Refining the eighth edition AJCC TNM classification and prognostic groups for papillary thyroid cancer with lateral nodal metastasis
- Authors
- Kim, HI[Kim, Hye In]; Kim, K[Kim, Kyunga]; Park, SY[Park, So Young]; Choe, JH[Choe, Jun-Ho]; Kim, JH[Kim, Jung-Han]; Kim, JS[Kim, Jee Soo]; Oh, YL[Oh, Young Lyun]; Hahn, SY[Hahn, Soo Yeon]; Shin, JH[Shin, Jung Hee]; Ahn, HS[Ahn, Hyeon Seon]; Kim, SW[Kim, Sun Wook]; Kim, TH[Kim, Tae Hyuk]; Chung, JH[Chung, Jae Hoon]
- Issue Date
- Mar-2018
- Publisher
- ELSEVIER SCIENCE BV
- Keywords
- Thyroid cancer; TNM staging; Lymph nodes; Prognosis; Mortality
- Citation
- ORAL ONCOLOGY, v.78, pp.80 - 86
- Indexed
- SCIE
SCOPUS
- Journal Title
- ORAL ONCOLOGY
- Volume
- 78
- Start Page
- 80
- End Page
- 86
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/20847
- DOI
- 10.1016/j.oraloncology.2018.01.021
- ISSN
- 1368-8375
- Abstract
- Background: In the eighth edition, TNM staging system omits location of nodal metastasis as a criterion for staging patients with papillary thyroid cancer (PTC). Accordingly, all of non-metastatic N1b PTC patients are classified as stage I or II solely according to an age-cutoff of 55 years. We hypothesized that incorporating other lymph node (LN) factors into TNM staging system would better predict cancer-specific mortality (CSM) in N1b patients. Methods: We enrolled 745 N1b PTC patients without distant metastasis. Alternative prognostic LN factors and cut-off points were assessed using Cox regression and time-dependent ROC analysis. Alternative prognostic groupings were derived based on minimal hazard differences for CSM among groups stratified by LN risk and age. We assessed accuracy of CSM prediction. Results: Lateral LN ratio (LNR) > 0.3 and largest LN size > 3 cm were prognostic factors for CSM. Stage II patients (eighth edition) with LN risk (lateral LNR > 0.3 or largest LN size > 3 cm) had a much higher CSM rate (20.9%) than those in the same stage without LN risk (3.2%). Alternative prognostic grouping (Group 1,< 55 years without LN risk; Group 2,< 55 years with LN risk or >= 55 years without LN risk; and Group 3, >= 55 with LN risk) achieved higher proportions of variance explained (PVEs) for predicting CSM (10.7%) than those of the eighth edition TNM staging system (4.8%). Conclusions: The proposed grouping for N1b patients using LN risk can distinguish patients with poor prognosis from those with good prognosis better than the eighth edition TNM staging system.
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Collections - Medicine > Department of Medicine > 1. Journal Articles
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