University of Missouri, Kansas City School of Medicine, Kansas City, Missouri.
Department of Otolaryngology-Head and Neck Surgery, Washington University in St Louis, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2017 Dec 1;143(12):1173-1180. doi: 10.1001/jamaoto.2017.0550.
The inclusion of patient features in addition to tumor morphology provides a more holistic staging system.
To identify prognostically important variables in papillary thyroid carcinoma (PTC) to incorporate into a comprehensive functional severity staging system (FSSS) and clinical severity staging system (CSSS) and to validate the model using a multi-institutional database.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of adults 18 years or older newly diagnosed or treated for nonmetastatic PTC at the Siteman Cancer Center from 1995 through 2012. Binary logistic regression was used to explore the association between 5-year survival and age, comorbidities, and tumor morphologic features. Conjunctive consolidation was used to create staging systems that incorporated important patient and tumor information. The created FSSS and CSSS were compared with the current AJCC staging system and externally validated using the National Cancer Database (NCDB).
Five-year survival.
The cohort consisted of 774 eligible patients with PTC. There were 119 (15%) deaths in the cohort and a 90% 5-year survival rate. The median age of the patients was 51 years (range, 18-91); 562 (73%) were women. Conjunctive consolidation combined age, comorbidity, and T stage to create a new CSSS with 3 categories where 5-year survival rates (95% CI) were as follows: stage A (n = 612), 95% (94%-97%); stage B (n = 131), 74% (67%-82%); and stage C (n = 31), 58% (41%-75%). The performance of the FSSS and CSSS was validated using the NCDB data. The new staging system indicates that patients with nonmetastatic disease, patients younger than 40 years, or patients without comorbidity regardless of age have a very high 5-year survival rate.
The FSSS and CSSS had better predictive results than the current AJCC staging system. The addition of patient features to tumor morphology provides a more comprehensive staging system that improves prognostic accuracy. These comprehensive staging systems can improve scientific reporting of disease outcomes, support comparative effectiveness studies, and guide clinical care by defining prognosis for newly diagnosed patients.
除肿瘤形态外，纳入患者特征可提供更全面的分期系统。
确定甲状腺乳头状癌（PTC）中具有预后意义的变量，以纳入综合功能严重程度分期系统（FSSS）和临床严重程度分期系统（CSSS），并使用多机构数据库验证该模型。
设计、地点和参与者：这是一项回顾性队列研究，纳入了 1995 年至 2012 年在 Siteman 癌症中心新诊断或治疗非转移性 PTC 的 18 岁及以上成年人。采用二元逻辑回归探讨 5 年生存率与年龄、合并症和肿瘤形态特征之间的关系。联合巩固用于创建纳入重要患者和肿瘤信息的分期系统。创建的 FSSS 和 CSSS 与当前 AJCC 分期系统进行比较，并使用国家癌症数据库（NCDB）进行外部验证。
5 年生存率。
该队列包括 774 例符合条件的 PTC 患者。队列中有 119 例（15%）死亡，90%的患者 5 年生存率为 90%。患者的中位年龄为 51 岁（范围为 18-91 岁）；562 例（73%）为女性。联合巩固将年龄、合并症和 T 分期相结合，创建了一个新的 CSSS，有 3 个类别，5 年生存率（95%CI）如下：A 期（n=612），95%（94%-97%）；B 期（n=131），74%（67%-82%）；C 期（n=31），58%（41%-75%）。使用 NCDB 数据验证了 FSSS 和 CSSS 的性能。新的分期系统表明，患有非转移性疾病、年龄小于 40 岁或无合并症的患者（无论年龄大小），5 年生存率非常高。
FSSS 和 CSSS 的预测结果优于现行 AJCC 分期系统。在肿瘤形态之外加入患者特征可提供更全面的分期系统，从而提高预后准确性。这些综合分期系统可以通过为新诊断患者定义预后来提高疾病结局的科学报告、支持有效性比较研究，并指导临床护理。
