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@ARTICLE{Augustin:307441,
      author       = {T. Augustin and D. Oliinyk and M. Haderlein and C. Frei and
                      J. Jacob and D. Medenwald and M. Trommer and M. Mäurer and
                      S. Drozdz and A. Rühle and A.-L. Grosu and N. H. Nicolay
                      and M. Waltenberger and S. E. Combs$^*$ and A. Löser and M.
                      Oertel and H. T. Eich and S. Janssen and J. Rauch and R.
                      Gurtner and R. Renollet and C. Spitzweg and D. Vordermark
                      and C. Belka$^*$ and L. Käsmann$^*$},
      title        = {{I}mpact of comorbidities on treatment management and
                      prognosis in patients with anaplastic thyroid cancer
                      ({ATC}).},
      journal      = {Journal of cancer research and clinical oncology},
      volume       = {152},
      number       = {1},
      issn         = {0301-1585},
      address      = {Heidelberg},
      publisher    = {Springer},
      reportid     = {DKFZ-2025-03040},
      pages        = {22},
      year         = {2026},
      note         = {Volume 152, article number 22, (2026)},
      abstract     = {To evaluate the impact of comorbidities on treatment
                      allocation and prognosis in anaplastic thyroid cancer, 137
                      patients from 10 German tertiary cancer centers treated with
                      radiotherapy between 2001 and 2020 were analyzed. Four
                      validated comorbidity scores were applied to assess
                      comorbidity burden. The primary objective was to identify
                      prognostic factors for the survival rate at 6 months after
                      radiotherapy and discriminate the comorbidity scores using
                      concordance statistics, ROC curve net reclassification
                      index, and integrated discrimination improvement for 6-month
                      survival. The median overall survival (OS) of the entire
                      cohort was 4 months $(95\%$ CI = 2.72-5.28). The 6-, 12- and
                      24-months survival rates were $42.1\%,$ $29.0\%$ and
                      $15.0\%,$ respectively. In the univariate analysis,
                      Karnofsky Performance Score (KPS) (> $70\%,$ p < 0.001),
                      UICC stage (p < 0.001), treatment modality (p < 0.001),
                      intention of treatment (p < 0.001) as well as lower scores
                      in the conventional Charlson Comorbidity Index (cCCI, p <
                      0.001), the updated Charlson Comorbidity Index (uCCI, p <
                      0.001) were associated with improved OS. KPS (> $70\%,$ p =
                      0.06) and type of therapy (p = 0.087) showed a trend in
                      multivariate analysis. Higher comorbidity burden (cCCI and
                      uCCI) was associated with less intensive treatment and lower
                      cumulative radiation doses in univariable analyses. However,
                      after adjustment for age and metastatic status, none of the
                      comorbidity indices remained independently associated with
                      the use of multimodal therapy or the prescribed EQD2 dose (p
                      > 0.05). Age, but not metastatic status, was linked to a
                      reduced likelihood of receiving multimodal treatment. In
                      contrast, KPS emerged as the only independent predictor of
                      higher EQD2 dose levels in the multivariable models.},
      keywords     = {Humans / Female / Male / Thyroid Carcinoma, Anaplastic:
                      therapy / Thyroid Carcinoma, Anaplastic: epidemiology /
                      Thyroid Carcinoma, Anaplastic: radiotherapy / Thyroid
                      Carcinoma, Anaplastic: pathology / Thyroid Carcinoma,
                      Anaplastic: mortality / Comorbidity / Prognosis / Middle
                      Aged / Aged / Thyroid Neoplasms: therapy / Thyroid
                      Neoplasms: pathology / Thyroid Neoplasms: epidemiology /
                      Thyroid Neoplasms: radiotherapy / Thyroid Neoplasms:
                      mortality / Adult / Aged, 80 and over / Retrospective
                      Studies / Survival Rate / ATC (Other) / Comorbidity (Other)
                      / Prognosis (Other) / Real-word data (Other) / Treatment
                      allocation (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41436662},
      pmc          = {pmc:PMC12728151},
      doi          = {10.1007/s00432-025-06403-7},
      url          = {https://inrepo02.dkfz.de/record/307441},
}