SpringerLink
Log in

The impact of radioactive iodine treatment on survival among papillary thyroid cancer patients according to the 7th and 8th editions of the AJCC/TNM staging system: a SEER-based study

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Papillary thyroid cancer is a very common endocrine malignancy. The 8th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system introduced major changes. We conducted this retrospective cohort analysis to assess the benefits of radioactive iodine (RAI) according to different stratification of patients. The source of the data was the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. From 2006 to 2015, patients with papillary thyroid cancer were included in our study. The interactions between different variables and RAI treatment were tested by multivariate Cox regression models to compare the survival differences according to RAI treatment between the patients assessed with the 7th and 8th edition of the AJCC/TNM staging system. The results of the interaction analysis and group comparisons indicated that the effects of RAI treatment on patients staged with the 7th and 8th editions were similar. Patients with early Stage, early T stage, N0 and subtotal or near total thyroidectomy benefited greatly from RAI treatment. Patients with Stage III according to the 8th edition benefited less from RAI than patients with Stage III according to the 7th edition. Patients with T1a benefited from RAI but benefited less than patients with other T stages. Patients with T3a benefited more from RAI than those with T3b. According to the 8th edition, Stage III/IV more accurately differentiates patients with advanced stage disease. These patients benefitted less from RAI treatment, which may be due to the relatively weaker iodine uptake by tumor cells. T1a patients benefitted less than patients with other T stages. The difference in RAI benefit between patients with T3a and T3b is a novel finding in our study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data in this article are from the SEER database.

References

  1. Vaccarella S, Franceschi S, Bray F, Wild CP, Plummer M, Dal Maso L (2016) Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. New Engl J Med 375(7):614–617. https://doi.org/10.1056/NEJMp1604412

    Article  PubMed  Google Scholar 

  2. Cabanillas ME, McFadden DG, Durante C (2016) Thyroid cancer. Lancet (London, England) 388(10061):2783–2795. https://doi.org/10.1016/s0140-6736(16)30172-6

    Article  CAS  Google Scholar 

  3. Dralle H, Machens A, Basa J, Fatourechi V, Franceschi S, Hay ID, Nikiforov YE, Pacini F, Pasieka JL, Sherman SI (2015) Follicular cell-derived thyroid cancer. Nat Rev Dis Primers 1:15077. https://doi.org/10.1038/nrdp.2015.77

    Article  PubMed  Google Scholar 

  4. Carling T, Udelsman R (2014) Thyroid cancer. Annu Rev Med 65:125–137. https://doi.org/10.1146/annurev-med-061512-105739

    Article  CAS  PubMed  Google Scholar 

  5. Tuttle RM, Haugen B, Perrier ND (2017) Updated American joint committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): What changed and why? Thyroid 27(6):751–756. https://doi.org/10.1089/thy.2017.0102

    Article  PubMed  PubMed Central  Google Scholar 

  6. Shteinshnaider M, Muallem Kalmovich L, Koren S, Or K, Cantrell D, Benbassat C (2018) Reassessment of differentiated thyroid cancer patients using the eighth TNM/AJCC classification system: a comparative study. Thyroid 28(2):201–209. https://doi.org/10.1089/thy.2017.0265

    Article  CAS  PubMed  Google Scholar 

  7. Lamartina L, Grani G, Arvat E, Nervo A, Zatelli MC, Rossi R, Puxeddu E, Morelli S, Torlontano M, Massa M, Bellantone R, Pontecorvi A, Montesano T, Pagano L, Daniele L, Fugazzola L, Ceresini G, Bruno R, Rossetto R, Tumino S, Centanni M, Meringolo D, Castagna MG, Salvatore D, Nicolucci A, Lucisano G, Filetti S, Durante C (2018) 8th edition of the AJCC/TNM staging system of thyroid cancer: what to expect (ITCO#2). Endocr Relat Cancer 25(3):L7–l11. https://doi.org/10.1530/erc-17-0453

    Article  PubMed  Google Scholar 

  8. Kim M, Kim YN, Kim WG, Park S, Kwon H, Jeon MJ, Ahn HS, Jung SH, Kim SW, Kim WB, Chung JH, Shong YK, Kim TH, Kim TY (2017) Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years? Clin Endocrinol 86(3):438–443. https://doi.org/10.1111/cen.13254

