The incidence and survival analysis for anaplastic thyroid cancer: a SEER database analysis

Abstract

Background: Thyroid carcinoma is the most common malignant endocrine tumor; the anaplastic thyroid cancer subtype is aggressive and has a poor prognosis. However, there is no effective treatment for this disease.

Methods: This study was analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. Joinpoint regression models, linear regression models, Kaplan-Meier survival curves and Cox regression models were used to study the trends in incidence, survival rate and median survival time and to detect the risk factors affecting prognosis in patients with anaplastic thyroid cancer.

Results: While the incidence rate and truncated incidence rate fluctuated slightly over the past 30 years, they were relatively stable and had no obvious upward trend (APC = -0.22 and 0.24, respectively, P>0.05). The median survival was 3.16 months, and the survival rate did not improve significantly (the APC values of the 3-, 6-, 9-, and 12-month survival rates were 0.44, 0.35, -0.23 and -0.86, respectively, P>0.05). After subgroup analysis and survival analysis, it was concluded that the prognosis of the patients might be related to their metastatic stage, surgical status, chemotherapy treatment, age and socioeconomic status at the time of diagnosis (P<0.05). Total thyroidectomy is superior to other methods and is beneficial in prolonging the life of patients and improving the overall survival rate (the median survival was 10 months, and the 6-month survival rate was 59.26%).

Conclusion: The incidence trend for anaplastic thyroid cancer over the last 30 years was stable, and the survival rate and median survival time were not significantly improved. The prognosis of the patients may be related to their metastatic stage, age, socioeconomic status, surgical status and chemotherapy treatment.

Keywords: Anaplastic thyroid cancer; SEER database; epidemiology; prognosis.

Figure 1

Curve of the Standardized Incidence from 1986 to 2015. A. Curve of Standardized Incidence. B. Curve of Truncated Incidence. The truncated incidence was counted among 35-64-year-old patients. The points indicate the observed incidence (per 100,000 person-years). The fitting curve shows the annual percentage change in standardized incidence from 1986 to 2015. Rates are age-adjusted to the 2000 US standard population.

Figure 2

Curve of disease-related survival rates from 1986 to 2015. The points represent observed disease-related relative survival rates. The fitting curve shows the annual percentage change in the survival rate from 1986 to 2015. Because the survival rate occurring above 1 year is 0, this method is not suitable for fitting it. Abbreviations: 3-0 joinpoint, 3-month survival rate; 6-0 joinpoint, 6-month survival rate; 9-0 joinpoint, 9-month survival rate. ^The APC had statistical significance, P<0.05.

Figure 3

Curve of disease-related median survival time from 1986 to 2015. Points represent median disease-related survival times. Trend line for calculating median survival time by linear regression (R square = 0.04, F test P = 0.304).

Figure 4

Kaplan-Meier Survival Curve of Anaplastic Thyroid Cancer from 1986 to 2015. Abbreviations: OS, Overall Survival; DFS, Disease-Free Survival.

Figure 5

Total survival subset analysis of anaplastic thyroid cancer patients from 1986 to 2015. Abbreviation: SES, socioeconomic status.

Figure 6

The influence of the choice of surgical methods on OS. A. The prognosis of patients with glandular lobe/subtotal/subtotal resection alone is worse than that of patients with bilateral total resection, P<0.0001. B. In patients undergoing bilateral total lobectomy, regional lymph node dissection had no effect on OS, P = 0.129.