1 Duke University School of Medicine, Durham, North Carolina.
2 Duke Cancer Institute , Durham, North Carolina.
Thyroid. 2017 Nov;27(11):1408-1416. doi: 10.1089/thy.2017.0306. Epub 2017 Oct 5.
This study aims to compare the seventh and eighth editions of the American Joint Commission on Cancer/Union for International Cancer Control (AJCC/UICC) tumor, node, metastasis staging system for patients with papillary thyroid cancer (PTC) in two national patient cohorts.
Adult PTC patients undergoing surgery were selected from the Surveillance, Epidemiology and End Results (SEER) program (2004-2012) and the National Cancer Database (2004-2012). Staging criteria for the seventh and eighth AJCC/UICC editions were applied separately to each cohort. Survival probabilities were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards models were used to estimate the association of stage with survival in both settings. The Akaike information criterion was used to assess model performance.
About 23% of patients were downstaged from the seventh to the eighth edition in SEER, while 24% were downstaged in the National Cancer Database. Disease-specific survival (DSS) and overall survival (OS) were significantly related to stage at diagnosis when using both the seventh and eighth editions of the AJCC/UICC staging system (p < 0.001). Patients classified into higher stages (III and IV) in the eighth edition showed a worse prognosis than those classified into similar stages in the seventh edition. After adjustment, PTC stages as defined by both editions were significantly associated with DSS and OS. With respect to both DSS and OS, the eighth edition PTC model appeared to be a better fit to the data (smaller Akaike information criterion values) compared to the seventh edition.
Based on these large contemporary national cohorts, the eighth edition AJCC/UICC tumor, node, metastasis classification for PTC is superior to the seventh edition for predicting survival.
本研究旨在比较美国癌症联合委员会/国际癌症控制联盟（AJCC/UICC）第七版和第八版肿瘤、淋巴结、转移分期系统在两个国家患者队列中用于甲状腺乳头状癌（PTC）患者的情况。
从监测、流行病学和最终结果（SEER）计划（2004-2012 年）和国家癌症数据库（2004-2012 年）中选择接受手术的成年 PTC 患者。分别将第七版和第八版 AJCC/UICC 分期标准应用于每个队列。使用 Kaplan-Meier 方法估计生存概率。使用多变量 Cox 比例风险模型估计在两种情况下分期与生存的关联。使用赤池信息量准则评估模型性能。
在 SEER 中，约 23%的患者从第七版降期至第八版，而在国家癌症数据库中，有 24%的患者降期。当使用 AJCC/UICC 分期系统的第七版和第八版时，疾病特异性生存（DSS）和总体生存（OS）与诊断时的分期显著相关（p<0.001）。在第八版中被分类为更高分期（III 期和 IV 期）的患者比在第七版中被分类为相似分期的患者预后更差。调整后，两个版本定义的 PTC 分期与 DSS 和 OS 显著相关。在 DSS 和 OS 方面，与第七版相比，第八版 PTC 模型似乎更适合数据（赤池信息量准则值较小）。
基于这些大型当代国家队列，第八版 AJCC/UICC 肿瘤、淋巴结、转移分类系统用于预测 PTC 患者的生存情况优于第七版。
