Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Oral Oncol. 2018 Dec;87:158-164. doi: 10.1016/j.oraloncology.2018.11.003. Epub 2018 Nov 9.
The recently published 8th edition of the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system was significantly updated following the thyroid cancer-related guidelines to provide better predictability of survival but not focus on recurrence. Therefore, we compared the predictive values of the 7th and 8th editions of the AJCC staging systems for recurrence-free survival (RFS) and overall survival (OS) after thyroidectomy for papillary thyroid carcinoma (PTC).
This retrospective study included 2930 patients who underwent thyroidectomy and neck dissection for previously untreated PTC between 2006 and 2014. TNM stage was defined according to 7th and 8th editions. Univariate and multivariate Cox proportional hazard regression analyses were used to identify associations between variables and RFS or OS. Multivariate models for the AJCC TNM stages were adjusted for clinical and pathological variables.
A significant number of patients classified as T3 with overall TNM stages II-IV in the AJCC 7th edition were down-staged in the 8th edition. Unadjusted T classification and overall TNM staging in both the 7th and 8th editions were significantly associated with RFS and OS rates (P < 0.001). After adjustment for clinicopathological factors, the overall TNM stage according to the AJCC 8th edition, but not the 7th edition, remained significantly associated with RFS and OS (P < 0.05), with better predictability of recurrence and survival, in patients with PTC.
The 8th edition AJCC staging system down-staged a large proportion of PTC patients, resulting in better predictability of recurrence and survival compared to the previous staging system.
This study compared the abilities of the 7th and 8th edition AJCC staging systems to predict recurrence and overall survival in 2930 patients with papillary thyroid carcinoma. The updated guidelines down-staged a large proportion of patients, resulting in better prediction of recurrence and survival than the previous staging system.
最近发布的第 8 版美国癌症联合委员会（AJCC）肿瘤-淋巴结-转移（TNM）分期系统在甲状腺癌相关指南的基础上进行了重大更新，旨在提高生存预测的准确性，但不关注复发。因此，我们比较了第 7 版和第 8 版 AJCC 分期系统对甲状腺乳头状癌（PTC）患者甲状腺切除术后无复发生存（RFS）和总生存（OS）的预测价值。
本回顾性研究纳入了 2006 年至 2014 年间接受甲状腺切除术和颈部淋巴结清扫术治疗的 2930 例未经治疗的 PTC 患者。TNM 分期根据第 7 版和第 8 版定义。采用单因素和多因素 Cox 比例风险回归分析来确定变量与 RFS 或 OS 之间的关系。AJCC TNM 分期的多因素模型根据临床和病理变量进行调整。
第 7 版 AJCC 中整体 TNM 分期为 II-IV 期的 T3 患者中，有相当一部分在第 8 版中被降级。未经调整的 T 分期和第 7 版和第 8 版的整体 TNM 分期与 RFS 和 OS 率显著相关（P<0.001）。在校正临床病理因素后，第 8 版 AJCC 总体 TNM 分期与 RFS 和 OS 显著相关（P<0.05），而第 7 版 AJCC 总体 TNM 分期与 RFS 和 OS 无显著相关性，这表明第 8 版 AJCC 分期系统在预测 PTC 患者的复发和生存方面具有更好的预测能力。
第 8 版 AJCC 分期系统对很大一部分 PTC 患者进行了降级，与之前的分期系统相比，更好地预测了复发和生存。
