Decisive role of surgery on improving overall survival outcomes of primary thyroid sarcoma: the first long-term...

Primary Thyroid Sarcoma (PTS) accounts for 1-2% of thyroid malignancies with limited survival data available. And it might be misidentified as the spindle cell subtype of anaplastic thyroid carcinoma (ATC) due to overlapping pathological features, which poses a significant diagnostic challenge.

A total of 42 PTS patients from 2000 to 2018 were screened from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival curve, Cox proportional hazard regression were applied.

Most patients with PTS are middle-aged to old, predominantly white, and slightly more female. The 5-year overall survival (OS) and 5-year disease specific survival (DSS) were 28.3% and 60.5%, respectively. Older age (>55 vs <=40, HR = 6.45, 95% CI 2.16-19.24, P < 0.001), undifferentiated pathological grade (vs moderately differentiated, HR = 17.02, 95% CI 1.74-166.89, P = 0.015), higher SEER stage (e.g., distant vs localized, HR = 7.76, 95% CI 2.12-8.84, P = 0.002), distant metastasis (M1 vs M0, HR = 2.93, 95% CI 1.09-7.91, P = 0.034) and no surgery performed (lobectomy vs no surgery, HR = 0.11, 95% CI 0.03-0.42, P = 0.001; total thyroidectomy vs no surgery, HR = 0.05, 95% CI 0.01-0.20, P < 0.001) were identified as independent prognostic factors, in which, surgery is the only factor that improves survival outcomes of PTS patients.

The current study outlined the features of PTS patients in demographic and clinical characteristics, survival outcomes, prognostic factors, general layout of cause of deaths and the desicive role of surgery in improving its survival benefits.