Prognostic Factors and Survival Score for Patients With Anaplastic Thyroid Carcinoma: A Retrospective Study from a Regional Registry

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...

Radiotherapy Plus Chemotherapy Leads to Prolonged Survival in Patients With Anaplastic Thyroid Cancer Compared With Radiotherapy Alone Regardless of Surgical Resection and Distant Metastasis: A Retrospective Population Study

“…A possible explanation for that may lie in that the extremely short survival of ATC patients leads to the statistical insignificance of lymph node invasion for survival. Similarly, no association of tumor size with survival was found in our study, in line with a small study ( 16 ) but contrary to two previous studies presenting a negative correlation of tumor size with survival ( 14 , 27 ). This discrepancy could be attributed to inadequate confounding factors controlled and small sample size.…”

Discussion on the Transoral Vestibular Approach Endoscopy for TC Patients and the Significance of Serum 25-Hydroxyvitamin D Classification

“…With the progression of the disease, TC in patients' body has different forms, including papillary TC, follicular thyroid carcinoma TC, and medullary TC. At present, the common clinical carcinogenesis is mostly papillary [ 2 ]. In clinical practice, surgical resection and lymph node dissection are mostly performed for TC, but the traditional surgical method brings large wounds to the body surface of TC patients.…”

Comparison of the cox regression to machine learning in predicting the survival of anaplastic thyroid carcinoma

“…The data for the above study were obtained from the SEER database. Meanwhile, a retrospective Study from Regional Registry studied 149 patients with ATC showed that age, tumor size, distant metastasis status were independent variables, definitely affecting survival rate of ATC, as analyzed by multivariable Cox proportional hazard regression [ 27 ]. Traditional Cox regression is the most convenient way to solve most survival prediction problems because its results are easy to interpret.…”