Subclassification of Tumor Extension and Nodal Metastasis in Papillary Thyroid Cancer to Improve Prognostic Accuracy of the Eighth Edition of the Tumor–Node–Metastasis Classification

  title={Subclassification of Tumor Extension and Nodal Metastasis in Papillary Thyroid Cancer to Improve Prognostic Accuracy of the Eighth Edition of the Tumor–Node–Metastasis Classification},
  author={Yasuhiro Ito and Akira Miyauchi and Minoru Kihara and Hiroo Masuoka and Takuya Higashiyama and Akihiro Miya},
  journal={World Journal of Surgery},
Background The eighth edition of the tumor–node–metastasis classification system (TNM-8th) reflects the prognosis of papillary thyroid cancer (PTC) better than the seventh edition. This study investigated methods to further improve the prognostic accuracy of the TNM-8th. Methods We enrolled 5683 patients who underwent surgery for PTC at the Kuma Hospital. We subdivided tumor extension (T4a) into T4a1 and T4a2 based on intraoperative gross findings and N1 according to size ( < 3 cm and ≥ 3 cm… 
5 Citations
Prognostic Value of Extranodal Tumor Extension in Papillary Thyroid Carcinoma: Proposal for Upstaging of Cases with Extranodal Tumor Extension
The prognostic significance of extranodal tumor extension (LNEx) in PTC is investigated and LNEx-positive patients younger than 55 years in Stage I and those aged 55 or older in Stage II are re-staged to II and III, respectively.
The Role of Tumor and Lymph Node Size and Extension in Papillary Thyroid Cancer Staging
  • H. Mazeh
  • Medicine
    World Journal of Surgery
  • 2019
It is brought to the attention of the readers that intraoperative findings need to be considered as vital for thyroid cancer staging and this approach cannot be overstated.
Impact of gross extrathyroidal extension into major neck structures on the prognosis of papillary thyroid carcinoma according to the American Joint Committee on Cancer eighth edition.
The results indicate that the progression of aerodigestive tract infiltration has an impact on the incidence of distant recurrence, and the presence of T4b disease has animpact on the occurrence of distant and locoregional recurrences.
Detailed characterization of metastatic lymph nodes improves the prediction accuracy of currently used risk stratification systems in N1 stage papillary thyroid cancer.
The combination of currently used risk stratification systems with detailed characterization of MLNs may improve the predictive accuracy for recurrence/progression in N1 PTC patients.
Diagnostic and prognostic value of preoperative systemic inflammatory markers in anaplastic thyroid cancer
This work aimed to explore potential diagnostic and prognostic value of systematic inflammatory markers (SIMs) in ATC and aDTC.


Prognostic value of the 8th edition of the tumor-node-metastasis classification for patients with papillary thyroid carcinoma: a single-institution study at a high-volume center in Japan.
Although the 8th edition of the TNM staging system is simpler and more convenient, as it includes fewer stages and addresses the issue of the 7th edition where stage IVA and III patients had similar prognoses, no objective evidence is established that it is superior to the 6th edition.
Prognostic value of the eighth edition AJCC TNM classification for differentiated thyroid carcinoma.
The results demonstrate that the eighth edition TNM more accurately predicts cancer-specific survival for patients with DTC than does the seventh edition.
Comparison of the Seventh and Eighth Editions of the American Joint Committee on Cancer/Union for International Cancer Control Tumor-Node-Metastasis Staging System for Differentiated Thyroid Cancer.
  • Mijin Kim, W. Kim, +8 authors M. Jeon
  • Medicine
    Thyroid : official journal of the American Thyroid Association
  • 2017
Applying TNM-8 could improve the accuracy of the staging system for predicting DSS in patients with differentiated thyroid carcinoma and a significant number of patients were reclassified to lower stages with the application of TNM/TNM-8.
Impact of the updated TNM staging criteria on prediction of persistent disease in a differentiated thyroid carcinoma cohort.
In a Brazilian cohort of differentiated thyroid carcinoma (DTC), 37% of DTC patients were down staged with the application of TNM-8 (vs.TNM-7), and TNm-8 seems to better stratify the risk of structural incomplete response at follow-up.
Establishment of an Intraoperative Staging System (iStage) by Improving UICC TNM Classification System for Papillary Thyroid Carcinoma
A new staging system based on not only preoperative but also intraoperative findings, which has high utility is established, and Appropriate intraoperative evaluation is mandatory to grade biological characteristics, including prognosis, of papillary carcinoma.
A novel classification system for patients with PTC: addition of the new variables of large (3 cm or greater) nodal metastases and reclassification during the follow-up period.
A novel classification system, in which large nodal metastases and postoperative reclassification were added, was devised, useful for choosing proper therapeutic strategies, offering rational information, and determining adequate postoperative follow-up schemes for individual patients with PTC.
Prognosis of patients with papillary thyroid carcinoma having clinically apparent metastasis to the lateral compartment.
It is suggested that N1b patients having metastasis larger than 3cm, those showing extranodal extension, and those having 5 or more clinically apparent metastasis should be regarded as high-risk, and that careful surgical treatment and postoperative follow-up are necessary.
Extranodal Tumor Extension to Adjacent Organs Predicts a Worse Cause-specific Survival in Patients with Papillary Thyroid Carcinoma
Presence of nodal ex significantly reflects the biologically aggressive behaviors of papillary carcinoma and has a prognostic value, especially for cause-specific survival of patients.
Prognostic Significance of Extrathyroid Extension of Papillary Thyroid Carcinoma: Massive but Not Minimal Extension Affects the Relapse-free Survival
These findings suggest that upgrading of T category for tumors with massive extension is appropriate, whereas that for tumor with only minimal extension is not, and careful surgical treatment and postoperative follow-up are required for tumorswith massive extension to posterior organs other than the recurrent laryngeal nerve.
Implication of minimal extrathyroidal extension as a prognostic factor in papillary thyroid carcinoma.
In patients with PTC, MEE does not impact RFS, and appropriate surgical intervention and postoperative follow up are mandatory in P TC, regardless of its extent.