Abstract
Anaplastic thyroid cancer (ATC) is a rare but extremely aggressive cancer of the thyroid, contributing up to 30-40% of thyroid cancer-specific mortality. We analyzed ATC characteristics and survival rates in Sicily to evaluate the possible influence of environmental factors. With this aim, data regarding ATC incidences in urban/rural and industrial, iodine-deficient, and volcanic vs control areas were compared in Sicily as well as ATC data from Sicily and USA. Using the Sicilian Register of Thyroid Cancer (SRTC) database incidence, age, gender, tumor size and histotype, extrathyroidal extension, stage, and coexistence with pre-existing differentiated thyroid cancer (DTC) were evaluated in different areas of Sicily and also compared with Surveillance Epidemiology and End Results data in USA. Forty-three ATCs were identified in Sicily in the period 2002-2009. In our series only age <70 years at diagnosis (p = 0.01), coexistence with DTC (p = 0.027) and tumor size ≤6 cm (p = 0.012) were significant factors for increased survival at univariate analysis (only age at multivariate analysis). No difference in ATC incidence was found in urban vs rural areas and in iodine-deficient and industrial vs control areas. By contrast, in the volcanic area of Sicily, where DTC incidence is doubled relative to the rest of the island, also ATC incidence was increased. ATC data in Sicily were similar to those reported in the same period in the USA where overall survival rate at 6 and 12 months, however, was smaller. The similar ATC data observed in Sicily and USA (having different genetic background and lifestyle) and the increased ATC incidence in the volcanic area of Sicily paralleling the increased incidence of papillary thyroid cancer are compatible with the possibility that casual additional mutations, more frequent in a background of increased cell replication like DCT, are the major causes of ATC rather than genetic background and/or direct environmental influences.
Highlights
Thyroid cancer is the most common endocrine tumor, making up 3.8% of all new cancers in the USA [1], and in the last three decades its incidence has continuously increased all over the world [2]
Analyzing 27 trace elements in drinking water, lichens, and in urines of residents in the volcanic area and in adjacent non-volcanic Sicilian areas, we found that values of many metals were significantly increased in water and atmosphere of the volcanic area with consequent biocontamination of the resident population [27, 28]
Forty-three anaplastic thyroid cancer (ATC) were identified among the 5,328 thyroid can cers diagnosed in Sicily between 2002 and 2009 (0.8% of all thyroid cancers in the same period) with an overall age-standardized incidence rate (ASRw) of 0.05/105 inhabitants/year, identical in males and females
Summary
Thyroid cancer is the most common endocrine tumor, making up 3.8% of all new cancers in the USA [1], and in the last three decades its incidence has continuously increased all over the world [2]. ATC, is different from the poorly differentiated thyroid cancers (DTCs) which maintain some of the immunohistochemical markers of the epithelial thyroid cell, such as Tg and thyroid transcription factor 1 (TTF1) [6, 7]. Anaplastic thyroid cancer (ATC) is a rare but extremely aggressive cancer of the thyroid, contributing up to 30–40% of thyroid cancer-specific mortality. We analyzed ATC characteristics and survival rates in Sicily to evaluate the possible influence of environmental factors. With this aim, data regarding ATC incidences in urban/rural and industrial, iodine-deficient, and volcanic vs control areas were compared in Sicily as well as ATC data from Sicily and USA
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