美国癌症联合委员会甲状腺癌分期系统（第8版）修订对甲状腺乳头状癌分期的影响

背景与目的：2017年美国癌症联合委员会发布了TNM分期系统第8版（TNM-8），该研究旨在比较TNM-8和第7版（TNM-7）分期规则下甲状腺乳头状癌（papillary thyroid carcinoma，PTC）患者分期的变化。方法：该研究共纳入2013—2015年因甲状腺乳头状癌而在中国医学科学院北京协和医学院北京协和医院行初治手术治疗的患者4 265例，手术范围至少包括患侧腺叶切除及患侧淋巴结清扫。根据年龄、性别、肿瘤大小、侵犯范围、淋巴结转移情况及远处转移情况，分别应用TNM-7及TNM-8分期规则进行分期，并对结果进行比较。结果：4 265例患者中，男性1 069例，女性3 196例。根据TNM-7分期，Ⅰ、Ⅱ、Ⅲ、Ⅳa、Ⅳb和Ⅳc期患者数量分别为3 093例（72.50%）、23例（0.54%）、942例（22.09%）、199例（4.67%）、1例（0.02%）和7例（0.16%）；而根据TNM-8分期，Ⅰ、Ⅱ、Ⅲ和Ⅳb期患者数量则分别为3 996例（93.60%）、259例（6.00%）、9例（0.20%）和1例（0.02%）。共有1 163例（27.3%）患者分期发生了调整，均为降期。降期原因包括年龄的划分升至55岁（781例，67.1%）、TNM分期规则调整（265例，22.8%）和T分期规则调整（117例，10.1%）。在3 059例微小癌患者中，根据TNM-7分期，Ⅰ~Ⅳ期的患者数量分别为2 323例（75.94%）、3例（0.10%）、649例（21.22%）和84例（2.70%）；根据TNM-8分期，Ⅰ~Ⅳ期的患者数量则分别为2 917例（95.30%）、138例（4.50%）、3例（0.10%）和1例（0.03%）。结论：应用TNM-8，与TNM-7相比，Ⅲ~Ⅳ期患者比例大幅减少，对于微小癌患者该特点更加突出，能更好地反映疾病的严重程度。

The impact of American Cancer Joint Committee Revised Thyroid Cancer Staging System (8th edition)on staging of papillary thyroid carcinoma

Background and purpose: The TNM staging system was updated to eighth edition (TNM-8) in 2017 by American Joint Committee on Cancer (AJCC). The purpose of this study was to compare staging results of the papillary thyroid carcinoma (PTC) using TNM-8 and seventh edition (TNM-7) staging systems. Methods: A total of 4 265 patients who were diagnosed with PTC and underwent primary surgery at the Peking Union Medical College Hospital from 2013 to 2015 were reviewed. The extent of surgery included lobectomy and ipsilateral lymph node dissection at least. According to age, gender, tumor size, extent of invasion, lymph node metastasis and distant metastasis, TNM-7 and TNM-8 staging systems were used for staging, and the results were compared. Results: A total of 4 265 patients (1 069 males and 3 196 females) were included. According to TNM-7 system, the number of patients with stage Ⅰ, Ⅱ, Ⅲ, Ⅳa, Ⅳb and Ⅳc were 3 093 (72.50%), 23 (0.54%), 942 (22.09 %), 199 (4.67%), 1 (0.02%) and 7 (0.16%), respectively. Using TNM-8 system, the number of patients with stage Ⅰ, Ⅱ, Ⅲ and IVb were 3 996 (93.60%), 259 (6.00%), 9 (0.20%) and 1 (0.02%), respectively. A total of 1 163 patients (27.3%) were down-staged. The reasons for the down-staging included the adjustment of age to 55 years (781 cases, 67.1%), the adjustment of TNM staging rules (265 cases, 22.8%), and the adjustment of T staging rules (117 cases, 10.1%). In 3 059 microcarcinoma patients, the numbers of Ⅰ-Ⅳ patients by TNM-7 were 2 323 (75.94%), 3 (0.10%), 649 (21.22%) and 84 (2.70%), respectively. By TNM-8, the numbers were 2 917 (95.30%), 138 (4.50%), 3 (0.10%) and 1 (0.03%), respectively. Conclusion: With the TNM-8, the proportion of patients with stage Ⅲ-Ⅳ is significantly decreased. This feature is even more prominent in patients with microcarcinoma, and can better indicate the severity of the disease.