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- Title
Association of Treatment Strategies and Tumor Characteristics With Overall Survival Among Patients With Anaplastic Thyroid Cancer: A Single-Institution 21-Year Experience.
- Authors
Wu, Shannon S.; Lamarre, Eric D.; Yalamanchali, Anirudh; Brauer, Philip R.; Hong, Hanna; Reddy, Chandana A.; Yilmaz, Emrullah; Woody, Neil; Ku, Jamie A.; Prendes, Brandon; Burkey, Brian; Nasr, Christian; Skugor, Mario; Heiden, Katherine; Chute, Deborah J.; Knauf, Jeffrey A.; Campbell, Shauna R.; Koyfman, Shlomo A.; Geiger, Jessica L.; Scharpf, Joseph
- Abstract
Key Points: Question: What are the overall survival outcomes in patients with anaplastic thyroid cancer (ATC) stratified by treatment strategies and tumor characteristics? Findings: This retrospective case series study of a large institutional cohort of 97 patients with ATC treated during 21 years found that definitive or adjuvant radiation therapy, younger age, and absence of distant metastases were associated with improved overall survival. Coexisting other tumor types on surgical specimens were associated with improved survival, and a subanalysis of patients who received targeted and/or immunotherapies showed that select patients had prolonged survival. Meaning: The findings of this retrospective case series study suggest that lower tumor stage, younger age at diagnosis, and the ability to receive definitive or adjuvant radiation therapy were associated with improved survival outcomes in patients with ATC. Importance: Survival outcomes for anaplastic thyroid cancer (ATC), the most aggressive subtype of thyroid cancers, have remained poor. However, targeted therapies and immunotherapies present new opportunities for treatment of this disease. Evaluations of survival outcomes over time with new multimodal therapies are needed for optimizing treatment plans. Objective: To evaluate the association of treatment strategies and tumor characteristics with overall survival (OS) among patients with ATC. Design, Setting, and Participants: This retrospective case series study evaluated the survival outcomes stratified by treatment strategies and tumor characteristics among patients with ATC treated at a tertiary level academic institution from January 1, 2000, to December 31, 2021. Demographic, tumor, treatment, and outcome characteristics were analyzed. Kaplan-Meier method and log rank test modeled OS by treatment type and tumor characteristics. Data were analyzed in May 2022. Main Outcomes and Measures: Overall survival (OS). Results: The study cohort comprised 97 patients with biopsy-proven ATC (median [range] age at diagnosis, 70 [38-93] years; 60 (62%) female and 85 [88%] White individuals; 59 [61%] never smokers). At ATC diagnosis, 18 (19%) patients had stage IVA, 19 (20%) had stage IVB, and 53 (55%) had stage IVC disease. BRAF status was assessed in 38 patients; 18 (47%) had BRAF-V600E variations and 20 (53%), BRAF wild type. Treatment during clinical course included surgery for 44 (45%) patients; chemotherapy, 41 (43%); definitive or adjuvant radiation therapy, 34 (RT; 35%); and targeted therapy, 28 (29%). Median OS for the total cohort was 6.5 (95% CI, 4.3-10.0) months. Inferior OS was found in patients who did not receive surgery (hazard ratio [HR], 2.12; 95% CI, 1.35-3.34; reference, received surgery), chemotherapy (HR, 3.28; 95% CI, 1.99-5.39; reference, received chemotherapy), and definitive or adjuvant RT (HR, 2.47; 95% CI, 1.52-4.02; reference, received definitive/adjuvant RT). On multivariable analysis, age at diagnosis (HR, 1.03; 95% CI, 1.01-1.06), tumor stage IVC (HR, 2.65; 95% CI, 1.35-5.18), and absence of definitive or adjuvant RT (HR, 1.90; 95% CI, 1.01-3.59) were associated with worse OS. Conclusions and Relevance: This retrospective single-institution study found that lower tumor stage, younger age, and the ability to receive definitive or adjuvant RT were associated with improved OS in patients with ATC. This retrospective case series study evaluates overall survival among patients with anaplastic thyroid cancer by treatment strategy and tumor characteristic at a tertiary level academic institution during a recent 21-year period.
- Publication
JAMA Otolaryngology-Head & Neck Surgery, 2023, Vol 149, Issue 4, p300
- ISSN
2168-6181
- Publication type
Article
- DOI
10.1001/jamaoto.2022.5045