title: The prognostic impacts of postoperative radiotherapy in the patients with resected anaplastic thyroid carcinoma: A systematic review and meta-analysis.
abstract: Optimal postoperative managements for anaplastic thyroid carcinoma (ATC) have not yet been sufficiently clarified. We conducted a systematic review and meta-analysis focussing on the impact of postoperative radiotherapy (PORT) in the patients with resected ATC.
  
  
  
  Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a comprehensive search was performed in the several databases. We included the studies that reported survival outcome in the patients with or without PORT following any type of surgical resection except biopsy only. Hazard ratio (HR) was extracted, and the random-effects model was used for the pooled analysis.
  
  
  
  Seventeen retrospective studies including 1147 analysable patients met all inclusion criteria. The overall research quality was relatively low with considerable methodological limitations. The pooled results showed that PORT significantly reduced the risk of death in all the patients with resected ATC compared with those with surgery alone (HR, 0.556; 95% confidence interval, 0.419-0.737; p < 0.001). Exploratory analyses demonstrated that patients with stage IVA (HR, 0.364; p = 0.012) and IVB (HR, 0.460; p = 0.059) may also have survival benefit from PORT, whereas stage IVC may not. No evidence of publication bias was found (p = 0.352).
  
  
  
  This study is the first meta-analysis assessing PORT in patients with ATC and provides convincing evidence that adequate resection followed by PORT may offer the prolonged survival. However, without evidence based on prospective randomised trials, it is still not known which subset of patients can really benefit from PORT.
authors.affiliation: Department of Radiation Oncology, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jeanny
authors.initials: J
authors.lastname: Kwon
authors.affiliation: Division of Biological Warfare Preparedness and Response, Armed Forces Medical Research Institute, Daejeon, Republic of Korea. Electronic address: karlly71@hanmail.net.
authors.forename: Byoung Hyuck
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Geriatric Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-Do, Republic of Korea; Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Jung
authors.affiliation: Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Besic
authors.affiliation: Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan; Anaplastic Thyroid Carcinoma Research Consortium of Japan, Republic of Korea.
authors.forename: Iwao
authors.initials: I
authors.lastname: Sugitani
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hong-Gyun
authors.initials: HG
authors.lastname: Wu
mesh_terms: D000368:Aged; D004812:Epidemiologic Methods; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D065646:Thyroid Carcinoma, Anaplastic / Q000532:radiotherapy* / Q000601:surgery; D013964:Thyroid Neoplasms / Q000532:radiotherapy* / Q000601:surgery
keywords: Anaplastic thyroid carcinoma; Meta-analysis; Postoperative radiotherapy; Systematic review