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Anaplastic thyroid carcinoma. Treatment outcome and prognostic
factors.
Cancer. 2005 Apr
1;103(7):1330-5.
BACKGROUND:
Anaplastic thyroid carcinoma (ATC) is rare but is one of the most
aggressive human malignancies. Several prognostic factors have been
observed in patients with ATC, and some experts advocate aggressive
multimodal therapy in selected patients. However, it is unclear
whether such an approach significantly improves survival. The authors
analyzed prognostic factors and treatment outcomes in patients with
ATC reported in the National Cancer Institute's Surveillance,
Epidemiology, and End Results data base. METHODS: The cohort consisted
of 516 patients with ATC reported to 12 population-based cancer
registries between 1973 and 2000. Demographic, pathologic, and
treatment data were used for univariate and multivariate survival
analyses. RESULTS: The mean patient age at diagnosis was 71.3 years,
and there were 171 men and 345 women. Eight percent of patients had
intrathyroidal tumors, 38% had extrathyroidal tumors and/or lymph node
invasion, and 43% of patients had distant metastasis. The average
tumor size was 6.4 cm (range, 1-15 cm). Sixty-four percent of patients
underwent surgical resection of their primary tumor, and 63% received
external beam radiotherapy. The overall cause-specific mortality rate
was 68.4% at 6 months and 80.7% at 12 months. Univariate analysis
showed that age < 60 years, female gender, intrathyroidal tumor,
external beam radiotherapy, surgical resection, and combined surgical
resection of tumor and radiotherapy were associated with a lower
cause-specific mortality. On multivariate analysis, only age < 60
years, an intrathyroidal tumor, and the combined use of surgical and
external beam radiation therapy were identified as independent
predictors of lower cause-specific mortality. CONCLUSIONS: Although
most patients with ATC had an extremely poor prognosis, patients < 60
years old with intrathyroidal tumors survived longer. Surgical
resection with external beam radiotherapy for ATC was associated with
lower cause-specific mortality.
Prognostic factors
of anaplastic thyroid carcinoma.
Surg Today. 2004; 34(5): 394-8.
PURPOSE:
Anaplastic thyroid carcinoma (ATC) is a relatively rare but very
aggressive malignancy, which usually results in death a few months
after diagnosis. However, some patients survive for a long time, and
the purpose of this study was to identify the prognostic factors of
ATC. METHODS: We retrospectively analyzed the records of 19 patients
diagnosed with ATC in our institution between 1984 and 2002. RESULTS:
The median survival was 9.4 months, with a range of 0.6-76.3 months,
and the 1-, 2-, and 5-year survival rates were 21%, 11%, and 5%,
respectively. The mean tumor size was 5.7 cm, with a range of 3.6-10.5
cm, and complete resection was achieved in 4 patients. The prognostic
factors according to univariate analysis were complete resection and
small tumor size of less than 5 cm ( P = 0.005 and 0.047). However,
according to multivariate analysis, complete resection was the only
prognostic factor for ATC ( P = 0.015). No association was found
between survival and acute symptoms, chemotherapy, radiation therapy,
extrathyroidal invasion, distant metastasis, age, or leukocytosis.
CONCLUSION: At present, while there is no successful treatment regimen
for ATC, only patients who undergo complete resection at a very early
stage have any chance of long-term survival.
Anaplastic thyroid
carcinoma: a 50-year experience at a single institution.
Surgery. 2001 Dec;130(6):1028-34
BACKGROUND:
Anaplastic thyroid carcinoma (ATC) is among the most aggressive of
human malignancies. However, there have been few large studies of
histologically well-defined ATC. We report the results of a 50-year
experience of this lethal malignancy. METHODS: We reviewed all cases
of ATC managed in this institution between 1949 and 1999. One
pathologist (J.R.G.) reviewed all pathologic material. Clinical
details were obtained from medical records, and current status of all
patients was determined. RESULTS: There were 134 cases, with a
female-to-male ratio of 1.5:1 and a mean age of 67 years. Benign
thyroid disease was present in 27 cases (20%) and well-differentiated
thyroid carcinoma in 31 (23%). Sixty-two patients (46%) had distant
metastases at diagnosis, and 98% of the tumors were locally invasive.
