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J Clin Endocrinol Metab. 2018 Dec 1;103(12):4609-4616. doi: 10.1210/jc.2018-01386.

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

Author information

1
Division of Endocrinology and Metabolism, Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Division of Endocrinology and Metabolism, Department of Medicine, Gyeongsang National University Graduate School of Medicine, Jinju, Gyeongsangnam-do, Korea.
3
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Changwon Medical Center, Changwon, Gyeongsangnam-do, Korea.
4
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
5
Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
6
Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
7
Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.

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.

PMID:
30137493
DOI:
10.1210/jc.2018-01386

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