International journal of endocrinology · 2019
An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients.
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Huang Nai-Si, Shi Xiao, Lei Bo-Wen, Wei Wen-Jun, Lu Zhong-Wu, Yu Peng-Cheng, Wang Yu, Ji Qing-Hai, Wang Yu-Long
Аннотация
BACKGROUND: Anaplastic thyroid cancer (ATC) responds poorly to conventional therapies and requires a multidisciplinary approach to manage. The aim of the current study is to explore whether aggressive treatment is beneficial, especially the appropriate extent of surgery in ATC.
METHODS: Patients diagnosed with ATC from 2004 to 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database and included in our study.
RESULTS: A total of 735 ATC patients were identified. The two-year overall survival (OS) rates for stage IVA, IVB, and IVC patients were 36.5%, 15.6%, and 1.4%, respectively. By directly comparing eight treatment modalities, we found that surgery + radiotherapy (RT) ± chemotherapy was the most effective treatment strategy. surgery + chemotherapy and RT + chemotherapy had comparable results (hazard ratio (HR) = 1.461, 95% confidential interval (CI): 0.843-2.531, P = 0.177). Multivariate Cox regression analysis also showed increased mortality risk in patients with increased age (HR = 1.022, P < 0.001), tumor extension to adjacent structures (HR = 1.649, P = 0.013), and distant metastasis (HR = 2.041, P < 0.001), while surgery + RT (HR = 0.600, P = 0.004) and chemotherapy (HR = 0.692, P = 0.010) were independently associated with improved OS. Further analysis revealed that patients undergoing total/near-total thyroidectomy (TT) had superior OS to those receiving less than TT (P < 0.001). In subgroup analysis, the benefit of TT remained significant in patients with tumors larger than 4.0 cm (HR = 0.776, 95% CI: 0.469-0.887, P = 0.007), with adjacent structure extension (HR = 0.642, 95% CI: 0.472-0.877, P = 0.005), including trachea and major vessels, but not in patients with early phase local disease such as tumor ≤ 4.0 cm or tumor within the thyroid or with minimal extrathyroidal extension. Patients with very locally advanced disease or distant metastasis could not benefit from TT as well.
CONCLUSIONS: In operable cases, surgery + RT ± chemotherapy was the optimal treatment modality. Otherwise, RT + chemotherapy was the appropriate strategy. However, TT was not beneficial for very early stage or metastatic ATC.
METHODS: Patients diagnosed with ATC from 2004 to 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database and included in our study.
RESULTS: A total of 735 ATC patients were identified. The two-year overall survival (OS) rates for stage IVA, IVB, and IVC patients were 36.5%, 15.6%, and 1.4%, respectively. By directly comparing eight treatment modalities, we found that surgery + radiotherapy (RT) ± chemotherapy was the most effective treatment strategy. surgery + chemotherapy and RT + chemotherapy had comparable results (hazard ratio (HR) = 1.461, 95% confidential interval (CI): 0.843-2.531, P = 0.177). Multivariate Cox regression analysis also showed increased mortality risk in patients with increased age (HR = 1.022, P < 0.001), tumor extension to adjacent structures (HR = 1.649, P = 0.013), and distant metastasis (HR = 2.041, P < 0.001), while surgery + RT (HR = 0.600, P = 0.004) and chemotherapy (HR = 0.692, P = 0.010) were independently associated with improved OS. Further analysis revealed that patients undergoing total/near-total thyroidectomy (TT) had superior OS to those receiving less than TT (P < 0.001). In subgroup analysis, the benefit of TT remained significant in patients with tumors larger than 4.0 cm (HR = 0.776, 95% CI: 0.469-0.887, P = 0.007), with adjacent structure extension (HR = 0.642, 95% CI: 0.472-0.877, P = 0.005), including trachea and major vessels, but not in patients with early phase local disease such as tumor ≤ 4.0 cm or tumor within the thyroid or with minimal extrathyroidal extension. Patients with very locally advanced disease or distant metastasis could not benefit from TT as well.
CONCLUSIONS: In operable cases, surgery + RT ± chemotherapy was the optimal treatment modality. Otherwise, RT + chemotherapy was the appropriate strategy. However, TT was not beneficial for very early stage or metastatic ATC.