Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Hernia, Hangzhou Xiaoshan First People's Hospital, Hangzhou, China.
Ann Surg Oncol. 2021 Oct;28(11):6564-6571. doi: 10.1245/s10434-021-09596-6. Epub 2021 Jan 31.
The incidence of papillary thyroid microcarcinoma has been constantly rising in recent decades. The tumor, node, metastasis staging system is designed to predict prognosis in patients with papillary thyroid carcinoma. Recent studies have shown that the American Joint Committee on Cancer (AJCC) 8th edition is superior to the 7th edition for predicting tumor recurrence in PTC patients. To date, whether the 8th edition is also better able to predict recurrence in papillary thyroid microcarcinoma (PTMC) remains unclear.
We enrolled 1007 cases from our thyroid cancer database in the First Affiliated Hospital, Zhejiang University School of Medicine, from 1997 to 2011. Univariable and multivariate Cox hazard regression analyses were used to identify the association between variables and recurrence. Disease-free survival was calculated using the Kaplan-Meier method and compared using the log-rank test.
A total of 1007 PTMC patients were enrolled, with a median follow-up of 67 months. Of 93 (9.2%) patients downstaged by the changes in versions, 49 (52.7%) were downstaged because the age-at-diagnosis cut-off used for staging increased from 45 to 55 years, while 35 (37.6%) were downstaged due to the weakening of the effects of lymph node metastasis. The recurrence rate of PTMC was 4.17%. Univariate Cox hazards regression analyses showed that TNM stage according to the AJCC 8th edition was significantly associated with recurrence, while the recurrence survival curves showed that TNM stage (stage I vs. stage II-IV) according to the AJCC 8th edition, but not the 7th edition, was significantly associated with disease-free survival (p < 0.05).
The AJCC 8th edition has better ability to predict recurrence in PTMC patients than the 7th edition.
近年来，甲状腺微小乳头状癌的发病率不断上升。肿瘤、淋巴结、远处转移分期系统旨在预测甲状腺乳头状癌患者的预后。最近的研究表明，美国癌症联合委员会（AJCC）第 8 版在预测 PTC 患者肿瘤复发方面优于第 7 版。迄今为止，第 8 版是否也能更好地预测甲状腺微小乳头状癌（PTMC）的复发仍不清楚。
我们从浙江大学医学院附属第一医院的甲状腺癌数据库中招募了 1007 例患者，时间范围为 1997 年至 2011 年。采用单变量和多变量 Cox 风险回归分析来确定变量与复发之间的关系。使用 Kaplan-Meier 方法计算无病生存率，并使用对数秩检验进行比较。
共纳入 1007 例 PTMC 患者，中位随访时间为 67 个月。在版本变化中降级的 93 例（9.2%）患者中，49 例（52.7%）因分期使用的诊断时年龄截止值从 45 岁增加到 55 岁而降级，而 35 例（37.6%）因淋巴结转移影响减弱而降级。PTMC 的复发率为 4.17%。单变量 Cox 风险回归分析显示，根据 AJCC 第 8 版的 TNM 分期与复发显著相关，而复发生存曲线显示，根据 AJCC 第 8 版（Ⅰ期与Ⅱ-Ⅳ期）的 TNM 分期与无病生存率显著相关，但根据第 7 版则不然（p<0.05）。
与第 7 版相比，AJCC 第 8 版在预测 PTMC 患者的复发方面具有更好的能力。
