Treatment and prognosis of anaplastic thyroid carcinoma: experience from a single institution in China.
BACKGROUND
Anaplastic thyroid carcinoma (ATC), a highly aggressive malignancy, has a poor prognosis, and the consensus on the most effective treatment is needed.


METHODS
Clinical data from all ATC patients treated in our institution over a 30-year period (between May 1980 and May 2010) were analyzed retrospectively with regard to mortality and survival rates (Kaplan-Meier). Multivariate analysis was performed using a Cox proportional hazards model.


RESULTS
Sixty cases were analyzed. The overall 1- and 3-year survival rates were 35.0% and 22.9%, respectively. Univariate analysis showed that the best prognosis was seen in patients younger than 55 years, those without distant metastases, those with white blood cell (WBC) counts < 10.0 × 10(9)/L or blood platelet (PLT) counts < 300.0 × 10(9)/L at presentation, those who did not receive chemotherapy, and those who received radiotherapy doses ≥ 40 Gy or underwent surgery plus postoperative radiotherapy. According to multivariate analysis, the WBC count at first presentation and the type of therapeutic regimen independently influenced survival.


CONCLUSIONS
We found that the elevated peripheral PLT count may be an adverse prognostic factor of ATC patients. The prognosis for ATC is especially poor for patients with distant metastasis, a WBC count ≥ 10.0×10(9)/L, a PLT count ≥ 300.0 × 10(9)/L, or age ≥ 55 years. WBC count at presentation and surgery with or without postoperative radiotherapy independently influenced the prognosis. Intensive treatment combining surgery with postoperative radiotherapy is recommended for ATC patients with stage IVA/B disease.
Department of Head and Neck Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, People's Republic of China.
Chuanzheng
C
Sun
Qiuli
Q
Li
Zedong
Z
Hu
Jiehua
J
He
Chao
C
Li
Guojun
G
Li
Xiaofeng
X
Tao
Ankui
A
Yang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D017370:Interleukin-11 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D065646:Thyroid Carcinoma, Anaplastic; D013964:Thyroid Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy
D017370:Interleukin-11; D015850:Interleukin-6