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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\u2013death multistate Markov model complemented Kaplan\u2013Meier analyses for mortality from initial diagnosis. Missing data were not imputed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 213 aDTC patients, 165 (77.5%) met\u2009\u2265\u20091 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\u20131 and 17 (18.5%) ECOG 2\u20134. 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\u00a0months (95% CI 9.2\u201329.9). Median OS from RR-DTC diagnosis was 4.7\u00a0years (3.4\u20138.0), shorter for de novo aDTC versus recurrent\/progressive eDTC (3.0 vs 8.0\u00a0years; log-rank p\u2009&lt;\u20090.0001). In multivariable analyses, age\u2009&lt;\u200955\u00a0years and WW\u2009\u2265\u200930\u00a0months were associated with longer OS, while de novo aDTC and ECOG 2\u20134 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;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12094-025-04122-6","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T18:42:43Z","timestamp":1763577763000},"page":"1839-1852","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical and treatment patterns of advanced and radioiodine-refractory differentiated thyroid cancer. 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Dr. Carlos L\u00f3pez L\u00f3pez reports grants and consultant fees from Bayer, grants and consultant fees from Eisai, grants and consultant fees from Pfizer, grants and consultant fees from Ipsen, grants and consultant fees from Novartis, grants and consultant fees from Lilly, during the conduct of the study; Dr. Marcel Sambo reports grants and consultant fees from Eisai, during the conduct of the study; Dr. Lorenzo Orcajo Rinc\u00f3n and Dr. Julio Rodr\u00edguez-Villanueva Garc\u00eda report employees from Eisai, with interests outside the submitted work; Dr. Marta Llanos reports consultant fees from Roche, consultant fees from Amgen, consultant fees from Eisai, consultant fees from Ipsen, consultant fees from Servier, consultant fees from Lilly, consultant fees from Merck, outside the submitted work; Dr. Elena Navarro-Gonz\u00e1lez reports consultant fees from Eisai, during the conduct of the study; Dr. Javier Aller reports consultant fees and non-financial support from Eisai, during the conduct of the study; consultant fees from Eisai, consultant fees and non-financial support from Ipsen, consultant fees and research grants from Lilly, consultant fees and research grants from Bayer, outside the submitted work; Dr. Guillermo Crespo reports grants from Ipsen, grants from Roche, grants from BMS, grants from Eisai, grants from Sanofi, grants from Janssen, grants from Eusa Pharma, grants from Pierre Fabre, outside the submitted work; Dr. Cintia Gonz\u00e1lez reports other from Hospital Santa Creu i Sant Pau, during the conduct of the study; Dr. Miguel Navarro reports consultant fees and non-financial support from Ipsen, non-financial support from Novartis, consultant fees and non-financial support from Bayer, outside the submitted work; Dr. Javier Valdivia reports consultant fees from Novartis, MSD, Roche and Eisai during the conduct of the study; Dr. Mar\u00eda Jos\u00e9 Villanueva reports consultant fees from Novartis, and GSK, outside the submitted work; Dr. I\u00f1aki Arg\u00fcelles reports consultant fees from Eisai, outside the submitted work; Dr. Juan Antonio Vallejo Casas reports grants, consultant fees and non-financial support from Eisai, during the conduct of the study; consultant fees and non-financial support from Sanofi, consultant fees from Bayer, consultant fees and non-financial support from Novartis, outside the submitted work; The remaining authors Dr. Manuel Dur\u00e1n-Poveda, Dr. Rita Joana Santos, Dr. Virginia Pubul, Dr. Sonsoles Guadalix, Dr. Carles Zaf\u00f3n, Dr. Javier Santamar\u00eda-Sandi, Dr. \u00c1ngel Segura, Dr. Pablo Gajate, Dr. Marcelino G\u00f3mez-Balaguer, Dr. Jordi Reverter, Dr. Juan Carlos Galofr\u00e9, and Dr. Beatriz Castelo have nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}