Treatment and prognosis of anaplastic thyroid carcinoma: experience from a single institution in China

Abstract

Background: Anaplastic thyroid carcinoma (ATC), a highly aggressive malignancy, has a poor prognosis, and the consensus on the most effective treatment is needed.

Methods: Clinical data from all ATC patients treated in our institution over a 30-year period (between May 1980 and May 2010) were analyzed retrospectively with regard to mortality and survival rates (Kaplan-Meier). Multivariate analysis was performed using a Cox proportional hazards model.

Results: Sixty cases were analyzed. The overall 1- and 3-year survival rates were 35.0% and 22.9%, respectively. Univariate analysis showed that the best prognosis was seen in patients younger than 55 years, those without distant metastases, those with white blood cell (WBC) counts < 10.0 × 10(9)/L or blood platelet (PLT) counts < 300.0 × 10(9)/L at presentation, those who did not receive chemotherapy, and those who received radiotherapy doses ≥ 40 Gy or underwent surgery plus postoperative radiotherapy. According to multivariate analysis, the WBC count at first presentation and the type of therapeutic regimen independently influenced survival.

Conclusions: We found that the elevated peripheral PLT count may be an adverse prognostic factor of ATC patients. The prognosis for ATC is especially poor for patients with distant metastasis, a WBC count ≥ 10.0×10(9)/L, a PLT count ≥ 300.0 × 10(9)/L, or age ≥ 55 years. WBC count at presentation and surgery with or without postoperative radiotherapy independently influenced the prognosis. Intensive treatment combining surgery with postoperative radiotherapy is recommended for ATC patients with stage IVA/B disease.

Figure 1. Survival curves for patients with ATC.

(A) Survival curves for patients with different ages (P = 0.033). (B) Survival curves for patients with different WBC counts (P = 0.006). (C) Survival curves for patients with different PLT counts (P = 0.025); this analysis contained 42 patients whose PLT counts were measured at their initial presentations. (D) Survival curves according to clinical tumor-node-metastasis stage (P = 0.030). (E) Survival curves for patients who received chemotherapy and for those who did not (P = 0.046). (F) Survival curves for patients who received different radiotherapy doses (P = 0.014). (G) Survival curves for all 60 ATC patients who received surgery plus postoperative radiotherapy or another therapy (P = 0.002). (H) Survival curves for stage IVB patients who received surgery plus postoperative radiotherapy or surgery alone (P = 0.050).