An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients

Abstract

Background. Anaplastic thyroid cancer (ATC) responds poorly to conventional therapies and requires a multidisciplinary approach to manage. The aim of the current study is to explore whether aggressive treatment is beneficial, especially the appropriate extent of surgery in ATC. Methods. Patients diagnosed with ATC from 2004 to 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database and included in our study. Results. A total of 735 ATC patients were identified. The two-year overall survival (OS) rates for stage IVA, IVB, and IVC patients were 36.5%, 15.6%, and 1.4%, respectively. By directly comparing eight treatment modalities, we found that surgery+radiotherapy RT±chemotherapy was the most effective treatment strategy. surgery+chemotherapy and RT+chemotherapy had comparable results (hazard ratio HR=1.461, 95% confidential interval (CI): 0.843-2.531, P=0.177). Multivariate Cox regression analysis also showed increased mortality risk in patients with increased age (HR=1.022, P<0.001), tumor extension to adjacent structures (HR=1.649, P=0.013), and distant metastasis (HR=2.041, P<0.001), while surgery+RT (HR=0.600, P=0.004) and chemotherapy (HR=0.692, P=0.010) were independently associated with improved OS. Further analysis revealed that patients undergoing total/near-total thyroidectomy (TT) had superior OS to those receiving less than TT (P<0.001). In subgroup analysis, the benefit of TT remained significant in patients with tumors larger than 4.0 cm (HR=0.776, 95% CI: 0.469-0.887, P=0.007), with adjacent structure extension (HR=0.642, 95% CI: 0.472-0.877, P=0.005), including trachea and major vessels, but not in patients with early phase local disease such as tumor≤4.0 cm or tumor within the thyroid or with minimal extrathyroidal extension. Patients with very locally advanced disease or distant metastasis could not benefit from TT as well. Conclusions. In operable cases, surgery+RT±chemotherapy was the optimal treatment modality. Otherwise, RT+chemotherapy was the appropriate strategy. However, TT was not beneficial for very early stage or metastatic ATC.

Clinical Outcome and Toxicity in the Treatment of Anaplastic Thyroid Cancer in Elderly Patients

“…The administration of chemotherapy in our cohort resulted in no further improvement of OS and PFS. Several studies confirm our controversial findings [ 12 , 15 , 50 ]. In contrast, two German studies found a survival benefit for administering concurrent or sequential chemotherapy to radiotherapy [ 16 , 44 ].…”

“…According to Wendler et al and Glaser et al [ 16 , 43 ], nodal involvement impacts OS negatively. Additionally, many larger and smaller studies report that patients with distant metastases experience a dismal prognosis [ 4 , 5 , 6 , 12 , 16 , 43 , 50 ]. In our study cohort, local nodal involvement and distant metastases were associated with poor outcome, which corresponds with the published literature.…”

“…These cases correspond to the unresectable stage IVB or stage IVC, in which, usually, no surgery or only an incomplete resection (R2) is possible [ 2 , 5 , 7 ]. In this situation, definitive chemoradiotherapy may provide local control and symptomatic relief [ 6 , 7 , 8 , 50 ].…”

Presentation and outcomes of patients with undifferentiated thyroid carcinoma: a national perspective

“…The overall survival rate at two years was 27.6% in patients without metastasis and 8.01% with metastatic disease. These results are comparable to a study of 735 patients in the Surveillance, Epidemiology, and End Results database, which showed a two-year overall survival of 10.7 (12). While the two-year overall survival remains poor, patients without metastasis who underwent tri-modal therapy including surgery, had the best overall survival.…”

Anaplastic thyroid carcinoma: a nationwide cohort study on incidence, treatment and survival in the Netherlands over 3 decades

“…The single center retrospective study from MD Anderson (2) also points out that tri-modal treatment showed the best overall survival and that development of distant metastases is the main cause for the steep decrease of the survival curve in the first year. The authors of the SEER data analysis (n = 735) by Huang et al (20) showed that (near) total thyroidectomy is the best surgical strategy. Patients with total thyroidectomy had superior OS (HR 0.65) compared to those patients in which total thyroidectomy was not performed.…”