Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Program Number: B329
Session Name: Poster Session
Survival Trends in Anaplastic Thyroid Cancer
Andrew T Peachman, BS1; Fahad Rind, MD2; Fadi Nabhan, MD3; Vineeth Sukrithan, MD4; Matthew O Old, MD2; Amit Agrawal, MD2; Stephen Y Kang, MD2; Catherine T Haring, MD2; Enver Ozer, MD2; Lauren E Miller, MD2; Nolan B Seim, MD2; 1The Ohio State University College of Medicine; 2Department of Otolaryngology-Head and Neck Surgery, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University Wexner Medical Center; 3Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The Ohio State University Wexner Medical Center; 4Department of Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterIntroduction: Anaplastic thyroid carcinoma is a rare and aggressive neoplasm of the thyroid most commonly seen in patients over the age of 60 and carries a poor prognosis. Surgery is occasionally performed for patients who have diseases that have not invaded critical adjacent structures, and evidence has been building recently for surgical management alongside chemoradiation therapy. Further, the introduction of BRAF inhibitors to the market has vastly changed the survival outcomes for patients positive for the mutation. This study aims to explore the recent survival trends in anaplastic thyroid patients.
Methods: A retrospective analysis was conducted on 77 patients with a diagnosis of anaplastic thyroid carcinoma at a tertiary care academic medical center between 2013 and 2023. The patients' initial presenting symptoms were collected as well as their past medical history and oncologic history. If a patient underwent surgical resection with intent to cure, they were characterized as a surgical patient. In contrast, patients who underwent tracheostomy, open biopsies, or less invasive, palliative resections were deemed non-surgical. Many surgical patients also received neo-adjective treatment. Additionally, tumor markers were collected on every patient. Kaplan Meier curves were created following statistical analysis of the various groups.
Results: 50 surgical and 27 non-surgical patients presented to a single institution with an average age of 65.5 years and a BMI of 30.2. 38 (49%) patients were males; 30 (39%) of the patients had a smoking history. Many of the patients who underwent surgical resection also underwent systemic therapy. 41 of the patients who underwent surgery had a selective, modified radical, or radical neck dissection. Patients were treated with appropriate adjuvant therapy as determined by the multi-disciplinary tumor board. Those who underwent surgical treatment for their cancer had a median survival of 14 months when compared to 7 months for those who were not treated with surgery (p=0.031). At 1 year, 50% of surgical patients were still alive compared to 37% of non-surgical patients. Initial analysis shows no differences in survival for BRAF or PD-L1 positivity alone, though does suggest a survival benefit for patients positive for both markers.
Conclusions: There is a survival advantage with curative intent surgery in the treatment and management of patients presenting with anaplastic thyroid carcinoma. These findings should inform clinicians that resectable disease may lead to better patient outcomes despite the morbidity associated with recovery from surgery. Definitive surgical treatment should be considered along with targeted, neo-adjuvant therapy and palliation in patients with anaplastic thyroid cancer.
