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Luo, Hongxiu; Tobey, Andrew; Auh, Sungyoung; Cochran, Craig; Zemskova, Marina; Reynolds, James; Lima, Cristiane; Burman, Kenneth; Wartofsky, Leonard; Skarulis, Monica; Kebebew, Electron; Klubo‐Gwiezdzinska, Joanna

The effect of lithium on the progression‐free and overall survival in patients with metastatic differentiated thyroid cancer undergoing radioactive iodine therapy

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  • Media type: E-Article
  • Title: The effect of lithium on the progression‐free and overall survival in patients with metastatic differentiated thyroid cancer undergoing radioactive iodine therapy
  • Contributor: Luo, Hongxiu; Tobey, Andrew; Auh, Sungyoung; Cochran, Craig; Zemskova, Marina; Reynolds, James; Lima, Cristiane; Burman, Kenneth; Wartofsky, Leonard; Skarulis, Monica; Kebebew, Electron; Klubo‐Gwiezdzinska, Joanna
  • imprint: Wiley, 2018
  • Published in: Clinical Endocrinology
  • Language: English
  • DOI: 10.1111/cen.13806
  • ISSN: 0300-0664; 1365-2265
  • Keywords: Endocrinology, Diabetes and Metabolism ; Endocrinology
  • Origination:
  • Footnote:
  • Description: <jats:title>Summary</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>Pretreatment with lithium (Li) is associated with an increased residence time of radioactive iodine (<jats:styled-content style="fixed-case">RAI</jats:styled-content>) in differentiated thyroid cancer (<jats:styled-content style="fixed-case">DTC</jats:styled-content>) metastases. There are no data translating this observation into long‐term outcomes. The study goal was to compare the efficacy of three methods of preparation for <jats:styled-content style="fixed-case">RAI</jats:styled-content> therapy in metastatic <jats:styled-content style="fixed-case">DTC</jats:styled-content>—thyroid hormone withdrawal (THW), <jats:styled-content style="fixed-case">THW</jats:styled-content> with pretreatment with Li (<jats:styled-content style="fixed-case">THW</jats:styled-content>+Li), and recombinant human <jats:styled-content style="fixed-case">TSH</jats:styled-content> (rh<jats:styled-content style="fixed-case">TSH</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Design/Patients/Measurements</jats:title><jats:p>We performed a cohort study comparing overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>) and progression‐free survival (<jats:styled-content style="fixed-case">PFS</jats:styled-content>) between the three groups: <jats:styled-content style="fixed-case">THW</jats:styled-content> (n = 52), <jats:styled-content style="fixed-case">THW</jats:styled-content>+Li (n = 41) and rh<jats:styled-content style="fixed-case">TSH</jats:styled-content> (n = 42). Kaplan‐Meier analyses were performed to compare <jats:styled-content style="fixed-case">OS</jats:styled-content> and <jats:styled-content style="fixed-case">PFS</jats:styled-content> between the groups. Cox proportional hazards regression model with a stepwise variable selection was performed to study the contribution of age, gender, histology, <jats:styled-content style="fixed-case">TNM</jats:styled-content> status, a location of distant metastases and <jats:styled-content style="fixed-case">RAI</jats:styled-content> dose.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>During the follow‐up of median 5.1 (<jats:styled-content style="fixed-case">IQR</jats:styled-content> = 3.0‐8.1) years, 52% of patients had disease progression and 12.6% died. Although <jats:styled-content style="fixed-case">THW</jats:styled-content>+Li group was characterized by the longest <jats:styled-content style="fixed-case">OS</jats:styled-content> (<jats:italic>P</jats:italic> = 0.007), only age (<jats:styled-content style="fixed-case">HR</jats:styled-content> 1.05, <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.01‐1.09, <jats:italic>P</jats:italic> = 0.01) and widespread disease (<jats:styled-content style="fixed-case">HR</jats:styled-content> 3.8, <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.2‐11.8, <jats:italic>P</jats:italic> = 0.02) were found to affect <jats:styled-content style="fixed-case">OS</jats:styled-content> in a multivariate model. There was no difference in <jats:styled-content style="fixed-case">PFS</jats:styled-content> between the groups (<jats:italic>P</jats:italic> = 0.47). Presence of distant metastases limited to the lungs only was associated with longer <jats:styled-content style="fixed-case">PFS</jats:styled-content> (<jats:styled-content style="fixed-case">PFS HR</jats:styled-content> 0.35, <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.20‐0.60, <jats:italic>P</jats:italic> = 0.0002).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The older age is associated with shorter <jats:styled-content style="fixed-case">OS</jats:styled-content>, while disease burden affects <jats:styled-content style="fixed-case">OS</jats:styled-content> and <jats:styled-content style="fixed-case">PFS</jats:styled-content> in patients with metastatic thyroid cancer. The method of preparation for <jats:styled-content style="fixed-case">RAI</jats:styled-content> therapy does not affect the outcome.</jats:p></jats:sec>