Nixon Iain J, Wang Laura Y, Migliacci Jocelyn C, Eskander Antoine, Campbell Michael J, Aniss Ahmad, Morris Lilah, Vaisman Fernanda, Corbo Rossana, Momesso Denise, Vaisman Mario, Carvalho Andre, Learoyd Diana, Leslie William D, Nason Richard W, Kuk Deborah, Wreesmann Volkert, Morris Luc, Palmer Frank L, Ganly Ian, Patel Snehal G, Singh Bhuvanesh, Tuttle R Michael, Shaha Ashok R, Gönen Mithat, Pathak K Alok, Shen Wen T, Sywak Mark, Kowalski Luis, Freeman Jeremy, Perrier Nancy, Shah Jatin P
1 Department of Surgery/Endocrinology, Memorial Sloan Kettering Cancer Center , New York, New York.
2 Department of Otolaryngology, Mount Sinai Hospital , Toronto, Canada .
Thyroid. 2016 Mar;26(3):373-80. doi: 10.1089/thy.2015.0315. Epub 2016 Feb 25.
Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions.
A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model.
Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7%, 97.3%, 96.6%, and 76.3%, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5%, 94.7%, 94.1%, and 67.6%, respectively. The change resulted in 12% of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6%. The change resulted in an increase in CPE from 0.90 to 0.92.
A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12% of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.
年龄是高分化甲状腺癌患者预后的关键因素。目前，45岁被用作分期的临界值，尽管越来越多的证据表明这个数值可能过低。本研究的目的是基于各机构提供的国际患者联合队列，评估将美国癌症联合委员会/国际癌症控制联盟（AJCC/UICC）分期系统的临界值从45岁改为55岁的可能性。
共纳入来自10个机构的9484例患者。为每位患者提供肿瘤（T）、淋巴结（N）和转移（M）数据以及年龄。以45岁和55岁为临界值，根据AJCC/UICC分期对该组患者进行分层。采用Kaplan-Meier方法计算疾病特异性生存率（DSS）的结果。计算一致性概率估计值（CPE）以比较每个模型的一致程度。
以45岁为临界值时，I-IV期的10年DSS率分别为99.7%、97.3%、96.6%和76.3%。以55岁为临界值时，I-IV期的10年DSS率分别为99.5%、94.7%、94.1%和67.6%。这一改变导致12%的患者分期降低，分期降低的组10年DSS为97.6%。这一改变使CPE从0.90提高到0.92。
将当前AJCC/UICC分期系统的临界年龄从45岁改为55岁，将导致12%的患者分期降低，并提高模型的统计有效性。这种改变对全球数千名患者具有临床意义，既能防止低风险疾病患者过度分期，又能为高风险患者提供更现实的预后估计。
