Iain J Nixon1, Deborah Kuk2, Volkert Wreesmann3, Luc Morris4, Frank L Palmer5, Ian Ganly6, Snehal G Patel7, Bhuvanesh Singh8, R Michael Tuttle9, Ashok R Shaha10, Mithat Gönen11, Jatin P Shah12. 1. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. iainjnixon@gmail.com. 2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. kukd@mskcc.org. 3. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. vwreesmann@yahoo.com. 4. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. morrisl@mskcc.org. 5. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. fpalmer2@gmail.com. 6. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. ganlyi@mskcc.org. 7. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. patels@mskcc.org. 8. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. singhb@mskcc.org. 9. Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. tuttlem@mskcc.org. 10. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. Shahaa@mskcc.org. 11. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. gonenm@mskcc.org. 12. Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10021, USA. shahj@mskcc.org.
Abstract
BACKGROUND: Age 45 years is used as a cutoff in the staging of well-differentiated thyroid cancer (WDTC) as it represents the median age of most datasets. The aim of this study was to determine a statistically optimized age threshold using a large dataset of patients treated at a comprehensive cancer center. METHODS: Overall, 1807 patients with a median follow-up of 109 months were included in the study. Recursive partitioning was used to determine which American Joint Committee on Cancer (AJCC) variables were most predictive of disease-specific death, and whether a different cutoff for age would be found. From the resulting tree, a new age cutoff was picked and patients were restaged using this new cutoff. RESULTS: The 10-year disease-specific survival (DSS) by Union for International Cancer Control (AJCC/UICC) stage was 99.6, 100, 96, and 81 % for stages I-IV, respectively. Using recursive partitioning, the presence of distant metastasis was the most powerful predictor of DSS. For M0 patients, age was the next most powerful predictor, with a cutoff of 56 years. For M1 patients, a cutoff at 54 years was most predictive. Having reviewed the analysis, age 55 years was selected as a more robust age cutoff than 45 years. The 10-year DSS by new stage (using age 55 years as the cutoff) was 99.2, 98, 100, and 74 % for stages I-IV, respectively. CONCLUSION: A change in age cutoff in the AJCC/UICC staging for WDTC to 55 years would improve the accuracy of the system and appropriately prevent low-risk patients being overstaged and overtreated.
BACKGROUND: Age 45 years is used as a cutoff in the staging of well-differentiated thyroid cancer (WDTC) as it represents the median age of most datasets. The aim of this study was to determine a statistically optimized age threshold using a large dataset of patients treated at a comprehensive cancer center. METHODS: Overall, 1807 patients with a median follow-up of 109 months were included in the study. Recursive partitioning was used to determine which American Joint Committee on Cancer (AJCC) variables were most predictive of disease-specific death, and whether a different cutoff for age would be found. From the resulting tree, a new age cutoff was picked and patients were restaged using this new cutoff. RESULTS: The 10-year disease-specific survival (DSS) by Union for International Cancer Control (AJCC/UICC) stage was 99.6, 100, 96, and 81 % for stages I-IV, respectively. Using recursive partitioning, the presence of distant metastasis was the most powerful predictor of DSS. For M0 patients, age was the next most powerful predictor, with a cutoff of 56 years. For M1 patients, a cutoff at 54 years was most predictive. Having reviewed the analysis, age 55 years was selected as a more robust age cutoff than 45 years. The 10-year DSS by new stage (using age 55 years as the cutoff) was 99.2, 98, 100, and 74 % for stages I-IV, respectively. CONCLUSION: A change in age cutoff in the AJCC/UICC staging for WDTC to 55 years would improve the accuracy of the system and appropriately prevent low-risk patients being overstaged and overtreated.
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