Thyroid Cancer Brain Metastasis Survival and Genomic Characteristics of a Large Tertiary Care Cohort
Thyroid Cancer Brain Metastasis Survival and Genomic Characteristics of a Large Tertiary Care Cohort
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DOI：
10.1097/rlu.0000000000002618
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发表时间：
2019-07-01
影响因子：
10.6
通讯作者：
Grewal, Ravinder K.
中科院分区：
文献类型：
--
作者：
Osborne, Joseph R.;Kondraciuk, Jessica D.;Grewal, Ravinder K.
目的分化型甲状腺癌（DTC）脑转移（BM）是一种少见的预后不良的肿瘤。我们研究了这一人群中总生存期（OS）的危险因素，并探讨了基因组改变的模式。方法单机构回顾性分析2000年1月至2016年11月收治的79例DTC患者。多个预后因素，包括年龄，性别，远端转移（DM），诊断时间，DM网站，BM诊断时间，BM数量和大小，基因组测序数据，颅骨切除术，外照射放射治疗，激酶抑制剂治疗，进行了评估。进行单变量和多变量分析。结果骨髓移植后中位生存期为18个月。1年和3年生存率分别为63%和33%。单因素分析确定了4个与生存期延长相关的协变量：DTC诊断和BM之间的时间小于3年（P = 0.01），从初始DM诊断到BM的时间为22个月或更短（P = 0.03），3个BM部位或更少（P = 0.002）和颅骨切除术（P = 0.05）。多变量模型显示与OS相关的3个变量：DTC诊断至BM时间小于3年（P = 0.04）、颅骨切除术（P = 0.06）和BM部位少于3个的患者（P = 0.06）。大多数BM患者存在端粒酶逆转录酶启动子突变，然而，突变状态不是生存的独立预测因子。结论对于DTC的BM，DTC诊断和BM之间的时间间隔，BM部位的数量和颅骨切除术与OS独立相关。需要进一步研究来确定基因组突变在晚期癌症中的作用。
Purpose Brain metastases (BMs) in patients with differentiated thyroid cancer (DTC) are rare but associated with poor prognosis. We examined risk factors for overall survival (OS) in this population and explored the pattern of genomic alterations. Methods Single-institution, retrospective review of all patients with DTC from January 2000 to November 2016 identified 79 patients for analysis. Multiple prognostic factors, including age, gender, distal metastasis (DM), diagnosis time, DM sites, BM diagnosis time, BM number and size, genomic sequencing data, craniectomy, external beam radiation therapy, and kinase inhibitor therapies, were evaluated. Univariate and multivariate analyses were performed. Results Median survival after BM was 18 months. One- and 3-year survival rates were 63% and 33%, respectively. Univariate analysis identified 4 covariates correlated with prolonged survival: time between DTC diagnosis and BM for less than 3 years (P = 0.01), time from initial DM diagnosis to BM for 22 months or less (P = 0.03), 3 BM sites or fewer (P = 0.002), and craniectomy (P = 0.05). Multivariate model revealed 3 variables associated with OS: DTC diagnosis to BM time of less than 3 years (P = 0.04), craniectomy (P = 0.06), and patients with fewer than 3 BM sites (P = 0.06). The majority of patients with BM had a telomerase reverse transcriptase promoter mutation, However, mutational status was not an independent predictor of survival. Conclusions For BM from DTC, time interval between DTC diagnosis and BM, number of BM sites, and craniectomy were independently associated with OS. Further studies are needed to define the role of genomic mutations in advanced cancer.