Staging Systems for Papillary Thyroid Carcinoma

Lang, Brian Hung‐Hin; Chow, Sin‐Ming; Lo, Chung‐Yau; Law, Stephen C.K.; Lam, Alfred King‐Yin

doi:10.1097/01.sla.0000262785.46403.9b

Cited by 110 publications

(141 citation statements)

References 41 publications

Supporting

Mentioning

134

Contrasting

Unclassified

Order By: Relevance

“…Further, none of the commonly used staging systems include adequate variables to address the impact of treatment on subsequent outcomes (6,7). Since initial surgery and RAI remnant ablation (RRA) are likely to have a major impact on risk of recurrence and risk of death in thyroid cancer patients, the failure to incorporate variables that assess response to these initial therapies into our staging systems will result in overly pessimistic predictions in high-risk patients having an excellent response to therapy and overly optimistic estimates in low-risk patients that fail initial therapy.…”

Section: Introductionmentioning

confidence: 99%

Estimating Risk of Recurrence in Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation: Using Response to Therapy Variables to Modify the Initial Risk Estimates Predicted by the New American Thyroid Association Staging System

Tuttle

Tala

Shah

et al. 2010

Thyroid

823

685

View full text Add to dashboard Cite

Background: A risk-adapted approach to management of thyroid cancer requires risk estimates that change over time based on response to therapy and the course of the disease. The objective of this study was to validate the American Thyroid Association (ATA) risk of recurrence staging system and determine if an assessment of response to therapy during the first 2 years of follow-up can modify these initial risk estimates. Methods: This retrospective review identified 588 adult follicular cell-derived thyroid cancer patients followed for a median of 7 years (range 1-15 years) after total thyroidectomy and radioactive iodine remnant ablation. Patients were stratified according to ATA risk categories (low, intermediate, or high) as part of initial staging. Clinical data obtained during the first 2 years of follow-up (suppressed thyroglobulin [Tg], stimulated Tg, and imaging studies) were used to re-stage each patient based on response to initial therapy (excellent, acceptable, or incomplete). Clinical outcomes predicted by initial ATA risk categories were compared with revised risk estimates obtained after response to therapy variables were used to modify the initial ATA risk estimates. Results: Persistent structural disease or recurrence was identified in 3% of the low-risk, 21% of the intermediaterisk, and 68% of the high-risk patients ( p < 0.001). Re-stratification during the first 2 years of follow-up reduced the likelihood of finding persistent structural disease or recurrence to 2% in low-risk, 2% in intermediate-risk, and 14% in high-risk patients, demonstrating an excellent response to therapy (stimulated Tg < 1 ng/mL without structural evidence of disease). Conversely, an incomplete response to initial therapy (suppressed Tg > 1 ng/mL, stimulated Tg > 10 ng/mL, rising Tg values, or structural disease identification within the first 2 years of follow-up) increased the likelihood of persistent structural disease or recurrence to 13% in low-risk, 41% in intermediate-risk, and 79% in high-risk patients. Conclusions: Our data confirm that the newly proposed ATA recurrence staging system effectively predicts the risk of recurrence and persistent disease. Further, these initial ATA risk estimates can be significantly refined based on the assessment of response to initial therapy, thereby providing a dynamic risk assessment that can be used to more effectively tailor ongoing follow-up recommendations.

show abstract

Section: Introductionmentioning

confidence: 99%

Estimating Risk of Recurrence in Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation: Using Response to Therapy Variables to Modify the Initial Risk Estimates Predicted by the New American Thyroid Association Staging System

Tuttle

Tala

Shah

et al. 2010

Thyroid

823

685

View full text Add to dashboard Cite

show abstract

“…The association of neck dissection and adjuvant radioiodine are matters of constant debate, both lacking level I evidence to be formally indicated. According to the last consensus of specialist societies in thyroid disease, neck dissection is indicated only in the presence of clinically detectable nodal disease [11][12][13][14][15][16][17][18] . Adjuvant radioiodine therapy should be administered in high-risk patients and avoided in low-risk ones, and may or may not be used in moderate risk cases 11,18,19 .…”

Section: Introduction Introduction Introduction Introduction Introducmentioning

confidence: 99%

Evolution in the profile of thyroid cancer cases treated in an oncology reference service: what changed in the last 20 years

