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Risk stratification in patients with anaplastic thyroid carcinoma: role of age

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Abstract

Background

Thyroid carcinoma is the only cancer that regards age as an important predictor of thyroid cancer-specific survival (CSS). While the 8th American Joint Committee on Cancer (AJCC) staging system raised the age cutoff from 45 to 55 years for differentiated thyroid carcinoma (DTC) to more accurately predict the prognosis, there is no new information regarding the role of age in the prognosis of anaplastic thyroid carcinoma (ATC). The aim of this study was to determine the optimal age cutoff values for mortality risk stratification in ATC patients. Furthermore, a nomogram to predict ATC CSS was developed in each age group.

Methods

Patients diagnosed with ATC between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. After applying inclusion and exclusion criteria, a total of 1140 patients were enrolled as cohort 1 to describe the characteristics of ATC, while a total of 556 patients were included as cohort 2 to determine age cutoff values for risk stratification by X-tile program. Training set and testing set were randomly generated to develop and validate a predictive nomogram of CSS in each age group.

Results

The 6-month, 1-year, and 2-year survival was 27.6%, 15.1%, and 6.2%, respectively, in cohort 1. X-tile program results showed that the optimal age cutoff values for mortality risk stratification were 65 and 85 years old (p < 0.001). Distant metastasis was independently associated with CSS in patients younger than 85 years old, and these patients benefited more from complete resection of the tumor and radiotherapy/chemotherapy. However, no predictors of CSS were identified in patients over 85 years old, and interventions (surgery, radiotherapy, and chemotherapy) targeting ATC had little role in disease control in these patients. The nomogram was developed and validated based on the independent CSS predictors in each age group. The C-index values of the training set and testing set were 0.735 [95% CI, 0.696–0.774] and 0.733 [95% CI, 0.663–0.804] for CSS in patients of ≤64 years old, while the values were 0.767 [95% CI, 0.730–0.804] and 0.783 [95% CI, 0.718–0.848] in patients of 65–84 years old. All of the C-index values were larger than 0.7, which showed acceptable prediction performance of the nomograms.

Conclusions

Age can be used as an auxiliary stratification factor of prognosis in ATC patients. The survival may be improved in patients younger than 85 years old if combination therapy (surgery, radiotherapy, and chemotherapy) was indicated and applicable, while no optimal therapeutic strategy was determined in patients older than 85 years old. The established nomograms can provide good prediction of CSS according to age group.

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Data availability

The data that support the findings of this study are openly available in software package SEER*Stat 8.3.5 (https://seer.cancer.gov/seerstat/).

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Acknowledgements

We are very grateful to the staff in Surveillance, Epidemiology, and End Results (SEER) Program for their kind work in data collection and delivery. We would like to thank Elsevier Ltd. very much for the language editing services.

Funding

This study was funded by Department of Science and Technology of Sichuan Province, China (Grant Number: 2020YFS0165).

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Authors and Affiliations

  1. Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China

    Mingjun Wang, Tao Wei, Rixiang Gong, Jingqiang Zhu & Zhihui Li

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  1. Mingjun Wang
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  4. Jingqiang Zhu
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Contributions

Conception and design: M.W., T.W., J.Z., and Z.L. Administrative support: Z.L. Provision of study materials or patients: Public database available in software package SEER*Stat 8.3.5 (https://seer.cancer.gov/seerstat/). Collection and assembly of data: M.W. Data analysis and interpretation: M.W., R.G., and Z.L. Manuscript writing: all authors. Final approval of manuscript: all authors.

Corresponding author

Correspondence to Zhihui Li.

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The authors declare no competing interests.

Ethical approval

This study was exempted from Institutional Review Board approval, in view of the SEER’s use of unidentifiable patient information. Due to the strict register-based nature of the study, informed consent was waived.

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Wang, M., Wei, T., Gong, R. et al. Risk stratification in patients with anaplastic thyroid carcinoma: role of age. Endocrine 77, 305–318 (2022). https://doi.org/10.1007/s12020-022-03085-w

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