An 8-year single institution review of demographic trends and treatment patterns among patients with anaplastic thyroid carcinoma.

Abstract

e18139 Background: Anaplastic thyroid carcinoma (ATC) is a rare entity with a dismal overall survival (OS) of <6 months. While historically, patients are older at presentation (median age ~65 yrs) with poor performance status, our institution has noticed a shift in incidence and patient demographics, which inspired investigation. Advances in molecular-targeted immunotherapies may influence treatment patterns, but evolving tumor characteristics could also impact the clinical presentation of the disease. We conducted an IRB-approved retrospective, single institution review of patients with ATC referred to the University of North Carolina (UNC) between 2016 and 2024 to characterize the contemporary demographics and survival outcomes. Methods: Patient demographic, clinical, molecular and survival data were extracted. Descriptive statistics aiming to compare age, performance status, and actionable tumor mutations were performed and Kaplan-Meier curves were generated. Statistical significance was set at <0.05. Stata was used for statistical analysis. Results: Between 2016 and 2024, 49 ATC cases were identified. At presentation, patients were white (63%), male (51%), never smokers (59%) with a median age of 71 years. The median ECOG performance status was 1 and did not differ by age. Forty patients (82%) received treatment for their cancer: surgery (59%), radiation therapy (71%), systemic therapy (71%). Strikingly, patients who did not receive any treatment had an average survival of 17 days (median 13 days, range 6-33 days), while those who initiated treatment lived for 484 days (median 271 days, range 31-2967 days). Comparing 2016-2019 with 2020-2024, the overall number of patients seen at our institution doubled (14 vs. 35 patients). ATC patients from 2020-2024 were numerically more likely to be non-white (40% v 29%), male (54% v 43%), and younger (70 v. 73 years) compared to 2016-2019. Since 2020, patients receiving any treatment increased by 15% including a shift toward surgical resection (43% v. 66%) and systemic therapies (50% v. 80%). Younger patients had longer overall survival (median 384 days for <65 v. 151 days for ≥ 65 years old). Conclusions: Review of our single institution experience reveals shifting demographics and treatment practices. While patients >65 had lower overall survival, they less likely to initiate treatment, despite good performance status. The availability of more effective and better tolerated therapies highlights the need for more patients to be considered for initiation of therapy regardless of their age. Additionally, the shifting demographics and increased incidence of ATC patients in the past 4 years warrants further investigation. Similar to the shifting demographics seen in oropharyngeal cancer patients as a result of the human papillomavirus, the timing of this demographic shift and incidence spike in ATC may be reflective of evolving etiologies, such as COVID-19.