Objective: Anaplastic thyroid cancer (ATC) is a rare but almost uniformly fatal disease and that is often approached nihilistically. We sought to identify prognostic factors for improved survival.
Methods: The National Cancer Database was used to identify patients with ATC between 2004-2014. Those who underwent surgery were examined separately from those who did not. Chi-square statistics and logistic regression models were used to compare patient and tumor characteristics in those surviving greater than six months.
Results: 2392 patients were reviewed with 1161 patients undergoing surgery while 1231 did not. Of the surgery group, 48.8% lived greater than six months compared to 21.2% in the non-surgery group. Multivariate analysis (MVA) for all patients showed increased survival with surgical patients(OR 2.4,CI 1.9-3.1). When MVA was performed separately for each group, both showed that being younger, healthier, without distant metastasis and receipt of chemotherapy or radiation were independently associated with increased survival. Among surgical patients, factors associated with increased survival included tumor size <5cm(OR1.4,CI 1.03-1.95), tumor within thyroid(OR3.3,CI 2.1-5.4) or invading only pericapsular structures(OR2.1,CI 1.4-3.1), and no positive lymph nodes(OR1.7,CI 1.1-2.5). No correlation with tumor characteristics were observed for patients who did not undergo surgery.
Conclusion: Surgical patients had improved outcomes compared to non-surgical patients. While selection bias likely exists, the poor outcomes among non-surgical patients, as well as the lack of any identifiable tumor characteristics correlating with improved outcomes, highlights the importance of surgery in this disease. Further efforts will be aimed towards developing risk-stratifying tools for surgical management of ATC.
