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Follicular, medullary thyroid cancer tied to increased bone event risk
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Adults with follicular or medullary thyroid cancer have a higher risk for bone metastases or skeletal-related events compared with adults with papillary thyroid cancer, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
Palak Choksi, MD, assistant professor of medicine, metabolism, endocrinology and diabetes in the department of medicine at the University of Michigan, Ann Arbor, and colleagues evaluated data from the 1991-2011 SEER-Medicare dataset on 30,063 adults (mean age, 64 years) with thyroid cancer to determine the presence of bone events and their effect on mortality.
Among the cohort, the most common type of thyroid cancer was papillary thyroid cancer (82.1%), followed by follicular (8.2%), Hürthle cell (4.5%), medullary (2.9%) and anaplastic (2.3%). Bone metastases developed in 3.9% of participants, 5.5% had a skeletal-related event and 8.1% had bone events (either bone metastases or a skeletal-related event).
Bone event occurrence was higher in participants with follicular thyroid cancer (15%) and medullary thyroid cancer (16.4%) compared with participants with papillary thyroid cancer (6.9%).
Compared with participants aged 50 years or younger, participants older than 65 years were more likely to develop bone metastases (OR = 1.87; 95% CI, 1.45-2.45) and skeletal-related events (OR = 2.4; 95% CI, 1.96-2.97). Bone metastases were more likely to occur in participants with follicular (OR = 2.25; 95% CI, 1.85-2.74) and medullary thyroid cancer (OR = 2.16; 95% CI, 1.6-2.86) compared with participants with papillary thyroid cancer. The same was true for skeletal-related events (follicular, OR = 1.4; 95% CI, 1.15-1.68; medullary, OR = 1.62; 95% CI, 1.23-2.11).
A higher risk for overall mortality (HR = 2.14; 95% CI, 1.94-2.36) and disease-specific mortality (HR = 1.59; 95% CI, 1.48-1.71) was independently associated with the presence of a bone event.
“Bone metastases and skeletal-related events are a serious complication in thyroid cancer,” Choksi told Endocrine Today. “Patients with follicular and medullary thyroid cancer have a greater likelihood of developing bone events. The occurrence of a bone event is an independent poor prognostic indicator. Our findings emphasize the need to appropriately evaluate bone events especially in the high-risk groups. Future studies focusing on the pathogenesis, prevention and treatment of bone events in high-risk patients are needed. In addition, there is a lack of prospective studies evaluating the benefits of denosumab (Prolia/Xgeva, Amgen) and bisphosphonates in thyroid cancer.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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