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Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years?

Publication ,  Journal Article
Kim, M; Kim, YN; Kim, WG; Park, S; Kwon, H; Jeon, MJ; Ahn, HS; Jung, S-H; Kim, SW; Kim, WB; Chung, JH; Shong, YK; Kim, TH; Kim, TY
Published in: Clin Endocrinol (Oxf)
March 2017

OBJECTIVE: Age >45 years is included as a variable in the tumor, node, metastases (TNM) staging of differentiated thyroid cancer (DTC), but a higher cut-off value has been suggested to be more clinically relevant and prevent over-staging. We evaluated the optimal age cut-off to predict disease-specific survival (DSS) in patients with DTC. DESIGN AND PATIENTS: This cohort study included 6333 patients with DTC who underwent thyroid surgery at two tertiary referral centres between 1996 and 2005. The optimal age cut-off value between 45 and 65 years for prediction of DSS was assessed. The proportion of variation explained (PVE) and Harrell's c-index was calculated to compare the predictability of each model. RESULTS: The median age of patients was 46·0 years (IQR 37·8-54·6), and 5498 (87%) were female. Median follow-up period was 10·0 years, and 10-year DSS rate was 98%. Using TNM staging with 45 years as the cut-off (TNM45), 10-year DSS rates of stage I-IV were 99·4%, 96·1%, 97·7% and 85·9%, respectively (PVE = 3·0%, Harrell's c-index = 0·693); and using 55 years as the cut-off (TNM55), 99·4%, 92·2%, 95·3% and 79·7%, respectively (PVE = 4·3%, Harrell's c-index = 0·776). On receiver operating characteristic curve analysis, the optimal age cut-off for prediction of DSS was 55·4 years (area under the curve = 0·837, P < 0·001). About 20% of patients were down-staged to stage I using TNM55 compared to that using TNM45. CONCLUSIONS: The cut-off age of 55 years was more appropriate for TNM staging to achieve better predictability for DSS in patients with DTC. This change would prevent over-staging in low-risk patients and prevent over-aggressive treatment.

Duke Scholars

Published In

Clin Endocrinol (Oxf)

DOI

EISSN

1365-2265

Publication Date

March 2017

Volume

86

Issue

3

Start / End Page

438 / 443

Location

England

Related Subject Headings

  • Thyroid Neoplasms
  • Survival Rate
  • Risk Assessment
  • ROC Curve
  • Prognosis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
 

Citation

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ICMJE
MLA
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Kim, M., Kim, Y. N., Kim, W. G., Park, S., Kwon, H., Jeon, M. J., … Kim, T. Y. (2017). Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years? Clin Endocrinol (Oxf), 86(3), 438–443. https://doi.org/10.1111/cen.13254
Kim, Mijin, Young Nam Kim, Won Gu Kim, Suyeon Park, Hyemi Kwon, Min Ji Jeon, Hyeon Seon Ahn, et al. “Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years?Clin Endocrinol (Oxf) 86, no. 3 (March 2017): 438–43. https://doi.org/10.1111/cen.13254.
Kim M, Kim YN, Kim WG, Park S, Kwon H, Jeon MJ, et al. Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years? Clin Endocrinol (Oxf). 2017 Mar;86(3):438–43.
Kim, Mijin, et al. “Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years?Clin Endocrinol (Oxf), vol. 86, no. 3, Mar. 2017, pp. 438–43. Pubmed, doi:10.1111/cen.13254.
Kim M, Kim YN, Kim WG, Park S, Kwon H, Jeon MJ, Ahn HS, Jung S-H, Kim SW, Kim WB, Chung JH, Shong YK, Kim TH, Kim TY. Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years? Clin Endocrinol (Oxf). 2017 Mar;86(3):438–443.
Journal cover image

Published In

Clin Endocrinol (Oxf)

DOI

EISSN

1365-2265

Publication Date

March 2017

Volume

86

Issue

3

Start / End Page

438 / 443

Location

England

Related Subject Headings

  • Thyroid Neoplasms
  • Survival Rate
  • Risk Assessment
  • ROC Curve
  • Prognosis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies