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Multicenter Study
. 2016 Mar;26(3):373-80.
doi: 10.1089/thy.2015.0315. Epub 2016 Feb 25.

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

Iain J Nixon  1 , Laura Y Wang  1 , Jocelyn C Migliacci  1 , Antoine Eskander  2 , Michael J Campbell  3 , Ahmad Aniss  4 , Lilah Morris  5 , Fernanda Vaisman  6 , Rossana Corbo  6 , Denise Momesso  7 , Mario Vaisman  7 , Andre Carvalho  8 , Diana Learoyd  4 , William D Leslie  9 , Richard W Nason  9 , Deborah Kuk  1 , Volkert Wreesmann  1 , Luc Morris  1 , Frank L Palmer  1 , Ian Ganly  1 , Snehal G Patel  1 , Bhuvanesh Singh  1 , R Michael Tuttle  1 , Ashok R Shaha  1 , Mithat Gönen  1 , K Alok Pathak  9 , Wen T Shen  10 , Mark Sywak  4 , Luis Kowalski  11 , Jeremy Freeman  2 , Nancy Perrier  5 , Jatin P Shah  1
Affiliations
Multicenter Study

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

Iain J Nixon et al. Thyroid. 2016 Mar.

Abstract

Background: Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions.

Methods: A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model.

Results: Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7%, 97.3%, 96.6%, and 76.3%, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5%, 94.7%, 94.1%, and 67.6%, respectively. The change resulted in 12% of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6%. The change resulted in an increase in CPE from 0.90 to 0.92.

Conclusions: A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12% of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.

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Figures

<b>FIG. 1.</b>
FIG. 1.
Comparison of disease-specific survival by American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system using an age cutoff of (A) 45 years and (B) 55 years.
<b>FIG. 2.</b>
FIG. 2.
Disease-specific survival of patients directly affected by the proposed change stratified by AJCC/UICC stage change.
<b>FIG. 3.</b>
FIG. 3.
Detailed analysis of disease-specific survival by initial and re-stage groupings (A) initially stage II on AJCC/UICC, (B) initially stage III on AJCC/UICC, and (C) initially stage IV on AJCC/UICC.
See this image and copyright information in PMC

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