考虑甲状腺外侵犯和侧颈部淋巴结转移对分化型甲状腺癌肿瘤-淋巴结-转移分期系统的修正。
Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis.
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Endocrinol Metab (Seoul). 2020 Mar;35(1):149-156. doi: 10.3803/EnM.2020.35.1.149.
BACKGROUND
Concerns have arisen about the classification of extra-thyroidal extension (ETE) and lateral cervical lymph node metastasis (N1b) in the 8th edition of the tumor-node-metastasis staging system (TNM-8). This study evaluated the prognostic validity of a modified-TNM staging system, focusing on ETE and N1b, in differentiated thyroid carcinoma (DTC) patients.
METHODS
This multicenter retrospective cohort study included 4,878 DTC patients from five tertiary hospitals. In the modified-TNM, T3b in TNM-8 was down-staged to T2, and stage II was subdivided into stages IIA and IIB. Older patients with N1b were reclassified as stage IIB.
RESULTS
The modified-TNM resulted in staging migration in 540 patients (11%) classified as stage II according to the TNM-8, with 75 (14%), 381 (71%), and 84 patients (16%) classified as stages I, IIA, and IIB, respectively. The 10-year disease-specific survival (DSS) rates in patients classified as stages I, II, III, and IV by TNM-8 were 99.8%, 95.9%, 81.0%, and 41.6%, respectively. The DSS rates of patients classified as stages I, IIA, IIB, III, and IV according to the modified-TNM were 99.8%, 96.4%, 93.3%, 81.0%, and 41.6%, respectively. DSS curves between stages on TNM-8 (<0.001) and modified-TNM (<0.001) differed significantly, but the modified-TNM discriminated better than TNM-8. The proportions of variation explained values of TNM-8 and modified-TNM were 6.3% and 6.5%, respectively.
CONCLUSION
Modification of the TNM staging system focusing on ETE and N1b could improve the prediction of DSS in patients with DTC. Further researches are needed to validate the prognostic accuracy of this modified-TNM staging system.
背景
第 8 版肿瘤-淋巴结-转移（TNM）分期系统中，甲状腺外侵犯（ETE）和颈侧区淋巴结转移（N1b）的分类引起了关注。本研究评估了改良 TNM 分期系统在分化型甲状腺癌（DTC）患者中的预后价值，重点关注 ETE 和 N1b。
方法
本多中心回顾性队列研究纳入了来自 5 家三级医院的 4878 例 DTC 患者。在改良-TNM 中，TNM-8 中的 T3b 降期为 T2，II 期进一步分为 IIA 和 IIB 期。年龄较大的 N1b 患者被重新分类为 IIB 期。
结果
根据 TNM-8 分类为 II 期的 540 例（11%）患者中，改良-TNM 导致分期迁移，其中 75 例（14%）、381 例（71%）和 84 例（16%）分别被分类为 I、IIA 和 IIB 期。根据 TNM-8 分类为 I、II、III 和 IV 期的患者 10 年疾病特异性生存率（DSS）分别为 99.8%、95.9%、81.0%和 41.6%。根据改良-TNM 分类为 I、IIA、IIB、III 和 IV 期的患者的 DSS 率分别为 99.8%、96.4%、93.3%、81.0%和 41.6%。TNM-8（<0.001）和改良-TNM（<0.001）分期之间的 DSS 曲线差异显著，但改良-TNM 优于 TNM-8。TNM-8 和改良-TNM 的变异解释比例分别为 6.3%和 6.5%。
结论
针对 ETE 和 N1b 的 TNM 分期系统的修改可以提高对 DTC 患者 DSS 的预测。需要进一步研究来验证该改良-TNM 分期系统的预后准确性。
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