    Article  Google Scholar 

  9. Nixon IJ, Kuk D, Wreesmann V, Morris L, Palmer FL, Ganly I, Patel SG, Singh B, Tuttle RM, Shaha AR, Gönen M, Shah JP (2016) Defining a valid age cutoff in staging of well-differentiated thyroid cancer. Ann Surg Oncol 23(2):410–415. https://doi.org/10.1245/s10434-015-4762-2

    Article  PubMed  Google Scholar 

  10. Nixon IJ, Wang LY, Migliacci JC, Eskander A, Campbell MJ, Aniss A, Morris L, Vaisman F, Corbo R, Momesso D, Vaisman M, Carvalho A, Learoyd D, Leslie WD, Nason RW, Kuk D, Wreesmann V, Morris L, Palmer FL, Ganly I, Patel SG, Singh B, Tuttle RM, Shaha AR, Gönen M, Pathak KA, Shen WT, Sywak M, Kowalski L, Freeman J, Perrier N, Shah JP (2016) An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. Thyroid 26(3):373–380. https://doi.org/10.1089/thy.2015.0315

    Article  PubMed  PubMed Central  Google Scholar 

  11. Perrier ND, Brierley JD, Tuttle RM (2018) Differentiated and anaplastic thyroid carcinoma: major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 68(1):55–63. https://doi.org/10.3322/caac.21439

    Article  PubMed  Google Scholar 

  12. Woo CG, Sung CO, Choi YM, Kim WG, Kim TY, Shong YK, Kim WB, Hong SJ, Song DE (2015) Clinicopathological significance of minimal extrathyroid extension in solitary papillary thyroid carcinomas. Ann Surg Oncol 22(Suppl 3):S728–733. https://doi.org/10.1245/s10434-015-4659-0

    Article  PubMed  Google Scholar 

  13. ** BJ, Kim MK, Ji YB, Song CM, Park JH, Tae K (2015) Characteristics and significance of minimal and maximal extrathyroidal extension in papillary thyroid carcinoma. Oral Oncol 51(8):759–763. https://doi.org/10.1016/j.oraloncology.2015.05.010

    Article  PubMed  Google Scholar 

  14. Zhi J, Wu Y, Hu L, Zhao J, Liu H, Ruan X, Hou X, Zhang J, Zheng X, Gao M (2020) Assessment of the prognostic value and N1b changes of the eighth TNM/AJCC staging system for differentiated thyroid carcinoma. Int J Clin Oncol 25(1):59–66. https://doi.org/10.1007/s10147-019-01522-x

    Article  CAS  PubMed  Google Scholar 

  15. Yang F, Zhong Q, Huang Z, Lian M, Fang J (2019) Survival in papillary thyroid microcarcinoma: a comparative analysis between the 7th and 8th versions of the AJCC/UICC staging system based on the SEER database. Front Endocrinol (Lausanne) 10:10. https://doi.org/10.3389/fendo.2019.00010

    Article  CAS  Google Scholar 

  16. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L (2016) 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26(1):1–133. https://doi.org/10.1089/thy.2015.0020

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ruel E, Thomas S, Dinan M, Perkins JM, Roman SA, Sosa JA (2015) Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer. J Clin Endocrinol Metab 100(4):1529–1536. https://doi.org/10.1210/jc.2014-4332

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kazaure HS, Roman SA, Sosa JA (2012) Insular thyroid cancer: a population-level analysis of patient characteristics and predictors of survival. Cancer 118(13):3260–3267. https://doi.org/10.1002/cncr.26638

    Article  PubMed  Google Scholar 

  19. Kazaure HS, Roman SA, Sosa JA (2012) Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients. Ann Surg Oncol 19(6):1874–1880. https://doi.org/10.1245/s10434-011-2129-x

    Article  PubMed  Google Scholar 

  20. Schlumberger M, Leboulleux S, Catargi B, Deandreis D, Zerdoud S, Bardet S, Rusu D, Godbert Y, Buffet C, Schvartz C, Vera P, Morel O, Benisvy D, Bournaud C, Toubert ME, Kelly A, Benhamou E, Borget I (2018) Outcome after ablation in patients with low-risk thyroid cancer (ESTIMABL1): 5-year follow-up results of a randomised, phase 3, equivalence trial. Lancet Diabetes Endocrinol 6(8):618–626. https://doi.org/10.1016/s2213-8587(18)30113-x

    Article  PubMed  Google Scholar 

  21. Marti JL, Morris LGT, Ho AS (2018) Selective use of radioactive iodine (RAI) in thyroid cancer: no longer “one size fits all”. Eur J Surg Oncol 44(3):348–356. https://doi.org/10.1016/j.ejso.2017.04.002

