Impact of comorbidities on treatment management and prognosis in patients with anaplastic thyroid cancer (ATC)

To evaluate the impact of comorbidities on treatment allocation and prognosis in anaplastic thyroid cancer, 137 patients from 10 German tertiary cancer centers treated with radiotherapy between 2001 and 2020 were analyzed. Four validated comorbidity scores were applied to assess comorbidity burden. The primary objective was to identify prognostic factors for the survival rate at 6 months after radiotherapy and discriminate the comorbidity scores using concordance statistics, ROC curve net reclassification index, and integrated discrimination improvement for 6-month survival. The median overall survival (OS) of the entire cohort was 4 months (95% CI = 2.72-5.28). The 6-, 12- and 24-months survival rates were 42.1%, 29.0% and 15.0%, respectively. In the univariate analysis, Karnofsky Performance Score (KPS) (> 70%, p < 0.001), UICC stage (p < 0.001), treatment modality (p < 0.001), intention of treatment (p < 0.001) as well as lower scores in the conventional Charlson Comorbidity Index (cCCI, p < 0.001), the updated Charlson Comorbidity Index (uCCI, p < 0.001) were associated with improved OS. KPS (> 70%, p = 0.06) and type of therapy (p = 0.087) showed a trend in multivariate analysis. Higher comorbidity burden (cCCI and uCCI) was associated with less intensive treatment and lower cumulative radiation doses in univariable analyses. However, after adjustment for age and metastatic status, none of the comorbidity indices remained independently associated with the use of multimodal therapy or the prescribed EQD2 dose (p > 0.05). Age, but not metastatic status, was linked to a reduced likelihood of receiving multimodal treatment. In contrast, KPS emerged as the only independent predictor of higher EQD2 dose levels in the multivariable models.

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Publication Details

Journal
Journal of Cancer Research and Clinical Oncology
Published
2025-12-23
DOI
https://doi.org/10.1007/s00432-025-06403-7
Primary Topic
Thyroid Cancer Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00

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article

Impact of comorbidities on treatment management and prognosis in patients with anaplastic thyroid cancer (ATC)

S. E. Combs, Matthias Mäurer, Claus Belka, Teresa Augustin et al.
Journal of Cancer Research and Clinical Oncology
Thyroid Cancer Diagnosis and Treatment
article

Impact of comorbidities on treatment management and prognosis in patients with anaplastic thyroid cancer (ATC)

S. E. Combs, Matthias Mäurer, Claus Belka, Teresa Augustin, Michael Oertel, Alexander Rühle, Sonia Drozdz, Maria Waltenberger, D Vordermark, Stefan Janssen, Marlen Haderlein, Dmytro Oliinyk, Christine Spitzweg, Nils H. Nicolay, Josefine Rauch, Anastassia Löser, Hans Theodor Eich, Julia Jacob, Ralph Gurtner, Prof Anca-Ligia Grosu, Charlotte Frei, Daniel Medenwald, Robert Renollet, Maike Trommer, Lukas Käsmann
article en

Abstract

To evaluate the impact of comorbidities on treatment allocation and prognosis in anaplastic thyroid cancer, 137 patients from 10 German tertiary cancer centers treated with radiotherapy between 2001 and 2020 were analyzed. Four validated comorbidity scores were applied to assess comorbidity burden. The primary objective was to identify prognostic factors for the survival rate at 6 months after radiotherapy and discriminate the comorbidity scores using concordance statistics, ROC curve net reclassification index, and integrated discrimination improvement for 6-month survival. The median overall survival (OS) of the entire cohort was 4 months (95% CI = 2.72-5.28). The 6-, 12- and 24-months survival rates were 42.1%, 29.0% and 15.0%, respectively. In the univariate analysis, Karnofsky Performance Score (KPS) (> 70%, p < 0.001), UICC stage (p < 0.001), treatment modality (p < 0.001), intention of treatment (p < 0.001) as well as lower scores in the conventional Charlson Comorbidity Index (cCCI, p < 0.001), the updated Charlson Comorbidity Index (uCCI, p < 0.001) were associated with improved OS. KPS (> 70%, p = 0.06) and type of therapy (p = 0.087) showed a trend in multivariate analysis. Higher comorbidity burden (cCCI and uCCI) was associated with less intensive treatment and lower cumulative radiation doses in univariable analyses. However, after adjustment for age and metastatic status, none of the comorbidity indices remained independently associated with the use of multimodal therapy or the prescribed EQD2 dose (p > 0.05). Age, but not metastatic status, was linked to a reduced likelihood of receiving multimodal treatment. In contrast, KPS emerged as the only independent predictor of higher EQD2 dose levels in the multivariable models.

Journal of Cancer Research and Clinical OncologyVol. 152(1)
Universität Hamburg (DE), University of Freiburg (DE), German Cancer Research Center (DE), Friedrich-Alexander-Universität Erlangen-Nürnberg (DE), University of Applied Sciences Landshut (DE), Heidelberg University (DE), University Hospital Bonn (DE), TUM Klinikum (DE), Helmholtz Zentrum München (DE), LMU Klinikum (DE), University Hospital Regensburg (DE), Universitätsklinikum Erlangen (DE), Düsseldorf University Hospital (DE), Ospedale di Bolzano (IT), Integrated Oncology (United States) (US), University Hospital Münster (DE), University Medical Center Hamburg-Eppendorf (DE), University Hospital Leipzig (DE), Jena University Hospital (DE), Mayo Clinic in Florida (US), Comprehensive Cancer Center Erlangen (DE), University Hospital in Halle (DE), University Hospital Cologne (DE), Olivia Newton-John Cancer Wellness & Research Centre (AU), Austin Health (AU), Deutsches Konsortium für Translationale Krebsforschung (DE), Heinrich Heine University Düsseldorf (DE), Technical University of Munich (DE), Martin Luther University Halle-Wittenberg (DE), Friedrich Schiller University Jena (DE), Ludwig-Maximilians-Universität München (DE), University of Lübeck (DE)
Amgen, AstraZeneca, Novocure, Deutsche Krebshilfe, Universität zu Köln
Reduced inequalities
Openalex Percentile: Top 31%
Thyroid Cancer Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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