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. 2019 Jan;165(1):6-11.
doi: 10.1016/j.surg.2018.04.078. Epub 2018 Nov 8.

Stage migration with the new American Joint Committee on Cancer (AJCC) staging system (8th edition) for differentiated thyroid cancer

Ashok R Shaha  1 , Jocelyn C Migliacci  2 , Iain J Nixon  2 , Laura Y Wang  2 , Richard J Wong  2 , Luc G T Morris  2 , Snehal G Patel  2 , Jatin P Shah  2 , R Michael Tuttle  3 , Ian Ganly  2
Affiliations

Stage migration with the new American Joint Committee on Cancer (AJCC) staging system (8th edition) for differentiated thyroid cancer

Ashok R Shaha et al. Surgery. 2019 Jan.

Abstract

Background: Tumor, node, and metastasis staging in thyroid carcinoma is important for assessing prognosis. However, patients with stage III or IV disease have an overall survival rate of 90%. The change to 55 years of age as the cutoff will create stage migration and many patients will be downstaged.

Methods: We reviewed our database of 3,650 patients to analyze the impact of the new American Joint Committee on Cancer staging system. There were 994 men (27%) and 2,656 women (73%). The median age was 46 years. Patients were staged using both 7th and 8th editions, with a cutoff of 55 years of age and new definitions of T3 and T4, and nodal staging.

Results: Of 3,650 patients, 1,057 (29%) were downstaged. There were 104 (10%) who went from stage IV to I, 109 (10%) who went from stage IV to stage II, and 68 (6%) who went to stage III. There were 218 (21%) who went from stage III to I, 347 (33%) who went from stage III to stage II, and 211 (20%) who went from stage II to I. The overall disease-specific and relapse-free survival was analyzed and showed better stratification with the new staging system.

Conclusion: The new staging system reflects more appropriately the biology of thyroid cancer and will have significant impact on the management of thyroid cancer.

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Conflict of interest statement

Conflict of Interest Statement

None declared.

Figures

Fig. 1.
Fig. 1.
Stage grouping based on 7th and 8th editions of thyroid cancer staging.
Fig. 2.
Fig. 2.
Cancer-specific survival based on 7th and 8th editions.
Fig. 3.
Fig. 3.
Overall survival based on 7th and 8th editions.
Fig. 4.
Fig. 4.
Recurrence-free survival based on 7th and 8th editions.
Fig. 5.
Fig. 5.
Alluvial flow diagram based on stage migration in the 7th and 8th editions.
See this image and copyright information in PMC

Comment in

  • Discussion.
    [No authors listed] [No authors listed] Surgery. 2019 Jan;165(1):10-11. doi: 10.1016/j.surg.2018.04.083. Surgery. 2019. PMID: 30526990 No abstract available.

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