第八版 AJCC TNM 分类对分化型甲状腺癌的预后价值。
Prognostic value of the eighth edition AJCC TNM classification for differentiated thyroid carcinoma.
机构信息
Division of Endocrinology & Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
出版信息
Oral Oncol. 2017 Aug;71:81-86. doi: 10.1016/j.oraloncology.2017.06.004. Epub 2017 Jun 10.
BACKGROUND
The prognostic value of the proposed eighth edition of the American Joint Committee on Cancer (AJCC) tumor, node, and metastasis (TNM) classification is currently unclear. The aim of the study was to evaluate the prognostic value of the eighth edition of the AJCC TNM classification.
METHODS
We retrospectively assessed 3176 patients with differentiated thyroid carcinoma (DTC) who underwent thyroidectomy at a tertiary Korean hospital from 1996 to 2005. Cancer-specific survival (CSS) was analyzed using the Kaplan-Meier method and compared using the log-rank test. Performance of the eighth edition TNM with respect to prediction of CSS was assessed against the current seventh edition.
RESULTS
Upon reclassification according to the eighth edition, 37.6% of patients were down-staged. The proportions of stage I and II tumors increased from 61.9% to 81.1% and from 1.7% to 16.0%, respectively, whereas those of stage III and IVB (formerly IVC in the seventh edition) decreased from 27.6% to 2.3% and 0.8% to 0.5%, respectively. The proportions of variance explained (PVEs) for the ability of the eighth and the seventh edition to predict CSS were 3.9% and 2.9%, respectively. The C-index values were 0.765 (95% confidence interval 0.764-0.766) for the eighth edition and 0.736 (0.735-0.737) for the seventh edition.
CONCLUSION
Our results demonstrate that the eighth edition TNM more accurately predicts CSS for patients with DTC than does the seventh edition.
背景
目前尚不清楚第八版美国癌症联合委员会（AJCC）肿瘤、淋巴结和转移（TNM）分类的预后价值。本研究旨在评估第八版 AJCC TNM 分类的预后价值。
方法
我们回顾性评估了 1996 年至 2005 年在一家韩国三级医院接受甲状腺切除术的 3176 例分化型甲状腺癌（DTC）患者。使用 Kaplan-Meier 法分析癌症特异性生存率（CSS），并使用对数秩检验进行比较。评估第八版 TNM 相对于当前第七版 TNM 对 CSS 预测的性能。
结果
根据第八版重新分类，37.6%的患者分期降低。I 期和 II 期肿瘤的比例从 61.9%增加到 81.1%和从 1.7%增加到 16.0%，而 III 期和 IVB 期（第七版中的 IVC）的比例从 27.6%下降到 2.3%和从 0.8%下降到 0.5%。第八版和第七版预测 CSS 能力的解释方差比例（PVEs）分别为 3.9%和 2.9%。第八版的 C 指数值为 0.765（95%置信区间为 0.764-0.766），第七版为 0.736（0.735-0.737）。
结论
我们的结果表明，与第七版相比，第八版 TNM 更能准确预测 DTC 患者的 CSS。
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