Anaplastic thyroid carcinoma in the Netherlands, very bad but not for all!
PH-0044
Abstract
Anaplastic thyroid carcinoma in the Netherlands, very bad but not for all!
Authors: de Ridder|, Mischa(1)*[m.de_ridder.RT@lumc.nl];Nieveen van Dijkum|, Els(2);Engelsman|, Anton(2);Ellen|, Kapiteijn(3);Klumpen|, Heinz-Josef(4);Rasch|, Coen(1);
(1)LUMC, Radiation Oncology, Leiden, The Netherlands;(2)Amsterdam UMC - Cancer Center Amsterdam, Surgery, Amsterdam, The Netherlands;(3)LUMC, Medical Oncology, Leiden, The Netherlands;(4)Amsterdam UMC - Cancer Center Amsterdam, Medical Oncology, Amsterdam, The Netherlands;
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Purpose or Objective
Anaplastic thyroid carcinoma (ATC) is a rare, but very aggressive type of thyroid cancer. Extensive local disease is the first presentation in most people and due to the rapid growth velocity of these tumors patients die of their local disease. Survival is known to be poor, but small series describe prolonged survival in patients treated with combined modality treatments.
Material and Methods
All patients with ATC between 1989-2016 were identified in the Netherlands Cancer Registry (NCR). Patient characteristics, treatment characteristics and survival was scored. Of all patients, excerpts from the pathology report were linked to gain tumor information. Standardized incidence rates were calculated, survival was estimated using the Kaplan Meier method and factors associated with survival were tested by univariable and multivariable regression model.
Results
In total 812 patients with ATC were included in the analyses. Mean standardized incidence rate was 0.18/100,000 (range over the years 0.11 – 0.27 / 100,000). A significant trend towards increase was found over the years with an annual percentage change of 1.3% / year (95% CI 0,4 – 2.1 %). Median overall survival was 2.2 months and estimated 1-year survival was 12%. Patients without distant metastases at time of diagnosis had an estimated 1-year survival of 21.6%. Exploratory analysis of the patients with a longer survival than 2 years showed that these patients had significantly less bilateral lymph node metastases (10% vs. 25%), less distant metastases (8% vs. 45%), underwent more often double or triple therapy (69% vs 19%) and were younger (age below 65 years 48% vs 24% (all with an p<0.001).
Conclusion
This is the first nationwide analysis of patients with ATC with a national coverage of the data. ATC is rare and is highly lethal with an median survival of 2.2 months and estimated 1-year survival of 12%. Major risk factor for ATC is previous well-differentiated thyroid cancer, since the incidence of thyroid cancer rose over the previous decades, the incidence rise found in our study could be linked to the overall rise in thyroid cancer. Despite the very low survival rates, there appears to be a subgroup of patients with prolonged survival. One key factor associated with prolonged survival is multimodality treatment containing surgery, radiotherapy and eventually chemotherapy. Future research will focus on a more distinctive definition of the subgroup that may benefit most from intensive treatment.