Rao Sarika N, Zafereo Mark, Dadu Ramona, Busaidy Naifa L, Hess Kenneth, Cote Gilbert J, Williams Michelle D, William William N, Sandulache Vlad, Gross Neil, Gunn G Brandon, Lu Charles, Ferrarotto Renata, Lai Stephen Y, Cabanillas Maria E
1 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center , Houston, Texas.
2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center , Houston, Texas.
Thyroid. 2017 May;27(5):672-681. doi: 10.1089/thy.2016.0395. Epub 2017 Feb 16.
Anaplastic thyroid cancer (ATC) is one of the most lethal forms of cancer with a high mortality rate. Current guidelines support surgery for resectable ATC followed by external beam radiation therapy (EBRT) with or without chemotherapy. Treatment for those who are unresectable is palliative. Our goal was to examine first-line therapies as well as the role of genomic profiling in an effort better understand how to approach ATC.
This is a retrospective study of ATC patients who were seen at our institution from January 2013 to October 2015. Median overall survival (OS) and time to treatment failure (TTF) were calculated by the Kaplan-Meier method.
Fifty-four patients were included. Median age at diagnosis was 63 years and 29/54 (54%) were women. The majority had stage IVC disease at diagnosis (50%), followed by IVB (32%), and IVA (18%). Approximately 93% had somatic gene testing. Initial treatment was surgery in 23 patients, EBRT with or without radiosensitizing chemotherapy in 29 patients, and systemic chemotherapy in 2 patients. Nineteen patients had all three treatment modalities. For the entire cohort, median OS was 11.9 months with 39% survival at 1 year and median TTF was 3.8 months. The majority of patients (74%) developed new distant metastasis or progression of existing metastatic disease. Patients who received trimodal therapy consisting of surgery, EBRT, and chemotherapy had a median OS of 22.1 months versus 6.5 months in those who received dual therapy with EBRT and chemotherapy (p = 0.0008). The TTF was the same in the two groups (7.0 and 6.5 months, respectively). Men were three times more likely to die from ATC than women (p = 0.0024). No differences in OS or TTF were noted based on tumor size (5 cm cutoff), age (60 years cutoff), or presence of any mutation. There was a trend toward shorter TTF in patients with somatic mutations in TP53.
Patients with ATC amenable to aggressive tri-modal therapy demonstrate improved survival. The short TTF, due primarily to distant metastatic disease, highlights the potential opportunity for improved outcomes with earlier initiation of systemic therapy including adjuvant or neoadjuvant therapy.
间变性甲状腺癌（ATC）是最致命的癌症形式之一，死亡率很高。当前指南支持对可切除的ATC进行手术，随后进行外照射放疗（EBRT），可联合或不联合化疗。对不可切除患者的治疗为姑息性治疗。我们的目标是研究一线治疗方法以及基因谱分析的作用，以便更好地了解如何治疗ATC。
这是一项对2013年1月至2015年10月在我们机构就诊的ATC患者的回顾性研究。采用Kaplan-Meier方法计算中位总生存期（OS）和治疗失败时间（TTF）。
纳入54例患者。诊断时的中位年龄为63岁，29/54（54%）为女性。大多数患者在诊断时为IVC期疾病（50%），其次是IVB期（32%）和IVA期（18%）。约93%的患者进行了体细胞基因检测。23例患者初始治疗为手术，29例患者接受EBRT联合或不联合放射增敏化疗，2例患者接受全身化疗。19例患者接受了所有三种治疗方式。对于整个队列，中位OS为11.9个月，1年生存率为39%，中位TTF为3.8个月。大多数患者（74%）出现新的远处转移或现有转移性疾病进展。接受手术、EBRT和化疗三联疗法的患者中位OS为22.1个月，而接受EBRT和化疗双联疗法的患者为6.5个月（p = 0.0008）。两组的TTF相同（分别为7.0个月和6.5个月）。男性死于ATC的可能性是女性的三倍（p = 0.0024）。根据肿瘤大小（以5 cm为界）、年龄（以60岁为界）或任何突变的存在情况，未观察到OS或TTF有差异。TP53体细胞突变患者的TTF有缩短趋势。
适合积极三联疗法的ATC患者生存期得到改善。主要由于远处转移性疾病导致的短TTF，凸显了通过更早开始包括辅助或新辅助治疗在内的全身治疗来改善预后的潜在机会。
