Thyroid Cancer pp 109-131 | Cite as

Staging Systems for Differentiated Thyroid Carcinomas

  • Ronnie Meiyi Wong
  • Glenn D. Braunstein
Part of the Endocrine Updates book series (ENDO, volume 32)


A multitude of retrospective studies have identified prognostic factors for the mortality and recurrence rates of thyroid carcinoma. Using a combination of these factors, many medical institutions have developed their own systems for the staging of thyroid carcinoma and the system used depends on physician or medical center preference. The stage of cancer generally refers to the extent, or invasion of disease, and how far the cancer has metastasized. The goal of each staging system is to provide a more precise depiction of the tumor, to aid the physician in the selection of the best course of treatment for the patient, and to assist in the prediction of disease-specific mortality. Depending on which system is utilized, major prognostic factors can include histologic variant, tumor grade, patient age, tumor size, lymph node involvement, invasion of adjacent structures surrounding the neck, or distant metastasis to other organs.

Most staging systems described in this chapter incorporate these prognostic factors while some may also include gender or extent of thyroidectomy performed as contributing features. Some systems restrict their staging and applicability to the relatively low risk and long-term survivability of the well-differentiated papillary (PTC) and follicular thyroid carcinomas (FTC). Other staging systems include the higher risk, less differentiated thyroid carcinomas, namely medullary (MTC) and the more fatal anaplastic thyroid carcinomas (ATCs).


Prognostic factors Histologic variant Tumor grade Lymph node involvement Papillary thyroid carcinoma Follicular thyroid carcinoma Anaplastic thyroid carcinoma 


