Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why?

Tuttle, R. Michael; Haugen, Bryan R.; Perrier, Nancy D.

doi:10.1089/thy.2017.0102

Cited by 584 publications

(477 citation statements)

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“…This is dramatically lower than the 10‐year DSS of 60%‐70% for stage III and <50% for stage IV DTC patients estimated by Tuttle et al . On the other hand, PDTC patients staged I or II according to the 8th edition did not achieve excellent or good outcomes, as estimated by Tuttle et al . In the present study, the 10‐year DSS was 83% and 55% for patients staged I and II, respectively; this finding was unexpected, as the 10‐year DSS was previously estimated at 98%‐100% for stage I and 85%‐95% for stage II DTC patients regardless of the cut‐off age .…”

Section: Discussioncontrasting

confidence: 76%

“…We predicted worse outcomes for patients staged III or IV according to the 8th edition criteria; however, the 5‐ and 10‐year DSS in these patients was 0%. This is dramatically lower than the 10‐year DSS of 60%‐70% for stage III and <50% for stage IV DTC patients estimated by Tuttle et al . On the other hand, PDTC patients staged I or II according to the 8th edition did not achieve excellent or good outcomes, as estimated by Tuttle et al .…”

Section: Discussioncontrasting

confidence: 55%

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Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor‐Node‐Metastasis Staging System (eighth edition)

Walczyk

Kopczyński

Gąsior-Perczak

et al. 2019

Clinical Endocrinology

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Summary Objective Poorly differentiated thyroid cancer (PDTC) is a rare, but aggressive thyroid cancer (TC) and a main cause of death from non‐anaplastic follicular cell‐derived TC. Assessing the risk of PDTC‐related death and the risk of recurrence is important for clinicians. The recent American Thyroid Association (ATA) 2015 guidelines and the updated 8th edition of the American Joint Committee on Cancer/Tumor‐Node‐Metastasis (AJCC/TNM) staging system should support clinicians in the management approach to PDTC patients. Patients Forty‐six consecutive PDTC patients treated in a single oncologic centre, 2000‐2017. Measurements Retrospective analysis of TNM stage, initial risk, response‐to‐therapy categories, follow‐up and final disease status incorporating the ATA 2015 criteria and the 8th AJCC/TNM staging system. Disease‐specific survival (DSS) using the Kaplan‐Meier method. Results Of the 46 PDTC 21 (45.6%) were ATA high risk (HR), 22 (47.8%), 17 (37%) and seven (15.2%) were TNM stages I, II, and III‐IV, respectively. During a median follow‐up of 55.5 months, two (4.3%) patients were recurrent, 18 (39.1%) died of PDTC. The 5‐/10‐year DSS were 65/57%, respectively. According to the AJCC/TNM, the 5‐/10‐year DSS of I, II, and III‐IV stage were 83/83%; 77/55%, and 0/0%, respectively. According to the 2015 ATA initial risk, the 5‐/10‐year DSS were 91/72% for ATA intermediate risk and 38/38% for ATA HR patients. Conclusions In PDTC patients, the updated AJCC/TNM staging system accurately predicts a high risk of death in stage III‐IV, whereas it seems to be inadequate for predicting a very low or low risk of death expected for differentiated TC in stage I‐II. The ATA initial HR may be also used to predict a high risk of PDTC‐related death.

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Section: Discussioncontrasting

confidence: 76%

Section: Discussioncontrasting

confidence: 55%

Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor‐Node‐Metastasis Staging System (eighth edition)

Walczyk

Kopczyński

Gąsior-Perczak

et al. 2019

Clinical Endocrinology

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“…Factors such as age, gender, histologic category, extrathyroidal extension, vascular invasion, lymph node metastases, AJCC/TNM staging [24], distant metastases, and final status were assessed using univariate and multivariate logistic regression models.…”

Section: Resultsmentioning

confidence: 99%

“…Patients were classified by the AJCC/TNM-8th edition [24] and ATA risk classification [9]. Distant metastases were assessed by cross-sectional images and considered present when there were highly suspicious images on computed tomography, magnetic resonance imaging, and/or XRay.…”

Section: Evaluation Of Outcomesmentioning

confidence: 99%

The Impact of Zoledronic Acid and Radioactive Iodine Therapy on Morbi-Mortality of Patients with Bone Metastases of Thyroid Cancer Derived from Follicular Cells

