Wang Min, Hu Di, Zeng Wen, Chen Sichao, Huang Yihui, Zhou Ling, Zhou Wei, Wei Wei, Zhang Chao, Liu Zeming, Guo Liang
Department of Plastic Surgery, Zhongnan Hospital of Wuhan University Wuhan 430071, China.
Department of Ophthalmology, Zhongnan Hospital of Wuhan University Wuhan 430071, China.
Am J Transl Res. 2020 Jun 15;12(6):2703-2710. eCollection 2020.
Medullary thyroid carcinoma (MTC) has been separated into its own chapter in the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. However, controversies still exist for the staging of MTC. This study aimed to identify prognostic differences among patients with MTC to define a more accurate staging system.
Data on cancer-specific survival from the Surveillance, Epidemiology, and End Results database between 2010 and 2014 were used for this study. Kaplan-Meier (K-M) curves, Cox proportional hazards regression analysis, and mortality per 1000-person-years were used to evaluate the mortality rate to create the new staging system.
A total of 960 cases were included in this analysis. The mortality rates of 24 different groups, which were classified using T stage (T1-4), N stage (N0-1b), and M stage (M0-1) were assessed using K-M curves. Cox proportional hazards regression analysis and mortality per 1000-person-years were used to classify patients, as stage I (T1-3N0-1aM0, 654, 68.34%), stage II (T1-3N1bM0, 181, 18.91%), stage III (T4N0-1bM0, 58, 6.06%), and stage IV (T1-4N0-1bM1, 64, 6.69%). The hazard ratios of stages II, III, and IV, using stage I as a reference, were 5.281 (95% confidence interval [CI], 1.236-22.562), 20.603 (95% CI, 4.400-96.467), and 55.717 (95% CI, 14.307-216.988), respectively. The mortality rates per 1000-person-years of stages I, II, III, and IV were 2.036 (95% CI, 0.657-6.312), 14.867 (95% CI, 6.679-33.092), 98.287 (95% CI, 54.432-177.478), and 224.199 (95% CI, 146.180-343.860), respectively.
Compared with the current AJCC tumor-node-metastasis (TNM) staging system for MTC, this new proposed TNM staging system, which is based on cancer-specific mortality rate analysis, provides more accurate risk stratification and can ensure more rational treatment measures.
甲状腺髓样癌（MTC）在美国癌症联合委员会（AJCC）第8版分期系统中已被单独列为一章。然而，MTC的分期仍存在争议。本研究旨在确定MTC患者的预后差异，以定义更准确的分期系统。
本研究使用了2010年至2014年监测、流行病学和最终结果数据库中癌症特异性生存数据。采用Kaplan-Meier（K-M）曲线、Cox比例风险回归分析和每1000人年死亡率来评估死亡率，以创建新的分期系统。
本分析共纳入960例病例。使用K-M曲线评估了24个不同组的死亡率，这些组根据T分期（T1-4）、N分期（N0-1b）和M分期（M0-1）进行分类。采用Cox比例风险回归分析和每1000人年死亡率将患者分为I期（T1-3N0-1aM0，654例，68.34%）、II期（T1-3N1bM0，181例，18.91%）、III期（T4N0-1bM0，58例，6.06%）和IV期（T1-4N0-1bM1，64例，6.69%）。以I期为参照，II期、III期和IV期的风险比分别为5.281（95%置信区间[CI]，1.236-22.562）、20.603（95%CI，4.400-96.467）和55.717（95%CI，14.307-216.988）。I期、II期、III期和IV期每1000人年的死亡率分别为2.036（95%CI，0.657-6.312）、14.867（95%CI，6.679-33.092）、98.287（95%CI，54.432-177.478）和224.199（95%CI，146.180-343.860）。
与目前AJCC的MTC肿瘤-淋巴结-转移（TNM）分期系统相比，这个基于癌症特异性死亡率分析提出的新TNM分期系统提供了更准确的风险分层，并能确保更合理的治疗措施。
