Comparison of staging and recurrence predictors in patients with differentiated thyroid cancer between the 7th and 8th editions of the American Joint Committee on Cancer staging systems.

IF 2.5 Q3 ENDOCRINOLOGY & METABOLISM Minerva endocrinology Pub Date : 2023-09-01 Epub Date: 2023-02-09 DOI:10.23736/S2724-6507.22.03791-5
Onur Elbasan, Dilek Gogas Yavuz
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Abstract

Background: The predictive value of American Joint Committee on Cancer (AJCC) 8 for recurrence in differentiated thyroid cancer (DTC) is not known. We aimed to compare AJCC 7 and 8 regarding the differences in staging and recurrence predictors in DTC.

Methods: Demographic, clinical (duration of disease and follow-up, the extent of surgery), laboratory (TSH, fT4, thyroglobulin, and antithyroglobulin), pathological (type of thyroid cancer, localization, multifocality, diameter, extrathyroidal extension [ETE], and lymph node [LN] metastasis), and imaging findings (sonography, and whole-body scan), and follow-up features (metastases, recurrence and/or persistence, and RAI need) were retrospectively analyzed in adult patients with DTC followed-up for at least six months. Staging was determined in accordance with AJCC 7 and AJCC 8, prediction of recurrence and persistence by ATA risk stratification, and death risk by AMES systems. The alterations in staging and recurrence predictors were analyzed.

Results: A majority of study patients (N.=524) were female (N.=424) and diagnosed with papillary cancer (N.=511), the median age at diagnosis was 44. 97.89% (N.=93) of stage 2-4 patients (N.=95) in AJCC 7 were down-staged in AJCC 8. We down-staged 41 patients of 45-55 years of age into stage 1 in AJCC 8 independent of LN status. A percentage of 26.71% of patients (N.=140) did have persistence, 9.54% (N.=50) persistence at the last follow-up, and 9.54% (N.=50) had recurrence. According to AJCC 8, T4 and AMES high risk were predictors for recurrence (hazard ratio: 3.053, P=0.023; hazard ratio:2.465, and P=0.005; respectively). Both AJCC 7 and 8 were associated with recurrence (P=0.008 and P<0.001, respectively). Stage 4 in AJCC 7, and stages 3 and 4 in AJCC 8 better predicted the probability of recurrence.

Conclusions: Our findings suggest that AJCC 8 better predicted the recurrence in DTC than AJCC 7. In AJCC 8, T4 tumor, AMES high risk, stages 3 and 4 predicted recurrence. The vast majority of patients with stages 2-4 in AJCC 7 were down-staged in AJCC 8.

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第7版和第8版美国癌症联合委员会分期系统中分化型甲状腺癌症患者分期和复发预测因素的比较。
背景:美国癌症联合委员会(AJCC)8对分化型癌症(DTC)复发的预测价值尚不清楚。我们旨在比较AJCC 7和8在DTC分期和复发预测因素方面的差异。方法:人口学、临床(疾病持续时间和随访、手术范围)、实验室(TSH、fT4、甲状腺球蛋白和抗甲状腺球蛋白)、病理学(甲状腺癌症类型、定位、多灶性、直径、甲状腺外延伸[ETE]和淋巴结[LN]转移),对随访至少六个月的成年DTC患者的影像学表现(超声和全身扫描)和随访特征(转移、复发和/或持续性以及RAI需求)进行回顾性分析。根据AJCC 7和AJCC 8确定分期,通过ATA风险分层预测复发和持续性,并通过AMES系统确定死亡风险。分析分期和复发预测因素的变化。结果:大多数研究患者(N=524)为女性(N=424),诊断为癌症(N=511),诊断时的中位年龄为44岁。AJCC 7的2-4期患者(N=95)中,有97.89%(N=93)在AJCC 8中分期下降。在AJCC 8中,我们将41名年龄在45-55岁的分期患者降为1期,与LN状态无关。26.71%的患者(N=140)确实有持续性,9.54%(N=50)在最后一次随访时有持续性。9.54%(N=50)有复发。根据AJCC 8,T4和AMES高风险是复发的预测因素(风险比:3.053,P=0.023;风险比:2.465,P=0.005;分别)。AJCC 7和AJCC 8均与DTC复发相关(P=0.008和P结论:我们的研究结果表明,AJCC 8比AJCC 7更好地预测DTC的复发。在AJCC 8,T4肿瘤,AMES高危,3期和4期预测复发。绝大多数AJCC 7中2-4期的患者在AJCC 8中是低分期的。
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