    Article  CAS  PubMed  Google Scholar 

  22. Verburg FA, Hänscheid H, Luster M (2017) Radioactive iodine (RAI) therapy for metastatic differentiated thyroid cancer. Best Pract Res Clin Endocrinol Metab 31(3):279–290. https://doi.org/10.1016/j.beem.2017.04.010

    Article  CAS  PubMed  Google Scholar 

  23. Wang TS, Goffredo P, Sosa JA, Roman SA (2014) Papillary thyroid microcarcinoma: an over-treated malignancy? World J Surg 38(9):2297–2303. https://doi.org/10.1007/s00268-014-2602-3

    Article  PubMed  Google Scholar 

  24. Kim M, Kim WG, Oh HS, Park S, Kwon H, Song DE, Kim TY, Shong YK, Kim WB, Sung TY, Jeon MJ (2017) Comparison of the seventh and eighth editions of the American Joint Committee on Cancer/Union for International Cancer Control Tumor-Node-Metastasis staging system for differentiated thyroid cancer. Thyroid 27(9):1149–1155. https://doi.org/10.1089/thy.2017.0050

    Article  PubMed  Google Scholar 

  25. Amin MBE, Greene S, Byrd F, Brookland DR, Washington RK, Gershenwald MK JE, Compton CC, Hess KR, Sullivan DC, Jessup JM, Brierley JDGLE, Schilsky RL, Balch CM, Winchester DP, Asare EA, Madera M GDM, Meye, LR (2017) AJCC Cancer Staging Manual, 8th edition. Springer International Publishing Thyroid differentiated and anaplastic carcinoma (Chapter 73).

  26. Pontius LN, Oyekunle TO, Thomas SM, Stang MT, Scheri RP, Roman SA, Sosa JA (2017) Projecting survival in papillary thyroid cancer: a comparison of the seventh and eighth editions of the American Joint Commission on Cancer/Union for International Cancer control staging systems in two contemporary national patient cohorts. Thyroid 27(11):1408–1416. https://doi.org/10.1089/thy.2017.0306

    Article  PubMed  PubMed Central  Google Scholar 

  27. Turk AT, Asa SL, Baloch ZW, Faquin WC, Fellegara G, Ghossein RA, Giordano TJ, LiVolsi VA, Lloyd R, Mete O, Rosai J, Suster S, Thompson LDR, Wenig BM (2019) Interobserver variability in the histopathologic assessment of extrathyroidal extension of well differentiated thyroid carcinoma supports the New American Joint Committee on cancer eighth edition criteria for tumor staging. Thyroid 29(5):619–624. https://doi.org/10.1089/thy.2018.0286

    Article  PubMed  Google Scholar 

  28. Youngwirth LM, Adam MA, Scheri RP, Roman SA, Sosa JA (2017) Extrathyroidal extension is associated with compromised survival in patients with thyroid cancer. Thyroid 27(5):626–631. https://doi.org/10.1089/thy.2016.0132

    Article  CAS  PubMed  Google Scholar 

  29. Nixon IJ, Ganly I, Patel S, Palmer FL, Whitcher MM, Tuttle RM, Shaha AR, Shah JP (2011) The impact of microscopic extrathyroid extension on outcome in patients with clinical T1 and T2 well-differentiated thyroid cancer. Surgery 150(6):1242–1249. https://doi.org/10.1016/j.surg.2011.09.007

    Article  PubMed  PubMed Central  Google Scholar 

  30. Al-Qurayshi Z, Shama MA, Randolph GW, Kandil E (2017) Minimal extrathyroidal extension does not affect survival of well-differentiated thyroid cancer. Endocr Relat Cancer 24(5):221–226. https://doi.org/10.1530/erc-16-0509

    Article  PubMed  Google Scholar 

  31. Moon HJ, Kim EK, Chung WY, Yoon JH, Kwak JY (2011) Minimal extrathyroidal extension in patients with papillary thyroid microcarcinoma: is it a real prognostic factor? Ann Surg Oncol 18(7):1916–1923. https://doi.org/10.1245/s10434-011-1556-z

    Article  PubMed  Google Scholar 

  32. Li M, Trivedi N, Dai C, Mao R, Wang Y, Ning Y, Gu SZ, Huo L, Siddiqui AD (2019) Does t stage affect prognosis in patients with stage IV B differentiated thyroid cancer? Endocr Pract. https://doi.org/10.4158/ep-2019-0051

