Clinicopathological and Prognostic Features of Anaplastic Thyroid Carcinoma: A Tunisian Study of 50 Cases

##plugins.themes.academic_pro.article.sidebar##

Published Oct 11, 2026
https://doi.org/10.62438/tunismed.v104i09.7042
Download
PDF
Vol. 104 No. 09 (2026): Tunis Med Sept 2026

##plugins.themes.academic_pro.article.main##

Alia Methnani
Department of Otolaryngology and Head and Neck Surgery, Salah Azaiz Institute, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Mariem Selmi
Department of Otolaryngology and Head and Neck Surgery, Salah Azaiz Institute, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Jihen Houas
ENT Department, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
Rim Braham
Department of Otolaryngology and Head and Neck Surgery, Salah Azaiz Institute, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Mohamed Dhaha
Department of Otolaryngology and Head and Neck Surgery, Salah Azaiz Institute, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Rim Abidi
Radiotherapy Department, Salah Azaiez Institute, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunisia
Chiraz Nasr
Radiotherapy Department, Salah Azaiez Institute, Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, 1007, Tunisia
Skander Kedous
Department of Otolaryngology and Head and Neck Surgery, Salah Azaiz Institute, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Saoussen Dhambri
Department of Otolaryngology and Head and Neck Surgery, Salah Azaiz Institute, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia

Abstract

Introduction: Anaplastic thyroid carcinoma (ATC) is an exceptionally rare and aggressive malignancy.
Aim: This study aimed to evaluate the clinical features, therapeutic outcomes, and prognostic factors within a Tunisian multicenter cohort.
Methods: We conducted a retrospective multicenter analysis of 50 ATC cases treated between 1998 and 2021 at two tertiary referral centers in Tunisia.
Results: The mean age was 62 years with a female predominance (M/F ratio 0.61). The most common presenting symptom was rapid enlargement of a long-standing goiter (80%). At diagnosis, the mean tumor size was 62 mm, and all patients presented with stage IV disease: IVA (n=1), IVB (n=23), and IVC (n=26). Therapeutic interventions included tracheostomy (n=29), surgical resection (n=21, with R0/R1 achieved in 16), and palliative radiotherapy (n=21). Only five patients received full multimodal therapy. Univariate analysis identified slow symptom onset, early stages (IVA/IVB), absence of distant metastasis, R0/R1 resection, and multimodal treatment as significant factors for improved survival. Conversely, obesity and blood group B were associated with poorer outcomes. The mean overall survival was 3.85 months, and no patient was alive at the last follow-up.
Conclusion: ATC is associated with a particularly unfavourable prognosis, with an overall survival of less than one year. While multimodal management appears to marginally improve survival, early diagnosis and the integration of targeted therapies and immunotherapies are essential to change the therapeutic landscape.

Keywords:

Anaplastic thyroid carcinoma , Targeted therapy , Immunotherapy , Radiotherapy , Chemotherapy

