Marginal treatment benefit in anaplastic thyroid cancer

Authors

  • Megan R. Haymart MD,

    Corresponding author
    1. Department of Medicine, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan
    2. Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
    • Corresponding author: Megan R. Haymart, MD, Assistant Professor of Medicine, Division of Metabolism, Endocrinology, and Diabetes, and Division of Hematology/Oncology, University of Michigan Health System, North Campus Research Complex, 2800 Plymouth Road, Building 16, Room 408E, Ann Arbor, MI 48109; Fax: (734) 936-8944; meganhay@umich.edu

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  • Mousumi Banerjee PhD,

    1. Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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  • Huiying Yin MS,

    1. Department of Surgery, University of Michigan, Ann Arbor, Michigan
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  • Francis Worden MD,

    1. Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
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  • Jennifer J. Griggs MD, MPH

    1. Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan
    2. Division of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
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Abstract

BACKGROUND

Because anaplastic thyroid cancer is a rare malignancy with a high mortality rate, the benefit of multimodality treatment was evaluated.

METHODS

Overall survival was determined in the 2742 patients captured by the National Cancer Database who were diagnosed with anaplastic thyroid cancer between 1998 and 2008. Kaplan-Meier analysis and then Cox proportional hazard regression was performed, controlling for patient characteristics and treatment.

RESULTS

Only older age (adjusted hazard ratio [AHR] for ≥ 85 years = 3.43, 95% confidence interval [CI] = 2.34-5.03; for 75-84 years, AHR = 2.85, 95% CI = 1.97-4.11; for 65-74 years, AHR = 2.20, 95% CI = 1.53-3.15; for 45-64 years, AHR = 2.08, 95% CI = 1.47-2.95) and omission of treatment were associated with greater mortality (omission of surgery: AHR = 1.79, 95% CI = 1.61-1.99; omission of radiation therapy: AHR = 1.56; 95% CI = 1.41-1.73; and omission of chemotherapy: AHR = 1.28, 95% CI = 1.15-1.43). In subgroup analysis of patients with American Joint Committee on Cancer stage IVA, IVB, and IVC anaplastic thyroid cancer, combination therapy with surgery, radiation, and chemotherapy was associated a difference in median survival of months.

CONCLUSIONS

Multimodality management of anaplastic thyroid cancer results in a marginal treatment benefit. The poor overall survival of all anaplastic thyroid cancer patients, regardless of treatment, emphasizes the need for informed patients whose preferences are incorporated into treatment decision-making. Cancer 2013;119:3133–3139. © 2013 American Cancer Society.

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