Impact of the change from the seventh to eighth edition of the AJCC TNM classification of malignant tumours and comparison with the MACIS prognostic scoring system in non‐medullary thyroid cancer

Abstract

BackgroundIn 2018, AJCC TNM staging changed for differentiated (DTC) and anaplastic (ATC) thyroid carcinoma. The impact of this change on mortality rates was investigated and compared with the MACIS prognostic score.MethodsAnalysis of a prospective database of DTC/ATC was undertaken. Patients were staged according to TNM7 and TNM8 criteria, and MACIS scores calculated. Five‐year disease‐specific mortality rates were determined. Proportions were compared with Fisher's exact and χ2 goodness‐of‐fit tests.ResultsBetween August 2002 and December 2016, 310 patients had primary surgery for thyroid cancer. After exclusions, 159 patients (154 DTC, 5 ATC) remained to be studied. The MACIS score was less than 6 in 105 patients (66·0 per cent), 6–6·99 in 19 (11·9 per cent), 7–7·99 in 14 (8·8 per cent) and 8 or more in 21 (13·2 per cent), with corresponding disease‐specific 5‐year mortality rates of 0, 5, 14 and 86 per cent. For TNM7 the distribution was stage I in 53·5 per cent (85 patients), stage II in 10·1 per cent (16), stage III in 14·5 per cent (23) and stage IV in 22·0 per cent (35), and differed from that for TNM8: 76·7 per cent (122), 10·7 per cent (17), 4·4 per cent (7) and 8·2 per cent (13) respectively (P < 0·001). Overall disease‐specific 5‐year mortality rates by stage for TNM7 versus TNM8 were: stage I, 0 of 85 versus 3 of 100 (P = 0·251); stage II, 0 of 16 versus 6 of 16 (P = 0·018); stage III, 3 of 23 versus 2 of 7 (P = 0·565); stage IV, 20 of 32 versus 11 of 11 (P = 0·020).ConclusionCompared with TNM7, TNM8 downstaged more patients to stage I and accurately reflected worse prognosis for stage IV disease. TNM8 is an inferior predictor of mortality compared with MACIS.

Impacts of the American Joint Committee on Cancer (AJCC) 8th edition tumor, node, metastasis (TNM) staging system on outcomes of differentiated thyroid cancer in Thai patients

“…There has also been a paucity of data on the comparison between the revised AJCC and other prognostic tools to predict the outcomes of DTC. The MACIS (Metastases, Age, Completeness of resection, Invasion, Size) prognostic system which had been used effectively in papillary thyroid carcinoma (PTC) for more than 3 decades [ 16 ] was recently demonstrated to be inferior to the AJCC8 in the survival outcome [ 17 ]. However, no comparison of recurrence outcomes between the MACIS and AJCC8 had been done.…”

Nomogram individually predicts the risk for distant metastasis and prognosis value in female differentiated thyroid cancer patients: A SEER-based study

“…Although FDTC has a favorable prognosis, about 30% of the patients experience relapse and metastasis, which indicates the need for an accurate assessment of their prognosis ( 30 ). AGES, MACIS, AMES scoring system, and the TNM staging system have been frequently employed for the prognostic stratification of cancer patients ( 31 ). However, no scoring system could comprehensively and accurately assess the prognosis of patients of DTC, especially for FDTCs.…”

Inability of Radioiodine Remnant Ablation to Improve Postoperative Outcome in Adult Patients with Low-Risk Papillary Thyroid Carcinoma

“…Our MACIS prognostic scoring system was introduced into our clinical practice 4 years before the publication of the first American Association of Clinical Endocrinology guidelines 42 and 13 years before the first ATA management guideline 43 and is still, 28 years later, used daily in our practice at Mayo Clinic. In addition, it has subsequently been adopted and used to aid in management decisions in medical centers in North America, 39 the United Kingdom, 44 Europe, 45,46 and Asia. 47 Like the prognostic scheme developed by the National Thyroid Cancer Treatment Cooperative Study Group, 26 the MACIS scheme, although designed to predict CSM, can also reliably predict TR in the setting of PTC patients with complete (potentially curative) surgical resection and no distant spread.…”