第七版与第八版美国癌症联合委员会/国际抗癌联盟分化型甲状腺癌肿瘤-淋巴结-远处转移分期系统比较。
Comparison of the Seventh and Eighth Editions of the American Joint Committee on Cancer/Union for International Cancer Control Tumor-Node-Metastasis Staging System for Differentiated Thyroid Cancer.
机构信息
1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
2 Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
出版信息
Thyroid. 2017 Sep;27(9):1149-1155. doi: 10.1089/thy.2017.0050. Epub 2017 Jul 24.
OBJECTIVE
To evaluate the efficacy and prognostic validity for disease-specific survival (DSS) of the eighth edition American Joint Committee on Cancer/Union for International Cancer Control tumor-node-metastasis (TNM) staging system (TNM-8) compared to the seventh edition (TNM-7) in patients with differentiated thyroid carcinoma (DTC).
METHODS
The seventh and eighth editions of the TNM staging system were applied to 1613 DTC patients who underwent thyroid surgery between 1996 and 2003. The proportion of variation explained and Harrell's c-index were evaluated to compare the predictive capability of DSS.
RESULTS
The mean age of the patients was 44.7 years, and the median follow-up period was 11.2 years. When TNM-8 was applied, 63% of T3 and 3% of N1b DTCs were downgraded to T1/T2 and N1a, respectively. About 38% of patients were downstaged according to TNM-8. The 10-year DSS rates in TNM-7 stages I, II, III, and IV were 99.7%, 98.2%, 98.8%, and 83.2%, respectively. Those in TNM-8 stages I, II, III, and IV were 99.6%, 95.4%, 72.3%, and 48.6%, respectively. The proportion of variation explained values of TNM-7 and TNM-8 were 6.0% and 7.0%, respectively. The Harrell's c-index of TNM-7 was 0.86 and that of TNM-8 was 0.88.
CONCLUSIONS
A significant number of patients were reclassified to lower stages with the application of TNM-8 compared to TNM-7. Applying TNM-8 could improve the accuracy of the staging system for predicting DSS in patients with DTC.
目的
评估第八版美国癌症联合委员会/国际癌症控制联盟肿瘤-淋巴结-转移（TNM）分期系统（TNM-8）相对于第七版（TNM-7）在分化型甲状腺癌（DTC）患者中疾病特异性生存（DSS）的疗效和预后有效性。
方法
将第七版和第八版 TNM 分期系统应用于 1996 年至 2003 年间接受甲状腺手术的 1613 例 DTC 患者。评估变异比例解释和 Harrell's c 指数以比较 DSS 的预测能力。
结果
患者的平均年龄为 44.7 岁，中位随访时间为 11.2 年。当应用 TNM-8 时，63%的 T3 和 3%的 N1b DTC 分别降级为 T1/T2 和 N1a。约 38%的患者根据 TNM-8 降期。TNM-7 分期 I、II、III 和 IV 期的 10 年 DSS 率分别为 99.7%、98.2%、98.8%和 83.2%，TNM-8 分期 I、II、III 和 IV 期的 10 年 DSS 率分别为 99.6%、95.4%、72.3%和 48.6%。TNM-7 和 TNM-8 的变异比例解释值分别为 6.0%和 7.0%。TNM-7 的 Harrell's c 指数为 0.86，TNM-8 的 Harrell's c 指数为 0.88。
结论
与 TNM-7 相比，应用 TNM-8 可将大量患者重新分类为较低分期。应用 TNM-8 可提高 DTC 患者分期系统预测 DSS 的准确性。
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