An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer

Iain J. Nixon, Laura Y. Wang, Jocelyn C. Migliacci, Antoine Eskander, Michael Campbell, Ahmad Aniss, Lilah Morris, Fernanda Vaisman, Rossana Corbo, Denise Momesso, Mario Vaisman, Andre Carvalho, Diana Learoyd, William D. Leslie, Richard W. Nason, Deborah Kuk, Volkert Wreesmann, Luc Morris, Frank L. Palmer, Ian GanlySnehal G. Patel, Bhuvanesh Singh, R. Michael Tuttle, Ashok R. Shaha, Mithat Gönen, K. Alok Pathak, Wen T. Shen, Mark Sywak, Luis Kowalski, Jeremy Freeman, Nancy Perrier, Jatin P. Shah

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Abstract

Background: Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions. Methods: A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model. Results: Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7%, 97.3%, 96.6%, and 76.3%, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5%, 94.7%, 94.1%, and 67.6%, respectively. The change resulted in 12% of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6%. The change resulted in an increase in CPE from 0.90 to 0.92. Conclusions: A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12% of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.

Original languageEnglish (US)
Pages (from-to)373-380
Number of pages8
JournalThyroid
Volume26
Issue number3
DOIs
StatePublished - Mar 1 2016

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Neoplasm Staging
Thyroid Neoplasms
Neoplasms
Survival Rate
Survival
Statistical Models
Neoplasm Metastasis

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

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An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. / Nixon, Iain J.; Wang, Laura Y.; Migliacci, Jocelyn C.; Eskander, Antoine; Campbell, Michael; Aniss, Ahmad; Morris, Lilah; Vaisman, Fernanda; Corbo, Rossana; Momesso, Denise; Vaisman, Mario; Carvalho, Andre; Learoyd, Diana; Leslie, William D.; Nason, Richard W.; Kuk, Deborah; Wreesmann, Volkert; Morris, Luc; Palmer, Frank L.; Ganly, Ian; Patel, Snehal G.; Singh, Bhuvanesh; Tuttle, R. Michael; Shaha, Ashok R.; Gönen, Mithat; Pathak, K. Alok; Shen, Wen T.; Sywak, Mark; Kowalski, Luis; Freeman, Jeremy; Perrier, Nancy; Shah, Jatin P.

In: Thyroid, Vol. 26, No. 3, 01.03.2016, p. 373-380.

Research output: Contribution to journalArticle

Nixon, IJ, Wang, LY, Migliacci, JC, Eskander, A, Campbell, M, Aniss, A, Morris, L, Vaisman, F, Corbo, R, Momesso, D, Vaisman, M, Carvalho, A, Learoyd, D, Leslie, WD, Nason, RW, Kuk, D, Wreesmann, V, Morris, L, Palmer, FL, Ganly, I, Patel, SG, Singh, B, Tuttle, RM, Shaha, AR, Gönen, M, Pathak, KA, Shen, WT, Sywak, M, Kowalski, L, Freeman, J, Perrier, N & Shah, JP 2016, 'An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer', Thyroid, vol. 26, no. 3, pp. 373-380. https://doi.org/10.1089/thy.2015.0315
Nixon, Iain J. ; Wang, Laura Y. ; Migliacci, Jocelyn C. ; Eskander, Antoine ; Campbell, Michael ; Aniss, Ahmad ; Morris, Lilah ; Vaisman, Fernanda ; Corbo, Rossana ; Momesso, Denise ; Vaisman, Mario ; Carvalho, Andre ; Learoyd, Diana ; Leslie, William D. ; Nason, Richard W. ; Kuk, Deborah ; Wreesmann, Volkert ; Morris, Luc ; Palmer, Frank L. ; Ganly, Ian ; Patel, Snehal G. ; Singh, Bhuvanesh ; Tuttle, R. Michael ; Shaha, Ashok R. ; Gönen, Mithat ; Pathak, K. Alok ; Shen, Wen T. ; Sywak, Mark ; Kowalski, Luis ; Freeman, Jeremy ; Perrier, Nancy ; Shah, Jatin P. / An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. In: Thyroid. 2016 ; Vol. 26, No. 3. pp. 373-380.
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title = "An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer",
abstract = "Background: Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions. Methods: A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model. Results: Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7{\%}, 97.3{\%}, 96.6{\%}, and 76.3{\%}, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5{\%}, 94.7{\%}, 94.1{\%}, and 67.6{\%}, respectively. The change resulted in 12{\%} of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6{\%}. The change resulted in an increase in CPE from 0.90 to 0.92. Conclusions: A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12{\%} of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.",
author = "Nixon, {Iain J.} and Wang, {Laura Y.} and Migliacci, {Jocelyn C.} and Antoine Eskander and Michael Campbell and Ahmad Aniss and Lilah Morris and Fernanda Vaisman and Rossana Corbo and Denise Momesso and Mario Vaisman and Andre Carvalho and Diana Learoyd and Leslie, {William D.} and Nason, {Richard W.} and Deborah Kuk and Volkert Wreesmann and Luc Morris and Palmer, {Frank L.} and Ian Ganly and Patel, {Snehal G.} and Bhuvanesh Singh and Tuttle, {R. Michael} and Shaha, {Ashok R.} and Mithat G{\"o}nen and Pathak, {K. Alok} and Shen, {Wen T.} and Mark Sywak and Luis Kowalski and Jeremy Freeman and Nancy Perrier and Shah, {Jatin P.}",
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TY - JOUR

