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A Novel N Staging System for Predicting Survival in Patients with Medullary Thyroid Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Despite the crucially prognostic value of lymph node metastasis (LNM) in patients with medullary thyroid cancer (MTC), only the LNM compartment alone was reflected in the 8th edition of the American Joint Committee on Cancer (AJCC) system.

Objective

This study aimed to incorporate the metastatic lymph node number and metastatic lymph node ratio to generate a more accurate and appropriate N staging system for patients with MTC based on recursive partitioning analysis.

Design, Setting, and Patients

Two cohorts were included in the analysis, including 1374 MTC patients from the Surveillance, Epidemiology, and End Results database as the derivation cohort, and 164 patients from Fudan University Shanghai Cancer Center as the validation cohort. The predictive performance of the alternative proposed N staging system was compared with that of the 8th AJCC system by using the Harrell concordance index (C-index) and the area under the receiver operating characteristic curve (AUC).

Results

In the derivation cohort, the C-index and the AUC at 10 years were 0.778 and 0.789, respectively, for the novel N staging system, and 0.749 and 0.741, respectively, for the 8th AJCC N staging system. Similar trends were also observed in the validation cohort. The proposed N staging system had a better prognostic performance.

Conclusion

With some improvements, the novel N staging system for MTC suggested from this research may be assessed for potential adoption in the next edition of the AJCC N staging system.

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Acknowledgement

The authors harbor sincere gratitude for the efforts of the SEER program in the establishment of the SEER database.

Funding

This work was supported by the National Natural Science Foundation of China (81772852), and the Science and Technology Commission of Shanghai Municipality (16ZR1406600).

Author information

Author notes

  1. Lili Chen, Kai Qian, and Kai Guo contributed equally to this work.

Authors and Affiliations

  1. Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China

    Lili Chen MM, Xiaoke Zheng MM, Wenyu Sun MM, Tuanqi Sun MD, Yunjun Wang MD, Duanshu Li MM, Yi Wu MD, Qinghai Ji MD & Zhuoying Wang MD, PhD

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Lili Chen MM, Xiaoke Zheng MM, Wenyu Sun MM, Tuanqi Sun MD, Yunjun Wang MD, Duanshu Li MM, Yi Wu MD, Qinghai Ji MD & Zhuoying Wang MD, PhD

  3. Department of Head and Neck Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Kai Qian MD, Kai Guo MM & Zhuoying Wang MD, PhD

Authors
  1. Lili Chen MM
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  2. Kai Qian MD
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  3. Kai Guo MM
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Corresponding author

Correspondence to Zhuoying Wang MD, PhD.

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Disclosures

Lili Chen, Kai Qian, Kai Guo, Xiaoke Zheng, Wenyu Sun, Tuanqi Sun, Yunjun Wang, Duanshu Li, Yi Wu, Qinghai Ji, and Zhuoying Wang have no disclosures to declare.

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Chen, L., Qian, K., Guo, K. et al. A Novel N Staging System for Predicting Survival in Patients with Medullary Thyroid Cancer. Ann Surg Oncol 26, 4430–4438 (2019). https://doi.org/10.1245/s10434-019-07871-1

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  • DOI: https://doi.org/10.1245/s10434-019-07871-1

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