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Kitahara CM, McCullough ML, Franceschi S, Rinaldi S, Wolk A,Neta G, et al. Anthropometric Factors and Thyroid Cancer Risk by
  2. Histological Subtype: Pooled Analysis of 22 Prospective Studies. Thyroid. 2016 Feb;26(2):306-18. doi: 10.1089/thy.2015.0319
  3. Ma J, Huang M, Wang L, Ye W, Tong Y, Wang H. Obesity and risk of thyroid cancer: evidence from a meta-analysis of 21 observational
  4. studies. Med Sci Monit. 2015 Jan 22;21:283-91. doi: 10.12659/MSM.892035.
  5. Stamatiou A, Herrera-Gómez RG, Szturz P, et al. Carcinome anaplasique de la thyroïde : nouvelles approches thérapeutiques.
  6. Rev Med Suisse. 2021 May 19;17(739):962-966. PMID: 34009754
  7. Bible KC, Kebebew E, Brierley J, Brito JP, Cabanillas ME, Clark TJ Jr, Di Cristofano A, Foote R, Giordano T, Kasperbauer J, Newbold
  8. K, Nikiforov YE, Randolph G, Rosenthal MS, Sawka AM, Shah M, Shaha A, Smallridge R, Wong-Clark CK. 2021 American Thyroid
  9. Association Guidelines for Management of Patients with Anaplastic Thyroid Cancer. Thyroid. 2021 Mar;31(3):337-386. doi: 10.1089/
  10. thy.2020.0944.
  11. Houlihan OA, Moore R, Jamaluddin MF, Sharifah A, Redmond HP, O'Reilly S, et al. Anaplastic thyroid cancer: outcomes of trimodal
  12. therapy. Rep Pract Oncol Radiother. 2021;26(3):416-22. doi : 10.5603/RPOR.a2021.0042
  13. Mohebati A, DiLorenzo M, Palmer F, Patel SG, Pfister D, Lee N, et al. Anaplastic Thyroid Carcinoma: A 25-year Single-Institution
  14. Experience. Ann Surg Oncol. 2014 May;21(5):1665-70. DOI: 10.1245/s10434-014-3545-5
  15. Hundahl SA, Cady B, Cunningham MP, et al. Initial results from a prospective cohort study of 5583 cases of thyroid carcinoma
  16. treated in the United States during 1996. Cancer. 2000 Jul 1;89(1):202-17. doi: 10.1002/1097-0142(20000701)89:1<202::AID-
  17. CNCR27>3.0.CO;2-A
  18. Hvilsom GB, Londero SC, Hahn CH, et al. Anaplastic thyroid carcinoma in Denmark 1996-2012: A national prospective study of
  19. patients. Cancer Epidemiol. 2018 Apr;53:65-71. doi: 10.1016/j. canep.2018.01.011.
  20. Smallridge RC, Copland JA. Anaplastic thyroid carcinoma: pathogenesis and emerging therapies. Clin Oncol (R Coll Radiol).
  21. Aug;22(6):486-97. doi: 10.1016/j.clon.2010.03.013
  22. Saini S, Tulla K, Maker AV, Burman KD, Prabhakar BS. Therapeutic advances in anaplastic thyroid cancer: a current perspective. Mol
  23. Cancer. 2018 Oct 23;17(1):154. doi: 10.1186/s12943-018-0903-0.
  24. Kebebew E, Greenspan FS, Clark OH, Woeber KA, McMillan A. Anaplastic thyroid carcinoma. Treatment outcome and prognostic
  25. factors. Cancer. 2005 Apr 1;103(7):1330-5. doi: 10.1002/cncr.20936.
  26. Are C, Shaha AR. Anaplastic thyroid carcinoma: biology, pathogenesis, prognostic factors, and treatment approaches. Ann
  27. Surg Oncol. 2006 Apr;13(4):453-64. doi: 10.1245/ASO.2006.05.042.
  28. Haigh PI, Ituarte PH, Wu HS, et al. Completely resected anaplastic thyroid carcinoma combined with adjuvant
  29. chemotherapy and irradiation is associated with prolonged survival. Cancer. 2001 Jun 15;91(12):2335- 42. doi: 10.1002/1097-0142(20010615)91:12<2335::AID- CNCR1266>3.0.CO;2-1
  30. Subbiah V, Kreitman RJ, Wainberg ZA, Cho JY, Schellens JHM, Soria Jc et al. Dabrafenib plus trametinib in patients with BRAF V600E-
  31. mutant anaplastic thyroid cancer: updated analysis from the phase II ROAR basket study. Ann Oncol. 2022 Apr;33(4):406-415. doi:
  32. 1016/j.annonc.2021.12.014.
  33. Glaser SM, Mandish SF, Gill BS, Balasubramani GK, Clump DA, Beriwal S. Anaplastic thyroid cancer: Prognostic factors, patterns of
  34. care, and overall survival. Head Neck. 2016 Apr;38 Suppl 1:E2083- 90. doi: 10.1002/hed.24384.