Thyroid carcinoma with bone metastases: a prognostic factor study.

Objective: Occult clinical presentations usually hinder the early detection and management of patients with bone metastases from thyroid carcinoma. We retrospectively investigated the clinical outcomes of such patients from 1993 to 2004 and analyzed the prognostic parameters.

Design: The basic demographic data and manifestations of 44 patients who had thyroid carcinoma with bone metastases were reviewed. We studied the gender, age, locations of metastases, histological types, treatment methods, hypercalcemic episodes and results of treatments. We used Kaplan-Meier survival analysis and log-rank tests to access the statistical significance.

Main outcome: The incidence of bone metastasis from thyroid carcinomas in this series was 5.0%. Twenty patients (45.4%) had follicular, 16 (36.3%) had papillary, 3 (6.8%) had anaplastic, 3 (6.8%) had medullary, and 2 (4.5%) had Hurthel cell carcinomas. Twelve patients had hypercalcemic episodes, ranging from 2.6 to 2.9 mmolL(-1) (mean ± SD: 2.68 ± 0.15 mmolL(-1)). Survival time after bone metastases ranged from 2 months to 8 years (mean ± SD: 5.3 ± 1.3 years). The 5-year survival rate was 79.4% and the 10-year survival rate was 52.9%. Regarding the histological cancer type, patients with papillary and follicular cancers survived significantly longer than those with anaplastic and medullary cancers (p < 0.05). In addition, the patients presenting with hypercalcemia had the worst survival (p < 0.05).

Conclusions: Thyroid carcinoma can present with bone metastases in its early stage. We found that both tumor type and hypercalcemia were significant prognostic factors for survival time.