Prognostic factors in thyroid cancer patients with brain metastases: A systematic review and individual patient data meta-analysis.

Abstract

e14004 Background: Brain metastases (BM) from thyroid cancer (TC) are rare but signify an advanced stage of the disease with poor survival outcomes. This study aimed to identify prognostic factors associated with overall survival (OS) in patients with BM from TC. Methods: A systematic review and individual patient data (IPD) meta-analysis were conducted. Data were extracted from studies retrieved from PubMed, Scopus, Embase, and MEDLINE up to January 1, 2025. A multivariable Cox proportional hazards model was used to estimate hazard ratios (HRs) for potential prognostic factors. Results: A total of 24 studies comprising 301 patients with BM from TC were included. The median OS was 12 months (IQR, 5–33 months). Key prognostic factors associated with worse survival included anaplastic or poorly differentiated carcinoma (HR, 2.11; 95% CI, 1.24–3.59; p = 0.006), poor performance status (ECOG > 1) (HR, 2.71; 95% CI, 1.86–3.94; p < 0.001), multiple brain metastases (HR, 1.71; 95% CI, 1.10–2.64; p = 0.018), and the presence of lung metastases (HR, 2.02; 95% CI, 1.30–3.15; p = 0.002). Neither the size nor the anatomical location of BM significantly impacted OS. Conclusions: BM from TC are associated with poor survival, with key prognostic factors including aggressive tumor subtypes, poor performance status, multiple brain metastases, and the presence of extracranial metastases, particularly in the lungs. These findings highlight the need for a multidisciplinary approach and the importance of systemic disease control in improving outcomes for this challenging patient population.