Advertisement

World Journal of Surgery

, Volume 42, Issue 11, pp 3632–3637 | Cite as

Clinical Status and Treatment of Liver Metastasis of Differentiated Thyroid Cancer Using Tyrosine Kinase Inhibitors

  • Yoshiyuki Saito
  • Kiminori Sugino
  • Hiroshi Takami
  • Kenichi Matsuzu
  • Takashi Uruno
  • Keiko Ohkuwa
  • Wataru Kitagawa
  • Mitsuji Nagahama
  • Hirofumi Kawakubo
  • Koichi Ito
  • Yuko Kitagawa
Original Scientific Report
  • 88 Downloads

Abstract

Background

Treatment of patients with liver metastasis of differentiated thyroid carcinoma (DTC) has not been sufficiently defined, because liver metastasis of DTC has been described mostly as case reports. Additionally, such patients are considered end-of-treatment responders. A relatively new approach using tyrosine kinase inhibitors (TKIs) may provide opportunities to manage systemic metastasis. This study aims to define the clinical features of DTC patients with liver metastasis and evaluate the benefits of TKIs.

Methods

We retrospectively analyzed clinical features of 29 patients (mean age 67.8 years) diagnosed with liver metastasis of DTC at our institution between January 1981 and May 2017.

Results

All patients had distant metastasis at other organ sites upon diagnosis of liver metastasis; 41% of them developed new metastasis afterward. Management after diagnosis of liver metastasis comprised palliative care (48%), radioactive iodine therapy (28%), and TKI therapy (24%). The median survival after diagnosis of liver metastasis was only 4.8 months. Survival rates were significantly better in patients with performance statuses between 0 and 2 on the Eastern Cooperative Oncology Group scale at diagnosis of liver metastasis (n = 22, 76%) treated with TKI compared to those who were not (P = 0.017; log-rank test; hazard ratio 0.19). One-year survival rates were 71.4 and 26.7% for patients treated with or without TKI, respectively.

Conclusions

Patients with liver metastasis had poor clinical prognosis. When other distant metastases existed at diagnosis of liver metastasis, TKI therapy was considered an effective therapeutic option for patients with liver metastasis of DTC.

