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

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.