Bangolo Ayrton I, Auda Auda, Bukasa-Kakamba John, Bhakta Nayan, Dey Shraboni, Lilhori Anupriya, Reddy Gowry, Alqinai Budoor, Sidiqui Aman, Sekhon Imranjot, Khatiashvili Barbare, Abbas Iqra, Kunnel Sandra, Jarri Amer, Martinez Emelyn, Daoud Deborah, Gupta Ishita, Gompa Harshini, Pender Silvanna, Aljaberi Dana, Aljanaahi Hamed, Kunnel Sandra S, Xiao Yingxia, Jung Yoontae, Nagpaul Sneha, Naz Afshan, Mallela Tejaswee, Maung Phyo Maung, Khalaf Ibtihal Y, Kim Soobee, Alrestom Roua, Gajera Aditya, Alkealy Hiba, Kansal Deepti, Dhall Sonam, Satheesha Sanya, Weissman Simcha, Fwelo Pierre
Department of Internal Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States.
Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States.
World J Exp Med. 2024 Sep 20;14(3):93869. doi: 10.5493/wjem.v14.i3.93869.
Anaplastic thyroid cancer (ATC) is an aggressive, rare malignancy associated with rapid growth and metastasis, and a very poor prognosis. We investigated the clinical characteristics, survival outcomes and independent prognostic factors associated with anaplastic thyroid cancer.
To assess to what extent the interaction between age and tumor stage affects mortality.
A total of 622 patients diagnosed with anaplastic thyroid cancer, between 2010 and 2017 were enrolled in our study by retrieving data from the Surveillance, Epidemiology and End Results (SEER) database. We analyzed demographics, clinical characteristics, overall mortality (OM) and cancer specific mortality (CSM) of ATC. Variables with a value < 0.1 were incorporated into the multivariate cox model to determine the independent prognostic factors. Furthermore, we analyzed the interaction between age and tumor stage on mortality.
In the multivariate analyses, the divorced/separated population had a lower OM [hazard ratio (HR) = 0.63, 95%CI: 0.42-0.94, < 0.05] and CSM (HR = 0.61, 95%CI: 0.40-0.92, < 0.05). OM was higher in tumors with direct extension only (HR = 6.26, 95%CI: 1.29-30.42, < 0.05) and tumors with distant spread (HR = 5.73, 95%CI: 1.34-24.51, < 0.05). CSM was also higher in tumors with direct extension (HR = 5.05, 95%CI: 1.05-24.19, < 0.05) and tumors with distant spread (HR = 4.57, 95%CI: 1.08-19.29, < 0.05). Mortality was not adversely affected by lymph node involvement. OM was lower in patients who received radiation (HR = 0.66, 95%CI: 0.53-0.83, < 0.01), chemotherapy (HR = 0.63, 95%CI: 0.50-0.79, < 0.01) or surgery (HR = 0.53, 95%CI: 0.43-0.66, < 0.01). CSM was also lower in patient who received radiation (HR = 0.64, 95%CI: 0.51-0.81, < 0.01), chemotherapy (HR = 0.62, 95%CI: 0.50-0.78, < 0.01) or surgery (HR = 0.51, 95%CI: 0.41-0.63, < 0.01). There was no significant interaction between age and tumor stage that affected mortality.
In this large US SEER database retrospective study, we found the mortality to be higher in advanced stage tumors with direct extension and distant metastasis. However, patients who received aggressive therapy showed a better overall survival. The aim of our study is to emphasize the importance of detecting ATC at an early stage and provide aggressive therapy to these patients. Since advanced stage ATC is associated with a dismal prognosis, we emphasize the need for randomized control trials and development of novel therapies that will be used to treat ATC.
间变性甲状腺癌（ATC）是一种侵袭性强、罕见的恶性肿瘤，生长迅速且易发生转移，预后极差。我们调查了间变性甲状腺癌的临床特征、生存结果及独立预后因素。
评估年龄与肿瘤分期之间的相互作用对死亡率的影响程度。
通过检索监测、流行病学和最终结果（SEER）数据库，纳入2010年至2017年间共622例诊断为间变性甲状腺癌的患者。我们分析了ATC的人口统计学、临床特征、总死亡率（OM）和癌症特异性死亡率（CSM）。将P值<0.1的变量纳入多因素Cox模型以确定独立预后因素。此外，我们分析了年龄与肿瘤分期对死亡率的相互作用。
在多因素分析中，离婚/分居人群的OM较低[风险比（HR）=0.63，95%置信区间：0.42-0.94，P<0.05]，CSM也较低（HR=0.61，95%置信区间：0.40-0.92，P<0.05）。仅直接侵犯的肿瘤（HR=6.26，95%置信区间：1.29-30.42，P<0.05）和有远处转移的肿瘤（HR=5.73，95%置信区间：1.34-24.51，P<0.05）的OM较高。直接侵犯的肿瘤（HR=5.05，95%置信区间：1.05-24.19，P<0.05）和有远处转移的肿瘤（HR=4.57，95%置信区间：1.08-19.29，P<0.）的CSM也较高。死亡率未受到淋巴结受累的不利影响。接受放疗（HR=0.66，95%置信区间：0.53-0.83，P<0.01）、化疗（HR=0.63，95%置信区间：0.50-0.79，P<0.01）或手术（HR=0.53，95%置信区间：0.43-0.66，P<0.01）的患者OM较低。接受放疗（HR=0.64，95%置信区间：0.51-0.81，P<0.01）、化疗（HR=0.62，95%置信区间：0.50-0.78，P<0.01）或手术（HR=0.51，95%置信区间：0.41-0.63，P<0.01）的患者CSM也较低。年龄与肿瘤分期之间不存在影响死亡率的显著相互作用。
在这项大型美国SEER数据库回顾性研究中，我们发现直接侵犯和远处转移的晚期肿瘤死亡率较高。然而，接受积极治疗的患者总生存期较好。我们研究的目的是强调早期检测ATC并为这些患者提供积极治疗的重要性。由于晚期ATC预后不佳，我们强调需要进行随机对照试验并开发用于治疗ATC的新疗法。
