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

Chuanzheng Sun, Qiuli Li, Zedong Hu, Jiehua He, Chao Li, Guojun Li, Xiaofeng Tao, Ankui Yang, Chuanzheng Sun, Qiuli Li, Zedong Hu, Jiehua He, Chao Li, Guojun Li, Xiaofeng Tao, Ankui Yang

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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Survival curves for patients with…
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).

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