OC14 - Brain metastasis in differentiated thyroid cancer: an international multicentric retrospective analysis
Bibliographic record
Abstract
Abstract Background Brain metastases (BM) from Differentiated Thyroid Cancer (DTC) occur in 0.9–1.5% of all DTC cases and in up to 18% of patients with distant metastases. Given their rarity, disease features and optimal management are unclear. Purpose To describe the clinical, biochemical, and radiological features of BM from DTC, and to identify prognostic factors and effective treatment strategies. Methods Multicentric retrospective study including 18 international referral centres for thyroid cancer management. Results We included 189 patients (102 females, 87 males) with BM from DTC. Most (92.6%) had additional distant metastases, and 98 patients (52.1%) had a single BM, while 23 patients (12.4%) had ≥4 BMs. Neurological symptoms prompted diagnosis in 50.8% of the patients. Initial treatments included stereotactic radiosurgery (SRS, 27.0%), neurosurgery (23.8%), whole-brain radiotherapy (WBRT, 18.5%), best supportive care (BSC, 10.6%), tyrosine kinase inhibitors (6.9%), radioiodine therapy (3.2%) and chemotherapy (1.1%). Objective-response rate (ORR) and disease-control rate (DCR) were highest with neurosurgery and neurosurgery + SRS and lowest with WBRT or BSC (p<0.001; Cramer’s V = 0.54 for ORR and 0.40 for DCR). The median overall survival (OS) from BM diagnosis was 15 months (25-75 IQR: 4.0–38.4). Multivariate Cox regression identified age >75 years (HR: 2.38, p=0.028), performance status (ECOG) [2 (HR: 2.30; p=0.018), 3 (HR: 2.59; p=0.034), 4 (HR: 8.97; p<0.001)], PTC histology (HR: 2.00, p=0.007), presence of extracranial metastases (HR: 2.28, p=0.028), and BM>4 (HR: 2.28, p=0.035) as independent predictors of worse OS. Based on these factors, we developed a disease-specific Graded Prognostic Assessment (GPA) system assigning scores from 0 to 2 for every feature; patients were stratified into four prognostic groups: Group 1 (GPA 0–1, n=31): median OS = 72.6 months, Group 2 (GPA 1.5–2, n=101): median OS = 33.1 months, Group 3 (GPA 2.5–3, n=45): median OS = 15.9 months and Group 4 (GPA 3.5–4, n=11): median OS = 1.2 month (log-rank p value <0.001). Conclusion(s) In this international, real-world study, we documented the disease features of the largest cohort of patients with BM from DTC. Surgery offers the best outcomes in selected cases. The proposed GPA model effectively stratifies prognosis and may guide clinical decision-making.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".