Survival Benefit of Intervention Treatment in Advanced Anaplastic Thyroid Cancer

Abstract

Background Management of anaplastic thyroid cancer (ATC) is a controversial issue; thus, proper treatment and prognostic factors should be investigated. Objectives To compare the survival outcomes of intervention and palliative treatment in ATC patients. Methods A hospital-based retrospective study was conducted in a single tertiary university hospital. The medical record charts were retrieved from November 20, 1987 to December 31, 2016. The final follow-up was ended by December 31, 2017. Patients’ demographic data, laboratory data, clinical presentation, and results of treatment modalities were analyzed. Results One hundred twenty-one records were analyzed that one-year overall survival rate of 3.5% (median survival time of 77 days); however, there was insufficient data on 16 cases to classify staging and treatment modalities. Therefore 105 ATC patients (37 stage IVa, 39 stage IVb, 29 stage IVc) were included with one-year overall survival rate of 4.0% (median survival time of 82 days). Intervention treatment allowed longer median survival times (p < 0.05) and a better survival rate (p < 0.05). Among the intervention treatment group, post-operative chemoradiation yielded the longest median survival time (187 days) and the longest survival rate (20%) (p < 0.05). At all stages, intervention modality allowed better median survival time, especially in stage IVa (p < 0.05). Unfavorable prognostic factors were adjusted with multiple cox regression model that showed significant factors included age ≥ 65 years (HR of 2.57), palliative treatment (HR of 1.85), and leukocytosis ≥ 10,000/mm3(HR of 2.76). Conclusions Intervention treatment provided a better survival outcome in all stages, especially in stage IVa with a significantly better median survival time. Among intervention treatments, postoperative chemoradiation offered the longest survival rate; thus, suggesting this should be considered in ATC patients who have resectable tumors and no poor prognostic factors such as older age and leukocytosis.

Evaluation of anaplastic thyroid carcinoma in the Kurdistan region of Iraq

“…Participants' tumour size was > 4 cm among the majority (77.3%) of participants. Previous studies reported tumours ranging between 3.6 and 10.5 cm, but only 68.9% of cases were reported to be larger than 4 cm [16,22]. Even though larger tumour sizes are bad prognostic factors [22], those with larger tumours survived longer than those with smaller ones in the current study.…”

“…Previous studies reported tumours ranging between 3.6 and 10.5 cm, but only 68.9% of cases were reported to be larger than 4 cm [16,22]. Even though larger tumour sizes are bad prognostic factors [22], those with larger tumours survived longer than those with smaller ones in the current study. This discrepancy could be explained by the role of large size in increasing patient awareness and motivation to seek treatment at an earlier stage, thereby increasing the scope of treatment and survival prospects.…”

“…However, in small, non-extended tumours, it could be considered a curative for a short duration, with potential application as a palliative measure in inoperable patients. However, it could potentially extend survival outcomes in the case of surgery combined with chemoradiation [22]. This study found that surgery showed a better median survival time of 7 months for operated cases, compared to 2 months for non-operable ones.…”