Skip to main content
Top
Published in: Endocrine 1/2022

01-04-2022 | Metastasis | Original Article

Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

Authors: Haruhiko Yamazaki, Kiminori Sugino, Jaeduk Yoshimura Noh, Ryohei Katoh, Kenichi Matsuzu, Chie Masaki, Junko Akaishi, Kiyomi Yamada Hames, Chisato Tomoda, Akifumi Suzuki, Keiko Ohkuwa, Wataru Kitagawa, Mitsuji Nagahama, Yasushi Rino, Koichi Ito

Published in: Endocrine | Issue 1/2022

Login to get access

Abstract

Purpose

There is no sufficient data about the clinical course and outcome in thyroid cancer patients who become pregnant after diagnosis of distant metastasis (DM). The current study was conducted to collect information regarding the clinical and reproductive characteristics, and outcomes in thyroid cancer patients who became pregnant after being diagnosed with DM.

Methods

Records of 125 differentiated thyroid cancer (DTC) patients with age ≤45 years at DM diagnosis who had visited Ito Hospital from January 2005 to June 2021 were retrospectively reviewed. Among those 125 patients, 28 who became pregnant after DM diagnosis were classified as pregnancy group, and the remained 97 patients were classified as comparator group.

Results

In pregnancy group, the median age at malignancy diagnosis, DM diagnosis, and first pregnancy after DM diagnosis was 25 years (range, 4–41 years), 27 years (range, 11–41 years), and 32 years (range, 25–45 years), respectively. Fifty-five pregnancies and 40 live births were reported. Other pregnancy outcomes were miscarriage (n = 14) and induced abortion (n = 1). The 10-year progression-free survival (PFS) rates of pregnant and comparator group were 92.1% and 74.4%, respectively (p = 0.018). The multivariate analysis showed that multiple 131I treatment was independent negative prognostic factor for PFS (p = 0.046).

