Метастазы в мозгу при раке щитовидной железы встречаются чаще, чем считалось ранее

Brain metastases in advanced nonanaplastic follicular cell-derived thyroid carcinoma (FCDTC) may be more common than previously appreciated, according to research published in The Oncologist. These results support consideration of routine brain imaging in select patients, particularly those with lung involvement, while performance status and intracranial disease burden appear to drive survival outcomes rather than molecular features. In this retrospective cohort analysis of 187 patients with advanced nonanaplastic FCDTC treated at a single tertiary center between 2007 and 2022, 32 (17%) developed brain metastases. Notably, only 56% of the overall cohort underwent dedicated central nervous system imaging, among whom the incidence rose to 30%, suggesting under-detection in routine practice. Most intracranial lesions (78%) were asymptomatic and identified incidentally during staging or surveillance imaging. The median age at thyroid cancer diagnosis was 56.2 years, and 55% of patients were male. Differentiated histology predominated (81%), with the remainder classified as poorly differentiated. Nearly all patients (95%) had received radioactive iodine, and 81% had distant metastatic disease. Median follow-up was 27.8 months. Among those with brain metastases, the median interval from initial diagnosis to intracranial involvement was 7.1 years, and most patients (81%) maintained an ECOG performance status of 0 to 1 at the time of detection. Lung metastases emerged as a strong predictor of brain involvement in multivariable modeling (adjusted odds ratio [OR], 8.27; 95% CI, 1.87-36.46). ARID2 alterations were enriched in patients with brain metastases (9% vs 1%; P =.02), although their low frequency and wide confidence intervals limited inclusion in adjusted analyses. “However, the role of ARID2 mutations warrants further investigation in larger studies,” explained first author Carly C Barron, MD, of the Department of Medicine, University of Toronto, Canada, and her colleagues. Other genomic features, including BRAF-like and RAS-like signatures, did not distinguish risk or outcomes. Management of brain metastases was heterogeneous and multimodal. Radiation therapy was administered in 84% of patients, including stereotactic radiosurgery in 16 and whole brain radiotherapy in 9, while 16% underwent surgical resection. Systemic therapy was initiated after intracranial progression in 16 patients, most commonly with lenvatinib (69%). Combined radiation and systemic therapy represented the most frequent treatment approach (47%). Despite the occurrence of brain metastases, overall survival did not significantly differ between patients with and without intracranial disease (median, 6.1 vs 6.6 years; P =.07). However, within the brain metastasis subgroup, worse outcomes were observed in those with ECOG performance status of at least 2 (adjusted hazard ratio [HR], 8.42; 95% CI, 1.96-36.11) and in those with 4 or more brain lesions (adjusted HR, 5.43; 95% CI, 1.51-19.48). Molecular alterations were not associated with survival. These findings highlight a potentially underrecognized burden of brain metastases in advanced thyroid cancer and underscore the clinical relevance of selective screening, particularly in patients with pulmonary metastases. “Future studies involving larger populations of patients with advanced thyroid cancer and brain metastases, coupled with comprehensive genomic data, are needed to refine prognostic models and develop disease-specific treatment paradigms, ultimately guiding more personalized and effective management strategies,” concluded Dr Barron and colleagues. References: Barron CC, Megid TBC, Deng Y, et al. Clinical and molecular features associated with the presence of brain metastases and survival in patients with advanced thyroid cancer. Oncologist. 2026;31(7):oyag211. doi:10.1093/oncolo/oyag211