Dyspnea as a prognostic factor in anaplastic thyroid carcinoma

Abstract

Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer. In this study, we review a single institution's experience with ATC over past 34 years. Through retrospective review, we attempted to identify the prognostic factors affecting the survival at our institution. We reviewed the records of 33 patients diagnosed with ATC by pathology over the last three decades. At our institution, median age at diagnosis was 68 years, the male to female ratio was 1.1:1, mean survival was 10 months and median survival was 4.7 months. Thirty-nine percentage of patients were treated with chemotherapy and 52% received radiation treatment. Thirty-six percentage received both chemotherapy and radiation and 58% of patients were treated with surgical intervention. Four of the patients received surgical intervention with curative intent. Tracheotomy was performed in 40% of patients. Eight patients survived more than 10 months. Univariate analysis showed that age greater than 60 and dyspnea at presentation were associated with decreased survival and that surgical intervention was associated with increased survival. Multivariate analysis identified only dyspnea at the time of presentation to be a significant independent prognostic factor affecting the mortality. While long-term survival is possible in some patients, ATC has a poor prognosis despite the attempts at aggressive treatment. In this study, we report that dyspnea was the only independent factor found to negatively affect the survival. This finding is unique in our study and supports the role of using signs at the time of presentation as potential prognostic factors for those patients with this aggressive disease.

Treatment and Prognosis of Anaplastic Thyroid Carcinoma: Experience from a Single Institution in China

“…Consequently, the significance of surgical resection of the primary tumor remains controversial [6]. In the present study, the extent of resection did not affect survival (χ 2 = 0.005, P = 0.998), which is similar to the findings of other studies [4,8,10,11]. However, most studies have found that curative resection significantly improved the survival of ATC patients [6,16–18].…”

“…In the present study, primary tumor size was not related to the prognosis of ATC patients, although other authors have reported that large tumors correlate with worse outcomes [2,5,8,14,18,36]. As in most reports [10,14,28], our study did not find lymph node metastasis ( P = 0.230) to be a prognostic factor. However, the patients with distant metastasis had worse 1- and 3-year OS rates than did the patients without distant metastasis ( P = 0.032), similar to the findings of other studies [5,8,13,14,18,28,29].…”

“…Furthermore, 20%–50% of patients present with distant metastases, most often pulmonary [1–3,6,9]. Multimodal therapy can achieve better results in terms of avoiding death from local invasion and suffocation[1,10], but no firm conclusions have been reached concerning treatment regimens[7-14]. Thus, there is a need to investigate the effects of multimodal therapy, to determine prognostic factors in ATC, and to provide practical and constructive information for clinicians.…”

Two Cases of Cervical Hemorrhage with Upper Airway Obstruction: A Life-Threatening Condition

“…We recommend not to waste precious time, and to secure the airway when there is suspicion of its severe impairment. Tashima et al [8] report that dyspnea at its outbreak is the only significant independent prognostic factor affecting the mortality of ATC. Following Kumar and Joshi's [14] point of view, we assert that a partial or, when it is possible to get a radical surgery, a total thyroidectomy is a possible and life-saving option for palliation of a severe compressive ATC.…”

Outcome after intensity modulated radiotherapy for anaplastic thyroid carcinoma

“…Most patients die a few months after diagnosis because of uncontrolled neck mass and metastases, and long-term survivors are rare [1-4]. In the dead patients, dyspnea was the most common cause due to extensive neck mass, and another cause was metastases [5]. A tracheotomy may sometimes be performed to solve airway obstruction, but which also deteriorated the quality of life in the patients.…”