Prognostic Factors and Therapeutic Strategy for Anaplastic Carcinoma of the Thyroid

Abstract

Although anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies, a few patients survive for a fairly long time after modern intensive treatment. We tried to identify prognostic factors of ATC to assist in deciding on the proper therapeutic strategy in individual patients. Of 47 patients with ATC (1976-1999), 3 patients with "incidental" ATC (largely differentiated thyroid carcinoma with a small region of ATC) were excluded because they had a favorable outcome. The 1-year survival rate of the remaining 44 patients with clinically distinct ATC was 16%. The presence of acute symptoms, large tumor (> 5 cm), distant metastasis, and leukocytosis (white blood cell count > or = 10,000/mm3) proved to be significant risk factors. Multivariate analysis by the Cox proportional hazard model showed that these four factors were independent factors for predicting death from ATC. We devised a novel prognostic index (PI) based on the number of these four unfavorable characteristics the patient possessed. Patients with a PI of < or =1 had a 62% survival rate at 6 months, whereas no patients with a PI of > or =3 survived longer than 6 months. All patients with a PI of 4 died from their disease within 3 months. Nine patients received multimodal treatment with a combination of surgery, external irradiation, and chemotherapy and had a long survival (mean 333 +/- 68 days; one patient is still alive and tumor-free), with a mean PI of 0.6. Our PI is useful as a means of selecting patients for aggressive therapy. When the PI is low, multimodal treatment should be attempted to obtain the best survival results; if it is high most patients are too seriously ill to tolerate intensive treatment and palliative therapy is recommended.

Thyroid Cancers: Considerations, Classifications, and Managements

“…A variety of previous studies have evaluated prognostic factors of ATC [99][100][101][102]. These prognostic factors include patients' age, tumor size, and clinical stage.…”

“…Symptoms can be related to invasion of tumor to neighboring structures such as recurrent laryngeal nerve (RLN), parasympathetic chain (causing Horner's syndrome), or even carotid arteries (causing stroke). About 40% of patients usually present with lymphadenopathy and up to 43% have distant metastasis, most commonly to the lung followed by bone and brain at the time of diagnosis [98].A variety of previous studies have evaluated prognostic factors of ATC [99][100][101][102]. These prognostic factors include patients' age, tumor size, and clinical stage.…”

Clinical Characteristics and Prognosis of Differentiated Thyroid Carcinoma with Small Foci of Anaplastic Transformation

“…One is that ATC concurrent with DTC was found about 50% (23-71%) in several cohort studies about ATC patients. 5,7,8,13) In a study analyzing entire tumor sections, every ATC contained components of papillary or follicular carcinoma or both. 14) Second evidence is that BRAF mutation was found in ATC with PTC component.…”

Anaplastic thyroid carcinoma

“…In a study by Venkatesh and colleagues, patients with localized disease had a median survival of 8 months in comparison to 3 months for patients with metastatic disease (Tan et al, 1995;Lo et al, 1999;Kim et al, 2007;Roche et al, 2010). A prognostic index was developed by Sugitani et al (2001) from a review of their series of 47 patients over 33 years (Venkatesh et al, 1990). Their index was based on a combination of four risk factors: (Hundahl et al, 1998;Kitamura et al, 1999) presence of acute symptoms, (Kebebew et al, 2005) tumor size greater than 5 cm, (Hundahl et al, 2000) distant metastasis, and (Davies and Welch, 2006) white cell count ≥10,000/µL (Venkatesh et al, 1990).…”

“…Complete resection has been identified as a prognostic factor in several clinical trials (Junor et al, 1992;Tan et al, 1995;Kobayashi et al, 1996;Sugitani et al, 2001). When feasible, surgery must aim at a radical intent.…”