Prospective application of our novel prognostic index in the treatment of anaplastic thyroid carcinoma.

BACKGROUND: We have previously performed retrospective analysis of patients with anaplastic thyroid carcinoma (ATC) treated between April 1976 and March 1999, revealing acute symptoms, large tumor (>5 cm), distant metastasis, and leukocytosis ≥ 10,000/mm(3) as the most important prognostic factors. We devised a novel prognostic index (PI) as the total number of these 4 factors present, giving a PI of 0-4.

METHODS: We have adopted this PI since April 1999. In principle, multimodal treatment has been encouraged for a PI of ≤ 1, whereas aggressive treatment has been avoided to maintain quality of life for a PI of ≥ 3. The validity of this therapeutic strategy was prospectively investigated in 74 patients with ATC.

RESULTS: Six-month survival rates for PI ≤ 1 and PI ≥ 3 were 72% and 12%, respectively. Among patients with a PI of ≤ 1,11 (42%) underwent multimodal treatment and showed significantly better survival than previous cases. Survival rates did not differ between stages. For patients with a PI of ≥ 3, survival rates were equally dismal, regardless of stage. Numbers of patients who underwent tracheostomy or died from local disease were significantly decreased compared with previous cases.

CONCLUSION: Our PI is valid for anticipating prognosis and aiding timely decisions on treatment policy for ATC patients.