Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis
BackgroundConcerns 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...
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| Format: | Article |
| Language: | English |
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Korean Endocrine Society
2020-03-01
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| Series: | Endocrinology and Metabolism |
| Subjects: | |
| Online Access: | https://e-enm.org/Synapse/Data/PDFData/2008ENM/enm-35-149.pdf |
| _version_ | 1818758044495904768 |
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| author | Mijin Kim Won Gu Kim Min Ji Jeon Hee Kyung Kim Hyon-Seung Yi Eun Sook Kim Bo Hyun Kim Won Bae Kim Young Kee Shong Ho-Cheol Kang Tae Yong Kim |
| author_facet | Mijin Kim Won Gu Kim Min Ji Jeon Hee Kyung Kim Hyon-Seung Yi Eun Sook Kim Bo Hyun Kim Won Bae Kim Young Kee Shong Ho-Cheol Kang Tae Yong Kim |
| author_sort | Mijin Kim |
| collection | DOAJ |
| description | BackgroundConcerns 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.MethodsThis 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.ResultsThe 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.ConclusionModification 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. |
| first_indexed | 2024-12-18T06:20:34Z |
| format | Article |
| id | doaj.art-d754927fc58343b4a7df37bee8a181c9 |
| institution | Directory Open Access Journal |
| issn | 2093-596X 2093-5978 |
| language | English |
| last_indexed | 2024-12-18T06:20:34Z |
| publishDate | 2020-03-01 |
| publisher | Korean Endocrine Society |
| record_format | Article |
| series | Endocrinology and Metabolism |
| spelling | doaj.art-d754927fc58343b4a7df37bee8a181c92022-12-21T21:18:10ZengKorean Endocrine SocietyEndocrinology and Metabolism2093-596X2093-59782020-03-0135114915610.3803/EnM.2020.35.1.149Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node MetastasisMijin Kim0Won Gu Kim1Min Ji Jeon2Hee Kyung Kim3Hyon-Seung Yi4Eun Sook Kim5Bo Hyun Kim6Won Bae Kim7Young Kee Shong8Ho-Cheol Kang9Tae Yong Kim10Division of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, .KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju, .KoreaDepartment of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, .KoreaDepartment of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, .KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, .KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .KoreaDepartment of Internal Medicine, Chonnam National University Medical School, Gwangju, .KoreaDivision of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, .KoreaBackgroundConcerns 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.MethodsThis 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.ResultsThe 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.ConclusionModification 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.https://e-enm.org/Synapse/Data/PDFData/2008ENM/enm-35-149.pdflymph nodesmortalityneoplasm stagingthyroid neoplasms |
| spellingShingle | Mijin Kim Won Gu Kim Min Ji Jeon Hee Kyung Kim Hyon-Seung Yi Eun Sook Kim Bo Hyun Kim Won Bae Kim Young Kee Shong Ho-Cheol Kang Tae Yong Kim Modification of the Tumor-Node-Metastasis Staging System for Differentiated Thyroid Carcinoma by Considering Extra-Thyroidal Extension and Lateral Cervical Lymph Node Metastasis Endocrinology and Metabolism lymph nodes mortality neoplasm staging thyroid neoplasms |
| 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 | lymph nodes mortality neoplasm staging thyroid neoplasms |
| url | https://e-enm.org/Synapse/Data/PDFData/2008ENM/enm-35-149.pdf |
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