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The present study investigated the association between local resection and cause of death in anaplastic thyroid carcinoma (ATC) patients with stage IVC disease.A total of 54 ATC patients with stage IVC disease were included in the study. Information including patient characteristics, laboratory data including complete blood count, treatment, and death were collected for analysis.The median overall survival (OS) for patients with or without resection was 8.4 [95% confidence interval (CI) 5.9-14.4)] and 4.2 (95% CI 2.5-6.2) months, respectively (p 0.001). No patients survived without resection at 1 year. Univariate analysis revealed that resection (p 0.001) and radiotherapy (p = 0.018) were significantly associated with OS. Multivariate analysis revealed that resection (hazard ratio 0.257; 95% CI 0.115-0.575; p 0.001) was the only independent prognostic factor of OS. In ATC patients with known resection status, the median OS for the patients with a resection status of R0/1 (n = 28) and R2 (n = 7) were 13.0 (95% CI 7.5-18.7) and 1.7 (95% CI 0.1-6.2) months, respectively (p 0.001). The most common specific cause of death was respiratory insufficiency (35%), followed by airway obstruction (25%) and cerebral cardiovascular-related death (5%). The frequency of airway obstruction was significantly lower in patients with resection (p = 0.018).Resection probably impacts on clinical course in ATC patients despite the presence of distant metastasis. However, R2 resection is likely to be harmful and surgeons should carefully consider the resectability of thyroid tumors.

Purpose This study aimed to analyze the clinical course of patients with differentiated thyroid cancer (DTC) who were treated by lenvatinib and investigate the specific criteria for the initiation of lenvatinib treatment in lung metastasis.MethodsA total of 111 patients with DTC treated by lenvatinib were included in the study. Patients were divided into two groups based on the target lesion for the initiation of lenvatinib treatment: lung metastasis group and other metastases group.ResultsIn the univariate analysis, the tumor size for the target lesion (p = 0.002) and target lesion (p < 0.001) were significantly associated with overall survival (OS). Multivariate analysis revealed that the target lesion [hazard ratio, 0.408; 95% confidence interval (CI), 0.206–0.810; p = 0.010] was the only independent prognostic factor of OS. Of the 53 patients in the lung metastasis group, 12 (23%) had lung metastasis-related finding such as pleural effusion (n = 12), hemoptysis (n = 2), and dyspnea (n = 1) at the initiation of lenvatinib treatment. The median OS in patients with or without lung metastasis-related findings were 41.0 [95% CI, 10.4–not available (NA)] months and 62.9 (95% CI, 53.0–NA) months, respectively (p = 0.022).ConclusionPatients with lung metastasis-related finding at the initiation of lenvatinib treatment had a poorer prognosis among the lung metastasis group. It is important to consider not only the tumor size but also the presence of lung metastasis-related findings when initiating lenvatinib treatment for DTC patients with lung metastasis.

Purpose This study aimed to estimate the proportion of patients with anaplastic thyroid carcinoma (ATC) at our institution who are likely to have the efficacy of immune checkpoint inhibitor (ICI) treatment by investigating programmed cell death ligand 1 (PD-L1) expression. Additionally, we investigated the association between PD-L1 expression and treatment outcomes of lenvatinib in patients with ATC. Methods The 19 lenvatinib-treated patients with ATC whose tissue samples available for immunohistochemistry were included in this study. The tumor proportion score (TPS) ≥1%was determined as positive for PD-L1 expression Results Of the 19 patients, 5 (26%) and 14 (74%) had a partial response to lenvatinib treatment and PD-L1 expression positivity, respectively. The median TPS was 30% in patients with positive PD-L1 expression. The median OS for all 19 patients was 4.8 (95% confidence interval [CI], 2.8–6.6) months with a 6-month OS rate of 36.8%. Furthermore, the median OS for patients with positive or negative PD-L1 expression was 5.3 (95% CI, 1.6–7.8) and 4.2 (95% CI, 1.1–not available) months, respectively (p = 0.277). Conclusion No correlation was observed between the PD-L1 expression in the ATC tissue samples and efficacy of lenvatinib. Furthermore, in our study, 14 (74%) of 19 patients with ATC had PD-L1 expression positivity. Although lenvatinib monotherapy may have limited efficacy, some patients with ATC have the possibility that the addition of ICI on lenvatinib is effective.

Background: Anaplastic thyroid cancer (ATC) is a very rare disease with a remarkably poor prognosis and with no established effective drug therapy. This study aimed to report the outcomes of lenvatinib single-agent therapy as an initial drug treatment in ATC and investigate its safety and efficacy. Methods: This retrospective cohort study included 56 patients with ATC with unresectable primary tumors of whom 36 were treated with lenvatinib and 12 with weekly paclitaxel (PTX), and 8 patients who refused any drug treatment received palliative care. Results: The average survival in the lenvatinib group is 5.8 months, which is significantly longer than 2.0 months in the PTX group (P = 0.005). The efficacy of lenvatinib in 36 patients with ATC, whose primary tumors were unresectable, was evaluated. The response rate was 33%, and the median overall survival was 5.0 months. A safety review indicated that lenvatinib should be used under the careful observation of local findings. Two patients, who showed a reduction with lenvatinib, underwent conversion surgery, which prolonged the prognosis in terms of avoiding events, such as asphyxia, fistula, and hemorrhage due to tumor growth; however, the surgical margins were positive, indicating that complete remission was impossible even if surgical resection was performed. Conclusions: Therefore, starting with lenvatinib treatment and finding a therapeutic drug based on the genomic analysis is an acceptable treatment strategy for ATC while halting the disease progression.