Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort study
ObjectivePoorly differentiated thyroid cancer (PDTC) is a rare, heterogeneous carcinoma from follicular cells, characterized by poor differentiation, aggressive spread, and poor prognosis. Currently, there is no specific staging system for PDTC. This study aimed to develop a new TNM staging system t...
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Frontiers Media S.A.
2025-08-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2025.1586542/full |
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| author | Yu Guo Yu Guo Yu Guo Yu Guo Qianyi Zhong Qianyi Zhong Liangen Xie Liangen Xie Liangen Xie Xudong Wang Liang Guo Shimin Zhuang Shimin Zhuang Shimin Zhuang Chunyan Jia Lijiao Wu Jin Peng Feng Pang Feng Pang Feng Pang Ankui Yang Ankui Yang Tianrun Liu Tianrun Liu Tianrun Liu Tianrun Liu |
| author_facet | Yu Guo Yu Guo Yu Guo Yu Guo Qianyi Zhong Qianyi Zhong Liangen Xie Liangen Xie Liangen Xie Xudong Wang Liang Guo Shimin Zhuang Shimin Zhuang Shimin Zhuang Chunyan Jia Lijiao Wu Jin Peng Feng Pang Feng Pang Feng Pang Ankui Yang Ankui Yang Tianrun Liu Tianrun Liu Tianrun Liu Tianrun Liu |
| author_sort | Yu Guo |
| collection | DOAJ |
| description | ObjectivePoorly differentiated thyroid cancer (PDTC) is a rare, heterogeneous carcinoma from follicular cells, characterized by poor differentiation, aggressive spread, and poor prognosis. Currently, there is no specific staging system for PDTC. This study aimed to develop a new TNM staging system tailored to PDTC for improved disease management.MethodsA new TNM staging system was designed and internally validated using data from the US SEER database (2004-2016) on PDTC cases. External validation was performed using data from four major institutions in China. Prognostic factors influencing cancer-specific survival (CSS) were identified through Cox regression analyses. Patients were stratified into subgroups based on adjusted hazard ratios (AHRs), weighted by these prognostic factors. The new system classified patients into five stages with distinct 5-year CSS outcomes.ResultsThe study analyzed 1,201 PDTC cases from SEER and 85 cases from China. Among the 876 patients in the training cohort, the new TNM staging system showed superior discrimination compared to the 8th edition of the AJCC TNM system. The 5-year CSS rates for the new stages I, II, III, IVA, and IVB were 96.3%, 88.4%, 69.4%, 43.3%, and 22.3%, respectively. The new system outperformed the 8th edition in predicting CSS, as shown by time-dependent ROC curves, C-index, and calibration plots. Both internal and external validation confirmed its predictive abilities.ConclusionThe current AJCC staging system inadequately predicts PDTC prognosis. The new TNM staging system developed in this study offers improved stratification and prognosis prediction, potentially guiding more effective clinical management for PDTC. |
| format | Article |
| id | doaj-art-bbe1440b7fb9465e9f74b1c3d0fb5576 |
| institution | DOAJ |
| issn | 1664-2392 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Endocrinology |
| spelling | doaj-art-bbe1440b7fb9465e9f74b1c3d0fb55762025-08-20T03:07:12ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922025-08-011610.3389/fendo.2025.15865421586542Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort studyYu Guo0Yu Guo1Yu Guo2Yu Guo3Qianyi Zhong4Qianyi Zhong5Liangen Xie6Liangen Xie7Liangen Xie8Xudong Wang9Liang Guo10Shimin Zhuang11Shimin Zhuang12Shimin Zhuang13Chunyan Jia14Lijiao Wu15Jin Peng16Feng Pang17Feng Pang18Feng Pang19Ankui Yang20Ankui Yang21Tianrun Liu22Tianrun Liu23Tianrun Liu24Tianrun Liu25Department of General Surgery (Thyroid Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaBiomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, ChinaThe First Clinical Medical College of Jinan University, Guangzhou, Guangdong, ChinaDepartment of Otorhinolaryngology Head and Neck Surgery, Guangzhou Twelfth People’s Hospital (The Affiliated Twelfth People’s Hospital of Guangzhou Medical University), Guangzhou Medical University, Guangzhou, ChinaDepartment of General Surgery (Thyroid Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaBiomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Basic and Translational Medicine on Head & Neck