lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed and are posted here as part of a 12-month trial. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

A Novel N-Staging System for Predicting Survival in Patients with Medullary Thyroid Cancer

18 Pages Posted: 12 Apr 2019

See all articles by Lili Chen

Lili Chen

Fudan University - Department of Head and Neck Surgery

Kai Qian

Shanghai Jiao Tong University (SJTU) - Department of Head and Neck Surgery

Xiaoke Zheng

Fudan University - Department of Head and Neck Surgery

Wenyu Sun

Fudan University - Department of Head and Neck Surgery

Tuanqi Sun

Fudan University - Department of Head and Neck Surgery

Yunjun Wang

Fudan University - Department of Head and Neck Surgery

Duanshu Li

Fudan University - Department of Head and Neck Surgery

Yi Wu

Fudan University - Department of Head and Neck Surgery

Qinghai Ji

Fudan University - Department of Head and Neck Surgery

Zhuoying Wang

Fudan University - Department of Head and Neck Surgery; Fudan University - Department of Oncology; Shanghai Jiao Tong University (SJTU) - Department of Head and Neck Surgery

More...

Abstract

Background: The status of lymph node metastasis (LNM) is crucial for evaluating prognosis in patients with medullary thyroid cancer (MTC). However, only the compartment of LNM was reflected in the eighth edition (8th) of the American Joint Committee on Cancer (AJCC) N-staging system. Therefore, a more accurate N-staging system is required for MTC.

Methods: Two large cohorts were included in this analysis and consisted of 1374 MTC patients from the Surveillance, Epidemiology, and End Results (SEER) database and 164 MTC patients from the Fudan University Shanghai Cancer Center (FUSCC) database. Using metastatic lymph node number (MLNN) and metastatic lymph node ratio (MLNR), a novel N-staging system that predicts the survival of MTC was derived and measured by concordance index (C-index).

Results: The cutoff values were 0 and 12 for MLNN and 0.6 (MLNN≤12) and 0.75 (MLNN≥13) for MLNR. Based on the values of MLNN and MLNR, we proposed the following novel N-staging system for MTC: N0, MLNN=0; N1, 1≤MLNN≤12 and MLNR <0.6; N2, 1≤MLNN≤12 and MLNR ≥0.6 or MLNN>12 and MLNR <0.75; and N3, MLNN >12 and MLNR ≥0.75. Multivariate Cox analysis indicated that the novel N-staging system was an independent prognostic factor for cancerspecific survival. The C-index was higher for the novel N-staging system than for the 8th AJCC N-staging system (SEER cohort: 0.783 vs. 0.756; FUSCC cohort: 0.716 vs. 0.670).

Conclusion: With some improvements, the novel N-staging system for MTC suggested from this research may be assessed for potential adoption in the next edition of the AJCC N-staging system.

Funding Statement: This work was supported by National Natural Science Foundation of China (81772852), the Science and Technology Commission of Shanghai Municipality (16ZR1406600).

Declaration of Interests: The authors report no conflicts of interest in this work.

Ethics Approval Statement: This study was approved by the Ethics Committee of FUSCC.

Keywords: medullary thyroid cancer, lymph node, metastasis, SEER, staging system

Suggested Citation

Chen, Lili and Qian, Kai and Zheng, Xiaoke and Sun, Wenyu and Sun, Tuanqi and Wang, Yunjun and Li, Duanshu and Wu, Yi and Ji, Qinghai and Wang, Zhuoying, A Novel N-Staging System for Predicting Survival in Patients with Medullary Thyroid Cancer (April 10, 2019). Available at SSRN: https://ssrn.com/abstract=3369764

Lili Chen

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Kai Qian

Shanghai Jiao Tong University (SJTU) - Department of Head and Neck Surgery

Shanghai
China

Xiaoke Zheng

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Wenyu Sun

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Tuanqi Sun

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Yunjun Wang

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Duanshu Li

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Yi Wu

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Qinghai Ji

Fudan University - Department of Head and Neck Surgery

Shanghai
China

Zhuoying Wang (Contact Author)

Fudan University - Department of Head and Neck Surgery ( email )

Shanghai
China

Fudan University - Department of Oncology ( email )

China

Shanghai Jiao Tong University (SJTU) - Department of Head and Neck Surgery ( email )

Shanghai
China

Click here to go to TheLancet.com

Go to TheLancet.com

Paper statistics

Abstract Views
15
Downloads
4