Donald S A McLeod1,2,3, Jacqueline Jonklaas4, James D Brierley5, Kenneth B Ain6, David S Cooper7, Henry G Fein8, Bryan R Haugen9, Paul W Ladenson7, James Magner10, Douglas S Ross11, Monica C Skarulis12, David L Steward13, Mingzhao Xing7, Danielle R Litofsky14, Harry R Maxon15, Steven I Sherman14. 1. 1 Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital , Herston, Australia . 2. 2 Population Health Department, QIMR Berghofer Medical Research Institute , Herston, Australia . 3. 3 School of Medicine, University of Queensland , Herston, Australia . 4. 4 Division of Endocrinology, Department of Medicine, Georgetown University Medical Center , Washington, District of Columbia. 5. 5 Department of Radiation Oncology, Princess Margaret Hospital , Toronto, Canada . 6. 6 Department of Internal Medicine, Veterans Affairs Medical Center and University of Kentucky , Lexington, Kentucky. 7. 7 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland. 8. 8 Division of Endocrinology and Metabolism, Sinai Hospital , Baltimore, Maryland. 9. 9 Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine , Aurora, Colorado. 10. 10 Genzyme, a Sanofi Company , Cambridge, Massachusetts. 11. 11 Thyroid Unit, Massachusetts General Hospital , Boston, Massachusetts. 12. 12 Diabetes, Endocrinology, Obesity Branch, National Institutes of Health , Bethesda, Maryland. 13. 13 Department of Head and Neck Surgery, University of Cincinnati Medical Center , Cincinnati, Ohio. 14. 14 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center , Houston, Texas. 15. 15 Department of Nuclear Medicine, University of Cincinnati Medical Center , Cincinnati, Ohio.
Abstract
BACKGROUND: Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. OBJECTIVE: This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. METHODS: A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R(2)). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. RESULTS: The best five alternate papillary cancer systems had age cut-points of 45-50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50-55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003-0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). CONCLUSIONS: No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation.
BACKGROUND:Thyroid cancer is unique for having age as a staging variable. Recently, the commonly used age cut-point of 45 years has been questioned. OBJECTIVE: This study assessed alternate staging systems on the outcome of overall survival, and compared these with current National Thyroid Cancer Treatment Cooperative Study (NTCTCS) staging systems for papillary and follicular thyroid cancer. METHODS: A total of 4721 patients with differentiated thyroid cancer were assessed. Five potential alternate staging systems were generated at age cut-points in five-year increments from 35 to 70 years, and tested for model discrimination (Harrell's C-statistic) and calibration (R(2)). The best five models for papillary and follicular cancer were further tested with bootstrap resampling and significance testing for discrimination. RESULTS: The best five alternate papillary cancer systems had age cut-points of 45-50 years, with the highest scoring model using 50 years. No significant difference in C-statistic was found between the best alternate and current NTCTCS systems (p = 0.200). The best five alternate follicular cancer systems had age cut-points of 50-55 years, with the highest scoring model using 50 years. All five best alternate staging systems performed better compared with the current system (p = 0.003-0.035). There was no significant difference in discrimination between the best alternate system (cut-point age 50 years) and the best system of cut-point age 45 years (p = 0.197). CONCLUSIONS: No alternate papillary cancer systems assessed were significantly better than the current system. New alternate staging systems for follicular cancer appear to be better than the current NTCTCS system, although they require external validation.
Authors: Jacqueline Jonklaas; David S Cooper; Kenneth B Ain; Thomas Bigos; James D Brierley; Bryan R Haugen; Paul W Ladenson; James Magner; Douglas S Ross; Monica C Skarulis; David L Steward; Harry R Maxon; Steven I Sherman Journal: Thyroid Date: 2010-11-07 Impact factor: 6.568
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Authors: Iain J Nixon; Ian Ganly; Snehal G Patel; Frank L Palmer; Monica M Whitcher; Rony Ghossein; R Michael Tuttle; Ashok R Shaha; Jatin P Shah Journal: Int J Surg Date: 2012-11-02 Impact factor: 6.071
Authors: D S Cooper; B Specker; M Ho; M Sperling; P W Ladenson; D S Ross; K B Ain; S T Bigos; J D Brierley; B R Haugen; I Klein; J Robbins; S I Sherman; T Taylor; H R Maxon Journal: Thyroid Date: 1998-09 Impact factor: 6.568
Authors: Iain J Nixon; Laura Y Wang; Jocelyn C Migliacci; Antoine Eskander; Michael J Campbell; Ahmad Aniss; Lilah Morris; Fernanda Vaisman; Rossana Corbo; Denise Momesso; Mario Vaisman; Andre Carvalho; Diana Learoyd; William D Leslie; Richard W Nason; Deborah Kuk; Volkert Wreesmann; Luc Morris; Frank L Palmer; Ian Ganly; Snehal G Patel; Bhuvanesh Singh; R Michael Tuttle; Ashok R Shaha; Mithat Gönen; K Alok Pathak; Wen T Shen; Mark Sywak; Luis Kowalski; Jeremy Freeman; Nancy Perrier; Jatin P Shah Journal: Thyroid Date: 2016-02-25 Impact factor: 6.568
Authors: Sunghwan Suh; Yun Hak Kim; Tae Sik Goh; Jin Lee; Dae Cheon Jeong; Sae-Ock Oh; Jong Chul Hong; Seong Jang Kim; In Joo Kim; Kyoungjune Pak Journal: Endocrine Date: 2017-10-13 Impact factor: 3.633
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