No abstract

Background/Aim: Anaplastic thyroid carcinoma (ATC) is the least common but most lethal of thyroid cancer, despite various therapeutic options, with limited efficacy. In order to help therapeutic decision-making, the purpose of this study was to develop a new prognostic score providing survival estimates in patients with ATC. Patients and Methods: Based on a multivariate analysis of 149 retrospectively analyzed patients diagnosed with ATC from 1968 to 2017 at a referral center, a propensity score was developed. A model was generated providing survival probability at 6 months and median overall survival estimates. Results: The median survival was 96 days. The overall survival rate was 35% at 6 months, 20% at 1 year and 13% at 2 years. Stepwise Cox regression revealed that the most appropriate death prediction model included metastatic spread, tumor size and age class as explanatory variables. This model made it possible to define three categories of patients with different survival profiles. Conclusion: Distant metastasis, age and primary tumor size are strong independent factors that affect prognosis in patients with ATC. Using these significant pretreatment factors, we developed a score to predict survival in these patients with poor prognosis.Although anaplastic thyroid carcinoma (ATC) is rare, it is one of the most aggressive malignancies. This type of carcinoma accounts for 1.7% of all thyroid malignancies and one-half of all thyroid cancer deaths (1, 2). The median survival for patients with ATC is 3-6 months, and it has a 1-year survival rate of 20% (3-6). Indeed, ATC most commonly presents in elderly patients with poor performance status, making it difficult to tolerate an active therapeutic approach (7), although some patients survive for a relatively long time after aggressive treatment (8, 9). In such frail patients, aggressive treatment may worsen the quality of life and occasionally even shorten survival; therefore, the selection of patients who will benefit from such aggressive multimodal therapy seems important. Optimal ATC treatment is questionable due to lack of randomized trials; most studies validate the benefit of surgery. Although some reports questioned the benefit of radiotherapy (10), improved survival has been shown with post-operative radiotherapy (11) and radiation dose escalation was also associated with longer survival rates in selected patients with metastatic disease (12). Combined chemoradiotherapy was favored over radiation alone (13,14). However, several series reported no benefit for chemotherapy (6,15). Retrospective studies identified some prognostic factors such as age, gender, presence of acute symptoms, tumor size, multicentricity, metastatic spread, white blood cell level, blood platelet level and serum albumin level, influenced survival of patients with ATC (13,16,17). Here, we reviewed data from 149 patients with ATC in an attempt to identify subsets of patients that either would benefit best from a more aggressive treatment strategy or for whom palliative care would be mo...

No abstract

BACKGROUND AND PURPOSE Anaplastic thyroid carcinoma (ATC) is the least common but most lethal of thyroid cancers despite various therapeutic options with limited efficacy. Some prognostic factors were identified in patients with ATC and a few patients survive for a relatively long time after modern intensive treatment. In order to help therapeutic decision-making, the purpose of this study was to develop a new prognostic score providing survival estimates in patients with ATC. METHODS Based on a multivariate analysis of 149 retrospectively analyzed patients diagnosed with ATC from 1968 to 2017 at a referral center, a propensity score was developed. A model was generated providing survival probability at 6 months and median overall survival estimates. RESULTS The median survival was 96 days. The overall survival rate was 35% at 6 months, 20% at 1 year and 13% at 2 years. Most of the patients (86%) died within 17 month, 17% died within the first month, 35% lived for 1-6 months and 47 % of the patients lived longer than 6 months after the initial consultation. The stepwise Cox regression revealed that the most appropriate death prediction model included metastatic spread, tumor size and age class as explanatory variables.This model made it possible to define three categories of patients with survival profiles which seems different: patients with no pejorative prognostic factor which had a survival probability at 6 months = 0,84 (95% CI: 0,69-1), patients with one or two pejoratives prognostics factors which have a survival probability at 6 months = 0,32 (95% CI: 0,22-0,46), and those with three pejoratives prognostics factors which had a survival probability at 6 months = 0,11 (95% CI: 0,018 -0,71). CONCLUSION Distant metastasis, age and primary tumor size are strong independent factors that affect prognosis in patients with ATC.Using these significant pretreatment factors, we developed a score to predict survival in these poor prognosis patients in order to provide easy-to-use tools for clinical practice. External validation in an additional dataset is needed for further outlooks.