Survival and Prognosis of Anaplastic Thyroid Cancer: A 15-year Observation at a Single Asian Institute

Abstract

Aim: Limited literature from Southeast Asia (SEA) exists on anaplastic thyroid cancer (ATC). The aim of this study was to ascertain factors associated with the survival of ATC at Putrajaya Hospital which is the main referral center for endocrine cases in West Malaysia. Materials and methods: This is a retrospective analysis of all patients with ATC between January 2002 and December 2016. Data concerning comorbidities, stage of disease, and clinical course were collected via electronic medical records and analyzed with Kaplan-Meier survival and log-rank tests for univariate and Cox proportional hazards model for multivariate analysis. This study was approved by the Malaysian Medical Research Ethics Committee (MREC). Results: A total of 76 patients were treated for ATC at our center, however, 11 had missing data and were excluded from the analysis. Of the remaining 65 patients, the majority were women (44 cases), and the mean age at presentation was 62 years. Majority of patients presented with stage IV C (50.8%) whilst others presented with IV A (3.1%) and IV B (46.2%). Most patients were treated palliatively (36.9%) whilst 29.2% underwent surgery only, 16.9% radiotherapy only, and 16.9% had multimodal therapies. Median survival was 2 months (range 1–14 months) with survival rates of 7.7–1.5% at 6 months and 1-year, respectively. Univariate analysis demonstrated that stage of disease and combination therapy improved survival. When correction was made for sex, age, and stage of disease, the only type of treatment received significantly affected outcomes. Multimodal therapy, either surgery and radiotherapy (hazard ratio 0.29, confidence interval 0.091–0.939, p = 0.03) or surgery followed by radiotherapy and chemotherapy (hazard ratio 0.09, confidence interval 0.01–1.0, p = 0.05) conferred better outcomes. Conclusion: The findings in this study that multimodal therapy conferred improved outcomes were comparable to that of numerous other studies, however, more research is needed in assessing the best treatment for this deadly disease.