The use of internal fixation for the treatment of a distal radial fracture differs widely among geographical regions and patient populations. Such variations highlight the need for improved comparative-effectiveness data to guide the treatment of this fracture.
Background
Since anaplastic thyroid cancer is a rare malignancy with a high mortality rate, we evaluated the benefit of multimodality treatment.
Methods
Overall survival was determined in the 2,742 patients captured by the National Cancer Database who were diagnosed with anaplastic thyroid cancer between 1998-2008. We performed Kaplan Meier and then Cox Proportional Hazard Regression controlling for patient characteristics and treatment.
Results
Only older age [adjusted hazard ratio for ≥ 85 (AHR) 3.43 (95% CI 2.34-5.03), for 75-84 AHR 2.85 (95% CI 1.97-4.11), for 65-74 AHR 2.20 (95% CI 1.53-3.15), for 45-64 AHR 2.08 (95% CI 1.47-2.95)] and omission of treatment were associated with greater mortality [omission of surgery AHR 1.79 (95% CI 1.61-1.99), omission of radiation therapy AHR 1.56 (95% CI 1.41-1.73), and omission of chemotherapy AHR 1.28 (95% CI 1.15-1.43)]. In subgroup analysis of patients with AJCC Stage IVA, IVB and IVC anaplastic thyroid cancer, combination therapy with surgery, radiation, and chemotherapy was associated a difference in median survival of months.
Conclusion
Multimodality management of anaplastic thyroid cancer results in a marginal treatment benefit. The poor overall survival of all anaplastic thyroid cancer patients, regardless of treatment, emphasizes the need for informed patients whose preferences are incorporated into treatment decision making.
Surgical complications are independently associated with omission of chemotherapy for stage III colorectal cancer and with a delay in adjuvant chemotherapy. These data suggest that complications of colorectal surgery may affect both short- and long-term cancer outcomes. Thus, the implementation of quality improvement measures that effectively reduce perioperative complications may also provide a long-term cancer survival benefit.
The number of lymph node metastases should be incorporated into MTC staging. The extent of surgery in patients with MTC should be tailored to tumor size and distant metastases.
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