Revised Perspective on the AJCC Staging System for Medullary Thyroid Cancer: A Study of Two Nationwide Cohorts

作者：Cenkai Shen, Yuxin Du, Shiyu Xiang, Zimeng Li, Chuqiao Liu, Zhiyan Liu, Yijun Wu, Liang Guo, Yan Zhang, Hao Zhang, Chuang Chen, Min Yin, Haitao Tang, Qinghai Ji, Wenjun Wei, Xiao Shi, Yu Wang · 发表于：Journal of the National Comprehensive Cancer Network · 年份：2025 · DOI：10.6004/jnccn.2024.7095 · 被引用次数：4 · 研究领域：Thyroid Cancer Diagnosis and Treatment、Thyroid and Parathyroid Surgery、Renal cell carcinoma treatment

BACKGROUND: The current AJCC TNM staging system for medullary thyroid cancer (MTC) is largely adapted from criteria for differentiated thyroid cancer, which may not fully capture MTC-specific prognostic factors. This study aimed to evaluate the prognostic significance of upper mediastinal lymph node metastasis (LNM) and propose corresponding modifications to the N category and staging system to improve their applicability for MTC. METHODS: We conducted a population-based, retrospective study enrolling patients with MTC from 19 Chinese referral centers. Demographics and pathologic characteristics were collected, and patients were categorized into 4 LNM subgroups: no LNM, central cervical LNM, lateral cervical LNM, and upper mediastinal (level VII) LNM. We assessed their prognostic significance using Kaplan-Meier survival curves and Cox regression analysis. Recursive partitioning analysis was then applied to regroup patients with similar overall survival (OS). To validate our findings, we analyzed an independent cohort from the SEER database. RESULTS: Our multicenter cohort included 827 patients with initially treated MTC, of whom 438 (53.0%) were female, with a median age of 50 years (IQR, 40-59). Upper mediastinal (level VII) LNM was present in 12.6% of patients and was significantly associated with worse OS, structural recurrence-free survival, and biochemical response compared with other LNM sites (all P<.05). Based on these findings, we proposed up-classifying level VII me...