Impact of Local Control on Clinical Course in Stage IVC Anaplastic Thyroid Carcinoma

Background The present study investigated the association between local resection and cause of death in anaplastic thyroid carcinoma (ATC) patients with stage IVC disease. Methods A total of 54 ATC patients with stage IVC disease were included in the study. Information including patient characteristics, laboratory data including complete blood count, treatment, and death were collected for analysis. Results The median overall survival (OS) for patients with or without resection was 8.4 [95% confidence interval (CI) 5.9–14.4)] and 4.2 (95% CI 2.5–6.2) months, respectively ( p < 0.001). No patients survived without resection at 1 year. Univariate analysis revealed that resection ( p < 0.001) and radiotherapy ( p = 0.018) were significantly associated with OS. Multivariate analysis revealed that resection (hazard ratio 0.257; 95% CI 0.115–0.575; p < 0.001) was the only independent prognostic factor of OS. In ATC patients with known resection status, the median OS for the patients with a resection status of R0/1 ( n = 28) and R2 ( n = 7) were 13.0 (95% CI 7.5–18.7) and 1.7 (95% CI 0.1–6.2) months, respectively ( p < 0.001). The most common specific cause of death was respiratory insufficiency (35%), followed by airway obstruction (25%) and cerebral cardiovascular-related death (5%). The frequency of airway obstruction was significantly lower in patients with resection ( p = 0.018). Conclusions Resection probably impacts on clinical course in ATC patients despite the presence of distant metastasis. However, R2 resection is likely to be harmful and surgeons should carefully consider the resectability of thyroid tumors.