Prognostic Factors and Treatment Outcomes for Anaplastic Thyroid Carcinoma: ATC Research Consortium of Japan Cohort Study of 677 Patients
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Anaplastic thyroid carcinoma (ATC) accounts for only 1 to 2% of all thyroid carcinomas, but it is one of the most lethal neoplasms in humans. To date, most findings about ATC have been derived from single-institution studies with limited numbers of cohorts. To obtain further insights into this “orphan disease,” we have established a multicenter registry, the ATC Research Consortium of Japan (ATCCJ). We analyzed prognostic factors and treatment outcomes using the large cohort database of the ATCCJ.
Most of the Japanese centers involved in the treatment of thyroid cancer were invited to join the ATCCJ and have provided information on ATC patients treated between 1995 and 2008. The database includes 677 cases from 38 registered institutions. Survival curves were determined using Kaplan-Meier methods and were compared using the log-rank test. Cox’s proportional hazards model was used for multivariate analysis.
Clinical varieties of ATC were classified into four types: common type (n = 547); incidental type (n = 29); anaplastic transformation at the neck (n = 95); anaplastic transformation at a distant site (n = 6). The incidental type followed by anaplastic transformation at the neck showed better outcomes than the other types. Anaplastic transformation at a distant site showed the worst outcomes. The 6-month and 1-year cause-specific survival (CSS) rates for common-type ATC were 36 and 18%, respectively. In all, 84 (15%) achieved long-term (>1 year) survival. Multivariate analysis identified age ≥70 years, presence of acute symptoms, leukocytosis (white blood cell count ≥10,000/mm3), large tumor >5 cm, T4b tumor, and distant metastasis as significant risk factors for lower survival. CSS rates also differed significantly depending on UICC stages, with 6-month CSSs of 60% for stage IVA, 45% for IVB, and 19% for IVC. For 36 of 69 (52%) stage IVA patients who underwent radical surgery, adjuvant therapies, including radiation therapy (RTX) and chemotherapy (CTX) did not show additional benefit statistically. Conversely, among 242 stage IVB patients, 80 (33%) underwent radical surgery. For those patients, therapies combining RTX with CTX significantly improved CSS.
Long-term survival is possible for selected patients with ATC. To determine the treatment strategy, UICC stage (disease extent) and other prognostic factors (e.g., biologic malignancy grade) should be considered.
KeywordsRadical Surgery Median Survival Time Differentiate Thyroid Carcinoma Anaplastic Thyroid Carcinoma Incidental Type
This work was supported in part by a grant-in-aid from the Public Trust Fund for Clinical Cancer Research. On behalf of the ATCCJ, we acknowledge and thank the following doctors and participating centers for their involvement in this nationwide study: Dr. Keisei Fujimori, Department of Breast and Endocrine Surgery, Tohoku University Hospital; Dr. Yuichiro Sato, Division of Head and Neck Surgery, Niigata Cancer Center Hospital; Dr. Ken-ichi Ito, Division of Breast and Endocrine Surgery, Shinshu University School of Medicine; Dr. Yuki Tomisawa, Department of Surgery, Iwate Medical University School of Medicine; Dr. Masayuki Tori, Department of Surgery, Osaka Police Hospital; Dr. Katsuhiro Tanaka, Department of Breast and Thyroid Surgery, Kawasaki Medical School; Dr. Nobuyuki Wada, Department of Surgery, Yokohama City University; Dr. Naoyoshi Onoda, Department of Surgical Oncology, Osaka City University Graduate School of Medicine; Dr. Tsuneo Imai, Department of Breast and Endocrine Surgery, Nagoya University; Dr. Makoto Kammori, Department of Surgery, Kanaji Thyroid Hospital; Dr. Yasuhisa Hasegawa, Department of Head and Neck Surgery, Aichi Cancer Center; Dr. Keizo Sugino, Department of Surgery, Akane Foundation Tsuchiya General Hospital; Dr. Hiroyuki Yamada, Department of Otolaryngology, Yamada Red-Cross Hospital; Dr. Tsuyoshi Yoshida, Department of Otolaryngology, Takeda General Hospital; Dr. Hiroshi Hosoi, Department of Otorhinolaryngology–Head and Neck Surgery, Nara Medical University; Dr. Masakazu Miyazaki, Department of Head and Neck Surgery, National Cancer Center East; Dr. Katsumi Iwase, Department of Endocrine Surgery, Fujita Health University; Dr. Masashi Sugasawa, Saitama Medical University International Medical Center; Dr. Yorihisa Orita, Department of Otolaryngology, Okayama Saiseikai General Hospital; Dr. Seiichi Yoshimoto, Department of Head and Neck Oncology, National Cancer Center Hospital; Dr. Tatsuya Uga, Department of Surgery, Nagasaki University; Dr. Atsushi Fukuuchi, Department of Breast and Endocrine Surgery, Mitsui Memorial Hospital; Dr. Hideo Kurihara, Department of Surgery, Kurihara Clinic; Dr. Kazuo Shimizu, Department of Endocrine Surgery, Nippon Medical School; Dr. Hisato Hara, Department of Breast and Endocrine Surgery, University of Tsukuba; Dr. Toshihisa Ogawa, Department of Breast and Endocrine Surgery, University of Tokyo; Dr. Hiroya Kitano, Division of Otolaryngology–Head and Neck Surgery, Department of Medicine of Sensory and Motor Organs, School of Medicine, Faculty of Medicine Tottori University; Dr. Kiyoaki Tsukahara, Tokyo Medical University Hachioji Medical Center, Dr. Minoru Fujimori, Department of Breast Surgery, Tokyo Medical University, Ibaraki Medical Center; Dr. Koki Miura, Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital; Dr. Yoshiyuki Kadokura, Department of Otolaryngology, Showa University Northern Yokohama Hospital; and Dr. Hirohumi Ami, Department of Surgery, Ohara General Hospital.
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