Lira¹,

Carvalho²,

Filho³

et al. 2014

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

Objective: To evaluate the characteristics of thyroid carcinoma cases treated at a reference hospital for cancer between 2008 and 2010.Methods: we studied 807 cases and analyzed the following clinicopathologic variables: symptoms, risk factors, diagnostic tests, staging, histological type, treatment performed and complications.Results: Females were more affected, with 660 cases (82%). The average age at diagnosis was 44.5 years. Prior exposure to ionizing radiation was reported by 22 (3%) patients, a family history of thyroid cancer by 89 (11%), and 289 (36%) individuals reported other types of cancer in the family. The fine needle aspiration biopsy was the main parameter for surgical indication and was suggestive of carcinoma in 463 patients (57%). Papillary carcinoma was the most common histological type, with 780 cases (96.6%). There were 728 (90%) total thyroidectomies, 43 (5.3%) reoperations or partial thyroidectomies followed by totalization, 23 (2.8%) extended thyroidectomies and only 13 (1.6%) partial thyroidectomies (lobectomy with isthmectomy). Neck dissection associated with thyroidectomy was done in 158 patients (19.5%). We observed a predominance of tumors classified as T1 in 602 (74.6%) patients. Transient hypocalcemia was the most frequent complication.Conclusion: The results show that the worldwide increase in the incidence of thyroid cancer has changed the profile of patients seen at a referral service. In addition, there were changes in the type of surgical treatment used, with increased use of total thyroidectomy in relation to partial and subtotal ones, and decreased use of elective neck dissections.

show abstract

“…However, which current staging system gives the most accurate prognostic information remains unclear. 8 of 17 current staging systems is used only for papillary thyroid cancer, and 9 staging systems can be used for 2 histological type (papillary and follicular thyroid cancer) or for all histological types (10). In this study, currently the most common used staging systems, De Groot, MACIS (only for papillary thyroid cancer staging), EORTC and TNM (can be used in all histologic subtypes) were evaluated.…”

Section: Discussionmentioning

confidence: 99%

The importance of staging systems for the determination of prognosis of well-differentiated thyroid cancer

Erol

Makay

İçöz

et al. 2013

UCD

View full text Add to dashboard Cite

Objective: In this study, we aimed to determine the significance of the staging systems (EORTC, De Groot, MACIS, and TNM) on the prognosis of well-differentiated thyroid cancer patients who underwent surgery in our clinics. Material and Methods:This retrospective study included 181 patients who were operated between December 1995-December 2007, with a diagnosis of thyroid cancer. In order to obtain data related to cancer staging, a computer program for PDA was developed to facilitate parameter recording. Survival analysis was performed. The findings were compared to the predicted rates by the staging systems.Results: According to the De Groot staging system, stage 1 and stage 2 patients' results were compatible, but stage 3 and 4 patients' results were different (stage 3; 87% versus 66.6%, stage 4; 35% versus 100%, p=0.04). In the MACIS staging system, 20-year survival rates are determined and comparison should not be made due to insufficient follow-up period in this study. When compared to the EORTC staging system, stage 3 and stage 4 patients' results were determined different (stage 3; 51% versus 100%, stage 4; 33% versus 50%, p=0.02). The most consistent results in terms of prognosis was determined in comparison with the TNM staging system (stage 1; 100% versus 97.8%, stage 4; 45.3% versus 50%). Conclusion:Many classification systems are proposed for well-differentiated thyroid cancer, to predict the behavior of the tumor. In this study, we concluded that for determination of prognosis in well-differentiated thyroid cancer, the TNM staging system could best predict prognosis consistent with clinical findings.Key Words: Thyroid cancer, staging systems, prognosis INTRODUCTIONThyroid cancer is the most common endocrine malignancy, accounts for less than 1% of malignancies diagnosed, and is slowly progressing (1, 2). Although survival is generally good, they cause more death than all endocrine organ cancers. Six out of every 1 million people die due to thyroid cancer. Approximately 85% of thyroid cancers are papillary thyroid cancer. Despite high survival rates, local recurrence and metastases may occur in some patients and this may require a more aggressive surgical treatment. In order to predict tumor behavior many classifications are proposed for differentiated thyroid cancer. Tumor, node, metastasis (TNM) scoring system is a method used for comparing thyroid cancer cases for clinical and pathologic aspects within different centers and recommended by American Joint Committee on Cancer (AJCC) (3, 4). The prognosis of patients with well-differentiated thyroid cancer can be predicted by TNM, De Groot, MACIS (metastasis, age, completeness of surgery, invasion of cancer, size) and the European Organization for Research on Treatment of Cancer (EORTC) classifications. After an initial preoperative evaluation, these patients should be re-evaluated postoperatively, taking into account the same criteria (5, 6). The three most important variables in all studies are patient age, presence/absence of local invasion and dis...

show abstract

Staging Systems for Papillary Thyroid Carcinoma

Abstract: Despite referral, treatment, and data collection biases inherent within each center, the TNM system remained to be the most applicable and consistent staging system for PTC in 2 centers managing the same population group.

Cited by 110 publications

References 41 publications

Estimating Risk of Recurrence in Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation: Using Response to Therapy Variables to Modify the Initial Risk Estimates Predicted by the New American Thyroid Association Staging System

Estimating Risk of Recurrence in Differentiated Thyroid Cancer After Total Thyroidectomy and Radioactive Iodine Remnant Ablation: Using Response to Therapy Variables to Modify the Initial Risk Estimates Predicted by the New American Thyroid Association Staging System

Evolution in the profile of thyroid cancer cases treated in an oncology reference service: what changed in the last 20 years

The importance of staging systems for the determination of prognosis of well-differentiated thyroid cancer

Contact Info

Product

Resources

About