Onitilo Adedayo A, Engel Jessica M, Lundgren Catharina Ihre, Hall Per, Thalib Lukman, Doi Suhail A R
Marshfield Clinic Weston Center, Weston, WI, USA.
J Clin Oncol. 2009 Apr 10;27(11):1872-8. doi: 10.1200/JCO.2008.20.2382. Epub 2009 Mar 9.
The TNM stratification has been found useful at stratifying patients with differentiated thyroid carcinoma (DTC) into prognostic risk groups. However, it is cumbersome to implement clinically given the large number of bins within this system and the complicated system of arriving at stage information.
We decided to quantify each variable in this system to arrive at a simplified quantitative alternative to the TNM system (QTNM) and compare this with the conventional system. We used our electronic record system to identify 614 cases of DTC managed at our institution from 1987 to 2006. Cancer-specific survival (CSS) and disease-free survival (DFS) were calculated by the Kaplan-Meier method, and a simplified QTNM score was devised using a Cox proportional hazards model.
We were able to quantify the TNM system as follows: 4 points each for age older than 45 years and presence of neck nodal metastases while 6 points for tumor size larger than 4 cm or extrathyroidal extension and 1 point for nonpapillary DTC. A sum of 0 to 5 points was low risk, 6 to 10 points intermediate, and 11 to 15 points high risk. Comparison with the conventional TNM system and two other systems revealed similar or better discrimination with the QTNM and this discrimination was maintained when this risk stratification was applied to a unique validation set.
The QTNM system as opposed to the conventional TNM system seems to be a simple and effective method for risk stratification for both recurrence and cancer-specific mortality.
已发现TNM分层有助于将分化型甲状腺癌（DTC）患者分为不同的预后风险组。然而，鉴于该系统内有大量分类以及获取分期信息的复杂系统，在临床实施时较为繁琐。
我们决定对该系统中的每个变量进行量化，以得出TNM系统的简化定量替代方案（QTNM），并将其与传统系统进行比较。我们使用电子记录系统识别了1987年至2006年在我们机构接受治疗的614例DTC病例。采用Kaplan-Meier法计算癌症特异性生存率（CSS）和无病生存率（DFS），并使用Cox比例风险模型设计了简化的QTNM评分。
我们能够对TNM系统进行如下量化：年龄大于45岁和存在颈部淋巴结转移各得4分，肿瘤大小大于4 cm或甲状腺外侵犯得6分，非乳头状DTC得1分。总分0至5分为低风险，6至10分为中度风险，11至15分为高风险。与传统TNM系统及其他两个系统的比较显示，QTNM具有相似或更好的区分度，并且当将这种风险分层应用于一个独特的验证集时，这种区分度得以维持。
与传统TNM系统相比，QTNM系统似乎是一种用于复发和癌症特异性死亡率风险分层的简单有效的方法。
