Impact of Timeliness of Resection and Thyroidectomy Margin Status on Survival for Patients with Anaplastic Thyroid Cancer: An Analysis of 335 Cases.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Paolo
P
Goffredo
Department of Biostatistics, Duke University, Durham, NC, USA.
Samantha M
SM
Thomas
Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Mohamed Abdelgadir
MA
Adam
Department of Surgery, Duke University Medical Center, Durham, NC, USA.|Duke Clinical Research Institute, Durham, NC, USA.
Julie A
JA
Sosa
Department of Surgery, Duke University Medical Center, Durham, NC, USA. Sanziana.roman@duke.edu.
Sanziana A
SA
Roman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D065646:Thyroid Carcinoma, Anaplastic / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D061665:Time-to-Treatment