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. 2020 Feb 27;12(3):552.
doi: 10.3390/cancers12030552.

Evaluation of the 8th Edition TNM Classification for Anaplastic Thyroid Carcinoma

Naoyoshi Onoda  1   2 , Iwao Sugitani  1   3 , Ken-Ichi Ito  1   4 , Akifumi Suzuki  1   5 , Takuya Higashiyama  1   6 , Tatsuya Fukumori  1   7 , Nobuyasu Suganuma  1   8 , Katsuhiko Masudo  1   9 , Hirotaka Nakayama  1   10 , Atsuhiko Uno  1   11 , Katsunari Yane  1   12 , Seiichi Yoshimoto  1   13 , Aya Ebina  1   14 , Yukari Kawasaki  1   15 , Shigeto Maeda  1   16 , Manabu Iwadate  1   17 , Shinichi Suzuki  1   17
Affiliations

Evaluation of the 8th Edition TNM Classification for Anaplastic Thyroid Carcinoma

Naoyoshi Onoda et al. Cancers (Basel). .

Abstract

Background: The tumor-node-metastasis (TNM) classification system to categorized anaplastic thyroid cancer (ATC) was revised.

Methods: The revised system was evaluated using a large database of ATC patients.

Results: A total of 757 patients were analyzed. The proportion and median overall survival values (OS: months) for each T category were T1 (n = 8, 1.1%, 12.5), T2 (n = 43, 5.7%, 10.9), T3a (n = 117, 15.5%, 5.7), T3b (n = 438, 57.9%, 3.9), and T4 (n = 151, 19.9%, 5.0). The OS of the N0 and N1 patients were 5.9 and 4.3, respectively (log-rank p < 0.01). Sixty-three (58.3%) patients migrated from stage IV A to IV B by revision based on the existence of nodal involvement and 422 patients (55.7%) were stratified into stage IV B, without a worsening of their OS (6.1), leaving 45 patients (5.9%) in stage IV A with fair OS (15.8). The hazard ratios for the survival of the patients of stage IV B compared to stage IV A increased from 1.1 to 2.1 by the revision. No change was made for stage IV C (n = 290, 38.8%, 2.8).

Conclusion: The revised TNM system clearly indicated the prognoses of ATC patients by extracting rare patients with fair prognoses as having stage IV A disease and categorized many heterogeneous patients in stage IV B.

Keywords: TNM classification; anaplastic thyroid cancer; disease stage; prognosis; prognostic index.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cohort diagram.
Figure 2
Figure 2
The OS of the patients according to the disease stage stratified by the American Joint Committee on Cancer/Union for International Cancer Control tumor–node–metastasis (AJCC/UICC TNM) classification, 7th edition (a) and 8th (b) edition.
Figure 2
Figure 2
The OS of the patients according to the disease stage stratified by the American Joint Committee on Cancer/Union for International Cancer Control tumor–node–metastasis (AJCC/UICC TNM) classification, 7th edition (a) and 8th (b) edition.
Figure 3
Figure 3
The patients who migrated from stage IV A of the 7th edition to stage IV B of the 8th edition showed significantly worse survival compared to the revised stage IV A patients (p = 0.02), as well as better survival than that of the former stage IV B patients (p = 0.03).
Figure 4
Figure 4
The overall survival (OS) of the patients with stage IV B disease stratified by the Prognostic Index.
See this image and copyright information in PMC

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