Naoyoshi Onoda1,2, Iwao Sugitani1,3, Ken-Ichi Ito1,4, Akifumi Suzuki1,5, Takuya Higashiyama1,6, Tatsuya Fukumori1,7, Nobuyasu Suganuma1,8, Katsuhiko Masudo1,9, Hirotaka Nakayama1,10, Atsuhiko Uno1,11, Katsunari Yane1,12, Seiichi Yoshimoto1,13, Aya Ebina1,14, Yukari Kawasaki1,15, Shigeto Maeda1,16, Manabu Iwadate1,17, Shinichi Suzuki1,17. 1. Anaplastic Thyroid Carcinoma Research Consortium of Japan, Tokyo 113-8603, Japan. 2. Department of Breast & Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan. 3. Department of Endocrine Surgery, Nippon Medical School, Tokyo 113-8603, Japan. 4. Division of Breast and Endocrine Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto 390-8621, Japan. 5. Department of Surgery, Ito Hospital, Tokyo 150-8308, Japan. 6. Department of Surgery, Kuma Hospital, Kobe 650-0011, Japan. 7. Department of Surgery, Kanaji Thyroid Hospital, Tokyo 114-0015, Japan. 8. Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama 241-8515, Japan. 9. Department of Breast and Endocrine Surgery, Yokohama City University Medical Center, Yokohama 232-0024, Japan. 10. Department of Surgery, Yokohama City University, Yokohama 236-0004, Japan. 11. Department of Otolaryngology-Head and Neck Surgery, Osaka General Medical Center, Osaka 558-8558, Japan. 12. Department of Otolaryngology-Head and Neck Surgery, Kindai University Nara Hospital, Ikoma 630-0293, Japan. 13. Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan. 14. Department of Head and Neck Surgery, Cancer Institute Hospital, Tokyo 135-8550, Japan. 15. Department of Surgery, Tsuchiya General Hospital, Hiroshima 730-0811, Japan. 16. Department of Surgery, National Hospital Organization Nagasaki Medical Center, Omura 856-8562, Japan. 17. Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima 960-1247, Japan.
Abstract
BACKGROUND: The tumor-node-metastasis (TNM) classification system to categorized anaplastic thyroid cancer (ATC) was revised. METHODS: The revised system was evaluated using a large database of ATC patients. RESULTS: A total of 757 patients were analyzed. The proportion and median overall survival values (OS: months) for each T category were T1 (n = 8, 1.1%, 12.5), T2 (n = 43, 5.7%, 10.9), T3a (n = 117, 15.5%, 5.7), T3b (n = 438, 57.9%, 3.9), and T4 (n = 151, 19.9%, 5.0). The OS of the N0 and N1 patients were 5.9 and 4.3, respectively (log-rank p < 0.01). Sixty-three (58.3%) patients migrated from stage IV A to IV B by revision based on the existence of nodal involvement and 422 patients (55.7%) were stratified into stage IV B, without a worsening of their OS (6.1), leaving 45 patients (5.9%) in stage IV A with fair OS (15.8). The hazard ratios for the survival of the patients of stage IV B compared to stage IV A increased from 1.1 to 2.1 by the revision. No change was made for stage IV C (n = 290, 38.8%, 2.8). CONCLUSION: The revised TNM system clearly indicated the prognoses of ATC patients by extracting rare patients with fair prognoses as having stage IV A disease and categorized many heterogeneous patients in stage IV B.
BACKGROUND: The tumor-node-metastasis (TNM) classification system to categorized anaplastic thyroid cancer (ATC) was revised. METHODS: The revised system was evaluated using a large database of ATCpatients. RESULTS: A total of 757 patients were analyzed. The proportion and median overall survival values (OS: months) for each T category were T1 (n = 8, 1.1%, 12.5), T2 (n = 43, 5.7%, 10.9), T3a (n = 117, 15.5%, 5.7), T3b (n = 438, 57.9%, 3.9), and T4 (n = 151, 19.9%, 5.0). The OS of the N0 and N1 patients were 5.9 and 4.3, respectively (log-rank p < 0.01). Sixty-three (58.3%) patients migrated from stage IV A to IV B by revision based on the existence of nodal involvement and 422 patients (55.7%) were stratified into stage IV B, without a worsening of their OS (6.1), leaving 45 patients (5.9%) in stage IV A with fair OS (15.8). The hazard ratios for the survival of the patients of stage IV B compared to stage IV A increased from 1.1 to 2.1 by the revision. No change was made for stage IV C (n = 290, 38.8%, 2.8). CONCLUSION: The revised TNM system clearly indicated the prognoses of ATCpatients by extracting rare patients with fair prognoses as having stage IV A disease and categorized many heterogeneous patients in stage IV B.