New proposed tumor-node-metastasis staging system for medullary thyroid carcinoma based on the Surveillance, Epidemiology, and End Results database

Min Wang; Di Hu; Wen Zeng; Sichao Chen; Yihui Huang; Ling Zhou; Wei Zhou; Wei Wei; Chao Zhang; Zeming Liu; Liang Guo

New proposed tumor-node-metastasis staging system for medullary thyroid carcinoma based on the Surveillance, Epidemiology, and End Results database

Am J Transl Res. 2020 Jun 15;12(6):2703-2710. eCollection 2020.

Authors

Min Wang¹, Di Hu¹, Wen Zeng², Sichao Chen¹, Yihui Huang¹, Ling Zhou¹, Wei Zhou¹, Wei Wei³, Chao Zhang⁴, Zeming Liu¹, Liang Guo¹

Affiliations

¹ Department of Plastic Surgery, Zhongnan Hospital of Wuhan University Wuhan 430071, China.
² Department of Ophthalmology, Zhongnan Hospital of Wuhan University Wuhan 430071, China.
³ Department of Pediatrics, St John Hospital and Medical Center Detroit, MI, USA.
⁴ Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China.

PMID: 32655802
PMCID: PMC7344094

Abstract

Background: Medullary thyroid carcinoma (MTC) has been separated into its own chapter in the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. However, controversies still exist for the staging of MTC. This study aimed to identify prognostic differences among patients with MTC to define a more accurate staging system.

Methods: Data on cancer-specific survival from the Surveillance, Epidemiology, and End Results database between 2010 and 2014 were used for this study. Kaplan-Meier (K-M) curves, Cox proportional hazards regression analysis, and mortality per 1000-person-years were used to evaluate the mortality rate to create the new staging system.

Results: A total of 960 cases were included in this analysis. The mortality rates of 24 different groups, which were classified using T stage (T1-4), N stage (N0-1b), and M stage (M0-1) were assessed using K-M curves. Cox proportional hazards regression analysis and mortality per 1000-person-years were used to classify patients, as stage I (T1-3N0-1aM0, 654, 68.34%), stage II (T1-3N1bM0, 181, 18.91%), stage III (T4N0-1bM0, 58, 6.06%), and stage IV (T1-4N0-1bM1, 64, 6.69%). The hazard ratios of stages II, III, and IV, using stage I as a reference, were 5.281 (95% confidence interval [CI], 1.236-22.562), 20.603 (95% CI, 4.400-96.467), and 55.717 (95% CI, 14.307-216.988), respectively. The mortality rates per 1000-person-years of stages I, II, III, and IV were 2.036 (95% CI, 0.657-6.312), 14.867 (95% CI, 6.679-33.092), 98.287 (95% CI, 54.432-177.478), and 224.199 (95% CI, 146.180-343.860), respectively.

Conclusions: Compared with the current AJCC tumor-node-metastasis (TNM) staging system for MTC, this new proposed TNM staging system, which is based on cancer-specific mortality rate analysis, provides more accurate risk stratification and can ensure more rational treatment measures.

Keywords: AJCC staging system; Medullary thyroid carcinoma; SEER; TNM staging system.