Dyspnea as a prognostic factor in anaplastic thyroid carcinoma

Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer. In this study, we review a single institution's experience with ATC over past 34 years. Through retrospective review, we attempted to identify the prognostic factors affecting the survival at our institution. We reviewed the records of 33 patients diagnosed with ATC by pathology over the last three decades. At our institution, median age at diagnosis was 68 years, the male to female ratio was 1.1:1, mean survival was 10 months and median survival was 4.7 months. Thirty-nine percentage of patients were treated with chemotherapy and 52% received radiation treatment. Thirty-six percentage received both chemotherapy and radiation and 58% of patients were treated with surgical intervention. Four of the patients received surgical intervention with curative intent. Tracheotomy was performed in 40% of patients. Eight patients survived more than 10 months. Univariate analysis showed that age greater than 60 and dyspnea at presentation were associated with decreased survival and that surgical intervention was associated with increased survival. Multivariate analysis identified only dyspnea at the time of presentation to be a significant independent prognostic factor affecting the mortality. While long-term survival is possible in some patients, ATC has a poor prognosis despite the attempts at aggressive treatment. In this study, we report that dyspnea was the only independent factor found to negatively affect the survival. This finding is unique in our study and supports the role of using signs at the time of presentation as potential prognostic factors for those patients with this aggressive disease.