Prognostic Factors and Treatment Outcomes for Anaplastic Thyroid Carcinoma: ATC Research Consortium of Japan Cohort Study of 677 Patients
Prognostic Factors and Treatment Outcomes for Anaplastic Thyroid Carcinoma: ATC Research Consortium of Japan Cohort Study of 677 Patients
复制标题
DOI：
10.1007/s00268-012-1437-z
复制
发表时间：
2012-06-01
影响因子：
2.6
通讯作者：
Suzuki, Shinichi
中科院分区：
文献类型：
--
作者：
Sugitani, Iwao;Miyauchi, Akira;Suzuki, Shinichi
间变性甲状腺癌(ATC)仅占所有甲状腺癌的1%至2%，但它是人类最致命的肿瘤之一。到目前为止，关于ATC的大多数发现都来自于有限数量的队列的单一机构研究。为了进一步了解这种“孤儿疾病”，我们建立了一个多中心注册机构--日本ATC研究联盟(ATCCJ)。我们使用ATCCJ的大型队列数据库分析了预后因素和治疗结果，大多数参与甲状腺癌治疗的日本中心都被邀请加入ATCCJ，并提供了1995至2008年间接受ATC治疗的患者的信息。该数据库包括来自38家注册机构的677例病例。生存曲线采用Kaplan-Meier法，比较采用对数等级检验。采用Cox比例风险模型进行多因素分析，将临床类型分为普通型(=547例)、偶发型(=29例)、颈部间变型(=95例)、远端间变型(=6例)。偶发型继发于颈部间变型的预后好于其他类型。远端的间变性转化显示出最糟糕的结果。普通型ATC的6个月和1年原因特定生存率分别为36%和18%。总体而言，84人(15%)获得了长期(1年)生存。多因素分析表明，年龄为千分之70岁、出现急性症状、白细胞增多(白细胞计数为千分之10,000/mm(3))、大肿瘤、T4b肿瘤和远处转移是降低生存率的重要危险因素。不同的UICC分期，6个月的CSS发生率也有显著差异，IVA期、IVB期和IVC期的6个月CSS分别为60%、45%和19%。对于69例接受根治性手术的IVA期患者中的36例(52%)，包括放射治疗(RTX)和化疗(CTX)在内的辅助治疗在统计上没有显示出额外的好处。相反，在242例IVB期患者中，80例(33%)接受了根治性手术。对于这些患者，RTX和CTX的联合治疗显著改善了CSS。部分ATC患者有可能长期存活。在确定治疗策略时，应考虑UICC分期(疾病程度)和其他预后因素(例如，生物恶性程度)。
Anaplastic thyroid carcinoma (ATC) accounts for only 1 to 2% of all thyroid carcinomas, but it is one of the most lethal neoplasms in humans. To date, most findings about ATC have been derived from single-institution studies with limited numbers of cohorts. To obtain further insights into this "orphan disease," we have established a multicenter registry, the ATC Research Consortium of Japan (ATCCJ). We analyzed prognostic factors and treatment outcomes using the large cohort database of the ATCCJ.Most of the Japanese centers involved in the treatment of thyroid cancer were invited to join the ATCCJ and have provided information on ATC patients treated between 1995 and 2008. The database includes 677 cases from 38 registered institutions. Survival curves were determined using Kaplan-Meier methods and were compared using the log-rank test. Cox's proportional hazards model was used for multivariate analysis.Clinical varieties of ATC were classified into four types: common type ( = 547); incidental type ( = 29); anaplastic transformation at the neck ( = 95); anaplastic transformation at a distant site ( = 6). The incidental type followed by anaplastic transformation at the neck showed better outcomes than the other types. Anaplastic transformation at a distant site showed the worst outcomes. The 6-month and 1-year cause-specific survival (CSS) rates for common-type ATC were 36 and 18%, respectively. In all, 84 (15%) achieved long-term (> 1 year) survival. Multivariate analysis identified age a parts per thousand yen70 years, presence of acute symptoms, leukocytosis (white blood cell count a parts per thousand yen10,000/mm(3)), large tumor > 5 cm, T4b tumor, and distant metastasis as significant risk factors for lower survival. CSS rates also differed significantly depending on UICC stages, with 6-month CSSs of 60% for stage IVA, 45% for IVB, and 19% for IVC. For 36 of 69 (52%) stage IVA patients who underwent radical surgery, adjuvant therapies, including radiation therapy (RTX) and chemotherapy (CTX) did not show additional benefit statistically. Conversely, among 242 stage IVB patients, 80 (33%) underwent radical surgery. For those patients, therapies combining RTX with CTX significantly improved CSS.Long-term survival is possible for selected patients with ATC. To determine the treatment strategy, UICC stage (disease extent) and other prognostic factors (e.g., biologic malignancy grade) should be considered.