Cancer, Tianjin, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin, ChinaDepartment of Head and Neck Surgery, Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, ChinaDepartment of General Surgery (Thyroid Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaBiomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Otolaryngology Head and Neck (Thyroid) Surgery, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, ChinaDepartment of Otolaryngology Head and Neck (Thyroid) Surgery, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, ChinaDepartment of General Surgery (Thyroid Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaBiomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China0Department of Head and Neck Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China1State Key Laboratory of Oncology in South China, Guangzhou, ChinaDepartment of General Surgery (Thyroid Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Otorhinolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaBiomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, ChinaDepartment of Thyroid Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, ChinaObjectivePoorly differentiated thyroid cancer (PDTC) is a rare, heterogeneous carcinoma from follicular cells, characterized by poor differentiation, aggressive spread, and poor prognosis. Currently, there is no specific staging system for PDTC. This study aimed to develop a new TNM staging system tailored to PDTC for improved disease management.MethodsA new TNM staging system was designed and internally validated using data from the US SEER database (2004-2016) on PDTC cases. External validation was performed using data from four major institutions in China. Prognostic factors influencing cancer-specific survival (CSS) were identified through Cox regression analyses. Patients were stratified into subgroups based on adjusted hazard ratios (AHRs), weighted by these prognostic factors. The new system classified patients into five stages with distinct 5-year CSS outcomes.ResultsThe study analyzed 1,201 PDTC cases from SEER and 85 cases from China. Among the 876 patients in the training cohort, the new TNM staging system showed superior discrimination compared to the 8th edition of the AJCC TNM system. The 5-year CSS rates for the new stages I, II, III, IVA, and IVB were 96.3%, 88.4%, 69.4%, 43.3%, and 22.3%, respectively. The new system outperformed the 8th edition in predicting CSS, as shown by time-dependent ROC curves, C-index, and calibration plots. Both internal and external validation confirmed its predictive abilities.ConclusionThe current AJCC staging system inadequately predicts PDTC prognosis. The new TNM staging system developed in this study offers improved stratification and prognosis prediction, potentially guiding more effective clinical management for PDTC.https://www.frontiersin.org/articles/10.3389/fendo.2025.1586542/fullpoorly differentiated thyroid cancernew TNM stageadjusted hazard ratiocancer-specific survivalprognosis prediction |
| spellingShingle | Yu Guo Yu Guo Yu Guo Yu Guo Qianyi Zhong Qianyi Zhong Liangen Xie Liangen Xie Liangen Xie Xudong Wang Liang Guo Shimin Zhuang Shimin Zhuang Shimin Zhuang Chunyan Jia Lijiao Wu Jin Peng Feng Pang Feng Pang Feng Pang Ankui Yang Ankui Yang Tianrun Liu Tianrun Liu Tianrun Liu Tianrun Liu Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort study Frontiers in Endocrinology poorly differentiated thyroid cancer new TNM stage adjusted hazard ratio cancer-specific survival prognosis prediction |
| title | Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort study |
| title_full | Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort study |
| title_fullStr | Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort study |
| title_full_unstemmed | Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort study |
| title_short | Development of a new TNM staging system for poorly differentiated thyroid carcinoma: a multicenter cohort study |
| title_sort | development of a new tnm staging system for poorly differentiated thyroid carcinoma a multicenter cohort study |
| topic | poorly differentiated thyroid cancer new TNM stage adjusted hazard ratio cancer-specific survival prognosis prediction |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2025.1586542/full |
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