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对甲状腺髓癌AJCC分期系统的修订观点:对两个全国性队列的研究
Cenkai Shen1, Yuxin Du1, Shiyu Xiang2
1Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Journal of the National Comprehensive Cancer Network : JNCCN
|March 13, 2025
概括
上部介质淋巴结转移是甲状腺髓癌 (MTC) 的关键预后因素. 这项研究提出了一种更新的TNM MTC分期系统,改进了风险分层和临床管理.
科学领域:
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
背景情况:
- 目前的 AJCC TNM 甲状腺髓癌 (MTC) 阶段测定是根据差异化甲状腺癌标准进行调整的,可能缺少 MTC 特定的预后因素.
- 在MTC中,上部中淋巴结转移 (LNM) 的预后意义需要进一步评估.
- 现有的分期系统可能无法完全捕捉到MTC进展和患者结果的细微差别.
研究的目的:
- 评估甲状腺髓癌 (MTC) 上部中枢 (VII级) 淋巴结转移的预后意义.
- 根据预后发现,建议对MTC的N类和TNM分期系统进行修改.
- 提高MTC患者分期的适用性和准确性.
主要方法:
- 一项以人口为基础的回顾性研究,涉及来自中国的19个转诊中心的827名初步接受MTC治疗的患者.
- 将患者分为四个淋巴结转移 (LNM) 亚组:没有,中央宫,侧宫和上间宫 (VII级).
- 使用卡普兰-梅尔曲线和考克斯回归评估预后意义;在独立的SEER数据库队列上进行验证.
主要成果:
- 在12.6%的患者中存在的上半端 (VII级) LNM与更糟糕的整体存活率 (OS),无复发存活率和生化反应显著相关.
- 建议将第七级转移从N1a重新分类到一个新的类别,N1c.
- 修改后的TNM分期系统在两组研究中都显示出与当前的AJCC系统相比,更高的预后歧视和预测能力.
结论:
- 上部介质淋巴结转移被确定为甲状腺髓癌 (MTC) 的关键预后因素.
- 对N类 (引入N1c) 和TNM分期系统的拟议调整为MTC患者提供了更好的风险分层.
- 修订后的分期系统有可能指导加强甲状腺髓癌的临床管理和治疗策略.
相关概念视频
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Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The iodine is then...
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