference for the clinical treatment of patients with bone metastases.Methods56 patients with bone metastases resulting from DTC were treated in Chinese PLA General Hospital from January 2008 to June 2016.Collected the clinical data of these 56 patients and summarized the clinical features of DTC patients with bone metastases.Collected and retrospectively analyzed the clinical data,such as age,gender,pathological type,single/multiple foci,extra-thyroid invasion and the number of cervical lymph node metastases,which may related to the DTC with bone metastases.Using single factor analysis and multivariate logistic regression analysis to investigate the reason of DTC patients with bone metastases.The risk factors which influenced the time from thyroidectomy to bone metastasis for DTC were analyzed by Wilcoxon test,life table analysis,and Cox regression analysis.Retrospective analysis of 52 patients with bone metastases resulting from DTC,who were treated the lesions of bone metastases by surgery alone,1311 alone or surgery combined with 1311.According to different treatment methods we divided patients into three groups:A group:20 patients were treated by surgery alone;group B:22 patients were treated by 1311 alone;C group:10 patients were treated by surgery combined with 1311.The differences in the rate of pain remission and the efficacy of bone metastases were compared between the three groups.Results1.The lesions of bone metastases from DTC were mainly occurred in the vertebrae.Multiple osteolytic bone metastases were;frequently observed in patients.The peak age of first diagnosed as bone metastases was 40-70 years old,and many patients had associated symptoms of bone metastases.2.Single-factor analysis showed that gender,pathological type,single/multiple foci,extra-thyroid invasion and the number of cervical lymph node metastasis are related to DTC with bone metastasis(P<0.05).Multivariate logistic regression analysis showed that the pathological types of follicular carcinoma,tumor multifocal,extra-thyroid invasion,the number of cervical lymph node metastases ? 6 are the independent risk factors of DTC patients with bone metastasis.3.Univariable analysis revealed that patients with extrathyroid extension and multifocal lesions had less time to metastasis.Multivariable Cox analysis revealed that extrathyroid extension and multifocal lesions are the independent factors influenced the time from thyroidectomy to bone metastasis for DTC.4.The patients in the surgery alone group and in the surgery combined with 131I group were have a better curative effect than in the 131I alone group in the pain relief rate of DTC with bone metastases,while there was no significant difference between surgery alone group and surgery combined with 131I group.The efficiency of bone metastases in the surgery combined with 131I group was better than that of the surgery alone group and the 131I alone group,but there was no significant difference between the surgery alone group and the 131I alone group.Conclusions1.The lesions of bone metastases from DTC are mainly occurred in the vertebrae;Multiple osteolytic bone metastases and local bone pain are often been found in patients.Doctors should pay more attention to patients,when unexplained skeletal pain occurs in DTC patients.2.Follicular thyroid carcinoma,multifocal lesions,extra-thyroidal invasion,and the number of lymph node metastasis?6 are independent risk factors for DTC patients with bone metastases.Patients with these high-risk factors should have a more strengthen postoperative follow-up.3.Extrathyroid extension and multifocal lesions are the independent factors influenced the time from thyroidectomy to bone metastasis for DTC.We should pay more attention to the patients with high-risk factors and develop a more careful follow-up planing.To improve the quality of life and prolong life survival.4.Surgical treatment can better relieve the pain of bone metastases in patients and improve the quality of life;1311 treatment can better control systemic bone metastases;surgery combined with 1311 treatment is the preferred treatment for DTC patients with bone metastases,which can effectively relieve local bone pain,improve the quality of life and prolong life survival.