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A Comparison of the Seventh and Eighth Editions of the AJCC Staging Systems to Predict Recurrence in Papillary Thyroid Microcarcinoma

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

Method

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.

Results

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).

Conclusions

The AJCC 8th edition has better ability to predict recurrence in PTMC patients than the 7th edition.

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Acknowledgments

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.

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Author notes

  1. Zhendong Chen and Jiaying Ruan contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Zhendong Chen MD, Jiaying Ruan MD, Yunjin Yao MD, Liping Wen MD, Zhuochao Mao MD, Shitu Chen MD., PhD, Zhongqi Li MD, Lisong Teng MD., PhD & Weibin Wang MD., PhD

  2. Department of Hernia, Hangzhou Xiaoshan First People’s Hospital, Hangzhou, China

    Honghong Zhu MD

  3. Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

    Yinu Zhao MD

  4. Department of Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY, USA

    Thomas J. Fahey MD

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  1. Zhendong Chen MD
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Correspondence to Lisong Teng MD., PhD or Weibin Wang MD., PhD.

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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 28, 6564–6571 (2021). https://doi.org/10.1245/s10434-021-09596-6

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  • DOI: https://doi.org/10.1245/s10434-021-09596-6

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