Establishment of an Intraoperative Staging System (iStage) by Improving UICC TNM Classification System for Papillary Thyroid Carcinoma

Ito, Yasuhiro; Ichihara, Kiyoshi; Masuoka, Hiroo; Fukushima, Mitsuhiro; Inoue, Hiroyuki; Kihara, Minoru; Tomoda, Chisato; Higashiyama, Takuya; Takamura, Yuuki; Kobayashi, Kaoru; Miya, Akihiro; Miyauchi, Akira

doi:10.1007/s00268-010-0710-2

Cited by 64 publications

(109 citation statements)

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“…In this series, Grade 1 patients had significantly worse DFS than Grade 0 patients and Grade 1 independently affected DFS on multivariate analysis, which was somewhat discrepant with our previous findings [5,9,10]. This is possibly because the patient series analyzed in this study is larger and average follow-up period is longer than those in the previous studies.…”

Section: Relationship Of Extension Grades To Patient Prognosiscontrasting

confidence: 56%

“…Grade 3 indicates patients whose primary lesions or node metastases extended to organs other than those in Grades 1 and 2 such as the esophageal mucosa, tracheal mucosa requiring airway resection, internal jugular vein, vagal nerve, phrenic nerve, and sternocleidomastoid muscle (189 patients). Our series did not include patients with PTC extending to the larynx and those with PTC that extended to prevertebral extension from primary lesions [1][2][3][4], we previously showed that extension from metastastic nodes is also a strong prognostic factor for PTC patients [7][8][9]. In this study, therefore, we investigated whether and how subdivision of extrathyroid extension not only from primary lesions but also from metastatic nodes can accurately reflect biological behaviors and prognoses of PTC patients.…”

Section: Classification Of Ptc Extensionmentioning

confidence: 99%

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Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

et al. 2011

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PaPillary thyroid carcinoma (PTC) is the most common malignancy arising from follicular cells of the thyroid. Generally, it is an indolent disease, but cases demonstrating certain characteristics are likely to show recurrence and even become life-threatening. Carcinoma extension is an important prognostic factor of PTC patients, which is adopted in various classification systems such as AMES [1], MACIS [2] and CIH classification [3]. However, all these systems evaluate carcinoma extension based only on its existence but not on its degree, indicating that cases showing a wide range of biological behaviors are classified into the same category.In the UICC TNM classification system [4], in contrast, there are three grades of extrathyroid extension; extension to sternothyroid muscle or perithyroid soft abstract. Carcinoma extension to adjacent organs is an important prognostic factor in papillary thyroid carcinoma (PTC). However, the biological behavior of PTC with carcinoma extension varies according to the degree of extension. In this study, we investigated whether and how subdivision of PTC extension accurately reflects patients' prognosis, using a series of 5508 patients with PTC without distant metastasis at presentation, who underwent initial surgery between 1988 and 2004. We classified extension from primary lesions or metastatic nodes into 4 grades based on intraoperative findings (Grade 0-4, Grades 3 and 4 were subdivision of T4a). Prognostic significance for disease-free and cause-specific survivals (DFS and CSS) of extension from primary lesions did not differ from that of extension from metastatic nodes in the same grades except for DFS of Grade 3 patients. DFS of patients became worse with higher grades and CSS was also significantly linked to advanced grades except for Grade 1. On multivariate analysis, Grades 1, 2 and 3 and Grades 2 and 3 were independent prognostic factors for DFS and CSS, respectively, together with other conventional prognostic factors. Taken together, extension from metastatic nodes has a prognostic significance equivalent to that from primary lesions if classified in the same grades. Subdivision of PTC extension corresponding to T4a into two grades can accurately reflect the biological behavior of PTC.

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Section: Relationship Of Extension Grades To Patient Prognosiscontrasting

confidence: 56%

Section: Classification Of Ptc Extensionmentioning

confidence: 99%

Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

et al. 2011

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“…[27][28][29][30][31][32][33]. On the other hand, it has been reported that younger PTC patients have lower disease-free survival (DFS) than middle-aged patients.…”

