Fig. 1Distribution of patients according to (A) T classifications and (B) tumor-node-metastasis (TNM) stages, as determined by the 8th edition of the TNM staging system (TNM-8) and the modified-TNM staging system.
Fig. 2Kaplan-Meier analysis of disease-specific survival (DSS) in patients with differentiated thyroid carcinoma classified according to (A) the 8th edition of the tumor-node-metastasis (TNM) staging system (TNM-8) and (B) the modified-TNM staging system.
Fig. 3Kaplan-Meier analysis of disease-specific survival (DSS) in patients who showed (A) stage migration after applying the modified-tumor-node-metastasis (TNM) staging system and (B) patients classified as stages IIA and IIB according to the modified-TNM. TNM-8, the 8th edition of the TNM staging system.
Table 1Prognostic Stages and Stage Groups According to the TNM-8 and the Modified-TNM
![enm-35-149-i001.jpg]()
|
TNM-8 |
Modified-TNM |
T category |
|
|
TX |
Primary tumor cannot be assessed |
Same as 8th edition |
T0 |
No evidence of primary tumor |
Same as 8th edition |
T1 |
Tumor size ≤2 cm, limited to the thyroid |
Same as 8th edition |
T2 |
Tumor size >2 cm and ≤4 cm, limited to the thyroid |
Tumor size >2 cm and ≤4 cm, limited to the thyroid, or gross extrathyroidal extension invading only strap muscles with tumor size ≤4 cm |
T3a |
Tumor size >4 cm, limited to the thyroid |
Tumor size >4 cm, limited to the thyroid |
T3b |
Gross extrathyroidal extension invading only strap muscles from Gross extrathyroidal extension invading only strap muscles a tumor of any size |
Gross extrathyroidal extension invading only strap muscles with tumor size >4 cm |
T4a |
Gross extrathyroidal extension invading subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve |
Same as 8th edition |
T4b |
Gross extrathyroidal extension invading prevertebral fascia, encasing the carotid artery, or mediastinal vessels |
Same as 8th edition |
The definitions of N and M categories are identical |
Stage group |
I: Tx Nx M0 <55 yr |
|
T1-2 N0/NX M0 ≥55 yr |
I: Tx Nx M0 <55 yr |
II: Tx Nx M1 <55 yr |
T1-2 N0/NX M0 ≥55 yr |
T1-2 N1 M0 ≥55 yr |
IIA: Tx Nx M1 <55 yr |
T3a/T3b Nx M0 ≥55 yr |
T1-2 N1a M0 ≥55 yr |
|
T3a/T3b N0-1a M0 ≥55 yr |
|
IIB: T1-2 N1b M0 ≥55 yr |
|
T3a/T3b N1b M0 ≥55 yr |
III: T4a Nx M0 ≥55 yr |
III: T4a Nx M0 ≥55 yr |
IVA: T4b Nx M0 ≥55 yr |
IVA: T4b Nx M0 ≥55 yr |
Table 2Baseline Clinical and Pathological Characteristics of Patients with Differentiated Thyroid Carcinoma
![enm-35-149-i002.jpg]()
Characteristic |
Value |
Number |
4,878 |
Age, yr |
45.9±12.2 |
Female sex |
4,226 (87) |
Pathology |
|
PTC |
4,704 (96) |
FTC |
174 (4) |
Primary tumor size, cm |
1.7±1.3 |
≤2 |
3,534 (72) |
2–4 |
1,116 (23) |
>4 |
228 (5) |
Extra-thyroidal extension |
|
Microscopic |
1,407 (29) |
Gross, invading only strap muscle |
577 (12) |
With primary tumor size ≤4 cm |
530 |
With primary tumor size >4 cm |
47 |
Gross, invading other than strap muscle |
267 (5) |
Cervical LN metastasis |
|
N1a |
1,624 (33) |
N1b |
492 (10) |
Distant metastasis |
74 (2) |
Total thyroidectomy |
3,891 (80) |
RAI treatment |
3,140 (64) |
Table 3Relative Risk of DSS and Prognostic Validity According to the TNM-8 and the Modified-TNM
![enm-35-149-i003.jpg]()
Variable |
No. (%) |
10-yr DSS rates, % |
HR |
95% CI |
P value |
PVE, % |
TNM-8 |
|
|
|
|
|
6.3 |
Stage I |
4,214 (86) |
99.8 |
1.0 |
Reference |
|
Stage II |
540 (11) |
95.9 |
23.0 |
11.6–45.6 |
<0.001 |
Stage III |
97 (2) |
81.0 |
143.0 |
68.8–297.5 |
<0.001 |
Stage IV |
27 (1) |
41.6 |
366.7 |
173.8–744.0 |
<0.001 |
Modified-TNM |
|
|
|
|
|
6.5 |
Stage I |
4,289 (88) |
99.8 |
1.0 |
Reference |
|
Stage IIA |
381 (8) |
96.4 |
16.7 |
8.1–34.0 |
<0.001 |
Stage IIB |
84 (2) |
93.3 |
38.6 |
17.4–85.4 |
<0.001 |
Stage III |
97 (2) |
81.0 |
121.1 |
60.5–242.5 |
<0.001 |
Stage IV |
27 (1) |
41.6 |
313.2 |
154.1–636.8 |
<0.001 |