Prognostic Factors in Thyroid Cancer Patients With Brain Metastases: A Systematic Review and Meta-Analysis.

Abstract

Background: Brain metastases from thyroid cancer (TC) are rare but signify an advanced stage of the disease with poor survival outcomes. This study aimed to identify prognostic factors associated with brain metastasis-specific survival (BMS) in patients with brain metastases from TC. Methods: A systematic review and meta-analysis were conducted. Data were extracted from studies retrieved from PubMed, Scopus, Embase, and MEDLINE up to July 18, 2025. A multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) for potential prognostic factors. Results: A total of 24 studies, including 301 patients with brain metastases from TC, were included. BMS was 18 months (confidence interval [CI], 1.07 to 3.56). Key prognostic factors associated with decreased BMS included anaplastic thyroid carcinoma (HR, 3.3; CI, 1.06 to 10.3; p = 0.04), poorly differentiated thyroid carcinoma (HR, 1.95; CI, 1.07 to 3.56; p = 0.03), poor performance status (Eastern Cooperative Oncology Group >1) (HR, 2.62; CI, 1.69 to 4.05; p < 0.001), multiple brain metastases (HR, 1.89; CI, 1.24 to 2.89; p = 0.004), and the presence of distant metastases (HR, 1.97; CI, 1.13 to 3.44; p = 0.018). Neither the size nor the anatomical location of brain metastases was significantly associated with BMS. Conclusions: Brain metastases from TC are associated with poor survival, with key prognostic factors including aggressive tumor subtypes, poor performance status, multiple brain metastases, and the presence of extracranial metastases, particularly in the lungs. These findings highlight the need for a multidisciplinary approach and the importance of systemic disease control in improving outcomes for this challenging patient population.