Impact of Timeliness of Resection and Thyroidectomy Margin Status on Survival for Patients with Anaplastic Thyroid Cancer: An Analysis of 335 Cases
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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.
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.
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.
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.
KeywordsMargin Status Anaplastic Thyroid Cancer National Cancer Data Base Resection Margin Status Negative Margin Status
Paolo Goffredo is supported by the Fondazione Italiana per la Ricerca sul Cancro – FIRC (Italian Foundation for Cancer Research).
The authors have nothing to declare. The data used in the study are derived from a de-identified National Cancer Data Base (NCDB) file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.
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