scholarly journals Clinical Validation of the Prognostic Stage Groups of the Eighth-Edition TNM Staging for Medullary Thyroid Carcinoma

2018 ◽  
Vol 103 (12) ◽  
pp. 4609-4616 ◽  
Author(s):  
So Young Park ◽  
Yoon Young Cho ◽  
Hye In Kim ◽  
Jun-Ho Choe ◽  
Jung-Han Kim ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Staging System ◽  
Predictive Performance ◽  
Tnm Staging ◽  
Cancer Specific Survival ◽  
Prognostic Performance ◽  
Medullary Thyroid ◽  
Tnm Staging System ◽  
Eighth Edition

Abstract Context Despite advances in thyroid cancer staging systems, considerable controversy about the current staging system for medullary thyroid carcinoma (MTC) continues. Objective We aimed to evaluate the prognostic performance of the current eighth edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control TNM staging system (TNM-8) and the alternative proposed prognostic stage groups based on recursive partitioning analysis (TNM-RPA). Design, Setting, and Patients We retrospectively analyzed 182 patients with MTC treated at a single tertiary Korean hospital between 1995 and 2015. Interventions and Main Outcome Measures Survival analysis was conducted according to TNM-8 and TNM-RPA. The area under the receiver-operating characteristic curve (AUC), the proportion of variation explained (PVE), and the Harrell concordance index (C-index) were used to evaluate predictive performance. Results Under TNM-8, only two (1.1%) patients were downstaged compared with the seventh edition of the AJCC TNM staging system (TNM-7). The AUC at 10 years, PVE, and C-index were 0.679, 8.7%, and 0.744 for TNM-7 and 0.681, 8.9%, and 0.747 for TNM-8, respectively. Under TNM-RPA, 104 (57.14%) patients were downstaged compared with TNM-8. TNM-RPA had better prognostic performance with respect to cancer-specific survival (AUC at 10 years, 0.750; PVE, 20.9%; C-index, 0.881). Conclusions The predictive performance of the revised TNM-8 in patients with MTC has not changed despite its modification from TNM-7. The proposed changes in TNM-RPA were statistically valid and may present a more reproducible system that better estimates cancer-specific survival of individual patients.

scholarly journals Replication of newly proposed TNM staging system for medullary thyroid carcinoma: a nationwide study

2019 ◽  
Vol 8 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Jes Sloth Mathiesen ◽  
Jens Peter Kroustrup ◽  
Peter Vestergaard ◽  
Per Løgstrup Poulsen ◽  
Åse Krogh Rasmussen ◽  
...  
Keyword(s):  
United States ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Stage Iv ◽  
Staging System ◽  
The United States ◽  
Population Based ◽  
Tnm Staging ◽  
Medullary Thyroid ◽  
Tnm Staging System

A recent study proposed new TNM groupings for better survival discrimination among stage groups for medullary thyroid carcinoma (MTC) and validated these groupings in a population-based cohort in the United States. However, it is unknown how well the groupings perform in populations outside the United States. Consequently, we conducted the first population-based study aiming to evaluate if the recently proposed TNM groupings provide better survival discrimination than the current American Joint Committee on Cancer (AJCC) TNM staging system (seventh and eighth edition) in a nationwide MTC cohort outside the United States. This retrospective cohort study included 191 patients identified from the nationwide Danish MTC cohort between 1997 and 2014. In multivariate analysis, hazard ratios for overall survival under the current AJCC TNM staging system vs the proposed TNM groupings with stage I as reference were 1.32 (95% CI: 0.38–4.57) vs 3.04 (95% CI: 1.38–6.67) for stage II, 2.06 (95% CI: 0.45–9.39) vs 3.59 (95% CI: 1.61–8.03) for stage III and 5.87 (95% CI: 2.02–17.01) vs 59.26 (20.53–171.02) for stage IV. The newly proposed TNM groupings appear to provide better survival discrimination in the nationwide Danish MTC cohort than the current AJCC TNM staging. Adaption of the proposed TNM groupings by the current AJCC TNM staging system may potentially improve accurateness in survival discrimination. However, before such an adaption further population-based studies securing external validity are needed.

New and Important Changes in the TNM Staging System for Breast Cancer

2018 ◽  
pp. 457-467 ◽  
Author(s):  
Gabriel N. Hortobagyi ◽  
Stephen B. Edge ◽  
Armando Giuliano
Keyword(s):  
Breast Cancer ◽  
Regional Lymph Node ◽  
Staging System ◽  
Distant Metastases ◽  
Tnm Staging ◽  
Pathology Report ◽  
Imaging Evaluation ◽  
Complete Surgical Excision ◽  
Tnm Staging System ◽  
Eighth Edition

