Abstract：
OBJECTIVE: Anaplastic thyroid carcinomas (ATC) are a heterogenous group of tumors of overall dismal prognosis. We designed models to identify relevant prognostic factors of survival of irradiated ATC patients including radiotherapy modalities (field size, dose).
METHODS: Between 2000 and 2017, 166 ATC patients\' treatments were divided into surgery and postoperative radiotherapy (poRT) or definitive radiotherapy (RT). Multiple imputation approach was used for missing data. Prognostic factors were identified using Lasso-penalized Cox modelling and predicted risk scores were built.
RESULTS: Patients undergoing RT (n=70) had more adverse patient and disease characteristics than those undergoing poRT (n=96). Corresponding median survival rates were 5.4 and 12.1 months, respectively. PoRT patients undergoing poRT more likely received extended-field radiotherapy with prophylactic nodal irradiation, but rather received platinum- vs. adriamycin-based chemoradiotherapy. Radiotherapy was conventionally fractionated, delivered >60Gy in 51.9% and 61.7% and used extended fields in 88.5% and 71.2% of patients with poRT or RT. Radiotherapy interruption rates for toxicity were similar in the two groups. The best poRT-group model identified age>45yo, PS≥1, pathologic tumor stage≥pT4b,>N1 and R2 resection as poor prognostic factors. The best RT-group model (C-index of 0.72) identified PS≥3,>N1 and extended-field radiotherapy with prophylactic nodal irradiation (as opposed to tumour-bed irradiation only) as poor prognostic factors.
CONCLUSIONS: In patients undergoing poRT, radiotherapy parameters had little influence over their survival irrespective of patient, disease characteristics, and quality of resection. In patients undergoing RT, extended-field radiotherapy improved survival in addition to PS and nodal stage.
METHODS: Between 2000 and 2017, 166 ATC patients\' treatments were divided into surgery and postoperative radiotherapy (poRT) or definitive radiotherapy (RT). Multiple imputation approach was used for missing data. Prognostic factors were identified using Lasso-penalized Cox modelling and predicted risk scores were built.
RESULTS: Patients undergoing RT (n=70) had more adverse patient and disease characteristics than those undergoing poRT (n=96). Corresponding median survival rates were 5.4 and 12.1 months, respectively. PoRT patients undergoing poRT more likely received extended-field radiotherapy with prophylactic nodal irradiation, but rather received platinum- vs. adriamycin-based chemoradiotherapy. Radiotherapy was conventionally fractionated, delivered >60Gy in 51.9% and 61.7% and used extended fields in 88.5% and 71.2% of patients with poRT or RT. Radiotherapy interruption rates for toxicity were similar in the two groups. The best poRT-group model identified age>45yo, PS≥1, pathologic tumor stage≥pT4b,>N1 and R2 resection as poor prognostic factors. The best RT-group model (C-index of 0.72) identified PS≥3,>N1 and extended-field radiotherapy with prophylactic nodal irradiation (as opposed to tumour-bed irradiation only) as poor prognostic factors.
CONCLUSIONS: In patients undergoing poRT, radiotherapy parameters had little influence over their survival irrespective of patient, disease characteristics, and quality of resection. In patients undergoing RT, extended-field radiotherapy improved survival in addition to PS and nodal stage.
摘要：
目的：间变性甲状腺癌（ATC）是一组异质性的肿瘤，总体预后不佳。我们设计了模型来确定接受放射治疗的ATC患者生存的相关预后因素，包括放射治疗方式（视野大小，剂量）。
方法：在2000年至2017年期间，166例ATC患者的治疗分为手术和术后放疗（poRT）或确定性放疗（RT）。对缺失的数据采用多重插补方法。使用Lasso惩罚Cox模型确定预后因素，并建立预测风险评分。
结果：接受RT的患者（n=70）比接受poRT的患者（n=96）具有更多的不良患者和疾病特征。相应的中位生存率分别为5.4个月和12.1个月，分别。接受PoRT的患者更有可能接受具有预防性淋巴结照射的扩展视野放疗，而是收到了铂-vs.基于阿霉素的放化疗。放射治疗通常是分割的，51.9%和61.7%的患者>60Gy，88.5%和71.2%的患者使用扩展视野。两组的放疗毒性中断率相似。最佳poRT组模型确定年龄>45yo，PS≥1，病理肿瘤分期≥pT4b，>N1和R2切除是不良预后因素。最佳的RT组模型（C指数为0.72）将PS≥3，>N1和具有预防性淋巴结照射（仅与肿瘤床照射相反）的扩展场放疗确定为不良预后因素。
结论：在接受PORT的患者中，放疗参数对患者的生存率影响不大，疾病特征，和切除质量。在接受RT的患者中，除PS和淋巴结分期外，扩展放射治疗还改善了生存率。
方法：在2000年至2017年期间，166例ATC患者的治疗分为手术和术后放疗（poRT）或确定性放疗（RT）。对缺失的数据采用多重插补方法。使用Lasso惩罚Cox模型确定预后因素，并建立预测风险评分。
结果：接受RT的患者（n=70）比接受poRT的患者（n=96）具有更多的不良患者和疾病特征。相应的中位生存率分别为5.4个月和12.1个月，分别。接受PoRT的患者更有可能接受具有预防性淋巴结照射的扩展视野放疗，而是收到了铂-vs.基于阿霉素的放化疗。放射治疗通常是分割的，51.9%和61.7%的患者>60Gy，88.5%和71.2%的患者使用扩展视野。两组的放疗毒性中断率相似。最佳poRT组模型确定年龄>45yo，PS≥1，病理肿瘤分期≥pT4b，>N1和R2切除是不良预后因素。最佳的RT组模型（C指数为0.72）将PS≥3，>N1和具有预防性淋巴结照射（仅与肿瘤床照射相反）的扩展场放疗确定为不良预后因素。
结论：在接受PORT的患者中，放疗参数对患者的生存率影响不大，疾病特征，和切除质量。在接受RT的患者中，除PS和淋巴结分期外，扩展放射治疗还改善了生存率。
