比较 AJCC 癌症分期系统第 7 版和第 8 版在分化型甲状腺癌中的预后价值。
Comparison of the prognostic value of AJCC cancer staging system 7th and 8th editions for differentiated thyroid cancer.
机构信息
Endocrinology Division, Cesar Milstein Hospital, CABA, Buenos Aires, Argentina.
Endocrinology Division Ramos Mejía Hospital, CABA, Buenos Aires, Argentina.
出版信息
BMC Endocr Disord. 2022 Jun 1;22(1):146. doi: 10.1186/s12902-022-01054-y.
BACKGROUND
In the last American Joint Committee on Cancer/Tumor, Node, Metastasis (AJCC/TNM) 8th edition (TNM8), several changes were introduced to this risk stratification system to improve the prognosis of differentiated thyroid cancer (DTC).
AIM
To validate the impact of TNM8 vs. TNM 7th edition (TNM7) in DTC in terms of predictive value in two hospitals from Buenos Aires, Argentina.
METHODS
Retrospective study of DTC patients from two institutions. Reclassification from TNM7 to TNM8, disease-specific survival (DSS), and final clinical outcomes at the end of follow-up (recurrent/persistent structural disease) (median 5 years) were analyzed. The proportion of variation explained (PVE) was used to compare the predictive capability of DSS of both classification systems.
RESULTS
Reclassification of 245 patients, aged (mean ± SD) 55 ± 15.36 years, 91% women, to TNM8 from TNM7 showed: 82% vs 57% stage I (SI), 10% vs 8.5% SII, 5% vs 22% SIII, 3% vs 12% SIV (p < 0.01). Forty percent of the population was downstaged with TNM8. Ten-year DSS rates for SI, SII, SIII and SIV in TNM7 were 100, 100, 100 and 74%, respectively and in TNM8: 97.6, 100, 100 and 37.5%, respectively. Out of 4 disease-specific deaths in SIV TNM7, one was subclassified to SI TNM8, corresponding to a 53-year-old patient with structural persistence. PVE for TNM8 (29%) was more than twice that of TNM7 (13%).
CONCLUSION
In this Argentinian DTC patients sample, it was confirmed that the new TNM8 classification is more accurate in predicting survival attributable to cancer than its previous version.
背景
在最新的美国联合癌症委员会/肿瘤、淋巴结、转移（AJCC/TNM）第 8 版（TNM8）中，对这一风险分层系统进行了多项修改，以改善分化型甲状腺癌（DTC）的预后。
目的
在阿根廷布宜诺斯艾利斯的两家医院验证 TNM8 与 TNM7 版（TNM7）在 DTC 中的预测价值。
方法
对来自两家机构的 DTC 患者进行回顾性研究。从 TNM7 重新分类为 TNM8、疾病特异性生存率（DSS）和随访结束时（复发/持续性结构性疾病）的最终临床结局（中位数 5 年）进行分析。采用比例变异解释（PVE）来比较两种分类系统对 DSS 的预测能力。
结果
对 245 名年龄（平均±标准差）为 55±15.36 岁、91%为女性的患者从 TNM7 重新分类为 TNM8，结果显示：I 期（SI）由 82%变为 57%，II 期由 10%变为 8.5%，III 期由 5%变为 22%，IV 期由 3%变为 12%（p<0.01）。40%的人群分期降低。TNM7 中 SI、SII、SIII 和 SIV 的 10 年 DSS 率分别为 100%、100%、100%和 74%，TNM8 中分别为 97.6%、100%、100%和 37.5%。在 TNM7 中 IV 期的 4 例 DTC 特异性死亡中，有 1 例重新分类为 TNM8 的 SI 期，对应一名 53 岁有结构性疾病持续存在的患者。TNM8 的 PVE（29%）是其前一版本（13%）的两倍多。
结论
在本项阿根廷 DTC 患者样本中，证实了新的 TNM8 分类在预测癌症相关生存方面比其前一版本更为准确。
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