Presence and Number of Lymph Node Metastases Are Associated With Compromised Survival for Patients Younger Than Age 45 Years With Papillary Thyroid Cancer

TL;DR: The changing incidence of thyroid cancer is described, potential explanations for these trends are suggested, the implications for patients are emphasized and ongoing and potential strategies to combat this growing clinical and public health issue are highlighted.

Abstract: In October 2016, the American Joint Committee on Cancer (AJCC; www.cancerstaging.org) published the eighth edition of the AJCC/TNM cancer staging system, which will replace the seventh edition that has been in use by clinicians, cancer registries, and researchers since 2009 (1). Unlike the American Thyroid Association (ATA) risk stratification system that is designed to predict disease recurrence, the AJCC/ TNM system is optimized to predict survival in patients with cancer (2,3). While clinicians are encouraged to use the scientific content of the eighth edition staging manual to enhance patient care, the actual implementation date for the eighth edition cancer staging system is planned to be January 1, 2018, in order to allow the cancer care community to make the infrastructure changes needed for data collection and implementation. All newly diagnosed cases through December 31, 2017, will continue to be staged by tumor registries according to the seventh edition staging system (https://cancer staging.org/About/news/Pages/Implementation-of-AJCC-8thEdition-Cancer-Staging-System.aspx). This commentary examines how the eighth edition differs from the seventh edition in the staging of differentiated and anaplastic thyroid cancers. Examination of the changes in the staging for medullary thyroid cancer will be presented in a follow-up commentary in the near future. Using an evidenced-based medicine approach to literature review and grading, a multidisciplinary expert committee identified several specific areas in the seventh edition staging system that needed to be modified in order to optimize initial staging. While it is beyond the scope of this commentary to explore fully the reasons underpinning the changes in the eighth edition, the details and rationale for each of these changes with corresponding literature review is presented in the text of the eighth edition staging system for those interested in the details (1). As will be seen in the discussion below, the net effect of most of the changes in the eighth edition will be to downstage a significant number of patients into lower stages that more accurately reflect their low risk of dying from thyroid cancer. More individualized and accurate assessments of the risk of dying from thyroid cancer and the risk of disease recurrence should have a significant impact on both initial therapeutic decision making (e.g., extent of thyroid surgery, need for radioactive iodine ablation/therapy, and/or need for thyrotropin suppressive therapy) and on follow-up management strategies.

TL;DR: The author notes 3 new basic principles that have emerged in this guidelines revision: the management of thyroid nodules, including the decision to perform a fine‐needle aspiration biopsy as well as follow-up decision making will be heavily influenced by the newly developed sonographic risk pattern.

TL;DR: These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes and were created to assist clinicians in the optimal surgical management of thyroid disease.

TL;DR: In this article, the authors examined trends in thyroid cancer incidence, histology, size distribution, and mortality in the United States, concluding that the increasing incidence of thyroid cancer is primarily due to the increased detection of small papillary cancers.

TL;DR: The hazard ratio (HR) is the main, and often the only, effect measure reported in many epidemiologic studies, and although the HR may change over time, some studies report only a single HR averaged over the duration of the study’s follow-up; here I review these 2 problems and some proposed solutions.

TL;DR: This is the first study to demonstrate that total thyroidectomy for papillary thyroid cancers ≥1.0 cm improves outcomes, and results in lower recurrence rates and improved survival for PTC ≥ 1.0cm compared with lobectomy.

TL;DR: An excellent survival rate is highlighted and risk classifications of persistent and recurrent disease based on the numbers of LN metastases and ECE-LN, LN Metastases location, tumor size, and thyroglobulin level are suggested.