School of Medicine, University of Queensland, Brisbane, Australia.
Endocrine. 2014 Jun;46(2):300-8. doi: 10.1007/s12020-013-0078-9. Epub 2013 Oct 31.
An Australian state database was used to test the validity of the Quantitative tumor/node/metastasis (QTNM) staging system for assessing prognosis of differentiated thyroid cancer (DTC) on the basis of four variables quantified at diagnosis (histopathology, age, node involvement, and tumor size). Using the Queensland Cancer Registry (QCR), we identified 788 cases of DTC diagnosed from 1982 to 2006 with complete staging information. Causes of death were ascertained by linking the QCR database with the Australian National Death Index. Subjects were staged according to AJCC TNM 7th edition and QTNM, and cancer-specific survival (CSS) was calculated by the Kaplan-Meier method. Cancer-specific mortality was observed in 22 (2.8 %) patients, with 10-year CSS for the cohort of 97.0 % at a median follow-up of 262.8 months. QTNM stage specific cancer survival at 10 years was 99.6, 97.0, and 78.6 % for low-, intermediate-, and high-risk groups, respectively. This was comparable to the original US dataset in which the QTNM was initially studied, and it fared better at discriminating survival than the standard TNM system, where there was overlap in survival between stages. The current study validates the QTNM system in an Australian cohort and shows at least equivalent discriminatory capacity to the current TNM staging system. The QTNM utilized prognostic variables of significance to produce an optimal three-stage stratification scheme. Given, its advantage in clearly discriminating between prognostic groups, clinical relevance and simplicity of use, we recommend that TNM be replaced with QTNM for risk stratification for both recurrence and CSS.
利用澳大利亚一个州的数据库，基于诊断时量化的 4 个变量（组织病理学、年龄、淋巴结转移和肿瘤大小），检测了定量肿瘤/淋巴结/转移（QTNM）分期系统评估分化型甲状腺癌（DTC）预后的有效性。我们通过昆士兰癌症登记处（QCR）确定了 1982 年至 2006 年期间确诊的 788 例 DTC 病例，这些病例具有完整的分期信息。通过将 QCR 数据库与澳大利亚国家死亡索引相链接，确定了死亡原因。根据 AJCC 第 7 版和 QTNM 对病例进行分期，通过 Kaplan-Meier 法计算癌症特异性生存（CSS）。观察到 22 例（2.8%）患者发生癌症特异性死亡，队列的 10 年 CSS 为 97.0%，中位随访时间为 262.8 个月。QTNM 分期的 10 年癌症生存率分别为低危、中危和高危组的 99.6%、97.0%和 78.6%。这与最初研究 QTNM 的美国原始数据集相当，并且在区分生存方面优于标准的 TNM 系统，该系统在分期之间存在生存重叠。本研究在澳大利亚队列中验证了 QTNM 系统，并且在预测生存方面显示出至少与当前 TNM 分期系统相当的区分能力。QTNM 利用对预后有意义的预后变量，制定了一个最佳的三阶段分层方案。鉴于其在明确区分预后组、临床相关性和使用简便性方面的优势，我们建议用 QTNM 取代 TNM 进行复发和 CSS 的风险分层。