Conclusions

DTC patients with age ≤45 years at DM diagnosis had good survival even though they became pregnant. Our results add to the information required for counseling thyroid cancer patients who have concerns about their fertility in the future.
Literature
1.
go back to reference E. Macerola, A.M. Poma, P. Vignali, A. Basolo, C. Ugolini, L. Torregrossa, F. Santini, F. Basolo, Molecular genetics of follicular-derived thyroid cancer. Cancers (Basel) 13, 1139 (2021)CrossRef E. Macerola, A.M. Poma, P. Vignali, A. Basolo, C. Ugolini, L. Torregrossa, F. Santini, F. Basolo, Molecular genetics of follicular-derived thyroid cancer. Cancers (Basel) 13, 1139 (2021)CrossRef
2.
go back to reference H. Yamazaki, H. Iwasaki, H. Takasaki, N. Suganuma, R. Sakai, K. Masudo, H. Nakayama, Y. Rino, M. Masuda, Efficacy and tolerability of initial low-dose lenvatinib to treat differentiated thyroid cancer. Medicine (Baltimore) 98, e14774 (2019)CrossRef H. Yamazaki, H. Iwasaki, H. Takasaki, N. Suganuma, R. Sakai, K. Masudo, H. Nakayama, Y. Rino, M. Masuda, Efficacy and tolerability of initial low-dose lenvatinib to treat differentiated thyroid cancer. Medicine (Baltimore) 98, e14774 (2019)CrossRef
3.
go back to reference K. Matsuzu, K. Sugino, K. Masudo, M. Nagahama, W. Kitagawa, H. Shibuya, K. Ohkuwa, T. Uruno, A. Suzuki, S. Magoshi, J. Akaishi, C. Masaki, M. Kawano, N. Suganuma, Y. Rino, M. Masuda, K. Kameyama, H. Takami, K. Ito, Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases. World J. Surg. 38, 68–79 (2014)CrossRef K. Matsuzu, K. Sugino, K. Masudo, M. Nagahama, W. Kitagawa, H. Shibuya, K. Ohkuwa, T. Uruno, A. Suzuki, S. Magoshi, J. Akaishi, C. Masaki, M. Kawano, N. Suganuma, Y. Rino, M. Masuda, K. Kameyama, H. Takami, K. Ito, Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases. World J. Surg. 38, 68–79 (2014)CrossRef
4.
go back to reference M.E. Cabanillas, M.A. Habra, Lenvatinib: role in thyroid cancer and other solid tumors. Cancer Treat Rev. 42, 47–55 (2016)CrossRef M.E. Cabanillas, M.A. Habra, Lenvatinib: role in thyroid cancer and other solid tumors. Cancer Treat Rev. 42, 47–55 (2016)CrossRef
5.
go back to reference C. Durante, N. Haddy, E. Baudin, S. Leboulleux, D. Hartl, J.P. Travagli, B. Caillou, M. Ricard, J.D. Lumbroso, F. De Vathaire, M. Schlumberger, Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J. Clin. Endocrinol. Metab. 91, 2892–2899 (2006)CrossRef C. Durante, N. Haddy, E. Baudin, S. Leboulleux, D. Hartl, J.P. Travagli, B. Caillou, M. Ricard, J.D. Lumbroso, F. De Vathaire, M. Schlumberger, Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J. Clin. Endocrinol. Metab. 91, 2892–2899 (2006)CrossRef
6.
go back to reference A.R. Shaha, J.C. Migliacci, I.J. Nixon, L.Y. Wang, R.J. Wong, L.G.T. Morris, S.G. Patel, J.P. Shah, R.M. Tuttle, I. Ganly, Stage migration with the new American Joint Committee on Cancer (AJCC) staging system (8th edition) for differentiated thyroid cancer. Surgery 165, 6–11 (2019)CrossRef A.R. Shaha, J.C. Migliacci, I.J. Nixon, L.Y. Wang, R.J. Wong, L.G.T. Morris, S.G. Patel, J.P. Shah, R.M. Tuttle, I. Ganly, Stage migration with the new American Joint Committee on Cancer (AJCC) staging system (8th edition) for differentiated thyroid cancer. Surgery 165, 6–11 (2019)CrossRef
7.
