Clinical and treatment patterns of advanced and radioiodine-refractory differentiated thyroid cancer. ERUDIT study

• Carlos López López ^[5] ; Marcel Sambo ^[6] ; Lorenzo Orcajo-Rincón ^[7] ; Manuel Durán-Poveda ^[8] ; Julio Rodríguez-Villanueva García ^[7] ; Rita Joana Santos ^[9] ; Marta Llanos Muñoz ^[1] ; Elena Navarro-González ^[10] ; Javier Aller ^[11] ; Virginia Pubul ^[12] ; Sonsoles Guadalix ^[13] ; Guillermo Crespo ^[2] ; Cintia González ^[14] ; Carles Zafón ^[15] ; Miguel Navarro ^[16] ; Javier Santamaría Sandi ^[17] ; Ángel Segura ^[18] ; Pablo Gajate ^[19] ; Marcelino Gómez-Balaguer ^[20] ; Javier Valdivia ^[21] ; Jordi L. Reverter ^[22] ; Juan Carlos Galofré ^[3] ; Beatriz Castelo ^[23] ; María José Villanueva ^[4] ; Juan Antonio Vallejo Casas ^[24]
  1. [1] Hospital Universitario de Canarias

     Hospital Universitario de Canarias

     San Cristóbal de La Laguna, España

     
  2. [2] Complejo Asistencial Universitario de Burgos

     Complejo Asistencial Universitario de Burgos

     Burgos, España

     
  3. [3] Clínica Universitaria de Navarra

     Clínica Universitaria de Navarra

     Pamplona, España

     
  4. [4] Universidade de Vigo

     Universidade de Vigo

     Vigo, España

     
  5. [5] Department of Medical Oncology, Marqués de Valdecilla University Hospital, IDIVAL, UNICAN, Santander, Cantabria, Spain
  6. [6] Department of Endocrinology, Gregorio Marañón University Hospital, Madrid, Spain
  7. [7] DHBL Oncology, Clinical Evidence Generation – Eisai Farmacéutica S.A, Madrid, Spain
  8. [8] Department of General and Digestive Surgery, Rey Juan Carlos University Hospital, Madrid, Spain
  9. [9] Department is Endocrinology, Hospital CUF Cascais, Cascais, Portugal
  10. [10] Department of Endocrinology, Virgen del Rocío University Hospital, Sevilla, Spain
  11. [11] Department of Endocrinology, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
  12. [12] Department of Nuclear Medicine, University Hospital and Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
  13. [13] Department of Endocrinology and Nutrition, Hospital Universitario, 12 de Octubre, Madrid, Spain
  14. [14] Department of Endocrinology and Nutrition, Consortium of the General University Hospital, CIBER-BBN, Valencia, Spain
  15. [15] Department of Endocrinology and Nutrition, Vall d’Hebron University Hospital and Autonomous University of Barcelona (UAB), Barcelona, Spain
  16. [16] Department of Medical Oncology, University Hospital of Salamanca, Salamanca, Spain
  17. [17] Department of Endocrinology, Cruces University Hospital, Vizcaya, Spain
  18. [18] Department of Medical Oncology Unit, La Fe University and Politecnic Hospital, Valencia, Spain
  19. [19] Department of Medical Oncology, Ramon y Cajal University Hospital, Madrid, Spain
  20. [20] Department of Endocrinology, Doctor Peset University Hospital, Valencia, Spain
  21. [21] Department of Oncology, University Hospital Centre Virgen de Las Nieves, Granada, Spain
  22. [22] Endocrine and Nutrition Service, Health Sciences Research Institute and University Hospital Germans Trias I Pujol, Badalona, Spain
  23. [23] Department of Medical Oncology, La Paz University Hospital, Madrid, Spain
  24. [24] Department of Nuclear Medicine (UGC), Maimónides Institute of Biomedical Research of Córdoba (IMIBIC), Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain

  Mostrar afiliaciones +
• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 28, Nº. 5, 2026, págs. 1839-1852
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Background:

    Radioiodine-refractory (RR) disease drives morbidity and mortality in advanced differentiated thyroid cancer (aDTC) and yet real-world longitudinal data from the Iberian Peninsula are sparse.

    Objectives:

    To characterize clinical features, multidisciplinary management, and outcomes of RR-DTC within a multicenter Iberian cohort, and to explore prognostic factors, including the impact of de novo versus recurrent/progressive presentation.

    Methods:

    Multicenter, retrospective cohort of adults with aDTC diagnosed in 2007–2012 at 23 Spanish/Portuguese centers, with follow-up until 2017. Baseline demographic and clinical characteristics, local/systemic treatments used, progression-free survival (PFS) on first-line systemic therapy (ST), overall survival (OS) from RR-DTC, and survival prognostic factors were assessed. An exploratory illness–death multistate Markov model complemented Kaplan–Meier analyses for mortality from initial diagnosis. Missing data were not imputed.

    Results:

    Of 213 aDTC patients, 165 (77.5%) met ≥ 1 RR-DTC criterion at any time during their follow-up. At RR-DTC diagnosis, ECOG was recorded in 92/165 (55.8%): 75 (81.5%) ECOG 0–1 and 17 (18.5%) ECOG 2–4. Management included watchful waiting (WW) in 79/165 (47.9%), locoregional therapy in 83/165 (50.3%), and ST in 61/165 (37.0%), predominantly sorafenib. Median PFS on first-line ST was 16.0 months (95% CI 9.2–29.9). Median OS from RR-DTC diagnosis was 4.7 years (3.4–8.0), shorter for de novo aDTC versus recurrent/progressive eDTC (3.0 vs 8.0 years; log-rank p < 0.0001). In multivariable analyses, age < 55 years and WW ≥ 30 months were associated with longer OS, while de novo aDTC and ECOG 2–4 were associated with higher mortality. From initial DTC diagnosis, the multistate model showed higher cumulative mortality for RR-DTC versus non-RR-DTC (HR 3.22; p < 0.001).

    Conclusions:

    In this Iberian cohort, RR-DTC was frequent and often managed within MDTs, with substantial WW use. De novo aDTC and poor performance status were associated with worse survival. Prolonged WW appeared associated with longer OS, but this likely reflects selection and lead/immortal-time biases underscoring the need for prospective validation.