{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T02:25:57Z","timestamp":1791339957696,"version":"4.3.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2024,7,1]],"date-time":"2024-07-01T00:00:00Z","timestamp":1719792000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Thyroid\u00ae"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>For patients with thyroid cancer, distant metastasis is a significant predictor of poor outcome. Since distant metastasis occurs in less than 10% of patients with differentiated thyroid cancer, correlates of survival in this vulnerable patient population remain understudied. This study aimed to identify prognostic groups among patients with differentiated thyroid cancer and distant metastases and to determine the role of, and interactions between, patient and tumor characteristics in determining survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We identified adult patients diagnosed with differentiated thyroid cancer with distant metastases from the U.S. SEER-17 cancer registry (2010\u20132019). Analyses were performed using Cox proportional hazards regression, survival trees, and random survival forest. Relative importance of patient and tumor factors important for disease-specific and overall survival was assessed based on the random survival forest analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Cohort consisted of 2411 patients with differentiated thyroid cancer with distant metastases followed for a median of 62 months. Most common histopathologic subtype (86.0%) was papillary thyroid cancer, and the most common sites of distant metastasis were the lungs (33.7%) and bone (18.9%). Cox proportional hazards model illustrated significant associations between survival and the following: patient age (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001), tumor size (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.01), and site of distant metastasis (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.05). Survival tree analyses identified three distinct prognostic groups based on disease-specific survival (DSS) (5-year survival of the prognostic groups was 92%, 64%, and 41%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) and four distinct prognostic groups based on overall survival (OS) (5-year survival of the prognostic groups was 96%, 84%, 57%, and 31%;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001). The first split in the survival trees for DSS and OS was by age at diagnosis (\u226457 years vs. \u226558 years) with subsequent splits based on presence\/absence of lung metastases, tumor size (\u22644 cm vs. &gt;4 cm), and patient age. A total of 558 patients (23.1%) died from thyroid cancer, and 757 patients (31.4%) died from all causes during the study period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study identifies distinct prognostic groups for patients with differentiated thyroid cancer with distant metastases and highlights the importance of patient age, lung metastases, and tumor size for determining both disease-specific and overall survival. These findings inform risk stratification and treatment decision-making in this understudied patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/thy.2023.0709","type":"journal-article","created":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T07:12:16Z","timestamp":1715929936000},"page":"837-845","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":37,"title":["Survival Prognostication in Patients with Differentiated Thyroid Cancer and Distant Metastases: A SEER Population-Based Study"],"prefix":"10.1177","volume":"34","author":[{"given":"Debbie W.","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis P.","family":"Worden","sequence":"additional","affiliation":[{"name":"Division of Hematology and Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine M.","family":"Veenstra","sequence":"additional","affiliation":[{"name":"Division of Hematology and Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1083-1575","authenticated-orcid":false,"given":"Megan R.","family":"Haymart","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mousumi","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00020-X"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2017.0102"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2006-9"},{"key":"e_1_3_6_7_2","unstructured":"Surveillance Epidemiology and End Results Program. Cancer stat facts: Thyroid cancer. Available at. Available from: https:\/\/seer.cancer.gov\/statfacts\/html\/thyro.html [Accessed [Last accessed: November29 2023]."},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-67-3-501"},{"key":"e_1_3_6_9_2","unstructured":"National Cancer institute. Surveillance Epidemiology and End Results (SEER) Surveillance Research Program. Available at. Available from: https:\/\/seer.cancer.gov\/about\/factsheets\/SEER_Overview.pdf [Last accessed: March10 2023]."},{"key":"e_1_3_6_10_2","unstructured":"Surveillance Epidemiology and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence\u2014SEER Research Plus Data 17 Registries Nov 2021 Sub (2000-2019) - Linked To County Attributes - Time Dependent (1990-2019) Income\/Rurality 1969-2019 Counties National Cancer Institute DCCPS Surveillance Research Program released April 2022 based on the November 2021 submission."},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.02222"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-2318"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00511"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2197"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.1665"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.11.141"},{"key":"e_1_3_6_17_2","first-page":"265","volume-title":"Statistical Advances in the Biomedical Sciences: Clinical Trials, Epidemiology, Survival Analysis, and Bioinformatics","author":"Banerjee M","year":"2008","unstructured":"Banerjee M, , Noone AM. 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