In:
Journal of Cancer Research and Clinical Oncology, Springer Science and Business Media LLC, Vol. 149, No. 7 ( 2023-07), p. 3527-3547
Kurzfassung:
Anaplastic thyroid carcinoma (ATC) is an orphan disease with a fatal outcome. Surgery to the primary tumor in metastatic ATC is controversial. Determination of specific surgical techniques may help facilitate local control and, hence, beneficial overall and disease-specific survival. Methods Using individualized patient data derived from our systematic review of literature and our single center study ( n = 123), conducting a Surveillance, Epidemiology, and End Results register (SEER)-based study ( n = 617) we evaluated surgery, its combination with systemic and local therapies in metastatic ATC. Results Pooled cohort study showed surgery ( p 〈 0.001), RT ≥ 30 Gy ( p 〈 0.001), ChT ( p 〈 0.001) and multimodal treatment ( p = 0.014) to result in improved OS univariately. In the multivariate analysis, surgery (1.997 [1.162–3.433], p = 0.012) and RT ≥ 30 Gy (1.877 [1.232–2.843], p = 0.012) were independent predictors for OS. In SEER-based study of patients undergoing any tumor-directed treatment ( n = 445) total thyroidectomy ( p = 0.031), administration of ChT ( p = 0.007), RT ( p 〈 0.001), combination of surgery and RT ± ChT ( p 〈 0.001) and multimodal treatment ( p 〈 0.001) correlated with an improved DSS univariately. On the multivariate analysis, debulking surgery was an independent predictor for a worse outcome (HR 0.535, 95%CI 0.332–0.862, p = 0.010), whereas RT administration correlated with a longer DSS (HR 2.316, 95%CI 1.362–3.939, p = 0.002). Among operated patients from SEER register total thyroidectomy ( p = 0.031), ChT ( p = 0.007), RT ( p 〈 0.001), combination of surgery and RT ± ChT ( p 〈 0.001) and multimodal treatment ( p 〈 0.001) correlated with an improved DSS in the univariate analysis, whereas debulking surgery was inversely correlated with the DSS ( p 〈 0.001). On the multivariate analysis, debulking surgery was an independent predictor for a worse DSS (HR 0.535, 95%CI 0.332–0.862, p = 0.010), whilst RT administration correlated with a longer DSS (HR 2.316, 95%CI 1.362–3.939, p = 0.002). Conclusions Surgery to the primary tumor with the aim of R0/R1 resection, but not debulking, is associated with a significant OS and DSS benefit even in systemically metastasized disease.
Materialart:
Online-Ressource
ISSN:
0171-5216
,
1432-1335
DOI:
10.1007/s00432-022-04223-7
Sprache:
Englisch
Verlag:
Springer Science and Business Media LLC
Publikationsdatum:
2023
ZDB Id:
1459285-X
