Wada Nobuyuki, Nakayama Hirotaka, Suganuma Nobuyasu, Masudo Yoshihiko, Rino Yasushi, Masuda Munetaka, Imada Toshio
Department of General Surgery, Yokohama City University Hospital and Medical Center, 3-9 Fukuura, Yokohama City, Kanagawa 236-0004, Japan.
J Clin Endocrinol Metab. 2007 Jan;92(1):215-8. doi: 10.1210/jc.2006-1443. Epub 2006 Oct 31.
The prognostic value of the sixth edition AJCC/UICC TNM classification is currently unclear.
The aim was to evaluate the prognostic value of the sixth edition.
We retrospectively assessed 354 primary differentiated thyroid carcinomas (77 men and 277 women; age, 51.2 yr; follow-up, 107.6 months) between 1964 and 2003. Sixty percent of patients underwent lobectomy, 40% underwent subtotal/total thyroidectomy, and only 2% were given radioiodine. There were 153, 104, 86, and 11 patients in fifth stages I, II, III, and IV, and 175, 76, 14, 68, 10, and 11 patients in sixth stages I, II, III, IVA, IVB, and IVC, respectively.
New T1-3 had no significant influence. In Cox proportional hazard analysis, T4a and T4b were significantly related to disease-specific survival (DSS). We separately analyzed 68 patients (age 45 yr or older) with extrathyroid extension. These T4 (fifth) tumors were reclassified as 6 T3, 52 T4a, and 10 T4b tumors. The 10-yr DSS rates were 100, 69.3, and 10.0% for T3, T4a, and T4b, respectively. T4b exhibited worse prognoses compared with T4a (P < 0.0001; hazard ratio, 10.1; 95% confidence interval, 4.1-25.3). Stages I and II in both editions achieved favorable prognoses. The 10-yr DSS rates were 67.0 and 27.3% in fifth stages III and IV, and 100, 74.5, 10.0, and 27.3% in sixth stages III, IVA, IVB, and IVC, respectively. DSS curves differed significantly between all sixth TNM stages (P < 0.0001).
The sixth edition more accurately predicts different outcomes according to the revised criteria for the degree of extrathyroid extension.
美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）第六版TNM分类的预后价值目前尚不清楚。
旨在评估第六版的预后价值。
我们回顾性评估了1964年至2003年间的354例原发性分化型甲状腺癌（男性77例，女性277例；年龄51.2岁；随访107.6个月）。60%的患者接受了甲状腺叶切除术，40%接受了次全/全甲状腺切除术，只有2%接受了放射性碘治疗。第五版I、II、III和IV期分别有153、104、86和11例患者，第六版I、II、III、IVA、IVB和IVC期分别有175、76、14、68、10和11例患者。
新的T1-3没有显著影响。在Cox比例风险分析中，T4a和T4b与疾病特异性生存（DSS）显著相关。我们分别分析了68例甲状腺外侵犯的患者（年龄45岁及以上）。这些第五版的T4肿瘤重新分类为6例T3、52例T4a和10例T4b肿瘤。T3、T4a和T4b的10年DSS率分别为100%、69.3%和10.0%。与T4a相比，T4b的预后更差（P < 0.0001；风险比，10.1；95%置信区间，4.1 - 25.3）。两个版本的I期和II期预后良好。第五版III期和IV期的10年DSS率分别为67.0%和27.3%，第六版III期、IVA期、IVB期和IVC期分别为100%、74.5%、10.0%和27.3%。所有第六版TNM分期之间的DSS曲线差异显著（P < 0.0001）。
根据修订后的甲状腺外侵犯程度标准，第六版能更准确地预测不同的预后结果。
