Comparable outcomes for patients with pT1a and pT1b differentiated thyroid cancer: Is there a need for change in the AJCC classification system?

Wang, Laura Y.; Nixon, Iain J.; Palmer, Frank L.; Thomas, Dominic; Tuttle, R. Michael; Shaha, Ashok R.; Patel, Snehal G.; Shah, Jatin P.; Ganly, Ian

doi:10.1016/j.surg.2014.08.037

Cited by 24 publications

(21 citation statements)

References 20 publications

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“…The datasets used in the present study lack information regarding recurrence. However, other longitudinal institutional studies have shown no difference in recurrence rates between T1a and T1b tumors at five years (10,11), and up to 15 years following the time of diagnosis (16)(17)(18).…”

Section: T1a Versus T1b Differentiated Thyroid Cancersdiscussionmentioning

confidence: 95%

“…In a study analyzing disease-specific survival at a single institution, Wang et al could find no difference in disease-specific survival among 1522 patients with T1 DTC tumors categorized as T1a versus T1b (10). They demonstrated a five-year diseasespecific survival of 100% for both groups, which is similar to the survival rates of 99.7% and 99.8% for T1a and T1b subgroups, respectively, observed in the present NCDB study (10). In a smaller institutional study of 269 patients, DeGroot et al also reported no difference in survival between tumors measuring <1 cm and those with tumors 1-2 cm in size (11).…”

Section: T1a Versus T1b Differentiated Thyroid Cancersdiscussionmentioning

confidence: 99%

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T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?

Anderson

Youngwirth

Scheri

et al. 2016

Thyroid

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Background: The 7th edition of the American Joint Committee on Cancer (AJCC) staging system trialed a subdivision of T1 tumors into T1a (<1 cm) and T1b (1.0-2 cm). The 2009 American Thyroid Association (ATA) guidelines recommended total thyroidectomy for tumors >1 cm, and lobectomy for those £1 cm. These AJCC staging parameters remain a focus of debate, and ATA guidelines are in transition. The aim of this study was to determine if the T1 staging subdivision is associated with different treatment strategies and patterns of patient survival. Methods: All adult patients with AJCC pT1 differentiated thyroid cancer (DTC) from the National Cancer Data Base (NCDB; 1998-2012 and Surveillance, Epidemiology, and End Results (SEER) program (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012) were divided into two groups based on tumor size: T1a versus T1b. Demographic, clinical, and pathologic features were evaluated. Multivariate regression analysis was used to determine factors associated with undergoing total thyroidectomy and radioactive iodine. Cox proportional hazards models were performed to determine factors associated with overall and disease-specific survival. Results: Among 149,912 DTC patients, 98,111 (65.4%) were T1a and 51,801 (34.6%) T1b in the NCDB; in SEER, among 18,381 patients, 11,208 (61.0%) had T1a and 7173 (39.0%) T1b tumors. Patients with T1b cancers were younger (48 vs. 51 years T1a) and more likely to have private insurance (76.2% vs. 74.1%), no comorbidities (86.0% vs. 83.8%), and undergo treatment at academic medical centers (41.4% vs. 40.3%; all p < 0.01). They also were more likely to undergo total thyroidectomy (87.7% vs. 74.3%), and had more lymphovascular invasion (10.2% vs. 3.3%), positive surgical margins (7.9% vs. 3.8%), metastatic lymph nodes (35.8% vs. 23.8%), and distant metastases (0.4% vs. 0.3%; all p < 0.01). Factors associated with radioactiveiodine use included younger patient age, lower income, having insurance, positive surgical margins, and T1b stage ( p < 0.01). After adjustment, overall ( p = 0.23) and disease-specific survival ( p = 0.93) were similar among patients with T1a versus T1b tumors. Conclusion: These results illustrate that patients with pT1a versus pT1b tumors undergo different treatment strategies. Based on the newly published 2015 ATA guidelines, whereby either lobectomy or total thyroidectomy can be performed for low-risk tumors, it might be anticipated that treatment differences will diminish over time. Therefore, division of AJCC T1 staging into T1a versus T1b subgroups might become obsolete over time.

