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Risk of Recurrence in Differentiated Thyroid Cancer: A Population-Based Comparison of the 7th and 8th Editions of the American Joint Committee on Cancer Staging Systems
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9 2019
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Source: Ann Surg Oncol. 26(9):2703-2710
[PDF-807.44 KB]
Details:
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Alternative Title:Ann Surg Oncol
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Personal Author:
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Description:Background:
Differentiated thyroid cancer (DTC) survival is excellent, making recurrence a more clinically relevant prognosticator. We hypothesize that the new American Joint Committee on Cancer (AJCC) 8th edition improves upon the utility of the 7th edition in predicting the risk of recurrence in DTC.
Methods:
A population-based retrospective review compared the risk of recurrence in patients with DTC according to the AJCC 7th and 8th editions using the SEER based Kentucky Cancer Registry from 2004–2012.
Results:
A total of 3248 patients with DTC were considered disease free after treatment. Twenty percent of patients were down-staged from the 7th to the 8th edition. Most patients had stage I disease (80% in the 7th edition and 94% in the 8th edition). A total of 110 (3%) patients recurred after a median of 27 months. Risk of recurrence was significantly associated with stage for both editions (p < 0.001). In the 7th edition, there was poor differentiation between lower stages and better differentiation between higher stages (stage II HR 0.91, 95%CI 0.39–2.11; stage III HR 3.72, 95%CI 2.29–6.07; stage IV HR 11.66, 95%CI 7.10–19.15; all compared with stage I). The 8th edition better differentiated lower stages (stage II HR 4.06, 95%CI 2.38–6.93; stage III HR 13.07, 95%CI 5.30–32.22; stage IV 11.88, 95%CI 3.76–37.59; all compared with stage I).
Conclusions:
AJCC 8th edition better differentiates risk of DTC recurrence for early stages compared to the 7th edition. Limitations remain, however, emphasizing the importance of adjunctive strategies to estimate risk of recurrence.
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Pubmed ID:30830539
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Pubmed Central ID:PMC6684465
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Volume:26
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Issue:9
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