Comparison of 8th and 7th editions of TNM staging in terms of mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer

Abstract

Objective To compare the eighth and seventh editions of TNM staging (TNM-8 and TNM-7) on disease-related mortality, persistent disease, and response to treatment in patients with differentiated thyroid cancer (DTC).

Methods and Materials We studied 400 patients (79% female) with DTC with a mean age of 40.93±14.11 years. TNM staging was recorded according to the 7th and 8th editions and patients were followed for at least 1 year and response to therapy was recorded according to ATA response categorization.

Results The mean follow up time was 42.5±15.24 months. Overall, 108 patients (27%) were down-staged using the TNM-8, mainly due to the changes in the age cut-off (14.5%), N (9.25%), and T categorization (3.25%). All patients in stage III and 82.8% in stage IV were down-staged. The mean Tg levels were significantly higher in stages III and IV in TNM-8 compared to TNM-7. Four disease-related death were recorded during follow up, all in stage IV according to TNM-7, while one was in stage II according to TNM-8. One year after treatment, persistent disease was detected in 12% and 77% of patients in stage III according to the 7th and 8th editions, respectively (P= 0.04). Similarly, biochemical incomplete response one year after treatment was seen in 7.3% and 87% in stage III disease using 7th and 8th editions (P = 0.006) that fell to 2.4% and 22% in the last visit respectively (P = 0.04).

Conclusion Persistent disease and incomplete response to therapy were more common in stages III and IV in TNM-8 compared to TNM-7. The eighth edition was a better predictor of persistent disease in stages III and IV disease.

Keywords

Thyroid - Differentiated thyroid carcinoma - TNM staging

Publikationsverlauf

Eingereicht: 04. Mai 2022

Angenommen nach Revision: 12. Juni 2024

Artikel online veröffentlicht:
10. Juli 2024

• References

• 1 Mazzaferri EL, Robbins RJ, Spencer C. et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. The Journal of Clinical Endocrinology & Metabolism 2003; 88 (04) 1433-1441
• 2 Hindié E, Zanotti-Fregonara P, Duron F. et al. Should ‘low-risk’thyroid cancer patients with residual thyroglobulin be re-treated with iodine 131?. Clinical endocrinology 2007; 66 (03) 329-334
• 3 Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA otolaryngology–head & neck surgery 2014; 140 (04) 317-322 DOI: 10.1001/jamaoto.2014.1. (PMID: 24557566)
• 4 Haugen BR, Alexander EK, Bible KC. 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 (01) 1-133
• 5 Lamartina L, Grani G, Arvat E. et al. 8th edition of the AJCC/TNM staging system of thyroid cancer: what to expect (ITCO#2). Endocr Relat Cancer 2018; 25 (03) L7-L11
• 6 Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer: what changed and why? : Mary Ann Liebert, Inc. 140 Huguenot Street, 3rd Floor New Rochelle, NY 10801 USA. 2017
• 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 (03) 373-380 DOI: 10.1089/thy.2015.0315. (PMID: 26914539)
• 8 Tuttle M, Morris L, Haugen B. et al. Thyroid-differentiated and anaplastic carcinoma. AJCC cancer staging manual. In: . New York: Springer; 2017: 873-890
• 9 Nava CF, Zanella AB, Scheffel RS. et al. Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort. Archives of endocrinology and metabolism 2019; 63 (01) 5-11 DOI: 10.20945/2359-3997000000097. (PMID: 30864625)
• 10 Shteinshnaider M, Muallem Kalmovich L, Koren S. et al. Reassessment of Differentiated Thyroid Cancer Patients Using the Eighth TNM/AJCC Classification System: A Comparative Study. Thyroid 2018; 28 (02) 201-209
• 11 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 (08) 976-981
• 12 Kim M, Jeon MJ, Oh HS. et al. Prognostic Implication of N1b Classification in the Eighth Edition of the Tumor-Node-Metastasis Staging System of Differentiated Thyroid Cancer. Thyroid 2018; 28 (04) 496-503 DOI: 10.1089/thy.2017.0473. (PMID: 29620964)
• 13 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 (09) 1149-1155 DOI: 10.1089/thy.2017.0050. (PMID: 28635571)
• 14 Cavalheiro BG, de Matos LL, Leite AKN. et al. Survival in differentiated thyroid carcinoma: Comparison between the 7th and 8th editions of the AJCC/UICC TNM staging system and the ATA initial risk stratification system. Head Neck 2021; 43 (10) 2913-2922
• 15 Dehbi HM, Mallick U, Wadsley J. et al. Recurrence after low-dose radioiodine ablation and recombinant human thyroid-stimulating hormone for differentiated thyroid cancer (HiLo): long-term results of an open-label, non-inferiority randomised controlled trial. The Lancet Diabetes & Endocrinology 2019; 7 (01) 44-51 DOI: 10.1016/S2213-8587(18)30306-1. (PMID: 30501974)