title: Marginal treatment benefit in anaplastic thyroid cancer.
abstract: BACKGROUND
  Because anaplastic thyroid cancer is a rare malignancy with a high mortality rate, the benefit of multimodality treatment was evaluated.
  
  
  METHODS
  Overall survival was determined in the 2742 patients captured by the National Cancer Database who were diagnosed with anaplastic thyroid cancer between 1998 and 2008. Kaplan-Meier analysis and then Cox proportional hazard regression was performed, controlling for patient characteristics and treatment.
  
  
  RESULTS
  Only older age (adjusted hazard ratio [AHR] for  ≥  85 years = 3.43, 95% confidence interval [CI] = 2.34-5.03; for 75-84 years, AHR = 2.85, 95% CI = 1.97-4.11; for 65-74 years, AHR = 2.20, 95% CI = 1.53-3.15; for 45-64 years, AHR = 2.08, 95% CI = 1.47-2.95) and omission of treatment were associated with greater mortality (omission of surgery: AHR = 1.79, 95% CI = 1.61-1.99; omission of radiation therapy: AHR = 1.56; 95% CI = 1.41-1.73; and omission of chemotherapy: AHR = 1.28, 95% CI = 1.15-1.43). In subgroup analysis of patients with American Joint Committee on Cancer stage IVA, IVB, and IVC anaplastic thyroid cancer, combination therapy with surgery, radiation, and chemotherapy was associated a difference in median survival of months.
  
  
  CONCLUSIONS
  Multimodality management of anaplastic thyroid cancer results in a marginal treatment benefit. The poor overall survival of all anaplastic thyroid cancer patients, regardless of treatment, emphasizes the need for informed patients whose preferences are incorporated into treatment decision-making.
authors.affiliation: Department of Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Megan R
authors.initials: MR
authors.lastname: Haymart
authors.forename: Mousumi
authors.initials: M
authors.lastname: Banerjee
authors.forename: Huiying
authors.initials: H
authors.lastname: Yin
authors.forename: Francis
authors.initials: F
authors.lastname: Worden
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012107:Research Design; D065646:Thyroid Carcinoma, Anaplastic; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000628:therapy*; D013965:Thyroidectomy; D016896:Treatment Outcome
keywords: anaplastic thyroid cancer; cancer; survival; thyroid; treatment