go back to reference I.J. Nixon, L.Y. Wang, J.C. Migliacci, A. Eskander, M.J. Campbell, A. Aniss, L. Morris, F. Vaisman, R. Corbo, D. Momesso, M. Vaisman, A. Carvalho, D. Learoyd, W.D. Leslie, R.W. Nason, D. Kuk, V. Wreesmann, L. Morris, F.L. Palmer, I. Ganly, S.G. Patel, B. Singh, R.M. Tuttle, A.R. Shaha, M. Gönen, K.A. Pathak, W.T. Shen, M. Sywak, L. Kowalski, J. Freeman, N. Perrier, J.P. Shah, An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. Thyroid 26, 373–380 (2016)CrossRef I.J. Nixon, L.Y. Wang, J.C. Migliacci, A. Eskander, M.J. Campbell, A. Aniss, L. Morris, F. Vaisman, R. Corbo, D. Momesso, M. Vaisman, A. Carvalho, D. Learoyd, W.D. Leslie, R.W. Nason, D. Kuk, V. Wreesmann, L. Morris, F.L. Palmer, I. Ganly, S.G. Patel, B. Singh, R.M. Tuttle, A.R. Shaha, M. Gönen, K.A. Pathak, W.T. Shen, M. Sywak, L. Kowalski, J. Freeman, N. Perrier, J.P. Shah, An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. Thyroid 26, 373–380 (2016)CrossRef
8.
go back to reference K. Sugino, M. Nagahama, W. Kitagawa, K. Ohkuwa, T. Uruno, K. Matsuzu, A. Suzuki, C. Tomoda, K.Y. Hames, J. Akaishi, C. Masaki, K. Ito, Distant metastasis in pediatric and adolescent differentiated thyroid cancer: clinical outcomes and risk factor analyses. J. Clin. Endocrinol. Metab. 105(11), dgaa545 (2020)CrossRef K. Sugino, M. Nagahama, W. Kitagawa, K. Ohkuwa, T. Uruno, K. Matsuzu, A. Suzuki, C. Tomoda, K.Y. Hames, J. Akaishi, C. Masaki, K. Ito, Distant metastasis in pediatric and adolescent differentiated thyroid cancer: clinical outcomes and risk factor analyses. J. Clin. Endocrinol. Metab. 105(11), dgaa545 (2020)CrossRef
9.
go back to reference C.M. Cottreau, I. Dashevsky, S.E. Andrade, D.K. Li, L. Nekhlyudov, M.A. Raebel, D.P. Ritzwoller, A.H. Partridge, P.A. Pawloski, S. Toh, Pregnancy-associated cancer: a U.S. population-based study. J. Womens Health 28, 250–257 (2019)CrossRef C.M. Cottreau, I. Dashevsky, S.E. Andrade, D.K. Li, L. Nekhlyudov, M.A. Raebel, D.P. Ritzwoller, A.H. Partridge, P.A. Pawloski, S. Toh, Pregnancy-associated cancer: a U.S. population-based study. J. Womens Health 28, 250–257 (2019)CrossRef
10.
go back to reference M. Derwahl, D. Nicula, Estrogen and its role in thyroid cancer. Endocr. Relat. Cancer 21, T273–T283 (2014)CrossRef M. Derwahl, D. Nicula, Estrogen and its role in thyroid cancer. Endocr. Relat. Cancer 21, T273–T283 (2014)CrossRef
11.
go back to reference Y. Ito, A. Miyauchi, T. Kudo, H. Ota, K. Yoshioka, H. Oda, H. Sasai, A. Nakayama, T. Yabuta, H. Masuoka, M. Fukushima, T. Higashiyama, M. Kihara, K. Kobayashi, A. Miya, Effects of pregnancy on papillary microcarcinomas of the thyroid re-evaluated in the entire patient series at Kuma Hospital. Thyroid 26, 156–160 (2016)CrossRef Y. Ito, A. Miyauchi, T. Kudo, H. Ota, K. Yoshioka, H. Oda, H. Sasai, A. Nakayama, T. Yabuta, H. Masuoka, M. Fukushima, T. Higashiyama, M. Kihara, K. Kobayashi, A. Miya, Effects of pregnancy on papillary microcarcinomas of the thyroid re-evaluated in the entire patient series at Kuma Hospital. Thyroid 26, 156–160 (2016)CrossRef
12.
go back to reference A.C. Chen, M.J. Livhits, L. Du, J.X. Wu, E.J. Kuo, M.W. Yeh, A.M. Leung, Recent pregnancy is not associated with high-risk pathological features of well-differentiated thyroid cancer. Thyroid 28, 68–71 (2018)CrossRef A.C. Chen, M.J. Livhits, L. Du, J.X. Wu, E.J. Kuo, M.W. Yeh, A.M. Leung, Recent pregnancy is not associated with high-risk pathological features of well-differentiated thyroid cancer. Thyroid 28, 68–71 (2018)CrossRef
13.
go back to reference C. Xi, Q. Zhang, H.J. Song, C.T. Shen, G.Q. Zhang, J.W. Sun, Z.L. Qiu, Q.Y. Luo, Pregnancy does not affect the prognoses of differentiated thyroid cancer patients with lung metastases. J. Clin. Endocrinol. Metab. 106, e3185–e3197 (2021)CrossRef C. Xi, Q. Zhang, H.J. Song, C.T. Shen, G.Q. Zhang, J.W. Sun, Z.L. Qiu, Q.Y. Luo, Pregnancy does not affect the prognoses of differentiated thyroid cancer patients with lung metastases. J. Clin. Endocrinol. Metab. 106, e3185–e3197 (2021)CrossRef