Expanded understanding of biologic factors that modulate the clinical course of malignant disease have led to the gradual integration of biomarkers into staging classifications. The American Joint Committee on Cancer (AJCC) TNM staging system is universally used and has largely displaced other staging classifications for most, although not all, cancers. Many of the chapters of the eighth edition of the AJCC TNM staging system integrated biomarkers with anatomic definitions. The Breast Chapter added estrogen receptor (ER) and progesterone receptor (PR) expression, HER2 expression, and/or amplification and histologic grade to the anatomic assessment of tumor size, regional lymph node involvement, and distant metastases (known as TNM). While preserving an anatomic staging system for continuity and for regions where modern biomarkers are not always available, the eighth edition emphasizes the increased prognostic precision of the clinical prognostic stage groups and the pathologic prognostic stage groups. The clinical prognostic stage groups are applicable to all patients with primary breast cancer before any treatment has been implemented, but require a clinical and imaging evaluation as well as a biopsy with grade and available ER, PR, and HER2 results; the pathologic prognostic stage groups are applicable to all patients treated with complete surgical excision as first treatment and also require a complete pathology report, grade, and ER, PR, and HER2. Applying the pathologic prognostic stage groups to a large database of patients staged by basic TNM groupings changed the stage grouping of almost 40% of patients. Grouping by pathologic prognostic stage groups led to a better prognostic distribution of the group and more precise individual prognostication.

scholarly journals A Model for the Prediction of Survival in Patients With Upper Tract Urothelial Carcinoma After Surgery

Dose-Response ◽  
2019 ◽  
Vol 17 (4) ◽  
pp. 155932581988287
Author(s):  
Guang-lin Zhang ◽  
Wei Zhou
Keyword(s):  
Urothelial Carcinoma ◽  
Predictive Ability ◽  
Staging System ◽  
Tnm Staging ◽  
Upper Tract Urothelial Carcinoma ◽  
Cancer Specific Survival ◽  
Upper Tract ◽  
Tnm Staging System ◽  
Prediction Of Survival ◽  
Validation Set

Objective: We aimed to formulate and validate prognostic nomograms that can be used to predict the prognosis of patients with upper tract urothelial carcinoma (UTUC). Methods: By consulting the Surveillance, Epidemiology, and End Results (SEER) database, we identified patients who were surgically treated for UTUC between 2004 and 2013. Variables were analyzed in both univariate and multivariate analyses. Nomograms were constructed based on independent prognostic factors. The prognostic nomogram models were established and validated internally and externally to determine their ability to predict the survival of patients with UTUC. Results: A total of 4990 patients were collected and enrolled in our analyses. Of these, 3327 patients were assigned to the training set and 1663 to the validation set. Nomograms were effectively applied to predict the 3- and 5-year survivals of patients with UTUC after surgery. The nomograms exhibited better accuracy for predicting overall survival (OS) and cancer-specific survival (CSS) than the tumor-node-metastasis (TNM) staging system and the SEER stage in both the training and validation sets. Calibration curves indicated that the nomograms exhibited high correlation to actual observed results for both OS and CSS. Conclusions: The nomogram models showed stronger predictive ability than the TNM staging system and the SEER stage. Precise estimates of the prognosis of UTUC might help doctors to make better treatment decisions.

Independent validation of the 2002 UICC TNM staging system for papillary renal cell carcinoma in a multicenter cohort

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5092-5092
Author(s):  
C. Wulfing ◽  
E. Herrmann ◽  
L. Trojan ◽  
A. Schrader ◽  
F. Becker ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Multivariate Analysis ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Papillary Renal Cell Carcinoma ◽  
Staging System ◽  
Tnm Staging ◽  
Cancer Specific Survival ◽  
Tnm Staging System

5092 Background: Papillary renal cell carcinoma (pRCC) is the second most malignant histologic subtype in nephrectomy specimens. To date, the most recognized staging system to stratify renal cancer patients is the 2002 UICC TNM classification system. Its accuracy for predicting patient outcome for pRCC is unknown. Methods: From ten urologic institutions in Germany follow-up data on 675 patients with pRCC were collected. In most cases histologic slides were available and central pathologic review was performed. The Kaplan-Meier method was used to derive the cumulative cancer-specific survival. For multivariate analysis of prognostic factors, a Cox regression analysis was performed. Results: 498 (74.1%) patients had organ-confined tumor stages (≤pT2). Synchronous distant metastases in the entire group occurred in 58 (8.7%) patients and 69 (11.2%) others developed metastatic disease during follow-up. Cancer-specific survival (CSS) was significantly related to TNM stage and histologic grading in univariate as well as in multivariate analysis (all p < 0.0001). 5-year CSS in pT1b tumors (90.0%) was significantly shorter compared to pT1a tumors (98.3%) (p = 0.017). Patients with ≥pT3 were at high risk for metastases (50.6%), while metastatic disease associated with ≤pT2 tumors occurred in 7.8% (p < 0.0001). Once metastatic disease was present, prognosis was poor (5-year CSS: 7.2%). Age was associated with a worse prognosis in the subgroup of ≥pT3 tumors in univariate (p = 0.026), but not in multivariate analysis. Conclusions: The 2002 UICC TNM staging system is applicable for pRCC. Clinical and radiologic follow-ups should be offered in frequent intervals to patients with venous thrombus and/or locally advanced disease. The role of age remains unclear, but should not be underestimated at risk stratification after tumor resection. No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document