In:
International Journal of Endocrinology, Hindawi Limited, Vol. 2019 ( 2019-02-19), p. 1-7
Abstract:
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.
Type of Medium:
Online Resource
ISSN:
1687-8337
,
1687-8345
DOI:
10.1155/2019/8428547
Language:
English
Publisher:
Hindawi Limited
Publication Date:
2019
detail.hit.zdb_id:
2502951-4
Permalink
