Prognosis of Anaplastic Thyroid Cancer

• ATC has a rapidly progressive course and early dissemination
• The most common sites of distant spread include, in descending order:
  • The lung, bone, and brain
• Metastases, particularly in the lung:
  • Are likely to be present at diagnosis in more than 50% of cases
• The overall 5-year survival rate:
  • Is reportedly less than 10%, and most patients do not live longer than a few months after diagnosis
• One study has shown that patients younger than 60 years who have ATC confined to the thyroid:
  • Have a better prognosis than patients who are older and have distant metastases
• A retrospective study from Korea found that:
  • Age less than 60 years, tumor size less than 7 cm, and lesser extent of disease:
    • Were independent predictors of lower disease-specific mortality 
• While some studies have suggested that postoperative radiotherapy:
  • May be of benefit in terms of survival, definitive prospective trials are lacking
• Akaishi et al conducted a review of 100 patients with ATC in a single hospital (Ito Hospital) from 1993-2009:
  • The 1-year survival rates were as follows:
    • Stage IVA – 72.7%
    • Stable IVB- 24.8%
    • Stable IVC – 8.2%
• Multivariate analysis demonstrated worse prognosis with:
  • Age older than 70 years, white blood cell count of 10,000/μL or more, extrathyroidal invasion, and distant metastases at the time of diagnosis
• Survival was significantly better if the patient received complete resection, external radiation at doses of 40 Gy or more, or both
• Orita et al developed a prognostic index that can predict prognosis and assist in the early treatment of ATC

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