Survival Figures

Survival figures vary and are based on a small number of cases. They have been reported at 2 years as near 0%,5 14%,2 and 17%'; at more than 3 years as 12%7; and at 5 years as 10%.2 Assiduous attempts have been made to define prognostic factors.1 Factors favoring prolonged survival included younger age (<45 years), disease confined to the neck, treatment characterized by total or subtotal thyroidectomy, and treatment by radiotherapy or chemotherapy or both. There appeared to be no significant survival advantage in the transformed group over the de novo anaplastic group. Analysis of long-term survivors (>24 months) indicated that they were significantly younger at diagnosis, had less disease, and received more extensive surgery, although this had not reached statistical significance. Ten of 12 long-term surviving patients received combined radiotherapy and chemotherapy postoperatively.1 In the Roswell Park Memorial series,2 patients who were female, who had tumors smaller than 6 cm, and who had undergone complete resection survived significantly longer.

One study from Latin America reported significantly longer survival in (1) patients with differentiated carcinoma with areas of anaplastic lesions limited to one lobe, (2) patients receiving a complete chemotherapy regimen, (3) patients with tumors smaller than 10 cm, and (4) those with a symptom duration of less than 4 months.58 A Japanese study reported a 1-year survival rate in 44 patients with ATC to be 16%. The presence of acute symptoms, large tumors (>5 cm), distant metastasis, and leukocytosis correlated with a poor outcome. A prognostic index (PI) based on these four factors was devised; patients with a PI less than or equal to 1 had 62% survival at 6 months, whereas no patients with a PI greater than 3 survived longer than 6 months.59

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