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Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis

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, focusin...

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Autores principales: Kim, Mijin, Kim, Won Gu, Jeon, Min Ji, Kim, Hee Kyung, Yi, Hyon-Seung, Kim, Eun Sook, Kim, Bo Hyun, Kim, Won Bae, Shong, Young Kee, Kang, Ho-Cheol, Kim, Tae Yong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Endocrine Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090305/
https://www.ncbi.nlm.nih.gov/pubmed/32207275
http://dx.doi.org/10.3803/EnM.2020.35.1.149
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author Kim, Mijin
Kim, Won Gu
Jeon, Min Ji
Kim, Hee Kyung
Yi, Hyon-Seung
Kim, Eun Sook
Kim, Bo Hyun
Kim, Won Bae
Shong, Young Kee
Kang, Ho-Cheol
Kim, Tae Yong
author_facet Kim, Mijin
Kim, Won Gu
Jeon, Min Ji
Kim, Hee Kyung
Yi, Hyon-Seung
Kim, Eun Sook
Kim, Bo Hyun
Kim, Won Bae
Shong, Young Kee
Kang, Ho-Cheol
Kim, Tae Yong
author_sort Kim, Mijin
collection PubMed
description 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 (P<0.001) and modified-TNM (P<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.
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spelling pubmed-70903052020-04-01 Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis Kim, Mijin Kim, Won Gu Jeon, Min Ji Kim, Hee Kyung Yi, Hyon-Seung Kim, Eun Sook Kim, Bo Hyun Kim, Won Bae Shong, Young Kee Kang, Ho-Cheol Kim, Tae Yong Endocrinol Metab (Seoul) Original Article 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 (P<0.001) and modified-TNM (P<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. Korean Endocrine Society 2020-03 2020-03-19 /pmc/articles/PMC7090305/ /pubmed/32207275 http://dx.doi.org/10.3803/EnM.2020.35.1.149 Text en Copyright © 2020 Korean Endocrine Society http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kim, Mijin
Kim, Won Gu
Jeon, Min Ji
Kim, Hee Kyung
Yi, Hyon-Seung
Kim, Eun Sook
Kim, Bo Hyun
Kim, Won Bae
Shong, Young Kee
Kang, Ho-Cheol
Kim, Tae Yong
Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis
title Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis
title_full Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis
title_fullStr Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis
title_full_unstemmed Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis
title_short Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis
title_sort modification of the tumor-node-metastasis staging system for differentiated thyroid carcinoma by considering extra-thyroidal extension and lateral cervical lymph node metastasis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090305/
https://www.ncbi.nlm.nih.gov/pubmed/32207275
http://dx.doi.org/10.3803/EnM.2020.35.1.149
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