Anaplastic Carcinoma Of The Thyroid

Background.Although anaplastic thyroid carcinoma(ATC)is one of the most aggressive human malignancies,it is an orphan disease.Patients with ATC have a dismal prognosis,the factors influencing the prognosis of ATC patients are still controversial,and no standard treatment for ATC has been established.We analyzed the prognostic factors and treatment outcomes in patients with ATC using data reported in the Surveillance,Epidemiology,and End Results(SEER)cancer registry with the aim to determine the prognostic factors associated with the survival of patients with ATC.By comparing the TNM staging criteria of thyroid undifferentiated carcinoma in the 7th edition and the 8th edition of AJCC,the staging criteria more suitable for clinical were discussed.Methods.We evaluated data from patients with thyroid cancer who were included in the SEER database between 2004 and 2013.Univariate and multivariate logistic regression models were used to analyze the correlation between the clinicopathological parameters and prognosis of undifferentiated thyroid cancer.The log-rank test was used to analyze the OS and DSS curves.Demographic,pathologic,and treatment data were used for univariate and multivariate survival analyses.Results.A total of 698 patients with ATC were identified.Of these,60.7% were women,and 80.4% were white.The mean age at diagnosis was 69.68 years.A total of 78.2% of patients had single lesions,18.5% had intrathyroidal tumors,and 44.6% had distant metastasis.Following diagnosis,33.8%,54.2%,and 57.9% of patients underwent lobectomy,total thyroidectomy,and radiation therapy,respectively.The median survival after diagnosis was 8.81 months.The 6-and 12-month disease-specific survival(DSS)rates were 48.3% and 29.8%,respectively.Meanwhile,the 6-and 12-month overall survival(OS)rates were 42.8% and 23.5%,respectively.The 6-month OS rates in the patients with stage IVA(7th edition),IVB(7th edition),and IVC(7th edition)were 50.4%?39.7% and 17.5%,respectively(P < 0.001).The 6-month OS rates in the patients with stage IVA(8th edition),IVB(8th edition),and IVC(8th edition)were 63.5%,NA,and 21.8%,respectively(P < 0.001).Univariate Cox regression analysis showed that age,lymph node involvement,thyroid extension,and radiotherapy were associated with the survival of patients with anaplastic carcinoma.Multivariate Cox regression analysis showed that the predictors of OS and DSS were age(P < 0.001,P = 0.001,respectively),tumor distant metastasis(P < 0.001,P < 0.001,respectively),thyroid extension(P < 0.001,P < 0.001,respectively),and radiation therapy(P < 0.001,P < 0.001,respectively).Conclusions.Age at pathological diagnosis,lymph node involvement,tumor distant metastasis,and thyroid extension are predictors of OS and DSS.Radiation therapy can definitely improve the overall survival rate of thyroid undifferentiated carcinoma,which is an independent predictor affecting its survival rate.Therefore,radiation therapy can be recommended for patients with thyroid undifferentiated carcinoma.The 7th AJCC standard for TNM stage of ATC patients is more reasonable and suitable for clinical use.