Medical Student Feature Article of The Month:

Association of Treatment Strategies and Tumor Characteristics With Overall Survival Among Patients With Anaplastic Thyroid Cancer

Wu SS, Lamarre ED, Yalamanchali A, et al. Association of Treatment Strategies and Tumor Characteristics With Overall Survival Among Patients With Anaplastic Thyroid Cancer: A Single-Institution 21-Year Experience. JAMA Otolaryngol Head Neck Surg. 2023;e225045. [Article Link]

What Factors Impact Survival in Anaplastic Thyroid Cancer?

This retrospective study of patients at a single-institution over 21 years looked at the overall survival rates for anaplastic thyroid cancer by demographics, tumor progression, and treatment strategies. Though its prevalence is relatively low, anaplastic thyroid cancer is the most aggressive subtype of thyroid cancer and is associated with low survival rates. 97 patients with anaplastic thyroid cancer were examined in this study. At diagnosis, the median age was 70 years, 19% of patients had stage IVA, 20% had stage IVB, and 55% had stage IVC disease. Treatment during the clinical course included surgery for 45% of patients, chemotherapy for 43% of patients, radiotherapy for 35% of patients, and targeted therapy for 29% of patients. Median overall survival for the cohort was 6.5 months (95% CI, 4.3 - 10.0 months) with reduced overall survival found in patients who did not receive radiation (HR: 2.47; 95% CI 1.52 - 4.02), undergo surgery (HR: 2.12; 95% CI 1.35 - 3.34), or receive chemotherapy (HR: 3.28; 95% CI 1.99 - 5.39). After multivariable analysis, age at diagnosis (HR: 1.03; 95% CI 1.01 - 1.06), IVC tumor stage (spread of tumor to distant tissues such as lymph nodes, lung, and bone) (HR: 2.65; 95% CI 1.35 - 5.18), and lack of radiation therapy (HR: 1.90; 95% CI 1.01 - 3.59) were shown to have an association with decreased overall survival. While anaplastic thyroid cancer carries a bleak prognosis, we should be educated on factors that may affect its survival. 

Peyton Robinson’s Takeaway: This study highlights the importance of early detection and definitive or adjuvant radiation treatment in anaplastic thyroid cancer. While there is a low chance of long-term survival, there are some ways to mitigate the aggressiveness of this cancer. 

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