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Section: T1a Versus T1b Differentiated Thyroid Cancersdiscussionmentioning

confidence: 95%

Section: T1a Versus T1b Differentiated Thyroid Cancersdiscussionmentioning

confidence: 99%

T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?

Anderson

Youngwirth

Scheri

et al. 2016

Thyroid

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“…There is little impact on outcome until disease reaches a significant size (currently considered 4 cm) at which tumor size becomes an independent predictor of survival. 21 Again, by resisting the temptation to reduce the size cut-off for the lowest risk tumors, an increased number of patients remain in the low-risk categories. This is entirely appropriate as there is no clinically significant difference in survival between those with 1 and 2 cm intrathyroid tumors, a fact consistently proven by the work of Prof Shah.…”

Section: Primary Thyroid Tumorsmentioning

confidence: 99%

“…This is entirely appropriate as there is no clinically significant difference in survival between those with 1 and 2 cm intrathyroid tumors, a fact consistently proven by the work of Prof Shah. [21][22][23] A second factor that should be considered in assessment of the primary tumor in patients with WDTC is whether there is evidence of ETE. For those patients with gross ETE, particularly ETE which invades posteriorly into the recurrent laryngeal nerve, airway, or esophagus, the impact on outcome is significant.…”

Section: Primary Thyroid Tumorsmentioning

confidence: 99%

Our Understanding of Well-differentiated Thyroid Cancer

Thompson¹,

Nixon²,

Souza³

2017

International Journal of Head and Neck Surgery

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Through significant contributions to our understanding of risk factors, prognostic indicators and management of welldifferentiated thyroid cancer (WDTC), Prof Jatin Shah has contributed much to the field of thyroid cancer in recent times. Many of the guidelines used in WDTC management today are a testament to his less-aggressive, dedicated and individualised approach. This article seeks to both review the current understanding of WDTC and to outline these contributions in a special issue dedicated to the career of Prof Shah.

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“…1 However, a recent retrospective analysis of over 3,600 patients with differentiated thyroid cancer found that tumors 1-2 cm have the same disease-specific survival and recurrence-free survival compared with tumors ≤ 1 cm when omitting tumors with aggressive features such as nodal metastatic disease and extrathyroidal extension. 2 Similarly, DeGroot et al reported a decreased risk of death and risk of recurrence for tumors > 1 cm in a group of 269 patients with papillary thyroid cancer treated with extensive initial surgery as well as post-operative I-131 ablation. 3 The frequency of nodal metastases was highest in papillary thyroid cancer (61%), whereas Hurthle cell carcinomas showed a 33% incidence of distant metastases in a retrospective review of 1,038 consecutive patients with differentiated thyroid cancer treated over a period of 55 years.…”

mentioning

confidence: 93%

Novel Approaches to Thyroid Cancer Treatment and Response Assessment

Grewal

Schöder

2016

Seminars in Nuclear Medicine

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The incidence of thyroid cancer has been on the rise. After total thyroidectomy of well differentiated thyroid tumors with intermediate or high-risk features on pathology, radioiodine remains one of the mainstays as the standard therapy for thyroid remnant ablation as well as treatment of metastatic disease. SPECT/CT, a relatively newer modality, has shown to play a pivotal role predominantly in the post-therapy setting by changing the risk stratification of patients with thyroid cancer. In the case of radioiodine failure, other modalities such as FDG PET/CT have been shown to provide prognostic information in terms of metabolic activity and external beam radiation therapy, thereby playing a role in disease management. The role of newer redifferentiation drugs has been evaluated with the use of I-124 PET/CT.

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Comparable outcomes for patients with pT1a and pT1b differentiated thyroid cancer: Is there a need for change in the AJCC classification system?

Cited by 24 publications

References 20 publications

T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?

T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?

Our Understanding of Well-differentiated Thyroid Cancer

Novel Approaches to Thyroid Cancer Treatment and Response Assessment

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