This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wada, N. Articles by Imada, T. Search for Related Content PubMed PubMed Citation Articles by Wada, N. Articles by Imada, T. Related Collections Thyroid Endocrine Oncology

Prognostic Value of the Sixth Edition AJCC/UICC TNM Classification for Differentiated Thyroid Carcinoma with Extrathyroid Extension

Department of General Surgery, Yokohama City University Hospital and Medical Center, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa 236-0004, Japan

Address all correspondence and requests for reprints to: Nobuyuki Wada, M.D., Department of General Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa 236-0004, Japan. E-mail: Wadan523{at}aol.com.

Context: The prognostic value of the sixth edition AJCC/UICC TNM classification is currently unclear.

Objective: The aim was to evaluate the prognostic value of the sixth edition.

Design and Patients: We retrospectively assessed 354 primary differentiated thyroid carcinomas (77 men and 277 women; age, 51.2 yr; follow-up, 107.6 months) between 1964 and 2003. Sixty percent of patients underwent lobectomy, 40% underwent subtotal/total thyroidectomy, and only 2% were given radioiodine. There were 153, 104, 86, and 11 patients in fifth stages I, II, III, and IV, and 175, 76, 14, 68, 10, and 11 patients in sixth stages I, II, III, IVA, IVB, and IVC, respectively.

Results: New T1–3 had no significant influence. In Cox proportional hazard analysis, T4a and T4b were significantly related to disease-specific survival (DSS). We separately analyzed 68 patients (age 45 yr or older) with extrathyroid extension. These T4 (fifth) tumors were reclassified as 6 T3, 52 T4a, and 10 T4b tumors. The 10-yr DSS rates were 100, 69.3, and 10.0% for T3, T4a, and T4b, respectively. T4b exhibited worse prognoses compared with T4a (P < 0.0001; hazard ratio, 10.1; 95% confidence interval, 4.1–25.3). Stages I and II in both editions achieved favorable prognoses. The 10-yr DSS rates were 67.0 and 27.3% in fifth stages III and IV, and 100, 74.5, 10.0, and 27.3% in sixth stages III, IVA, IVB, and IVC, respectively. DSS curves differed significantly between all sixth TNM stages (P < 0.0001).

Conclusion: The sixth edition more accurately predicts different outcomes according to the revised criteria for the degree of extrathyroid extension.

This article has been cited by other articles:

				A. A. Onitilo, J. M. Engel, C. I. Lundgren, P. Hall, L. Thalib, and S. A.R. Doi Simplifying the TNM System for Clinical Use in Differentiated Thyroid Cancer J. Clin. Oncol., April 10, 2009; 27(11): 1872 - 1878. [Abstract] [Full Text] [PDF]

				N. Wada, K. Masudo, H. Nakayama, N. Suganuma, K. Matsuzu, S. Hirakawa, Y. Rino, M. Masuda, and T. Imada Recommendation for Subclass Evaluation of TNM stage IVA Papillary Thyroid Carcinomas: T4aN1b Patients Are at Risk for Recurrence and Survival Ann. Surg. Oncol., May 1, 2008; 15(5): 1511 - 1517. [Abstract] [Full Text] [PDF]