美国癌症联合委员会第 8 版 T 分期系统在甲状腺乳头状癌中的分析。
An Analysis of The American Joint Committee on Cancer 8th Edition T Staging System for Papillary Thyroid Carcinoma.
机构信息
Department of Head and Neck Surgery, Liverpool Hospital, New South Wales, Australia.
Department of Medicine, University of New South Wales, New South Wales, Australia.
出版信息
J Clin Endocrinol Metab. 2018 Jun 1;103(6):2199-2206. doi: 10.1210/jc.2017-02551.
BACKGROUND
The American Joint Committee on Cancer (AJCC) removed microscopic extrathyroidal extension (ETE) from the 8th edition T staging for papillary thyroid cancer (PTC) based on increasing evidence that it is not an independent prognostic factor.
OBJECTIVES
We compared the prognostic performance of AJCC 7th (pT7) and 8th (pT8) edition T stage systems, particularly in patients ≥55 years old without macroscopic ETE or distant metastases in whom T classification affects AJCC Tumor Node Metastasis (TNM) stage.
METHOD
A retrospective analysis of disease-free survival (DFS) in 577 patients with PTC comparing pT8 vs pT7 using the Akaike information criterion (AIC), Harrell's C-index, and Proportion of Variation Explained (PVE).
RESULTS
Of 105 patients with AJCC7 T3 disease, 74 were down-staged. Overall, the prognostic performance of pT7 and pT8 was similar. However, in patients ≥55 years old without macroscopic ETE or distant metastases, pT8 was inferior to pT7 on the basis of higher AIC, lower C-index (0.67 vs 0.76), and lower PVE (30% vs 45%). In this subset, microscopic ETE was associated with multiple other adverse prognostic features and reduced DFS (hazard ratio, 2.8; 95% confidence interval, 1.5 to 5.2; P = 0.002), irrespective of tumor size.
DISCUSSION
In our cohort, pT8 was inferior to pT7 in patients ≥55 years old without macroscopic ETE or distant metastases in whom T classification affects TNM stage. Microscopic ETE was strongly associated with other adverse prognostic factors and reduced DFS in this patient subgroup and may be an effective surrogate for disease biology in PTC, irrespective of whether it is an independent prognostic factor.
背景
美国癌症联合委员会（AJCC）基于越来越多的证据表明微观甲状腺外延伸（ETE）不是独立的预后因素，因此将其从第 8 版甲状腺乳头状癌（PTC）的 T 分期中删除。
目的
我们比较了 AJCC 第 7 版（pT7）和第 8 版（pT8）T 分期系统的预后性能，特别是在没有宏观 ETE 或远处转移且 T 分类影响 AJCC 肿瘤淋巴结转移（TNM）分期的≥55 岁患者中。
方法
对 577 例 PTC 患者的无病生存（DFS）进行回顾性分析，比较 pT8 与 pT7 时使用 Akaike 信息准则（AIC）、Harrell's C 指数和变异比例解释（PVE）。
结果
在 105 例 AJCC7 T3 疾病患者中，有 74 例降期。总体而言，pT7 和 pT8 的预后性能相似。然而，在没有宏观 ETE 或远处转移的≥55 岁患者中，基于较高的 AIC、较低的 C 指数（0.67 对 0.76）和较低的 PVE（30% 对 45%），pT8 不如 pT7。在这个亚组中，微观 ETE 与其他多个不良预后特征相关，DFS 降低（风险比，2.8；95%置信区间，1.5 至 5.2；P = 0.002），与肿瘤大小无关。
讨论
在我们的队列中，在没有宏观 ETE 或远处转移且 T 分类影响 TNM 分期的≥55 岁患者中，pT8 不如 pT7。微观 ETE 与其他不良预后因素密切相关，并降低了该患者亚组的 DFS，并且可能是 PTC 疾病生物学的有效替代指标，无论其是否为独立的预后因素。
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