BACKGROUND
The most common types of thyroid cancer (papillary and follicular) have an excellent prognosis, with response and/or cure rates reaching 95%. This is due to, in part, excellent treatment options, including surgery and radioactive iodine therapy. In contrast, anaplastic thyroid carcinoma (ATC) is a very rare and aggressive type of thyroid cancer with a poor prognosis. This is due predominantly to the fact that we do not have good, effective treatment options for ATC. Indeed, the average survival of a patient with ATC is 9.5 months, which makes it one of the most deadly cancers.

Prior studies have reported several factors that can affect the prognosis of ATC patients, including the disease stage, pathological type, type of treatment and the patients’ performance status. For example, ATC patients who received combination therapy (surgery followed by a combination of chemotherapy and radiotherapy), targeted therapy or immunotherapy had an improved survival. The goal of this study was to evaluate prognostic factors in a large group of patients with ATC from a care center network in France.

THE FULL ARTICLE TITLE
Jannin, A et al ENDOCAN-TUTHYREF Network 2023 Factors associated with survival in anaplastic thyroid carcinoma: A multi-center study from the ENDOCANTUTHYREF Network. Thyroid 33:1190–1200. PMID: 37855745

SUMMARY OF THE STUDY
This multicenter study included 360 ATC patients who received treatment at a network of 19 care centers in France between 2010 and 2020. The average age was 72 years with 61% of patients being women. Most patients (60%) had mild symptoms at diagnosis, with European Cooperative Oncology Group (ECOG) scores of 0-1. Overall, 41% of patients had neck compressive symptoms at diagnosis, including hoarseness, swallowing and breathing difficulty. The average time from the onset of compressive symptoms to the cancer diagnosis was 56 days, only 28% of patients being diagnosed within 30 days.

At diagnosis, the cancer stage was advanced in all patient: stage IVa in 15 (4%), IVb in 102 (28%), IVc in 231 (64%), and unknown in 12 (4%) patients. Only 54% of patients had molecular testing, the most frequent mutation found being TP53 (64% of patients). A total of 62% of patient had ATC consisting of only ATC cells, 27% had ATC including a combination of ATC and other thyroid cancer cells and 5% had transformed ATC, when ATC developed in patients with a prior diagnosis of thyroid cancer. A total of 18% of patients received only supportive care. Among the treated patients, 71% received chemotherapy and 59% received radiation therapy. Only 19% underwent thyroidectomy. Second-line treatments, including targeted therapy and immunotherapy were administered to 32% of patients.

Overall survival (OS) was defined as the time from the date of the ATC diagnosis to death from any cause. The average OS was 6.8 months, with disease progression being the main cause of death (68% of patients). The average OS rate at 6 months, 1 year, and 2 years was 53%, 33% and 20%. Based on the cancer stage, the average OS was not achieved in patients with stage IVa disease (more than 50% of patients were still alive at the end of the study) and was 11.4 months in those with stage IVb and 4.6 months in those with stage IVc disease. Based on the cancer type, patients with the combination of ATC and another thyroid cancer had a longer OS (14.7 months) compared to those with ATC developing in patients with an existing thyroid cancer (6 months) and with ATC alone (3.7 months). After an average follow-up of 52 months, 15 patients (4%) with an average age of 59 years were disease free. Of these, 33.3% had stage IVa and 67% had stage IVb disease. Overall, 7 (46%) patients had ATC alone and 8 (53.3%) had ATC in combination with other thyroid cancer. All but 1 patient (93%) underwent surgery, all underwent radiotherapy, and 80% underwent chemotherapy. Multimodal treatment improved survival, while age and gender did not affect survival.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Although ATC is very aggressive with an advanced stage at initial diagnosis and overall poor prognosis, there is heterogeneity in prognosis among patients based on several factors, including the cancer stage and type, treatment modality, and the patient’s performance status. Patients with lower performance status, advanced stage, and “pure” compared to “mixed” ATC had lower survival rates. The prognosis of ATC patients could be improved by reducing the time to diagnosis and using a multimodal treatment with early molecular testing to guide a more personalized treatment approach.

— Alina Gavrila, MD, MMSC

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