An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients
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 dia...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2019/8428547 |
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| author | Nai-si Huang Xiao Shi Bo-wen Lei Wen-jun Wei Zhong-wu Lu Peng-cheng Yu Yu Wang Qing-hai Ji Yu-long Wang |
| author_facet | Nai-si Huang Xiao Shi Bo-wen Lei Wen-jun Wei Zhong-wu Lu Peng-cheng Yu Yu Wang Qing-hai Ji Yu-long Wang |
| author_sort | Nai-si Huang |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-555ecac133ff42a2b940639a11cc437e |
| institution | Kabale University |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
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| series | International Journal of Endocrinology |
| spelling | doaj-art-555ecac133ff42a2b940639a11cc437e2025-02-03T05:59:18ZengWileyInternational Journal of Endocrinology1687-83371687-83452019-01-01201910.1155/2019/84285478428547An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 PatientsNai-si Huang0Xiao Shi1Bo-wen Lei2Wen-jun Wei3Zhong-wu Lu4Peng-cheng Yu5Yu Wang6Qing-hai Ji7Yu-long Wang8Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaDepartment of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, ChinaBackground. 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.http://dx.doi.org/10.1155/2019/8428547 |
| spellingShingle | Nai-si Huang Xiao Shi Bo-wen Lei Wen-jun Wei Zhong-wu Lu Peng-cheng Yu Yu Wang Qing-hai Ji Yu-long Wang An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients International Journal of Endocrinology |
| title | An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients |
| title_full | An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients |
| title_fullStr | An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients |
| title_full_unstemmed | An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients |
| title_short | An Update of the Appropriate Treatment Strategies in Anaplastic Thyroid Cancer: A Population-Based Study of 735 Patients |
| title_sort | update of the appropriate treatment strategies in anaplastic thyroid cancer a population based study of 735 patients |
| url | http://dx.doi.org/10.1155/2019/8428547 |
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