Prognostic value of the 8th edition of the tumor-node-metastasis classification for patients with papillary thyroid carcinoma: a single-institution study at a high-volume center in Japan

Yasuhiro Ito; Akira Miyauchi; Mitsuyoshi Hirokawa; Masatoshi Yamamoto; Hitomi Oda; Hiroo Masuoka; Hisanori Sasai; Mitsuhiro Fukushima; Takuya Higashiyama; Minoru Kihara; Akihiro Miya

doi:10.1507/endocrj.EJ18-0019

ORIGINAL

Prognostic value of the 8^th edition of the tumor-node-metastasis classification for patients with papillary thyroid carcinoma: a single-institution study at a high-volume center in Japan

Yasuhiro Ito, Akira Miyauchi, Mitsuyoshi Hirokawa, Masatoshi Yamamoto, Hitomi Oda, Hiroo Masuoka, Hisanori Sasai, Mitsuhiro Fukushima, Takuya Higashiyama, Minoru Kihara, Akihiro Miya

Author information

Yasuhiro Ito
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Akira Miyauchi
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Mitsuyoshi Hirokawa
Department of Diagnostic Pathology, Kuma Hospital, Kobe 650-0011, Japan
Masatoshi Yamamoto
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Hitomi Oda
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Hiroo Masuoka
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Hisanori Sasai
Department of Head and Neck Surgery, Kuma Hospital, Kobe 650-0011, Japan
Mitsuhiro Fukushima
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Takuya Higashiyama
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Minoru Kihara
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan
Akihiro Miya
Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan

Keywords: Papillary carcinoma, Thyroid, Tumor-node-metastasis staging system, Lymph node metastasis, Carcinoma extension

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2018 Volume 65 Issue 7 Pages 707-716

DOI https://doi.org/10.1507/endocrj.EJ18-0019

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Abstract

The tumor-node-metastasis (TNM) staging system is most commonly adopted to evaluate the prognosis of patients with thyroid carcinoma. The 8^th edition of the TNM staging system, an extensively revised version of the 7^th edition, was recently released. We aimed to investigate whether and how well the 8^th edition reflects the cause-specific survival (CSS) of patients with papillary thyroid carcinoma by analyzing the cases in 5,892 patients who underwent initial surgery at Kuma Hospital between 1987 and 2005. The median postoperative follow-up duration was 178 months (range: 6–357 months). One patient with T4b disease was excluded from the analysis. Overall, 116 (2.0%) patients died of thyroid carcinoma. The proportion of variance explained (PVE) for CSS in the 7^th and 8^th editions was 10.69 and 10.97, respectively. Using the 7^th edition, CSS of patients with stage IVA and stage III disease was similar (p = 0.32). In contrast, using the 8^th edition, CSS was poorer in stage II than in stage I (p < 0.001), in stage III than in stage II (p < 0.001), and in stage IVB than in stage III (p < 0.001). Similar results were observed for disease-free survival. Although we could not establish any objective evidence that the 8^th edition is superior to the 7^th edition, the 8^th edition is simpler and more convenient, as it includes fewer stages and addresses the issue of the 7^th edition where stage IVA and III patients had similar prognoses.

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