Prognostic factors of anaplastic thyroid carcinoma.

BACKGROUND AND PURPOSE: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies. We tried to elucidate the possible prognostic factors. METHODS: A retrospective review was conducted of ATC patients in National Taiwan University Hospital from 1978 to 2003. Their demographic characteristics, clinical presentations, laboratory data and treatment modalities were reviewed. Possible prognostic factors for survival were evaluated. RESULTS: Forty-five patients (14 males and 31 females) of mean age 61.9 +/- 12.6 yr were included in this study. The median survival time was 94 days (range 6 to 776 days). The overall survival rate was 27% at 6 months and 10% at 1 yr. Thirty-two patients receiving intervention regimens had a median survival of 106 days, while 13 patients receiving palliative therapy had a median survival of 39 days. The difference in survival is statistically significant (logrank test, p = 0.017). Adjusted with sex and age, increment in white blood cell count (per 10(9)/l) and serum albumin (per 1.0 g/l) had a hazard ratio of 1.12 (Cox regression, p < 0.001) and 0.92 (p = 0.041), respectively. Patients with leukocytosis [white blood cell (WBC) count > 10(10)/l] or hypoalbuminemia (serum albumin < 35 g/l) had significant shorter survival than patients without leukocytosis or hypoalbuminemia (logrank test p = 0.008 and p = 0.032, respectively). Patients with serum T4 levels lower than 64.35 nmol/l had significantly shorter survival than patients without hypothyroxinemia (median survival 24 vs 128 days, logrank test, p = 0.004). CONCLUSIONS: ATC is an aggressive malignancy. Leukocytosis, hypoalbuminemia and hypothyroxinemia indicated poor prognosis. Survival time might be prolonged if intervention treatment is tolerable.