Section: Categories Of Thyroid Malignanciesmentioning

confidence: 99%

Thyroid Cancers: Considerations, Classifications, and Managements

Khosravi¹,

Kouhi²,

Saeedi³

et al. 2017

Diagnosis and Management of Head and Neck Cancer

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Rapidly increasing trend of thyroid cancer incidence has turned this disease into a global concern. An estimated number of 64,300 new cases of thyroid cancer occurred in men and women in 2016, which represents 3.8% of all new cancer cases of USA (htps://seer. cancer.gov/statfacts/html/thyro.html). Thus, there is a high possibility for every physician to encounter a case of thyroid cancer during his/her professional lifetime. In this chapter, we clariied epidemiology, diferent categories, and new approaches toward diagnosis and management of thyroid cancer.Keywords: thyroid cancer, epidemiology, diferentiated thyroid cancer, undiferentiated thyroid cancer, thyroid nodule Detailed epidemiology of thyroid cancerAs the most common endocrine cancer and ifth most common cancer in women, thyroid cancer includes approximately 1-1.5% of all new cases of cancer diagnosed annually in the USA based on previous data [1][2][3]. Thyroid cancer is more prevalent among women and those with positive family history of thyroid disease. Some prior studies have reported a worldwide increasing trend for thyroid cancer incidence in recent decades [4]. Annual percent change (APC) is a commonly used indicator for the assessment of changes in incidence. Based on US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program, it has been reported 2.4% from 1980 to 1997 and 6.6% from 1997 to 2009 in both genders for thyroid cancer (data available at htp://seer.cancer.gov/statfacts/html/thyro.html).© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.According to [2009][2010][2011][2012][2013] data, the rate of new cases of thyroid cancer was 13.9 per 100,000 men and women per year (Figure 1). Table 1 summarizes number of new cases per 100,000 persons by race/ethnicity and sex. A recently published study on adolescent cancer incidence during 1975-2012 has reported a 2.12% increase for females and 1.59% for males between 15 and 19 years of age [5]. However, there is a study indicating that thyroid cancer incidence trend has slowed following release of American Thyroid Association (ATA) guideline in 2009 [6, 7]. It has been reported that overall thyroid cancer incidence had an increasing trend about 8% per year from 2000 to 2009. But APC showed a deceleration about 3% in men and 2.8% in women, which was conined to tumors less than 2.9 cm of size for women [7].Also, thyroid cancer-related mortality was estimated to consist 0.3% of all cancer-related deaths in 2016. A 5-year survival rate of 98.1% has been reported for thyroid cancer. Despite increasing trend of incidence, thyroid cancer mortality has a relatively stable rate about 0.5 cases per 100,000 persons both from 1973 to 2002 and 2009 to 2013 [8, 9].In conclusion, it seems that thyroid cancer has been following an ...

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“…Our risk classification system was established in 2010 in order to accurately prognose PTC patients [5]. As shown in Table 4, high-risk patients were more likely to die of PTC than others, and intermediate-risk patients were more likely to show lymph node recurrence, but not distant recurrence, than low-risk patients.…”

Section: Resultsmentioning

confidence: 99%

“…Risk classification was established as described previously [5], and is summarized in Table 1. We classified PTC patients without distant metastasis at initial surgery into three categories according to backgrounds and clinicopathological features based on pre-and intraoperative findings.…”

Section: Risk Classification Based On Pre-and Intraoperative Findingsmentioning

confidence: 99%

Prognostic value of poorly differentiated carcinoma in Japanese Society of Thyroid Surgery in a series of papillary thyroid carcinoma patients: Comparison with risk classification system in Kuma Hospital

et al. 2012

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PAPILLARY THYROID CARCINOMA (PTC) is the most common malignancy originating from the thyroid, and generally shows an indolent character. Abstract. Papillary thyroid carcinoma (PTC) often has poorly differentiated components, and it is discriminated from others and classified as an independent entity in the General Rules for the Description of Thyroid Cancer by Japanese Society of Thyroid Surgery (JSTS). In this study, we compared the prognostic significance between this type of poorly differentiated carcinoma (PDC-JSTS) and our risk classification system based on pre-and intraoperative findings in a series of PTC patients. The 10-year lymph node-and distant organ recurrence-free survival (LN-DFS and DRFS) and cause-specific survival (CSS) of high-risk patients were much poorer than in PDC-JSTS patients. In multivariate analysis, PDC-JSTS independently predicted a poor prognosis, but prognostic impacts for LN-DFS, DRFS, and CSS of high-risk in our risk classification were stronger than those of PDC-JSTS. In conclusion, it is appropriate that PDC-JSTS is defined as a subtype of PTC rather than as an independent entity.

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Establishment of an Intraoperative Staging System (iStage) by Improving UICC TNM Classification System for Papillary Thyroid Carcinoma

Abstract: We established a new classification system, iStage, based not only on preoperative but also on intraoperative findings, which has high utility. Appropriate intraoperative evaluation is mandatory to grade biological characteristics, including prognosis, of papillary carcinoma.

Cited by 64 publications

References 20 publications

Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

Prognostic significance of carcinoma extension from primary lesions and metastatic nodes in papillary thyroid carcinoma: appropriateness of three subdivisions of extension

Thyroid Cancers: Considerations, Classifications, and Managements

Prognostic value of poorly differentiated carcinoma in Japanese Society of Thyroid Surgery in a series of papillary thyroid carcinoma patients: Comparison with risk classification system in Kuma Hospital

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