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Pleural effusion linked to poor survival in thyroid cancer

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David Broome

BOSTON — Among patients with well-differentiated metastatic thyroid carcinoma, mortality risk factors include older age, incomplete tumor resection, certain metastasis locations and, notably, pleural effusion among those with lung metastases, according to data presented here.

“This is the first time that development of a pleural effusion was identified as a significant risk factor for decreased overall survival and cancer-specific survival in patients with metastatic well-differentiated thyroid carcinoma,” David Broome, MD, an internal medicine resident at the Cleveland Clinic Foundation, told Endocrine Today. “The development of a pleural effusion and its significant association with a decrease in [overall survival] and [cancer-specific survival] represent a novel prognostic finding.”

Broome and colleagues conducted a retrospective cohort review of 139 patients with well-differentiated metastatic thyroid cancer (60.4% men; median age at diagnosis, 59 years; 84% white; 10.4% black) seen at a tertiary care center between 1990 and 2010. Researchers used a 15-year Kaplan-Meier survival estimate for overall and cancer-specific survival and Cox proportional hazard models.

Among the cohort, 75.6% of patients had papillary thyroid cancer, 21.5% had follicular thyroid cancer and nearly 3% had Hürthle cell disease; 37 patients died, with a median 70.5 months from diagnosis to death, for a 26.6% 15-year mortality rate overall and 23% cancer-specific mortality rate.

Patients older than 45 years had an HR for cancer-specific mortality of 3.62 (95% CI, 1.21-10.85). Cancer-specific mortality was also increased for those with metastases in multiple locations (HR = 4.06; 95% CI, 1.41-11.67), incomplete tumor resection (HR = 2.47; 95% CI, 1.19-5.1), bone metastases (HR = 2.32; 95% CI, 1.08-4.97), other metastases (HR = 3.19; 95% CI, 1.49-6.82) and higher MACIS tumor rating score (HR = 1.91; 95% CI, 1.39-2.62).

Lung metastases were the most common site, observed in 37.5% of the cohort. The HR among those with pleural effusion was 5.14 (95% CI, 1.59-16.64) for cancer-specific mortality and 6.02 (95% CI, 1.97-18.37) for overall mortality.

“The most surprising finding from our research is the profound effect of pleural effusion on prognosis and that its hazard ratio is higher than any of the previously identified prognostic risk factors for patients, yet this is not a finding we are mindful of when caring for patients with metastatic well-differentiated thyroid carcinoma,” Broome said. “Our research findings suggest that, maybe, endocrinologists should consider pleural effusion when determining prognosis for patients with metastatic well-differentiated thyroid carcinoma.” – by Jill Rollet

Reference:

Broome S, et al. Abstract 1059. Presented at: AACE Annual Scientific and Clinical Congress; May 16-20, 2018; Boston.

Disclosure: Broome reports no relevant financial disclosures.