TY - JOUR
T1 - A critical analysis of the American Joint Committee on Cancer (AJCC) staging system for differentiated thyroid carcinoma in young patients on the basis of the Surveillance, Epidemiology, and End Results (SEER) registry
AU - Tran Cao, Hop S.
AU - Johnston, Lily E.
AU - Chang, David C.
AU - Bouvet, Michael
N1 - Funding Information:
The SEER project is a United States population-based cancer registry that began in 1973 and is supported by the National Cancer Institute and Centers for Disease Control and Prevention. SEER contains data across multiple geographic regions on incidence, prevalence, mortality, and population-based variables and currently represents approximately 28% of the U.S. population. The SEER data set also contains information on the primary characteristics of the tumor, including site, spread, and histology when available, as well as limited information regarding treatment, excluding chemotherapy. Histological diagnoses in the SEER database use the International Classification of Disease for Oncology (ie, ICD-O) coding system and may overlap (eg, different codes for papillary carcinoma and papillary adenocarcinoma).
PY - 2012/8
Y1 - 2012/8
N2 - Background: Differentiated thyroid carcinomas (DTC) are the only tumors for which age is a determinant of stage in the American Joint Committee on Cancer's (AJCC) staging protocol. In this study, we re-examined the relationship between age, extent of disease, and prognosis by using a large dataset with longer follow-up times. Methods: We examined the Surveillance, Epidemiology, and End Results (SEER) registry data 1973 to 2005 for patients with DTC as their only known malignancy. We used Cox multivariate analyses to generate mortality hazard ratios, controlling for several variables, to evaluate the effects of age and disease extent. Results: We identified 55,402 patients with DTC. Of these, 49,240 had sufficient data to generate a TNM stage on the basis of AJCC guidelines. Within stage II, younger patients (<45 years) have worse outcomes than older patients (P <.001). Younger patients had an 11-fold increase in mortality between stages I and II, whereas there was no difference for older patients. When we uniformly applied the 45-and-older staging protocol to all patients, we found that stages III-IVc had a significantly greater risk of mortality for all patients compared with stage I. Conclusion: The presence of regional and metastatic thyroid cancer bears prognostic significance for all ages. Under current AJCC guidelines, young patients with metastatic thyroid cancer may be understaged.
AB - Background: Differentiated thyroid carcinomas (DTC) are the only tumors for which age is a determinant of stage in the American Joint Committee on Cancer's (AJCC) staging protocol. In this study, we re-examined the relationship between age, extent of disease, and prognosis by using a large dataset with longer follow-up times. Methods: We examined the Surveillance, Epidemiology, and End Results (SEER) registry data 1973 to 2005 for patients with DTC as their only known malignancy. We used Cox multivariate analyses to generate mortality hazard ratios, controlling for several variables, to evaluate the effects of age and disease extent. Results: We identified 55,402 patients with DTC. Of these, 49,240 had sufficient data to generate a TNM stage on the basis of AJCC guidelines. Within stage II, younger patients (<45 years) have worse outcomes than older patients (P <.001). Younger patients had an 11-fold increase in mortality between stages I and II, whereas there was no difference for older patients. When we uniformly applied the 45-and-older staging protocol to all patients, we found that stages III-IVc had a significantly greater risk of mortality for all patients compared with stage I. Conclusion: The presence of regional and metastatic thyroid cancer bears prognostic significance for all ages. Under current AJCC guidelines, young patients with metastatic thyroid cancer may be understaged.
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U2 - 10.1016/j.surg.2012.02.015
DO - 10.1016/j.surg.2012.02.015
M3 - Article
C2 - 22503316
AN - SCOPUS:84864285350
SN - 0039-6060
VL - 152
SP - 145
EP - 151
JO - Surgery (United States)
JF - Surgery (United States)
IS - 2
ER -