Treatment and Prognosis of Anaplastic Thyroid Carcinoma: A Clinical Study of 50 Cases

Abstract

IntroductionAlthough anaplastic thyroid carcinoma (ATC) is rare, it is one of the most aggressive human cancers. The optimal multimodal therapy policy of ATC is still debated, and a standardized treatment strategy remains to be established. This study aimed to evaluate the management aspect and prognosis of ATC.Materials and MethodsThe data were analyzed retrospectively for 50 patients with ATC to evaluate the clinical characters, management and factors influencing survival. Survival analysis was performed by Kaplan-Merier method and log-rank test, and multivariate analysis was performed using Cox proportional hazard model.ResultsThe 1-year and 2-year overall survival rates (OS) were 48.0% and 26.0% respectively in all patients, with the 2-year OS of 40.0% and 31.0% and 6.3% for stage IVA, IVB and IVC respectively (P <0.05). In stage IVA and IVB patients, combined surgery with radiotherapy improved overall survival, and the 2-year OS were 50.0% and 35.7% respectively in the group with combined surgery with radiotherapy and the group with surgery with only (P <0.05). Postoperative radiotherapy improved local control rate in stage IVA and IVB patients (P <0.05). However, surgery, radiotherapy or chemotherapy could not improve the survival of stage IVC patients. Multivariate analysis showed that distant metastases, surgery, radiotherapy and tumor residue could predict the prognosis.ConclusionCombined surgery and radiotherapy could improve overall survival in stage IVA and IVB patients. Patients with ATC have a bad prognosis. Distant metastases, surgery, radiotherapy and tumor residue are the most important factors affecting the prognosis.

Treatment Outcome and Prognostic Factors of Anaplastic Thyroid Carcinoma: A Single Institution Experience in Egypt

“…One of the features of ATC is the aggressive invasion of the thyroid capsule, adjacent structures, early lymph nodes and distant spread. In this study, there was a small number of patients with invaded recurrent laryngeal nerve (5/30 patients), trachea (5/30 patients), and strap muscles (4/30 patients), contrary to Liu et al where 31/50 patients had invasion of the surrounding structures 16 . The incidence of metastases at presentation was 40% which is less than that in the study by Aslan et al (55%, 16/29) where 8 patients presented with metastases and 8 patients developed it shortly after 27 .…”

“…Univariate and multivariate analyses of factors affecting survival by Kihara et al showed that complete surgery was an independent prognostic factor 43 . Other reports also found that complete resection was associated with longer survival compared to incomplete surgery or biopsy 14,16 . Sun et al reported on treatment and prognosis of 60 patients diagnosed with ATC 14 .…”

“…The authors also showed that postoperative RT dose > 33.1 Gy led to better survival (p=0.04). Liu et al recommended postoperative RT doses of 40 Gy in stage IVA and IVB disease and also palliative doses in stage IVC to improve the quality of life 16 . Toxicity can be a limiting factor with RT because concurrent chemotherapy is often used, and the large RT volume that includes a significant part of the larynx and cervical esophagus 5 .…”

“…The local tumor extent and the general condition of the patient determine the surgical strategy. A good rule of thumb is that stage IVA or stage IVB disease in which grossly negative margins (R1) can be obtained should have a complete resection because it is associated with improved PFS and OS 1,16 . Complete resection is possible in approximately one-third of patients at presentation.…”

“…Sugitani et al identified age and limited tumor size which is associated with higher tumor resectability as prognostic variables 24 . Liu et al reported that tumor size < 4 cm, distant spread, surgical resection, RT and residual tumor were independent factors of prognosis of ATC patients who underwent treatment 16 . A large, multicenter Japanese study also identified age ≥ 70 years, presence of acute symptoms, leucocytosis, tumor size >5 cm, T4B tumor, and distant metastasis as poor prognostic indicators of survival.…”