Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort
ABSTRACT Objective: The 8th TNM system edition (TNM-8) released in 2018 presents significant changes when compared to the 7th edition (TNM-7). The aim of this study was to assess the impact of changing the TNM staging criteria on the outcomes in a Brazilian cohort of differentiated thyroid carcinom...
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| Format: | Article |
| Language: | English |
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Brazilian Society of Endocrinology and Metabolism
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| Series: | Archives of Endocrinology and Metabolism |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972019000100005&lng=en&tlng=en |
| _version_ | 1818562156936822784 |
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| author | Carla Fernanda Nava André B. Zanella Rafael Selbach Scheffel Ana Luiza Maia Jose Miguel Dora |
| author_facet | Carla Fernanda Nava André B. Zanella Rafael Selbach Scheffel Ana Luiza Maia Jose Miguel Dora |
| author_sort | Carla Fernanda Nava |
| collection | DOAJ |
| description | ABSTRACT Objective: The 8th TNM system edition (TNM-8) released in 2018 presents significant changes when compared to the 7th edition (TNM-7). The aim of this study was to assess the impact of changing the TNM staging criteria on the outcomes in a Brazilian cohort of differentiated thyroid carcinoma (DTC). Subjects and methods: DTC patients, attending a tertiary, University-based hospital, were classified by TNM-7 and TNM-8. Prediction of disease outcomes status of the two systems was compared in a retrospective cohort study design. Results: Four hundred and nineteen DTC patients were evaluated, comprised by 82% (345/419) women, with mean age at diagnosis of 46.4 ± 15.6 years, 89% (372/419) papillary thyroid carcinoma, with a median tumor size of 2.3 cm (P25-P75, 1.3-3.5). One hundred and sixty patients (38%) had lymph node metastases and 47 (11%) distant metastases at diagnosis. Using the TNM-7 criteria, 236 (56%) patients were classified as Stage I, 50 (12%) as Stage II, 75 (18%) as Stage III and 58 (14%) as Stage IV. When evaluated by the TNM-8, 339 (81%) patients were classified as Stage I, 64 (15%) as Stage II, 2 (0.5%) as Stage III and 14(3%) as Stage IV. After a median follow-up of 4.4years (P25-P75 2.6-6.6), the rate of incomplete biochemical and/or structural response was 54% vs. 92% (P = 0.004) and incomplete structural response was 42% vs. 86% (P = 0.009) for patients classified as stage IV by TNM-7 vs TNM-8, respectively. Only 4 (1%) disease-related deaths were recorded. Conclusions: In our cohort, 37% of DTC patients were down staged with the application of TNM-8 (vs. TNM-7). Additionally, TNM-8 seems to better stratify the risk of structural incomplete response at follow-up. |
| first_indexed | 2024-12-14T01:00:01Z |
| format | Article |
| id | doaj.art-923b2562c1d5499aa9af88c43d5e0121 |
| institution | Directory Open Access Journal |
| issn | 2359-4292 |
| language | English |
| last_indexed | 2024-12-14T01:00:01Z |
| publisher | Brazilian Society of Endocrinology and Metabolism |
| record_format | Article |
| series | Archives of Endocrinology and Metabolism |
| spelling | doaj.art-923b2562c1d5499aa9af88c43d5e01212022-12-21T23:23:19ZengBrazilian Society of Endocrinology and MetabolismArchives of Endocrinology and Metabolism2359-429263151110.20945/2359-3997000000097S2359-39972019000100005Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohortCarla Fernanda NavaAndré B. ZanellaRafael Selbach ScheffelAna Luiza MaiaJose Miguel DoraABSTRACT Objective: The 8th TNM system edition (TNM-8) released in 2018 presents significant changes when compared to the 7th edition (TNM-7). The aim of this study was to assess the impact of changing the TNM staging criteria on the outcomes in a Brazilian cohort of differentiated thyroid carcinoma (DTC). Subjects and methods: DTC patients, attending a tertiary, University-based hospital, were classified by TNM-7 and TNM-8. Prediction of disease outcomes status of the two systems was compared in a retrospective cohort study design. Results: Four hundred and nineteen DTC patients were evaluated, comprised by 82% (345/419) women, with mean age at diagnosis of 46.4 ± 15.6 years, 89% (372/419) papillary thyroid carcinoma, with a median tumor size of 2.3 cm (P25-P75, 1.3-3.5). One hundred and sixty patients (38%) had lymph node metastases and 47 (11%) distant metastases at diagnosis. Using the TNM-7 criteria, 236 (56%) patients were classified as Stage I, 50 (12%) as Stage II, 75 (18%) as Stage III and 58 (14%) as Stage IV. When evaluated by the TNM-8, 339 (81%) patients were classified as Stage I, 64 (15%) as Stage II, 2 (0.5%) as Stage III and 14(3%) as Stage IV. After a median follow-up of 4.4years (P25-P75 2.6-6.6), the rate of incomplete biochemical and/or structural response was 54% vs. 92% (P = 0.004) and incomplete structural response was 42% vs. 86% (P = 0.009) for patients classified as stage IV by TNM-7 vs TNM-8, respectively. Only 4 (1%) disease-related deaths were recorded. Conclusions: In our cohort, 37% of DTC patients were down staged with the application of TNM-8 (vs. TNM-7). Additionally, TNM-8 seems to better stratify the risk of structural incomplete response at follow-up.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972019000100005&lng=en&tlng=enDifferentiated thyroid carcinomaTNM stagingprognosis |
| spellingShingle | Carla Fernanda Nava André B. Zanella Rafael Selbach Scheffel Ana Luiza Maia Jose Miguel Dora Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort Archives of Endocrinology and Metabolism Differentiated thyroid carcinoma TNM staging prognosis |
| title | Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort |
| title_full | Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort |
| title_fullStr | Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort |
| title_full_unstemmed | Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort |
| title_short | Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort |
| title_sort | impact of the updated tnm staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort |
| topic | Differentiated thyroid carcinoma TNM staging prognosis |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2359-39972019000100005&lng=en&tlng=en |
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