Zhang Kun, Wang Xinyi, Lei Jianyong, Su Anping, Wei Tao, Li Zhihui, Chen Ya-Wen
Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Ann Surg Oncol. 2025 Apr;32(4):2732-2742. doi: 10.1245/s10434-024-16852-y. Epub 2025 Jan 27.
Anaplastic thyroid cancer (ATC) is a highly lethal disease, often diagnosed with advanced locoregional and distant metastases, resulting in a median survival of just 3-5 months. This study determines the stratified effectiveness of baseline treatments in all combinations, enabling precise prognoses prediction and establishing benchmarks for advanced therapeutic options.
The study extracted a cohort of pathologically confirmed ATC patients from the Surveillance, Epidemiology, and End Results program. Overall, 1879 patients from 2000 to 2018 were identified from the database. Kaplan-Meier survival curve estimation and Cox proportional hazard regression were applied.
Overall, compared with no treatment, surgery raised 1-year overall survival (OS) from 0.6% to 30% and median survival from <1 month to 3 months in ATC patients. For stage IVa, surgery increased 1-year OS from 21.5% to 71.8% and median survival from 2 to 23.5 months, and in stage IVb, surgery increased 1-year OS from 9.4% to 41.3% and median survival from 2 to 7 months; however, in stage IVc, the benefits of surgery were not markedly different from non-surgical approaches. When combined with surgery, other effective non-surgical ATC treatments demonstrated a surgery-dominant synergistic effect, particularly for stages IVa and IVb ATC, but not for stage IVc ATC.
Our study provides insights into stratified baseline treatments for patients with ATC in all stages, emphasizing surgery's vital role in a multimodal approach.
间变性甲状腺癌（ATC）是一种高度致命的疾病，常被诊断为局部晚期和远处转移，中位生存期仅为3至5个月。本研究确定了所有组合的基线治疗的分层有效性，从而能够进行精确的预后预测并为先进的治疗方案建立基准。
该研究从监测、流行病学和最终结果计划中提取了一组经病理证实的ATC患者。总体而言，从数据库中识别出了2000年至2018年的1879例患者。应用了Kaplan-Meier生存曲线估计和Cox比例风险回归。
总体而言，与未治疗相比，手术将ATC患者的1年总生存率（OS）从0.6%提高到30%，中位生存期从不到1个月提高到3个月。对于IVa期，手术将1年OS从21.5%提高到71.8%，中位生存期从2个月提高到23.5个月；在IVb期，手术将1年OS从9.4%提高到41.3%，中位生存期从2个月提高到7个月；然而，在IVc期，手术的益处与非手术方法没有明显差异。当与手术联合使用时，其他有效的非手术ATC治疗显示出以手术为主的协同效应，特别是对于IVa期和IVb期ATC，但对于IVc期ATC则不然。
我们的研究为各阶段ATC患者的分层基线治疗提供了见解，强调了手术在多模式治疗方法中的关键作用。
