Insight into Differentiated Thyroid Cancer Gross Pathological Specimen Shrinkage and Its Influence on TNM Staging

Abstract The American Joint Committee on Cancer (AJCC) 8th TNM staging system of differentiated thyroid cancer defines gross strap muscle invasion as T3b stage. However, the impact of strap muscle invasion on disease-specific survival (DSS) remains controversial. To elucidate the survival impact of strap muscle invasion of any degree in thyroid cancers, the Surveillance, Epidemiology, and End Results (SEER) database (1973–2018) was queried for thyroid cancer only patients on July 2019 (n = 19,914). The Cox proportional hazard analysis with multivariable adjustment revealed that strap muscle invasion was not a significant factor for DSS in tumors equal to or smaller than 40 mm (hazard ratio (HR) = 1.620 [confidence interval (CI) 0.917 – 2.860]; p = 0.097). The competing risk analysis with multivariable adjustment showed that strap muscle invasion did not significantly impact DSS regardless of tumor size or cause of death (cancer-caused death (Subdistribution HR (SDHR) = 1.567 [CI 0.984 – 2.495]; p = 0.059); deaths to other causes (SDHR = 1.155 [CI 0.842 – 1.585]; p = 0.370). A “modified” staging schema discarding strap muscle invasion as a T stage criterion showed better 10-year DSS distinction between T stages. The modified staging schema may better reflect cancer-caused death risk and may prevent potential overstaging.

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Regional Variation across Canadian Centers in Radioiodine Administration for Thyroid Remnant Ablation in Well-Differentiated Thyroid Cancer Diagnosed in 2000–2010

Journal of Thyroid Research ◽

10.1155/2016/2867916 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

I. Rachinsky ◽

M. Rajaraman ◽

W. D. Leslie ◽

A. Zahedi ◽

C. Jefford ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Distant Metastases ◽

Tnm Staging ◽

Remnant Ablation ◽

Thyroid Hormone Withdrawal ◽

Care Patterns ◽

Major Variation ◽

Well Differentiated ◽

Over Time

Background. Use of radioactive iodine (RAI) ablation has been reported to vary significantly between studies. We explored variation in RAI ablation care patterns between seven thyroid cancer treatment centers in Canada.Methods. The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe and analyze patterns of care for thyroid cancer. We analyzed data from seven participating centers on RAI ablation in patients diagnosed with well-differentiated (papillary and follicular) thyroid cancer between 2000 and 2010. We compared RAI ablation protocols including indications (based on TNM staging), preparation protocols, and administered dose. We excluded patients with known distant metastases at time of RAI ablation.Results. We included 3072 patients. There were no significant differences in TNM stage over time. RAI use increased in earlier years and then declined. The fraction of patients receiving RAI varied significantly between centers, ranging between 20–85% for T1, 44–100% for T2, 58–100% for T3, and 59–100% for T4. There were significant differences in the RAI doses between centers. Finally, there was major variation in the use of thyroid hormone withdrawal or rhTSH for preparation of RAI ablation.Conclusion. Our study identified significant variation in use of RAI for ablation in patients with well-differentiated thyroid cancer both between Canadian centers and over time.

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The 8th American Joint Committee on Cancer TNM staging for Well-differentiated Thyroid Cancer: What\'s New?

World Journal of Endocrine Surgery ◽

10.5005/wjoes-10-3-iv ◽

2018 ◽

Vol 10 (3) ◽

pp. 0-0

Author(s):

Deepak Abraham

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Tnm Staging ◽

American Joint Committee ◽

Well Differentiated

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Comparison of long-term prognosis for differentiated thyroid cancer according to the 7th and 8th editions of the AJCC/UICC TNM staging system

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018820921019 ◽

2020 ◽

Vol 11 ◽

pp. 204201882092101 ◽

Cited By ~ 1

Author(s):

Kwangsoon Kim ◽

Jin Kyong Kim ◽

Cho Rok Lee ◽

Sang-Wook Kang ◽

Jandee Lee ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Disease Free Survival ◽

Staging System ◽

Tnm Staging ◽

University Hospital ◽

Tnm Staging System ◽

Staging Systems ◽

8Th Edition

Background: The 8th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) tumor-node-metastasis (TNM) staging system was released with major revisions. The purpose of this retrospective study was to investigate differences between the 7th and 8th editions of the AJCC/UICC TNM staging system and to compare the predictability of prognosis between the two staging systems with patients who underwent thyroidectomy for differentiated thyroid cancer (DTC) at a single institution. Methods: A total of 3238 patients underwent thyroid operation from January 2002 to December 2006 at Yonsei University Hospital (Seoul, Korea), of which 2294 with complete clinical data and sustained follow up were enrolled. Clinicopathologic features and TNM staging by applying the 7th and 8th editions of the AJCC/UICC were analyzed retrospectively by the complete review of medical charts and pathology reports of patients. Mean follow-up duration was 132.9 ± 27.9 months. Results: A significant number of T3 patients were downstaged to T1 (838, 36.5%) and T2 (122, 5.3%). After applying the 8th edition of the AJCC/UICC TNM staging system, the number of stage I patients increased significantly from 1434 (62.5%) to 2058 (89.7%), whereas numbers of stage III and IV patients decreased significantly from 644 (28.1%) to 33 (1.4%) and from 199 (8.7%) to 17 (0.7%), respectively. According to Kaplan–Meier survival analyses and values of the Harrell’s c-index and integrated area under the curve (iAUC), the 8th edition has significantly better predictive performance for disease-free survival (DFS) and disease-specific survival (DSS) than the 7th edition. Conclusions: A significant population was downstaged after applying the 8th edition of the AJCC/UICC TNM staging system, and the 8th edition provided significantly better accuracy in predicting DFS and DSS in patients with DTC.