T1 - An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer

AU - Nixon, Iain J.

AU - Wang, Laura Y.

AU - Migliacci, Jocelyn C.

AU - Eskander, Antoine

AU - Campbell, Michael

AU - Aniss, Ahmad

AU - Morris, Lilah

AU - Vaisman, Fernanda

AU - Corbo, Rossana

AU - Momesso, Denise

AU - Vaisman, Mario

AU - Carvalho, Andre

AU - Learoyd, Diana

AU - Leslie, William D.

AU - Nason, Richard W.

AU - Kuk, Deborah

AU - Wreesmann, Volkert

AU - Morris, Luc

AU - Palmer, Frank L.

AU - Ganly, Ian

AU - Patel, Snehal G.

AU - Singh, Bhuvanesh

AU - Tuttle, R. Michael

AU - Shaha, Ashok R.

AU - Gönen, Mithat

AU - Pathak, K. Alok

AU - Shen, Wen T.

AU - Sywak, Mark

AU - Kowalski, Luis

AU - Freeman, Jeremy

AU - Perrier, Nancy

AU - Shah, Jatin P.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions. Methods: A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model. Results: Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7%, 97.3%, 96.6%, and 76.3%, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5%, 94.7%, 94.1%, and 67.6%, respectively. The change resulted in 12% of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6%. The change resulted in an increase in CPE from 0.90 to 0.92. Conclusions: A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12% of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.

AB - Background: Age is a critical factor in outcome for patients with well-differentiated thyroid cancer. Currently, age 45 years is used as a cutoff in staging, although there is increasing evidence to suggest this may be too low. The aim of this study was to assess the potential for changing the cut point for the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system from 45 years to 55 years based on a combined international patient cohort supplied by individual institutions. Methods: A total of 9484 patients were included from 10 institutions. Tumor (T), nodes (N), and metastasis (M) data and age were provided for each patient. The group was stratified by AJCC/UICC stage using age 45 years and age 55 years as cutoffs. The Kaplan-Meier method was used to calculate outcomes for disease-specific survival (DSS). Concordance probability estimates (CPE) were calculated to compare the degree of concordance for each model. Results: Using age 45 years as a cutoff, 10-year DSS rates for stage I-IV were 99.7%, 97.3%, 96.6%, and 76.3%, respectively. Using age 55 years as a cutoff, 10-year DSS rates for stage I-IV were 99.5%, 94.7%, 94.1%, and 67.6%, respectively. The change resulted in 12% of patients being downstaged, and the downstaged group had a 10-year DSS of 97.6%. The change resulted in an increase in CPE from 0.90 to 0.92. Conclusions: A change in the cutoff age in the current AJCC/UICC staging system from 45 years to 55 years would lead to a downstaging of 12% of patients, and would improve the statistical validity of the model. Such a change would be clinically relevant for thousands of patients worldwide by preventing overstaging of patients with low-risk disease while providing a more realistic estimate of prognosis for those who remain high risk.

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U2 - 10.1089/thy.2015.0315

DO - 10.1089/thy.2015.0315

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