Andrade¹,

Probstner²,

Decnop³

et al. 2018

Eur Thyroid J

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Objective: Bone metastases bring greater morbi-mortality to patients with differentiated thyroid carcinoma (DTC). Treatment was limited to radioactive iodine (RAI) and local approaches. Currently, bisphosphonates are included in the therapeutic arsenal. The aim of this study is to evaluate the impact of bone metastases and their treatment with zoledronic acid (ZA) and RAI therapy. Methods: We retrospectively review 50 DTC patients with structurally evident bone metastases followed in a tertiary cancer center from 1994 to 2018. Clinical-pathologic characteristics, skeletal related events (SRE), and therapeutic approaches were recorded. Results: Among the 50 patients analyzed, 22 underwent ZA adjuvant therapy and 28 did not. Mortality rate was 44%. Those patients presented SREs more frequently (90.9 vs. 67.9% the survival group, p = 0.05) and also had a greater number of bone lesions (40.9 vs. 10.7% had more than 6 metastatic sites, p = 0.03). The same group of patients was analyzed before and after therapy with ZA and the incidence of SRE decreased from 1.81 (0–8) before therapy to 0.29 (0–7) after therapy (p = 0.006). Comparing similar groups of 22 patients treated with ZA with 28 patients not treated, there was a trend of better overall survival (OS) in the group that received this drug (147 vs. 119 months, p = 0.06) and significantly improvement when bone metastases were RAI avid 155 (125–185) versus 120 (85–157) months, p < 0.01. Conclusion: ZA can successfully diminish the chance of having new SRE and possibly affect OS in DTC patients with bone metastases. The positive impact of RAI adjuvant treatment on OS is directly associated with RAI uptake.

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“…Patients with persistence/recurrence tended to be younger (p = 0.08) and to present with multifocal tumors (p = 0.07), but only ETE (univariate analysis, p = 0.019) and lymph node involvement (multivariate analysis, p = 0.001) were significantly associated with persistence/recurrence. Comparisons of stratification using the 7 th and 8 th AJCC/ TNM systems (9) indicated that when switching from the former system to the latter system, the percentage of patients classified as stage I increased from 89% to 95.2% and the percentage of patients classified as stage II decreased from 10% to 4.8%. Unfortunately, only 33% of patients with recurrent/persistent disease underwent…”

mentioning

confidence: 99%

The Janus faces of thyroid carcinoma

Martins¹

2018

Archives of Endocrinology and Metabolism

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T hyroid cancer is the most common endocrine neoplasia, and its incidence has increased dramatically in several countries during the last three decades (1). This phenomenon has been attributed to overdiagnosis due to a combination of improvements in new imaging techniques, especially high-resolution ultrasound, and increased access of patients to health care systems (2). Irrespective of controversies regarding whether the growing number of thyroid cancer diagnoses is attributable to overdiagnosis alone (2) or reflects an actual increase in cases (3-5), the majority of tumor recently diagnosed is comprised of small papillary carcinomas (PTCs), (1.5-2.0 cm or less in size). Fortunately, more than 90% of them are curable with total thyroidectomy complemented or not with radioiodine (RAI). Although most PTCs are considered to be low risk, there are cases in which the tumor, even if small, exhibits aggressive behavior, and distant metastases can be present at diagnosis.In this issue of the Archives of Endocrinology and Metabolism (AE&M), these two faces of thyroid cancer were addressed in two well-written papers on patients with PTC in two Latin American countries. Domínguez and cols. (6), retrospectively reviewed the medical records of 209 patients with papillary thyroid microcarcinoma (PTMC) from 2009 to 2013, with a median follow-up of 4.4 years. Overall, 90% of these cases involved female patients; moreover, despite stratification into a low-risk group, 88% of patients received RAI, a treatment that was provided in accordance with older guidelines (7) and had no impact on tumor recurrence/persistence. As expected, classical PTC was the predominant histology (78%), tumors were frequently unilateral (76.1%), 17.9% of tumors had minimal extrathyroidal extension (ETE), 16.7% of cases involved lymph node metastasis, and there were no distant metastases. According to the American Thyroid Association (ATA) guidelines 2009 risk recurrence stratification (7), 70.8% of tumors were classified as low risk; this percentage increased to 78.5% when the ATA's 2015 risk stratification was used (8). In addition, persistence/recurrence was extremely uncommon: 1.5% of patients exhibited biochemical persistence/ recurrence, and 5.5% of patients exhibited structural persistence/recurrence. Patients with persistence/recurrence tended to be younger (p = 0.08) and to present with multifocal tumors (p = 0.07), but only ETE (univariate analysis, p = 0.019) and lymph node involvement (multivariate analysis, p = 0.001) were significantly associated with persistence/recurrence. Comparisons of stratification using the 7 th and 8 th AJCC/ TNM systems (9) indicated that when switching from the former system to the latter system, the percentage of patients classified as stage I increased from 89% to 95.2% and the percentage of patients classified as stage II decreased from 10% to 4.8%. Unfortunately, only 33% of patients with recurrent/persistent disease underwent

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Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What Changed and Why?

Cited by 584 publications

References 9 publications

Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor‐Node‐Metastasis Staging System (eighth edition)

Poorly differentiated thyroid cancer in the context of the revised 2015 American Thyroid Association Guidelines and the Updated American Joint Committee on Cancer/Tumor‐Node‐Metastasis Staging System (eighth edition)

The Impact of Zoledronic Acid and Radioactive Iodine Therapy on Morbi-Mortality of Patients with Bone Metastases of Thyroid Cancer Derived from Follicular Cells

The Janus faces of thyroid carcinoma

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