The prognostic value of lymph node metastasis and the eighth edition of AJCC for patients with anaplastic thyroid cancer

Abstract

Objective The eighth edition of the American Joint Committee on Cancer (AJCC‐v8) for anaplastic thyroid cancer (ATC) made a revision in staging for patients with lymph node metastasis (LNM) based on the seventh edition of AJCC (AJCC‐v7). Our study aimed to evaluate the predictive ability of AJCC‐v8 for survival in patients with ATC by exploring the association between lymph node stage and prognosis of ATC patients. Methods Retrospective study of ATC in Surveillance, Epidemiology and End Results (SEER) database. The association between LNM and survival of ATC was estimated by the Kaplan‐Meier method and Cox regression model. The predictive performances of the AJCC‐v8 and AJCC‐v7 were estimated through C‐index, Akaike information criterion (AIC) and Bayesian information criterion (BIC). Results A total of 313 patients with ATC were included in our analysis. Notably, LNM was identified as an independent risk factor for ATC mortality (adjusted HR, 1.47, 95% CI, 1.10–1.96; p = .009), while the risk of mortality in N1a group was comparable to that in N1b group according to univariate (HR, 1.30, 95% CI, 0.92–1.82; p = .133) and multivariate (adjusted HR 0.87, 95% CI, 0.60–1.27; p = .467) cox analyses. Applying the AJCC‐v8, the survival of migration population staged T1‐3aN1M0 was significantly worse than that of T1‐3aN0M0 patients (IVA stage), while was not different from that of T3b‐T4bN0/N1M0 patients (IVB stage). With a higher C‐index (0.60 vs. 0.59), lower AIC (2728 vs. 2732) and BIC (2732 vs. 2735), AJCC‐v8 was demonstrably a more favourable prediction model than AJCC‐v7. Conclusions This study demonstrated that LNM was independently associated with poor prognosis of ATC, and AJCC‐v8 with the modified staging of patients with LNM showed better survival predictive performance in ATC patients than AJCC‐v7.

A novel prognostic model based on log odds of positive lymph nodes to predict outcomes of patients with anaplastic thyroid carcinoma after surgery

“…In that case, a prognostic model based on LN involvement is needed for survival assessment for ATC patients after surgery. Although the 8th AJCC staging system is widely used in clinical practice, it refers only to the three prognosis‐related indicators (T/N/M) without considering other important factors, so its predictive ability for ATC is limited 10 . The Japanese Clinical Practice Guidelines designed the Prognostic Index (PI) for identifying patients who are appropriate candidates for aggressive treatment 33 .…”

“…Although the 8th AJCC staging system is widely used in clinical practice, it refers only to the three prognosisrelated indicators (T/N/M) without considering other important factors, so its predictive ability for ATC is limited. 10 The Japanese Clinical Practice Guidelines designed the Prognostic Index (PI) for identifying patients who are appropriate candidates for aggressive treatment. 33 The PI could be a helpful indicator to design an optimal therapeutic strategy as an addition to the AJCC classification.…”

“…The demographic and clinicopathologic characteristics of the involved patients were summarized in Table 1. The median age was 68 years (IQR, 61-75.5), and the median survival time was 7 months (IQR, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The entire cohort comprised 107 women (53.7%) and 167 white patients (83.9%).…”

“…This modification revealed the prognostic influence of metastatic LN in ATC. One recent study demonstrated that metastatic LN was an independent factor in predicting a worse prognosis of ATC, while the mortality risk showed no difference between patients with metastatic LNs in different locations (N1a vs. N1b) 10 . It suggested that the predictive value of AJCC N status, which is based on the location of metastatic LN in ATC, was relatively poor.…”

Thyroid Cancer and COVID-19: Prospects for Therapeutic Approaches and Drug Development

“…Notably, PTC has a better prognosis with reduced mortality. However, other types of thyroid cancer (e.g., ATC) have a worse prognosis ( 5 ). The main goal of thyroid cancer treatment is to improve both overall survival and quality of life.…”