14.
go back to reference S. Takahashi, A. Horie, S. Yamamura, A. Kawamura, A. Yamaguchi, M. Sunada, H. Tani, H. Mogami, J. Hamanishi, E. Kondoh, M. Mandai, Oncofertility care in young women and the outcomes of pregnancy over the last 5 years. Future Sci. OA 7, FSO680 (2021)CrossRef S. Takahashi, A. Horie, S. Yamamura, A. Kawamura, A. Yamaguchi, M. Sunada, H. Tani, H. Mogami, J. Hamanishi, E. Kondoh, M. Mandai, Oncofertility care in young women and the outcomes of pregnancy over the last 5 years. Future Sci. OA 7, FSO680 (2021)CrossRef
15.
go back to reference E. Sullivan, Y. Wang, M. Chapman, G. Chambers, Success rates and cost of a live birth following fresh assisted reproduction treatment in women aged 45 years and older, Australia 2002-2004. Hum. Reprod. 23, 1639–1643 (2008)CrossRef E. Sullivan, Y. Wang, M. Chapman, G. Chambers, Success rates and cost of a live birth following fresh assisted reproduction treatment in women aged 45 years and older, Australia 2002-2004. Hum. Reprod. 23, 1639–1643 (2008)CrossRef
16.
go back to reference Y. Kanda, Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 48, 452–458 (2013)CrossRef Y. Kanda, Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 48, 452–458 (2013)CrossRef
17.
go back to reference Y. Ito, N. Onoda, T. Okamoto, The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: core questions and recommendations for treatments of thyroid cancer. Endocr. J. 67, 669–717 (2020)CrossRef Y. Ito, N. Onoda, T. Okamoto, The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: core questions and recommendations for treatments of thyroid cancer. Endocr. J. 67, 669–717 (2020)CrossRef
18.
go back to reference H.J. Song, Z.L. Qiu, C.T. Shen, W.J. Wei, Q.Y. Luo, Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors. Eur. J. Endocrinol. 173, 399–408 (2015)CrossRef H.J. Song, Z.L. Qiu, C.T. Shen, W.J. Wei, Q.Y. Luo, Pulmonary metastases in differentiated thyroid cancer: efficacy of radioiodine therapy and prognostic factors. Eur. J. Endocrinol. 173, 399–408 (2015)CrossRef
19.
go back to reference A.M. Sawka, D.C. Lakra, J. Lea, B. Alshehri, R.W. Tsang, J.D. Brierley, S. Straus, L. Thabane, A. Gafni, S. Ezzat, S.R. George, D.P. Goldstein, A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin. Endocrinol. 69, 479–490 (2008)CrossRef A.M. Sawka, D.C. Lakra, J. Lea, B. Alshehri, R.W. Tsang, J.D. Brierley, S. Straus, L. Thabane, A. Gafni, S. Ezzat, S.R. George, D.P. Goldstein, A systematic review examining the effects of therapeutic radioactive iodine on ovarian function and future pregnancy in female thyroid cancer survivors. Clin. Endocrinol. 69, 479–490 (2008)CrossRef
20.
go back to reference M. Nies, A.E.P. Cantineau, E.G.J.M. Arts, M.H. van den Berg, F.E. van Leeuwen, A.C. Muller Kobold, M.S. Klein Hesselink, J.G.M. Burgerhof, A.H. Brouwers, E.W.C.M. van Dam, B. Havekes, M.M. van den Heuvel-Eibrink, E.P.M. Corssmit, L.C.M. Kremer, R.T. Netea-Maier, H.J.H. van der Pal, R.P. Peeters, J.T.M. Plukker, C.M. Ronckers, H.M. van Santen, A.N.A. van der Horst-Schrivers, W.J.E. Tissing, G. Bocca, E. van Dulmen-den Broeder, T.P. Links, Long-term effects of radioiodine treatment on female fertility in survivors of childhood differentiated thyroid carcinoma. Thyroid 30, 1169–1176 (2020)CrossRef M. Nies, A.E.P. Cantineau, E.G.J.M. Arts, M.H. van den Berg, F.E. van Leeuwen, A.C. Muller Kobold, M.S. Klein Hesselink, J.G.M. Burgerhof, A.H. Brouwers, E.W.C.M. van Dam, B. Havekes, M.M. van den Heuvel-Eibrink, E.P.M. Corssmit, L.C.M. Kremer, R.T. Netea-Maier, H.J.H. van der Pal, R.P. Peeters, J.T.M. Plukker, C.M. Ronckers, H.M. van Santen, A.N.A. van der Horst-Schrivers, W.J.E. Tissing, G. Bocca, E. van Dulmen-den Broeder, T.P. Links, Long-term effects of radioiodine treatment on female fertility in survivors of childhood differentiated thyroid carcinoma. Thyroid 30, 1169–1176 (2020)CrossRef
