Abstract
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.
Similar content being viewed by others
References
Smallridge RC, Copland JA. Anaplastic thyroid carcinoma: pathogenesis and emerging therapies. Clin Oncol. 2010;22:486–97.
American Joint Committee on Cancer staging system. 2014. http://www.cancer.org/cancer/thyroidcancer/detailedguide/thyroid-cancer-staging. Accessed Sept 2014.
Smallridge RC, Ain KB, Asa SL, et al. American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer. Thyroid. 2012;22:1104–39.
O’Neill JP, Shaha AR. Anaplastic thyroid cancer. Oral Oncol. 2013;49:702–6.
Haymart MR, Banerjee M, Yin H, Worden F, Griggs JJ. Marginal treatment benefit in anaplastic thyroid cancer. Cancer. 2013;119:3133–9.
Chen J, Tward JD, Shrieve DC, Hitchcock YJ. Surgery and radiotherapy improves survival in patients with anaplastic thyroid carcinoma: analysis of the Surveillance, Epidemiology, and End Results, 1983–2002. Am J Clin Oncol. 2008;31:460–4.
Sugitani I, Hasegawa Y, Sugasawa M, et al. Super-radical surgery for anaplastic thyroid carcinoma: a large cohort study using the Anaplastic Thyroid Carcinoma Research Consortium of Japan database. Head Neck. 2014;36:328–33.
Brown RF, Ducic Y. Aggressive surgical resection of anaplastic thyroid carcinoma may provide long-term survival in selected patients. Otolaryngol Head Neck Surg. 2013;148:564–71.
National Cancer Data Base. http://ncdbpuf.facs.org/. Accessed May 2014.
Shaha AR. TNM classification of thyroid carcinoma. World J Sur. 2007;31:879–87.
Fritz A, Jack Percy C, Jack A, et al. International Classification of disease for oncology. 3rd ed. Geneva: World Health Organization; 2000. http://apps.who.int/iris/bitstream/10665/96612/1/9789241548496_eng.pdf?ua=1.
Passler C, Scheuba C, Prager G, et al. Anaplastic (undifferentiated) thyroid carcinoma (ATC). A retrospective analysis. Langenbecks Arch Surg. 1999;384:284–93.
Akaishi J, Sugino K, Kitagawa W, et al. Prognostic factors and treatment outcomes of 100 cases of anaplastic thyroid carcinoma. Thyroid. 2011;21:1183–9.
Haigh PI, Ituarte PH, Wu HS, et al. Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival. Cancer. 2001;91:2335–42.
McIver B, Hay ID, Giuffrida DF, et al. Anaplastic thyroid carcinoma: a 50-year experience at a single institution. Surgery. 2001;130:1028–34.
Winchester DP, Stewart AK, Phillips JL, Ward EE. The national cancer data base: past, present, and future. Ann Surg Oncol. 2010;17:4–7.
Acknowledgment
Paolo Goffredo is supported by the Fondazione Italiana per la Ricerca sul Cancro – FIRC (Italian Foundation for Cancer Research).
Disclosure
The authors have nothing to declare. The data used in the study are derived from a de-identified National Cancer Data Base (NCDB) file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigators.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goffredo, P., Thomas, S.M., Adam, M.A. et al. Impact of Timeliness of Resection and Thyroidectomy Margin Status on Survival for Patients with Anaplastic Thyroid Cancer: An Analysis of 335 Cases. Ann Surg Oncol 22, 4166–4174 (2015). https://doi.org/10.1245/s10434-015-4742-6
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-015-4742-6