Abstract：
Background: Anaplastic thyroid carcinoma (ATC) is a rare and frequently fatal type of thyroid cancer. The degree of heterogeneity in survival rates for ATC is incompletely studied. This study evaluated the factors associated with overall survival (OS) of patients with ATC using multicenter real-world data from a national tertiary care center network in France. Methods: In this multicenter, retrospective cohort study, all patients with ATC diagnosed between 2010 and 2020 were identified from the national database of the French ENDOCAN-TUTHYREF network. Factors associated with OS were examined in multivariable analyses using Cox proportional hazards models. Results: The study included 360 patients. Of these, 220 (61%) were female and the median age was 72 years (interquartile range: 62-80). The percentages of patients with pure and mixed (synchronously-transformed) ATC (p-ATC and st-ATC) were 62.5% and 26.7%, respectively. The median OS was 6.8 months [confidence interval, CI: 5.5-8.1]: not reached for stage IVa, 11.4 months [8.2-17.8] for IVb, and 4.6 months [3.5-5.7] for IVc. Surgery, radiation therapy to the neck, chemotherapy, and best supportive care were administered to 69 (19.2%), 214 (59.4%), 254 (70.6%), and 66 (18.3%) patients, respectively. In a multivariable analysis, including stage IVb-IVc patients, significantly higher OS was observed in patients with Eastern Cooperative Oncology Group performance-status of 0-1 (hazard ratio [HR], 0.6; [CI, 0.4-0.9], p < 0.02), stage IVb [HR, 0.5; CI, 0.4-0.8, p < 0.001], and multimodal treatment (surgery and chemoradiotherapy) [HR, 0.07; CI, 0.04-0.1, p < 0.001]. Variables associated with significantly worse OS included: p-ATC (vs. st-ATC) [HR, 1.83; CI, 1.33-2.51, p = 0.001] and a neutrophil-to-lymphocyte ratio (NLR) >5.05 [HR, 2.05, CI, 1.39-3.05, p < 0.001]. Conclusions: Factors independently associated with improved OS in ATC included: European Cooperative Oncology Group performance status, disease stage, multimodality treatment, synchronously transformed ATC, and lower NLR. Long-term OS was observed in selected patients with ATC who underwent multimodal treatment.
摘要：
背景：间变性甲状腺癌（ATC）是一种罕见且经常致命的甲状腺癌。ATC生存率的异质性程度尚未完全研究。这项研究使用来自法国国家三级护理中心网络的多中心真实世界数据评估了与ATC患者的总体生存率（OS）相关的因素。方法：在这个多中心，回顾性队列研究，从法国ENDOCAN-TUTHYREF网络的国家数据库中确定了2010年至2020年间诊断的所有ATC患者.使用Cox比例风险模型在多变量分析中检查了与OS相关的因素。结果：本研究共纳入360例患者。其中,220（61%）为女性，中位年龄为72岁（四分位距：62-80）。纯和混合（同步转化）ATC（p-ATC和st-ATC）患者的百分比分别为62.5％和26.7％，分别。中位OS为6.8个月[置信区间，CI：5.5-8.1]：IVa阶段未达到，IVb为11.4个月[8.2-17.8]，IVc为4.6个月[3.5-5.7]。手术,颈部放射治疗,化疗,最佳支持性护理达到69人(19.2%)，214（59.4%），254（70.6%），66名(18.3%)病人,分别。在多变量分析中，包括IVb-IVc期患者，在东部肿瘤协作组表现状态为0-1的患者中观察到显著较高的OS(风险比[HR]，0.6；[CI，0.4-0.9]，p<0.02),阶段IVb[HR，0.5；CI，0.4-0.8，p<0.001]，和多模式治疗(手术和放化疗)[HR，0.07；CI，0.04-0.1，p<0.001]。与明显更差的操作系统相关的变量包括：p-ATC(vs.ST-ATC)[人力资源，1.83；CI，1.33-2.51，p=0.001]和中性粒细胞与淋巴细胞比率（NLR）>5.05[HR，2.05，CI，1.39-3.05，p<0.001]。结论：与ATCOS改善独立相关的因素包括：欧洲肿瘤协作组的表现状况，疾病阶段,多模态治疗,同步变换的ATC，和较低的NLR。在接受多模式治疗的选定ATC患者中观察到长期OS。
