Validation of the QTNM staging system for cancer-specific survival in patients with differentiated thyroid cancer

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ORIGINAL ARTICLE

Validation of the QTNM staging system for cancer-specific survival in patients with differentiated thyroid cancer Daniel Mankarios • Peter Baade • Pip Youl Robin H. Mortimer • Adedayo A. Onitilo • Anthony Russell • Suhail A. R. Doi

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Received: 14 July 2013 / Accepted: 4 October 2013 Ó Springer Science+Business Media New York 2013

Abstract An Australian state database was used to test the validity of the Quantitative tumor/node/metastasis (QTNM) staging system for assessing prognosis of differentiated thyroid cancer (DTC) on the basis of four variables quantified at diagnosis (histopathology, age, node involvement, and tumor size). Using the Queensland Cancer Registry (QCR), we identified 788 cases of DTC diagnosed from 1982 to 2006 with complete staging information. Causes of death were ascertained by linking the QCR database with the Australian National Death Index. Subjects were staged according to AJCC TNM 7th

Electronic supplementary material The online version of this article (doi:10.1007/s12020-013-0078-9) contains supplementary material, which is available to authorized users. D. Mankarios  R. H. Mortimer  A. Russell School of Medicine, University of Queensland, Brisbane, Australia P. Baade  P. Youl Cancer Council Queensland, Brisbane, QLD, Australia R. H. Mortimer Royal Brisbane Hospital, Brisbane, QLD, Australia A. A. Onitilo Department of Hematology/Oncology, Marshfield Clinic Weston Center, 3501 Cranberry Boulevard, Weston, WI 54476, USA A. A. Onitilo  S. A. R. Doi (&) Clinical Epidemiology Unit, School of Population Health, University of Queensland, Brisbane, QLD, Australia e-mail: [email protected] A. Russell  S. A. R. Doi Department of Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia

edition and QTNM, and cancer-specific survival (CSS) was calculated by the Kaplan–Meier method. Cancer-specific mortality was observed in 22 (2.8 %) patients, with 10-year CSS for the cohort of 97.0 % at a median follow-up of 262.8 months. QTNM stage specific cancer survival at 10 years was 99.6, 97.0, and 78.6 % for low-, intermediate, and high-risk groups, respectively. This was comparable to the original US dataset in which the QTNM was initially studied, and it fared better at discriminating survival than the standard TNM system, where there was overlap in survival between stages. The current study validates the QTNM system in an Australian cohort and shows at least equivalent discriminatory capacity to the current TNM staging system. The QTNM utilized prognostic variables of significance to produce an optimal three-stage stratification scheme. Given, its advantage in clearly discriminating between prognostic groups, clinical relevance and simplicity of use, we recommend that TNM be replaced with QTNM for risk stratification for both recurrence and CSS. Keywords Differentiated thyroid cancer  Prognosis  QTNM  Cancer staging  TNM

Introduction Differentiated thyroid carcinoma (DTC) is both the most common endocrine malignancy as well as the ninth most prevalent canc

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