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.
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