Garg Surabhi, Mouli Sasi, Singh Kul Ranjan, Ramakant Pooja, Mishra Anand K, Rana Chanchal
Department of Endocrine Surgery, King George's Medical University, Lucknow, UP India.
Indian J Surg Oncol. 2022 Mar;13(1):208-215. doi: 10.1007/s13193-021-01401-w. Epub 2021 Aug 2.
Anaplastic thyroid carcinoma (ATC) is an aggressive malignancy with dismal outcome especially in metastatic setting. Consensus for ideal treatment of advanced and metastatic ATC remains elusive. This study aimed to analyze the impact of palliative chemotherapy versus supportive care on overall survival in patients with metastatic anaplastic thyroid carcinoma. Patients diagnosed with ATC between the period January 2018 and December 2019 were prospectively followed. The patients opting for palliative chemotherapy received 3 weekly Paclitaxel (175 mg/m) and Carboplatin (AUC-5). Out of the 31 patients diagnosed with ATC, clinicopathological profile of 29 patients was analyzed (2 patients who underwent upfront surgical resection with curative intent were excluded), out of which 20 patients were included in the survival analysis. The median age of presentation was 55.8 years with male:female ratio 1.9:1. Seventeen out of the total 29 patients presented with anaplastic transformation in long-standing goiter. Nineteen out of 20 (95%) patients presented with distant metastasis with lungs being the most common site. Nodal metastasis was present in all patients. Invasion of the strap muscles (90%) and trachea (80%) was the most common peri-thyroidal tissue invasion followed by invasion of the esophagus (40%), internal jugular vein (30%), and carotid artery (5%). Twelve out of the 20 patients opted for palliative chemotherapy. Overall, median survival from the time of diagnosis was 2.6 months, with median survival in patients receiving chemotherapy 3.1 months and those opting for supportive care 1.6 months (=0.004). Out of all the factors analyzed, male sex (HR 6.521, 95% CI 1.143-37.206, value 0.03) and vascular invasion (HR 0.066, 95% CI 0.009-0.499, value 0.008) were poor prognostic indicators. Palliative chemotherapy showed increased survival benefit in patients with metastatic ATC. Male sex and vascular invasion were found to be significant factors associated with poor outcomes on Cox regression analysis.
间变性甲状腺癌（ATC）是一种侵袭性恶性肿瘤，预后很差，尤其是在发生转移的情况下。对于晚期和转移性ATC的理想治疗方法，目前尚未达成共识。本研究旨在分析姑息化疗与支持治疗对转移性间变性甲状腺癌患者总生存期的影响。对2018年1月至2019年12月期间诊断为ATC的患者进行前瞻性随访。选择姑息化疗的患者接受每周一次的紫杉醇（175mg/m²）和卡铂（AUC-5）治疗，共3周。在31例诊断为ATC的患者中，分析了29例患者的临床病理特征（排除2例接受根治性手术切除的患者），其中20例患者纳入生存分析。患者的中位发病年龄为55.8岁，男女比例为1.9:1。29例患者中有17例在长期存在的甲状腺肿中出现间变性转变。20例患者中有19例（95%）出现远处转移，最常见的转移部位是肺。所有患者均有淋巴结转移。最常见的甲状腺周围组织侵犯是带状肌侵犯（90%）和气管侵犯（80%），其次是食管侵犯（40%）、颈内静脉侵犯（30%）和颈动脉侵犯（5%）。20例患者中有12例选择了姑息化疗。总体而言，从诊断时起的中位生存期为2.6个月，接受化疗的患者中位生存期为3.1个月，选择支持治疗的患者中位生存期为1.6个月（P=0.004）。在所有分析的因素中，男性（HR 6.521，95%CI 1.143-37.206，P值0.03）和血管侵犯（HR 0.066，95%CI 0.009-0.499，P值0.008）是不良预后指标。姑息化疗在转移性ATC患者中显示出更高的生存获益。在Cox回归分析中，男性和血管侵犯被发现是与不良预后相关的重要因素。