21.
go back to reference K.Y. Ko, R.F. Yen, C.L. Lin, M.F. Cheng, W.S. Huang, C.H. Kao, Pregnancy outcome after I-131 therapy for patients with thyroid cancer: a nationwide population-based cohort study. Medicine (Baltimore) 95, e2685 (2016)CrossRef K.Y. Ko, R.F. Yen, C.L. Lin, M.F. Cheng, W.S. Huang, C.H. Kao, Pregnancy outcome after I-131 therapy for patients with thyroid cancer: a nationwide population-based cohort study. Medicine (Baltimore) 95, e2685 (2016)CrossRef
22.
go back to reference J.X. Wu, S. Young, K. Ro, N. Li, A.M. Leung, H.K. Chiu, A. Harari, M.W. Yeh, Reproductive outcomes and nononcologic complications after radioactive iodine ablation for well-differentiated thyroid cancer. Thyroid 25, 133–138 (2015)CrossRef J.X. Wu, S. Young, K. Ro, N. Li, A.M. Leung, H.K. Chiu, A. Harari, M.W. Yeh, Reproductive outcomes and nononcologic complications after radioactive iodine ablation for well-differentiated thyroid cancer. Thyroid 25, 133–138 (2015)CrossRef
23.
go back to reference M. Sugiura-Ogasawara, Y. Ozaki, T. Kitaori, N. Suzumori, S. Obayashi, S. Suzuki, Live birth rate according to maternal age and previous number of recurrent miscarriages. Am. J. Reprod. Immunol. 62, 314–319 (2009)CrossRef M. Sugiura-Ogasawara, Y. Ozaki, T. Kitaori, N. Suzumori, S. Obayashi, S. Suzuki, Live birth rate according to maternal age and previous number of recurrent miscarriages. Am. J. Reprod. Immunol. 62, 314–319 (2009)CrossRef
24.
go back to reference K. Kawase, K. Nomura, S. Nomura, S. Akashi-Tanaka, T. Ogawa, I. Shibasaki, M. Shimada, T. Taguchi, E. Takeshita, Y. Tomizawa, K. Hanazaki, T. Hanashi, H. Yamauchi, H. Yamashita, S. Nakamura, How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society. Surg. Today 51, 309–321 (2021)CrossRef K. Kawase, K. Nomura, S. Nomura, S. Akashi-Tanaka, T. Ogawa, I. Shibasaki, M. Shimada, T. Taguchi, E. Takeshita, Y. Tomizawa, K. Hanazaki, T. Hanashi, H. Yamauchi, H. Yamashita, S. Nakamura, How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society. Surg. Today 51, 309–321 (2021)CrossRef
25.
go back to reference I. Messuti, S. Corvisieri, F. Bardesono, I. Rapa, J. Giorcelli, R. Pellerito, M. Volante, F. Orlandi, Impact of pregnancy on prognosis of differentiated thyroid cancer: clinical and molecular features. Eur. J. Endocrinol. 170, 659–666 (2014)CrossRef I. Messuti, S. Corvisieri, F. Bardesono, I. Rapa, J. Giorcelli, R. Pellerito, M. Volante, F. Orlandi, Impact of pregnancy on prognosis of differentiated thyroid cancer: clinical and molecular features. Eur. J. Endocrinol. 170, 659–666 (2014)CrossRef
26.
go back to reference M. Harada, Y. Osuga, Fertility preservation for female cancer patients. Int. J. Clin. Oncol. 24, 28–33 (2019)CrossRef M. Harada, Y. Osuga, Fertility preservation for female cancer patients. Int. J. Clin. Oncol. 24, 28–33 (2019)CrossRef
Metadata
Title
Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis
Authors
Haruhiko Yamazaki
Kiminori Sugino
Jaeduk Yoshimura Noh
Ryohei Katoh
Kenichi Matsuzu
Chie Masaki
Junko Akaishi
Kiyomi Yamada Hames
Chisato Tomoda
Akifumi Suzuki
Keiko Ohkuwa
Wataru Kitagawa
Mitsuji Nagahama
Yasushi Rino
Koichi Ito
Publication date
01-04-2022
Publisher
Springer US
Published in
Endocrine / Issue 1/2022
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-021-02969-7

Other articles of this Issue 1/2022

Endocrine 1/2022 Go to the issue