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New Insight into the Treatment of Advanced Differentiated Thyroid Cancer

Journal of Thyroid Research ◽

10.1155/2012/437569 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Arash Safavi ◽

Aparna Vijayasekaran ◽

Marlon A. Guerrero

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Systemic Treatment ◽

Clinical Effectiveness ◽

Cytotoxic Chemotherapy ◽

Therapeutic Modalities ◽

Insight Into ◽

Radioactive Iodine Ablation ◽

Biologic Basis

The vast majority of patients with differentiated thyroid cancer (DTC) are treated successfully with surgery and radioactive iodine ablation, yet the treatment ofadvancedcases is frustrating and largely ineffective. Systemic treatment with conventional cytotoxic chemotherapy is basically ineffective in most patients with advanced DTC. However, a better understanding of the genetics and biologic basis of thyroid cancers has generated opportunities for innovative therapeutic modalities, resulting in several clinical trials. We aim to delineate the latest knowledge regarding the biologic characteristics of DTC and to describe the available data related to novel targeted therapies that have demonstrated clinical effectiveness.

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Prognostic effects ofTERTpromoter mutations are enhanced by coexistence withBRAForRASmutations and strengthen the risk prediction by the ATA or TNM staging system in differentiated thyroid cancer patients

Cancer ◽

10.1002/cncr.29934 ◽

2016 ◽

Vol 122 (9) ◽

pp. 1370-1379 ◽

Cited By ~ 80

Author(s):

Young Shin Song ◽

Jung Ah Lim ◽

Hoonsung Choi ◽

Jae-Kyung Won ◽

Jae Hoon Moon ◽

...

Keyword(s):

Thyroid Cancer ◽

Cancer Patients ◽

Risk Prediction ◽

Differentiated Thyroid Cancer ◽

Staging System ◽

Tnm Staging ◽

Tnm Staging System

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Improved prognostic value of the eighth edition of the AJCC/TNM staging system for differentiated thyroid cancer

Endocrine Abstracts ◽

10.1530/endoabs.56.p1135 ◽

2018 ◽

Author(s):

Velsen Evert van ◽

Merel Stegenga ◽

Kemenade Folkert van ◽

Boen Kam ◽

Ginhoven Tessa van ◽

...

Keyword(s):

Thyroid Cancer ◽

Prognostic Value ◽

Differentiated Thyroid Cancer ◽

Staging System ◽

Tnm Staging ◽

Tnm Staging System ◽

Eighth Edition

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Impacts of the American Joint Committee on Cancer (AJCC) 8th edition tumor, node, metastasis (TNM) staging system on outcomes of differentiated thyroid cancer in Thai patients

Heliyon ◽

10.1016/j.heliyon.2021.e06624 ◽

2021 ◽

Vol 7 (3) ◽

pp. e06624

Author(s):

Yotsapon Thewjitcharoen ◽

Waralee Chatchomchuan ◽

Krittadhee Karndumri ◽

Sriurai Porramatikul ◽

Sirinate Krittiyawong ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Staging System ◽

Tnm Staging ◽

Tumor Node Metastasis ◽

Node Metastasis ◽

American Joint Committee ◽

Tnm Staging System ◽

8Th Edition

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Risk stratification of patients with locally aggressive differentiated thyroid cancer

Nuklearmedizin ◽

10.3413/nukmed-0302 ◽

2010 ◽

Vol 49 (03) ◽

pp. 79-84 ◽

Cited By ~ 20

Author(s):

J. A. Krämer ◽

K. W. Schmid ◽

H. Dralle ◽

M. Dietlein ◽

H. Schicha ◽

...

Keyword(s):

Overall Survival ◽

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Staging System ◽

Nodal Metastasis ◽

Tnm Staging ◽

Event Free Survival ◽

Free Survival ◽

Kaplan Meier

SummaryThe Multicentre Study Differentiated Thyroid Cancer (MSDS) collective represents a well defined group of patients with locally aggressive thyroid carcinomas (pT4; AJCC/UICC 1997). The aim of the present study was to compare the survival of patients with minimum and extensive extrathyroidal growth according to the new AJCC/UICC TNM staging system 2009. Patients, methods: The followup data of 347 patients were analysed. Patients were reclassified according to the current AJCC/UICC 2009 classification. The event-free and overall survival was evaluated using Kaplan-Meier analysis. In addition, postoperative complications and status of disease were documented. Results: 327 patients were assigned to stage pT3 and 20 patients to stage pT4a, respectively. Median follow-up was 6.1 years (range 0.04–9.8 years). 92.5% of patients reached complete remission. There were 7.8 % recurrences in the thyroid bed, in locoregional lymph nodes and/or in distant sites. The overall survival was >98% both in pT3 and pT4a patients (p = n. s.). In contrast, the event-free survival was significantly less favourable in pT4a patients (p < 0.001). Using multivariate analysis the following parameters were significant predictors of event-free survival: histological tumour type, degree of extrathyroidal extension and nodal metastasis (p < 0.05). Conclusions: The MSDS patients with locally aggressive differentiated thyroid cancer showed an excellent overall survival during a median follow-up of 6.1 years. According to the current AJCC/UICC 2009 classification, pT3 patients with minimal extra thyroidal extension revealed a significantly better event-free survival than pT4a patients with extensive extrathyroidal growth.

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