Is there a need for yet another staging system for differentiated thyroid cancer?
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EDITORIAL
Is there a need for yet another staging system for differentiated thyroid cancer? Michael Bouvet
Received: 29 January 2014 / Accepted: 3 February 2014 Ó Springer Science+Business Media New York 2014
Papillary thyroid carcinoma and follicular thyroid carcinoma together comprise a generally indolent group of cancers known as differentiated thyroid carcinomas (DTCs). In 2014, there will be an estimated 62,980 new cases of differentiated thyroid cancer, and the incidence is rising faster than any other cancer in the USA [1]. Although the prognosis of DTC is generally good, a small subset of patients eventually die of the disease and up to 30 % of patients experience a recurrence of their disease after 30 years of follow-up [2]. As a result, a number of studies have identified various clinical and pathologic predictors for DTC and devised risk-group stratification or staging systems to select those at high risk of disease recurrence for more aggressive surgical and adjuvant treatment, while those at low risk would be spared aggressive treatment. The American Joint Committee on Cancer (AJCC)/ Union for International Cancer Control tumor–node– metastasis (TNM) staging system is the most widely used and is considered the international gold standard and the staging system currently recommended by the American Thyroid Association [3]. Other thyroid cancer staging systems include the Mayo Clinic’s metastases, age, complete resection, invasion, size [4]; the Lahey Clinic’s age, metastases, extent, size [5]; and the European Organization for Research and Treatment of Cancer systems [6]. One review of the literature found over 14 different staging systems for papillary thyroid cancer alone [7]. M. Bouvet Department of Surgery, University of California San Diego, San Diego, CA, USA M. Bouvet (&) Moores UCSD Cancer Center, 3855 Health Sciences Drive #0987, La Jolla, CA 92093-0987, USA e-mail: [email protected]
With so many staging systems for thyroid cancer, one might ask, is there a need for yet another staging system? While the TNM stratification has been found useful at stratifying patients with DTC into prognostic risk groups, it is cumbersome to implement clinically given the large number of bins within this system and the complicated system of arriving at stage information. In 2009, Onitilo et al. [8] reported a simplified quantitative alternative to the TNM system (QTNM) and compared this with the conventional system. Six hundred and fourteen cases of DTC managed at their institution from 1987 to 2006 were identified. Cancerspecific survival (CSS) and disease-free survival (DFS) were calculated by the Kaplan–Meier method, and a simplified QTNM score was devised using a Cox proportional hazards model. The TNM system was quantified as follows: 4 points each for age older than 45 years and presence of neck nodal metastases while 6 points for tumor size larger than 4 cm or extrathyroidal extension and 1 point for non-papillary DTC. A sum of 0–5 points was low risk, 6–10 points intermediate, and 11–15 points high ri
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