Notes

Authors’ contribution

YS, KS, HT, TU, and KO contributed to study conception and design. YS, KS, and KM helped in analysis and interpretation of data. YS, KS, and HT contributed to drafting manuscript. WK, MN, HK, KI, and YK helped in revising the manuscript. YK contributed to final approval of the article.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Mazzaferri EL, Kloos RT (2001) Clinical review 128: current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 86:1447–1463CrossRefGoogle Scholar
  2. 2.
    Hundahl SA, Fleming ID, Fremgen AM et al (1998) A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985–1995. Cancer 83:2638–2648CrossRefGoogle Scholar
  3. 3.
    Schlumberger MJ (1998) Papillary and follicular thyroid carcinoma. New Engl J Med 338:297–306CrossRefGoogle Scholar
  4. 4.
    Casara D, Rubello D, Saladini G et al (1993) Different features of pulmonary metastases in differentiated thyroid cancer: natural history and multivariate statistical analysis of prognostic variables. J Nucl Med 34:1626–1631PubMedGoogle Scholar
  5. 5.
    Shaha AR, Shah JP, Loree TR (1997) Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg 174:474–476CrossRefGoogle Scholar
  6. 6.
    Lin JD, Huang MJ, Juang JH et al (1999) Factors related to the survival of papillary and follicular thyroid carcinoma patients with distant metastases. Thyroid 9:1227–1235CrossRefGoogle Scholar
  7. 7.
    Clark JR, Lai P, Hall F et al (2005) Variables predicting distant metastases in thyroid cancer. Laryngoscope 115:661–667CrossRefGoogle Scholar
  8. 8.
    Benbassat CA, Mechlis-Frish S, Hirsch D (2006) Clinicopathological characteristics and long-term outcome in patients with distant metastases from differentiated thyroid cancer. World J Surg 30:1088–1095.  https://doi.org/10.1007/s00268-005-0472-4 CrossRefPubMedGoogle Scholar
  9. 9.
    Lang BH, Wong KP, Cheung CY et al (2013) Evaluating the prognostic factors associated with cancer-specific survival of differentiated thyroid carcinoma presenting with distant metastasis. Ann Surg Oncol 20:1329–1335CrossRefGoogle Scholar
  10. 10.
    Madani A, Jozaghi Y, Tabah R et al (2015) Rare metastases of well-differentiated thyroid cancers: a systematic review Ann. Surg Oncol 22:460–466CrossRefGoogle Scholar
  11. 11.
    Song HJ, Xue YL, Xu YH et al (2011) Rare metastases of differentiated thyroid carcinoma: pictorial review. Endocr Relat Cancer 18:R165–R174CrossRefGoogle Scholar
  12. 12.
    Haugen BR, Alexander EK, Bible KC et al (2015) American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016(26):1–133Google Scholar
  13. 13.
    Brown AP, Greening WP, McCready VR et al (1984) Radioiodine treatment of metastatic thyroid carcinoma: the Royal Marsden Hospital experience. Br J Radiol 57:323–327CrossRefGoogle Scholar
  14. 14.
    Mizukami Y, Michigishi T, Nonomura A et al (1990) Distant metastases in differentiated thyroid carcinomas: a clinical and pathologic study. Hum Pathol 21:283–290CrossRefGoogle Scholar
  15. 15.
    Shah DH, Samuel AM (1996) Metastasis to the liver in well-differentiated carcinoma of the thyroid. Thyroid 6:607–611CrossRefGoogle Scholar
  16. 16.
    Wood WJ Jr, Singletary SE, Hickey RC (1989) Current results of treatment for distant metastatic well-differentiated thyroid carcinoma. Arch Surg 124:1374–1377CrossRefGoogle Scholar
  17. 17.
    Silliphant WM, Klinck GH, Levitin MS (1964) Thyroid carcinoma and death. A clinicopathological study of 193 autopsies. Cancer 17:513–525CrossRefGoogle Scholar
  18. 18.
    Silverberg SG, Hutter RV, Foote FW Jr (1970) Fatal carcinoma of the thyroid: histology, metastases, and causes of death. Cancer 25:792–802CrossRefGoogle Scholar
  19. 19.
    Heitz P, Moser H, Staub JJ (1976) Thyroid cancer: a study of 573 thyroid tumors and 161 autopsy cases observed over a thirty-year period. Cancer 37:2329–2337CrossRefGoogle Scholar
  20. 20.
    Kouso H, Ikegami T, Ezaki T et al (2005) Liver metastasis from thyroid carcinoma 32 years after resection of the primary tumor: report of a case. Surg Today 35:480–482CrossRefGoogle Scholar
  21. 21.
    Ohwada S, Iino Y, Hosomura Y et al (1993) Solitary metastasis from papillary thyroid carcinoma in cirrhotic liver with hepatocellular carcinoma. Jpn J Clin Oncol 23:309–312PubMedGoogle Scholar
  22. 22.
    Kondo T, Katoh R, Omata K et al (2000) Incidentally detected liver metastasis of well-differentiated follicular carcinoma of the thyroid, mimicking ectopic thyroid. Pathol Int 50:509–513CrossRefGoogle Scholar
  23. 23.
    Salvatori M, Perotti G, Rufini V et al (2004) Solitary liver metastasis from Hurthle cell thyroid cancer: a case report and review of the literature. J Endocrinol Invest 27:52–56CrossRefGoogle Scholar
  24. 24.
    Wertenbroek MW, Links TP, Prins TR et al (2008) Radiofrequency ablation of hepatic metastases from thyroid carcinoma. Thyroid 18:1105–1110CrossRefGoogle Scholar
  25. 25.
    Farina E, Monari F, Tallini G et al (2016) Unusual thyroid carcinoma metastases: a case series and literature review. Endocr Pathol 27:55–64CrossRefGoogle Scholar
  26. 26.
    Guglielmi R, Pacella CM, Dottorini ME et al (1999) Severe thyrotoxicosis due to hyperfunctioning liver metastasis from follicular carcinoma: treatment with (131)I and interstitial laser ablation. Thyroid 9:173–177CrossRefGoogle Scholar
  27. 27.
    Agriantonis DJ, Hall L, Wilson MA (2009) Utility of SPECT/CT as an adjunct to planar whole body I-131 imaging: liver metastasis from papillary thyroid cancer. Clin Nucl Med 34:247–248CrossRefGoogle Scholar
  28. 28.
    Kraft O (2005) Hepatic metastasis of differentiated thyroid carcinoma. Nucl Med Rev Cent East Eur 8:44–46PubMedGoogle Scholar
  29. 29.
    Brose MS, Nutting CM, Jarzab B et al (2014) Sorafenib in radioactive iodine-refractory, locally advanced or metastatic differentiated thyroid cancer: a randomised, double-blind, phase 3 trial. Lancet 384:319–328CrossRefGoogle Scholar
  30. 30.
    Schlumberger M, Tahara M, Wirth LJ et al (2015) Lenvatinib versus placebo in radioiodine-refractory thyroid cancer. New Engl J Med 372:621–630CrossRefGoogle Scholar
  31. 31.
    Brient C, Mucci S, Taieb D et al (2015) Differentiated thyroid cancer with liver metastases: lessons learned from managing a series of 14 patients. Int Surg 100:490–496CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Yoshiyuki Saito
    • 1
    • 2
  • Kiminori Sugino
    • 1
  • Hiroshi Takami
    • 1
  • Kenichi Matsuzu
    • 1
  • Takashi Uruno
    • 1
  • Keiko Ohkuwa
    • 1
  • Wataru Kitagawa
    • 1
  • Mitsuji Nagahama
    • 1
  • Hirofumi Kawakubo
    • 2
  • Koichi Ito
    • 1
  • Yuko Kitagawa
    • 2
  1. 1.Department of SurgeryIto HospitalTokyoJapan
  2. 2.Department of Surgery, School of MedicineKeio UniversityTokyoJapan

Personalised recommendations