Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4166–4174

Impact of Timeliness of Resection and Thyroidectomy Margin Status on Survival for Patients with Anaplastic Thyroid Cancer: An Analysis of 335 Cases

  • Paolo Goffredo
  • Samantha M. Thomas
  • Mohamed Abdelgadir Adam
  • Julie A. Sosa
  • Sanziana A. Roman
Endocrine Tumors

DOI: 10.1245/s10434-015-4742-6

Cite this article as:
Goffredo, P., Thomas, S.M., Adam, M.A. et al. Ann Surg Oncol (2015) 22: 4166. doi:10.1245/s10434-015-4742-6

Abstract

Background

Controversies regarding anaplastic thyroid cancer (ATC) surround aggressiveness of tumor resection in the presence of extrathyroidal extension and the impact of delayed surgery on patient survival. Our goal was to analyze the survival implications of complete and timely resections.

Methods

Adult patients with ATC were culled from the National Cancer Data Base for the years 2003–2006. Kaplan–Meier curves and Cox proportional hazard regression analyses were used for univariate and multivariate survival analyses, respectively.

Results

A total of 680 ATC patients were identified. In the surgical cohort (n = 335), the female-to-male ratio was 1.6:1; mean age was 68.6 years. Patients with ATCs were staged as IVA in 42.7 % of cases, IVB in 32.2 %, and IVC in 25.1 %. Median time from diagnosis to surgery was 15 days. Negative margin status was more often achieved in patients diagnosed with stage IVA disease (p < 0.001). Compared to surgical patients, those who did not receive thyroid resections were older and had a more advanced stage of disease (both p < 0.001). In multivariable analyses, positive margin status was associated with increased mortality in stage IVA ATC (p = 0.017) but had no survival impact in stages IVB and IVC (p > 0.05). After adjustment for possible confounders, increasing time from diagnosis to surgery was not found to be associated with compromised survival outcomes for any disease stage.

Conclusions

Timely and aggressive surgical management should be pursued in patients with intrathyroidal disease; however, aggressive resections may not be recommended for patients with stage IVB and IVC disease when morbidity and operative risks outweigh the limited benefits of surgery.

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Paolo Goffredo
    • 1
  • Samantha M. Thomas
    • 2
  • Mohamed Abdelgadir Adam
    • 3
  • Julie A. Sosa
    • 3
    • 4
  • Sanziana A. Roman
    • 3
  1. 1.Department of SurgeryUniversity of Iowa Carver College of MedicineIowa CityUSA
  2. 2.Department of BiostatisticsDuke UniversityDurhamUSA
  3. 3.Department of SurgeryDuke University Medical CenterDurhamUSA
  4. 4.Duke Clinical Research InstituteDurhamUSA