The incidence of papillary thyroid microcarcinoma has been constantly rising in recent decades. The tumor, node, metastasis staging system is designed to predict prognosis in patients with papillary thyroid carcinoma. Recent studies have shown that the American Joint Committee on Cancer (AJCC) 8th edition is superior to the 7th edition for predicting tumor recurrence in PTC patients. To date, whether the 8th edition is also better able to predict recurrence in papillary thyroid microcarcinoma (PTMC) remains unclear.
We enrolled 1007 cases from our thyroid cancer database in the First Affiliated Hospital, Zhejiang University School of Medicine, from 1997 to 2011. Univariable and multivariate Cox hazard regression analyses were used to identify the association between variables and recurrence. Disease-free survival was calculated using the Kaplan–Meier method and compared using the log-rank test.
A total of 1007 PTMC patients were enrolled, with a median follow-up of 67 months. Of 93 (9.2%) patients downstaged by the changes in versions, 49 (52.7%) were downstaged because the age-at-diagnosis cut-off used for staging increased from 45 to 55 years, while 35 (37.6%) were downstaged due to the weakening of the effects of lymph node metastasis. The recurrence rate of PTMC was 4.17%. Univariate Cox hazards regression analyses showed that TNM stage according to the AJCC 8th edition was significantly associated with recurrence, while the recurrence survival curves showed that TNM stage (stage I vs. stage II–IV) according to the AJCC 8th edition, but not the 7th edition, was significantly associated with disease-free survival (p < 0.05).
The AJCC 8th edition has better ability to predict recurrence in PTMC patients than the 7th edition.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2014. National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2014/, based on November 2016 SEER data submission, posted to the SEER website in April 2017.
Hedinger C, Williams ED, Sobin LH. The WHO histological classification of thyroid tumors: a commentary on the second edition. Cancer. 1989;63(5):908–11.
Bramley MD, Harrison BJ. Papillary microcarcinoma of the thyroid gland. Br J Surg. 1996;83(12):1674–83.
Du L, Wang Y, Sun X, et al. Thyroid cancer: trends in incidence, mortality and clinical-pathological patterns in Zhejiang Province, Southeast China. BMC Cancer. 2018;18(1):291.
Leboulleux S, Tuttle R, Pacini F, Schlumberger M. Papillary thyroid microcarcinoma: time to shift from surgery to active surveillance? Lancet Diabetes Endocrinol. 2016;4(11):933–42.
Kim TH, Kim YN, Kim HI, et al. Prognostic value of the eighth edition AJCC TNM classification for differentiated thyroid carcinoma. Oral Oncol. 2017;71:81–6.
Kim M, Kim WG, Oh HS, et al. Comparison of the seventh and eighth editions of the American Joint Committee on Cancer/Union for International Cancer Control tumor-node-metastasis staging system for differentiated thyroid cancer. Thyroid. 2017;27(9):1149–55.
Pontius LN, Oyekunle TO, Thomas SM, et al. Projecting survival in papillary thyroid cancer: a comparison of the seventh and eighth editions of the American Joint Commission on Cancer/Union for International Cancer Control staging systems in two contemporary national patient cohorts. Thyroid. 2017;27(11):1408–16.
van Velsen EFS, Stegenga MT, van Kemenade FJ, et al. Comparing the prognostic value of the eighth edition of the American Joint Committee on Cancer/Tumor Node Metastasis Staging System between papillary and follicular thyroid cancer. Thyroid. 2018;28(8):976–81.
Nam SH, Bae MR, Roh JL, et al. A comparison of the 7th and 8th editions of the AJCC staging system in terms of predicting recurrence and survival in patients with papillary thyroid carcinoma. Oral Oncol. 2018;87:158–64.
Gan T, Huang B, Chen Q, et al. 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. Ann Surg Oncol. 2019;26(9):2703–10.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4.
Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9.
Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295(18):2164–7.
Park JS, Chang JW, Liu L, Jung SN, Koo BS. Clinical implications of microscopic extrathyroidal extension in patients with papillary thyroid carcinoma. Oral Oncol. 2017;72:183–7.
Nixon IJ, Wang LY, Migliacci JC, et al. An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. Thyroid. 2016;26(3):373–80.
Jonklaas J, Nogueras-Gonzalez G, Munsell M, et al. The impact of age and gender on papillary thyroid cancer survival. J Clin Endocrinol Metab. 2012;97(6):E878-887.
Kim M, Kim YN, Kim WG, et al. Optimal cut-off age in the TNM staging system of differentiated thyroid cancer: is 55 years better than 45 years? Clin Endocrinol (Oxford). 2017;86(3):438–43.
Ito Y, Kakudo K, Hirokawa M, et al. Clinical significance of extrathyroid extension to the parathyroid gland of papillary thyroid carcinoma. Endocr J. 2009;56(2):251–5.
Siddiqui S, White MG, Antic T, et al. Clinical and pathologic predictors of lymph node metastasis and recurrence in papillary thyroid microcarcinoma. Thyroid. 2016;26(6):807–15.
Ding Y, Mao Z, Ruan J, Su X, Li L, Fahey TJ, et al. Nomogram-based new recurrence predicting system in early-stage papillary thyroid cancer. Int J Endocrinol. 2019;2019:1029092. https://doi.org/10.1155/2019/1029092.
Yin DT, Yu K, Lu RQ, Li X, Xu J, Lei M. Prognostic impact of minimal extrathyroidal extension in papillary thyroid carcinoma. Medicine (Baltimore). 2016;95(52):e5794.
Moon HJ, Kim EK, Chung WY, Yoon JH, Kwak JY. Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann Surg Oncol. 2011;18(7):1916–23.
Besic N, Pilko G, Petric R, Hocevar M, Zgajnar J. Papillary thyroid microcarcinoma: prognostic factors and treatment. J Surg Oncol. 2008;97(3):221–5.
Hay ID, Hutchinson ME, Gonzalez-Losada T, et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery. 2008;144(6):980–7 (discussion 987–988).
Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas: frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg. 2003;237(3):399–407.
Hwangbo Y, Kim JM, Park YJ, et al. Long-term recurrence of small papillary thyroid cancer and its risk factors in a Korean multicenter study. J Clin Endocrinol Metab. 2017;102(2):625–33.
Tam S, Boonsripitayanon M, Amit M, et al. Survival in differentiated thyroid cancer: comparing the AJCC cancer staging seventh and eighth editions. Thyroid. 2018;28(10):1301–10.
He LY, Chen ML, Wang WW, et al. The analysis of clinicopathologic predictors of lymph node metastasis and postoperative recurrence in patients with papillary thyroid microcarcinoma from Guangdong Province, China-a multicenter retrospective study. Int J Clin Exp Pathol. 2017;10(9):9735–43.
Ito Y, Miyauchi A, Kihara M, Higashiyama T, Kobayashi K, Miya A. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24(1):27–34.
Haugen B, Alexander E, Bible K, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1–133.
This study was supported by grants from the Natural Science Foundation of Zhejiang Province (No. LQ18H120002) and the National Natural Science Foundation of China (No. 81772853 and 81972495). The authors thank all participants for their contribution to the thyroid database.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Chen, Z., Ruan, J., Yao, Y. et al. A Comparison of the Seventh and Eighth Editions of the AJCC Staging Systems to Predict Recurrence in Papillary Thyroid Microcarcinoma. Ann Surg Oncol (2021). https://doi.org/10.1245/s10434-021-09596-6