  1. 1.
    Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;174(5):474–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Shaha AR, Ferlito A, Rinaldo A. Distant metastases from thyroid and parathyroid cancer. ORL J Otorhinolaryngol Relat Spec. 2001;63(4):243–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Shoup M, Stojadinovic A, Nissan A, et al. Prognostic indicators of outcomes in patients with distant metastases from differentiated thyroid carcinoma. J Am Coll Surg. 2003;197(2):191–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Wartofsky L, Van Norstrand D. Staging of thyroid cancer. In: Wartofsky L, Van Nostrand D, editors. Thyroid cancer, a comprehensive guide to clinical management. 2nd ed. Totowa, NJ: Humana Press; 2006. p. 87–95.Google Scholar
  5. 5.
    Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;114(6):1050–8.PubMedGoogle Scholar
  6. 6.
    Sugitani I, Nobukatsu K, Fujimoto Y, Yanagisawa K. A novel classification system for patients with PTC: addition of the new variables of large (3 cm or great) nodal metastases and reclassification during the follow-up period. Surgery. 2004;135(2):139–48.PubMedCrossRefGoogle Scholar
  7. 7.
    Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery. 1987;102(6):1088–95.PubMedGoogle Scholar
  8. 8.
    D’Avanzo A, Ituarte P, Treseler P, et al. Prognostic scoring systems in patients with follicular thyroid cancer: a comparison of different staging systems in predicting the patient outcome. Thyroid. 2004;14(6):453–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery. 1998;104(6):947–53.CrossRefGoogle Scholar
  10. 10.
    Haigh PI, Urbach DR, Rotstein LE. AMES prognostic index and extent of thyroidectomy for well-differentiated thyroid cancer in the US. Surgery. 2004;136(3):609–16.PubMedCrossRefGoogle Scholar
  11. 11.
    Sherman SI. Toward a standard clinicopathologic staging approach for differentiated thyroid carcinoma. Semin Surg Oncol. 1999;16:12–5.PubMedCrossRefGoogle Scholar
  12. 12.
    DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab. 1990;71(2):414–24.PubMedCrossRefGoogle Scholar
  13. 13.
    Pasieka JL, Zedenius J, Auer G, et al. Addition of nuclear DNA content to the AMES risk-group classification for papillary thyroid cancer. Surgery. 1992;112(6):1154–60.PubMedGoogle Scholar
  14. 14.
    Lang BH, Lo CY, Chan WF, Lam KY, Wan KT. Staging systems for papillary thyroid carcinoma, a review and comparison. Ann Surg. 2007;245(3):366–78.PubMedCrossRefGoogle Scholar
  15. 15.
    Passler C, Prager G, Scheuba C, Kaserer K, Zettinig G, Niederle B. Application of staging systems for differentiated thyroid carcinoma in an endemic goiter region with iodine substitution. Ann Surg. 2003;237(2):227–34.PubMedGoogle Scholar
  16. 16.
    Shaha AR, Shah JP, Loree R. Patterns of failure in differentiated carcinoma of the thyroid based on risk groups. Head Neck. 1998;20(1):26–30.PubMedCrossRefGoogle Scholar
  17. 17.
    Leite KRM, de Araujo VC, Meirelles MIR, Lopes Costa AL, Camara-Lopes LH. No relationship between proliferative activity and the MACIS prognostic scoring system in papillary thyroid carcinoma. Head Neck. 1999;21(7):602–5.CrossRefGoogle Scholar
  18. 18.
    Shaha AR, Shah JP, Loree R. Risk group stratification and prognostic factors in papillary carcinoma of thyroid. Ann Surg Oncol. 1996;3(6):534–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Shaha AR, Loree TR, Shah JP. Intermediate-risk group for differentiated carcinoma of thyroid. Surgery. 1994;116(6):1036–41.PubMedGoogle Scholar
  20. 20.
    Shaha AR. Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer. Laryngoscope. 2004;114(3):393–402.PubMedCrossRefGoogle Scholar
  21. 21.
    Shah JP, Loree TR, Dharker D, Strong EW, Begg C. Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992;164(6):658–61.PubMedCrossRefGoogle Scholar
  22. 22.
    Kuriakose MA, Hicks WL, Loree TR, Yee H. Risk group-based management of differentiated thyroid carcinoma. J R Coll Surg Edinb. 2001;46(4):216–23.PubMedGoogle Scholar
  23. 23.
    Noguchi S, Murakami N, Kawamoto H. Classification of papillary cancer of the thyroid based on prognosis. World J Surg. 1994;18(4):552–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Sherman SI, Brierley JD, Sperling M, et al. Prospective multicenter study of thyroid carcinoma treatment, ­initial analysis of staging and outcome. Cancer. 1998;83(5):1012–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994;97(5):418–28.PubMedCrossRefGoogle Scholar
  26. 26.
    Akslen LA. Prognostic importance of histologic grading in papillary thyroid carcinoma. Cancer. 1993;72(9):2680–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Brierley JD, Panzarella T, Tsang RW, Gospodarowicz MK, O’Sullivan S. A comparison of different staging systems predictability of patient outcome, thyroid carcinoma as an example. Cancer. 1997;79(12):2414–23.PubMedCrossRefGoogle Scholar
  28. 28.
    Shaha AR. TNM classification of thyroid carcinoma. World J Surg. 2007;31(5):879–87.PubMedCrossRefGoogle Scholar
  29. 29.
    American Cancer Society: Learn about cancer website. How is thyroid cancer staged? cancer/Detailed Guide/thyroid-cancer survival rates. Accessed 9 Dec 2010.
  30. 30.
    Comparison guide: Cancer staging manual fifth versus sixth edition. Accessed 26 Aug 2007
  31. 31.
    Edge SE, Byrd DR, Carducci MA, Compton CA, ­editors. AJCC cancer staging manual. 7th ed. New York, NY: Springer; 2009.Google Scholar
  32. 32.
    Beenken S, Roye D, Weiss H, Sellers M, Urist M, Diethelm A, et al. Extent of surgery for intermediate-risk well-differentiated thyroid cancer. Am J Surg. 2000;179(1):51–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Lerch H, Schober O, Kuwert T, Hans-Bernard S. Survival of differentiated thyroid carcinoma studied in 500 patients. J Clin Oncol. 1997;15(5):2067–75.PubMedGoogle Scholar
  34. 34.
    Sebastian SO, Gonzalez JM, Paricio P, et al. Papillary thyroid carcinoma, prognostic index for survival including the histological variety. Arch Surg. 2000;135(3):272–7.PubMedCrossRefGoogle Scholar
  35. 35.
    Schemper M. The relative importance of prognostic factors in studies of survival. Stat Med. 1993;12(24):2377–82.PubMedCrossRefGoogle Scholar
  36. 36.
    Lang BH, Lo CY, Chan WF, Lam KY, Wan KY. Staging systems for follicular thyroid carcinoma: application to 171 consecutive patients treated in a tertiary referral center. Endocr Relat Cancer. 2007;14(1):29–42.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Divison of Endocrinology, Diabetes, and Metabolism, Department of MedicineCedars-Sinai Medical CenterLos AngelesUSA

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