Evaluating the use of a two-step age-based cutoff for the UICC/AJCC TNM staging system in patients with papillary or follicular thyroid cancer

in European Journal of Endocrinology
Authors:
Evert F S van Velsen Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

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https://orcid.org/0000-0002-6938-065X
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Robin P Peeters Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

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https://orcid.org/0000-0001-7732-9371
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Merel T Stegenga Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

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Uwe Mäder Comprehensive Cancer Center, Würzburg, Germany

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Christoph Reiners Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany

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F J van Kemenade Academic Center for Thyroid Diseases, Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands

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Tessa M van Ginhoven Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands

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W Edward Visser Academic Center for Thyroid Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

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Frederik Anton Verburg Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
Academic Center for Thyroid Diseases, Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

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Correspondence should be addressed to E F S van Velsen Email e.vanvelsen@erasmusmc.nl
DOI:
https://doi.org/10.1530/EJE-21-1056
Volume/Issue:
Volume 186: Issue 3
Page Range:
389–397
Article Type:
Research Article
Online Publication Date:
09 Feb 2022
Copyright:
© European Society of Endocrinology 2022
Restricted access

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Background

The joint Union International Contre le Cancer and American Joint Committee on Cancer (UICC/AJCC) Tumor, Node, Metastasis (TNM) staging system for differentiated thyroid cancer (DTC) involves a single age cutoff as a prognostic criterion. Because a single cutoff is a dichotomization of what might be a sliding scale, using multiple age cutoffs might result into a better stage definition. The aim of our study was to investigate if using a two-step age-based cutoff would improve the TNM staging system regarding disease-specific survival (DSS).

Methods

We retrospectively studied two cohorts of adult DTC patients from The Netherlands and Germany. DSS was analyzed for papillary (PTC) and follicular thyroid cancer (FTC) separately, investigating several two-step age-based cutoffs for those with distant metastases; below lower threshold classified as stage I, between lower and upper threshold as stage II, and above upper threshold as stage IV.

Results

We included 3074 DTC patients (77% PTC). For PTC, an age cutoff of 45 with 50 years had the best statistical model performance, while this was 25 with 40 years for FTC. However, differences with the optimal single age cutoffs of 50 years for PTC and 40 years for FTC were small.

Conclusions

The optimal two-step age-based cutoff to predict DSS is 45 with 50 years for PTC and 25 with 40 years for FTC, rather than 55 years currently used for DTC. Although these two-step age-based cutoffs were marginally better from a statistical point of view, from a clinical point of view, the recently defined optimal single age cutoffs of 50 years for PTC and 40 years for FTC might be preferable.

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Sept 2018 onwards Past Year Past 30 Days
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Print ISSN:
0804-4643
Online ISSN:
1479-683X

     European Society of Endocrinology

Copyright:
© European Society of Endocrinology 2022
Page(s):
9
Article Type:
Research Article
Received Date:
14 Oct 2021
Accepted Date:
13 Jan 2022
Print Publication Date:
01 Mar 2022
Online Publication Date:
09 Feb 2022
Sept 2018 onwards Past Year Past 30 Days
Abstract Views 3498 17 13
Full Text Views 183 0 0
PDF Downloads 160 0 0
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