Primary treatment was surgical for 96 patients (72%). Complete
resection was achieved in 29 cases (30%), with "minimal residual
disease" in 25. Neither extent of operation nor completeness of
resection affected survival (P > .4). Postoperative radiotherapy gave
slightly longer median survival (5 vs 3 months), which was not
significant (P < .08). Multimodal therapy, including operation,
chemotherapy, and radiotherapy, did not improve survival. CONCLUSIONS:
The outlook for patients with ATC remains grim. Novel treatments for
ATC are desperately needed.
Anaplastic thyroid carcinoma: current diagnosis and
treatment.Ann
Oncol. 2000 Sep;11(9):1083-9.
BACKGROUND:
Anaplastic thyroid carcinoma (ATC), accounting for 5% to 15% of
primary malignant thyroid neoplasms, is one of the most aggressive
solid tumors in humans. Generally, it is rapidly fatal, with a mean
survival of six months after diagnosis. Multimodality treatment with
surgery and/or external beam radiotherapy and chemotherapy are of
fundamental importance for local control of disease and to enhance
survival. DESIGN: We evaluated consecutive patients with ATC observed
at the Mayo Clinic from 1971 to 1993 and reviewed relevant articles
published in major English-language medical journals. We used the
MEDLINE database, selected bibliographies, and articles available in
our personal files. RESULTS: ATC usually does not concentrate
radioiodine or express thyroglobulin. It is essential to verify the
diagnosis histologically because insular thyroid cancer, lymphomas,
and medullary thyroid cancer are occasionally confused with
undifferentiated neoplasms. Immunohistochemical study is helpful in
establishing the diagnosis. Multimodal therapy and the development of
effective systemic chemotherapeutic agents should result in
improvements in survival, although no single agent has yet been
identified. CONCLUSIONS: Aggressive multimodality treatment regimens
show promise in improving local control in patients with ATC. However,
survival rates remain low. Despite intense application of such
therapy, no standardized successful treatment protocol has been
established.
Anaplastic thyroid
carcinoma: risk factors and outcome.
Surgery. 1991 Dec;110(6):956-61.
Anaplastic
thyroid carcinoma, in contrast to well-differentiated thyroid
carcinoma, has a dismal prognosis, and little progress has been made
in improving survival for this disease. We reviewed our experience
during a 23-year period to identify risk factors and possible methods
to improve outcome. Between 1966 and 1989, 340 patients with thyroid
carcinoma underwent operation. Of these, 17 (5%) were undergoing
operative treatment of anaplastic or undifferentiated thyroid
carcinoma. The female/male ratio was 3.5:1, and mean age at
presentation was 63 years. The most common presenting symptoms
included neck mass, voice change, or dysphagia. Unusual presentations
included symptomatic bradycardia from compression of the vagus nerve
and superior vena cava syndrome. Four patients had a history of
well-differentiated thyroid carcinoma. Nine patients had been
diagnosed or treated in the past for "goiter" or a neck mass, and four
patients had concurrent differentiated thyroid carcinoma associated
with the anaplastic tumor. Thus 13 (76%) of 17 patients had a previous
thyroid disorder, benign or differentiated malignant, and eight (47%)
of 17 patients had previous or concurrent differentiated thyroid
carcinoma. At the time of presentation, six patients had unilateral
true vocal cord paralysis. At operation, 14 patients had local
extension of the tumor and four required tracheostomy. Only five of 12
patients showed response to postoperative radiation therapy. Overall
median survival was 12 months, and 13 (76%) of 17 patients died. The
two patients alive longer than 12 months had only small foci of
anaplastic carcinoma in association with well-differentiated
carcinoma. Anaplastic thyroid carcinoma is a locally and systemically
aggressive disease, with long-term survival seen only in those with
well-localized anaplastic tumor. The major risk factor in this series
is a history of previous benign or malignant thyroid disease. Because
of this, a more aggressive approach to thyroid masses may be
warranted. Long-standing goiters or benign nodules should be followed
carefully and considered for resection if they grow or do not respond
to medical therapy, and total thyroidectomy for malignant disease may
obviate the subsequent development of anaplastic carcinoma. This
method of early diagnosis and resection of abnormal thyroid tissue
seems to be the only method currently available to improve the nearly
uniform fatality of this disease.
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