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. (Surgery 2011;150:1212-9.)