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Endocrine Abstracts (2023) 92 PS3-27-06 | DOI: 10.1530/endoabs.92.PS3-27-06

1Univ. Lille, Cnrs, Inserm, Chu Lille, Umr9020-U1277 - Canther - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France, Endocrinology, Lille, France; 2Gustave Roussy, Département D’imagerie Médicale, Service de Médecine Nucléaire et Cancérologie Endocrinienne, [email protected], Villejuif, France; 3Department of Public Health, Valenciennes Hospital, France., Lille, France; 4Department of Endocrinology and Metabolism, University Hospital of Lille, France., Lille, France; 5Gustave Roussy, Villejuif, France; 6Department of Endocrinology and Metabolism, Armentières Hospital, France, Armentières, France; 7Department of Nuclear Medicine, University Hospital of Lille and Lille University, France, Lille, France; 8Department of Endocrinology and Metabolism, University Hospital of Lille, France., University of Lille, Lille, France, Lille, France; 9Cancer Campus Gustave Roussy, Villejuif, France; 10Gustave Roussy, Université Paris-Sud, Villejuif, France, Villejuif, France; 11Hug, Hug, Publier, France; 12Department of Endocrinology and Metabolism, University Hospital of Lille, France., France

Purpose: Bone metastases (BM) are frequent in differentiated thyroid cancer (DTC). These patients may present skeletal-related events (SRE), the leading cause of DTC-related morbidity. We aimed to evaluate the clinical features, treatment approaches, and outcomes including overall survival (OS) of DTC patients with BM complicated by SRE and their evolution over time.

Methods: 178 consecutive DTC patients harbouring BM were enrolled in this retrospective study conducted in two tertiary referral centres of the French ENDOCAN-TUTHYREF network between 1989 and 2015. SRE were defined as the need for any bone irradiation or surgery, spinal cord compression, pathologic fractures or hypercalcemia.

Results: A hundred and twenty-seven patients (71.3%) had SREs associated with BM including the 75 cases (42.1%) with SRE occurring at diagnosis. The median time to first SRE was 13 months [0-67.5]. Seventy-six patients (66%) had multiple SRE (median: 2 (1-3). The most frequent SRE was the need for radiotherapy (75.6%) following by bone surgery (58.3%) and pathologic fractures (52%). In patients with SRE, before 2005 (n =54), the number of locoregional treatment (LTR) performed was respectively 94 in 55 patients before 2005 and 155 in 78 patients after 2005. Bone resorption inhibitors (BRI) were used in 34% of the patients with SRE being prescribed for osteolytic BM only (29.6% of the cohort before 2005 and 38.7% after 2005). Pathological fracture occurred respectively in 34 patients (63%) and 40 patients (51.2%) before and after 2005. In the multivariate analysis, only osteolysis and aggressive variants or poorly DTC (PDTC) were able to predict SRE (OR, 6.7; 95% CI, 1.4-34.9, P = 0.02; OR, 7.7; 95% CI, 1.2-50, P = 0.03 respectively); no association was found with an age > 55 years (P = 0.3), synchronous BM (P =0.3), number of BM (P = 0.055), BM FDG-PET/CT uptake (P = 0.129) and the RAI refractory status (P = 0.6). Among the patient with BM FDG-PET/CT uptake, 92% patients had a SRE. The median OS from BM diagnosis for patients with SRE was 45 months (24–81.7) vs 72 months (33.7-101) for patients without SRE. The occurrence of SRE (HR, 0.6; 95% CI, 0.2-1.4, P = 0.246) was not independently associated with increased overall mortality in multivariate analysis.

Discussion: Almost two thirds of DTC patients with BM experience a SRE. Osteolysis and aggressive variants or PDTC were associated to higher risk of SRE. We observed an increased in LTR and BRI prescription after 2005 with a decrease of pathological fracture. Among these patients, SRE occurrence did not impact OS.

Volume 92

45th Annual Meeting of the European Thyroid Association (ETA) 2023

European Thyroid Association 

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