    Article  PubMed  Google Scholar 

  33. Liu N, Meng Z, Jia Q, Tan J, Zhang G, Zheng W, Wang R, Li X, Hu T, Upadhyaya A, Zhou P, Wang S (2016) Multiple-factor analysis of the first radioactive iodine therapy in post-operative patients with differentiated thyroid cancer for achieving a disease-free status. Sci Rep 6:34915. https://doi.org/10.1038/srep34915

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Garg A, Chopra S, Ballal S, Soundararajan R, Bal CS (2015) Differentiated thyroid cancer in patients over 60 years of age at presentation: a retrospective study of 438 patients. J Geriatr Oncol 6(1):29–37. https://doi.org/10.1016/j.jgo.2014.09.182

    Article  PubMed  Google Scholar 

  35. Al-Qurayshi Z, Bu Ali D, Srivastav S, Kandil E (2017) Financial implication of radioactive iodine therapy for early-stage papillary thyroid cancer. Oncology 93(2):122–126. https://doi.org/10.1159/000466700

    Article  CAS  PubMed  Google Scholar 

  36. Sacks W, Wong RM, Bresee C, Braunstein GD (2015) Use of evidence-based guidelines reduces radioactive iodine treatment in patients with low-risk differentiated thyroid cancer. Thyroid 25(4):377–385. https://doi.org/10.1089/thy.2014.0298

    Article  CAS  PubMed  Google Scholar 

  37. Winter J, Winter M, Krohn T, Heinzel A, Behrendt FF, Tuttle RM, Mottaghy FM, Verburg FA (2016) Patients with high-risk differentiated thyroid cancer have a lower I-131 ablation success rate than low-risk ones in spite of a high ablation activity. Clin Endocrinol 85(6):926–931. https://doi.org/10.1111/cen.13123

    Article  CAS  Google Scholar 

  38. Hassan A, Riaz S, Bashir H, Nawaz MK, Hussain R (2016) Can the American thyroid association risk of recurrence predict radioiodine refractory disease in differentiated thyroid cancer? Eur Thyroid J 5(4):261–267. https://doi.org/10.1159/000448920

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Hu G, Zhu W, Yang W, Wang H, Shen L, Zhang H (2016) The Effectiveness of radioactive iodine remnant ablation for papillary thyroid microcarcinoma: a systematic review and meta-analysis. World J Surg 40(1):100–109. https://doi.org/10.1007/s00268-015-3346-4

    Article  CAS  PubMed  Google Scholar 

  40. Kim HJ, Kim NK, Choi JH, Kim SW, ** SM, Suh S, Bae JC, Min YK, Chung JH, Kim SW (2013) Radioactive iodine ablation does not prevent recurrences in patients with papillary thyroid microcarcinoma. Clin Endocrinol 78(4):614–620. https://doi.org/10.1111/cen.12034

    Article  Google Scholar 

  41. Lin HW, Bhattacharyya N (2009) Survival impact of treatment options for papillary microcarcinoma of the thyroid. The Laryngoscope 119(10):1983–1987. https://doi.org/10.1002/lary.20617

    Article  PubMed  Google Scholar 

  42. Xue S, Wang P, Liu J, Chen G (2017) Radioactive iodine ablation decrease recurrences in papillary thyroid microcarcinoma with lateral lymph node metastasis in Chinese patients. World J Surg 41(12):3139–3146. https://doi.org/10.1007/s00268-017-4134-0

    Article  PubMed  PubMed Central  Google Scholar 

  43. Mihailovic J, Stefanovic L, Stankovic R (2013) Influence of initial treatment on the survival and recurrence in patients with differentiated thyroid microcarcinoma. Clin Nucl Med 38(5):332–338. https://doi.org/10.1097/RLU.0b013e3182872ed2

    Article  PubMed  Google Scholar 

  44. Clement SC, Peeters RP, Ronckers CM, Links TP, van den Heuvel-Eibrink MM, Nieveen van Dijkum EJ, van Rijn RR, van der Pal HJ, Neggers SJ, Kremer LC, van Eck-Smit BL, van Santen HM (2015) Intermediate and long-term adverse effects of radioiodine therapy for differentiated thyroid carcinoma–a systematic review. Cancer Treat Rev 41(10):925–934. https://doi.org/10.1016/j.ctrv.2015.09.001

    Article  CAS  PubMed  Google Scholar 

  45. Molenaar RJ, Sidana S, Radivoyevitch T, Advani AS, Gerds AT, Carraway HE, Angelini D, Kalaycio M, Nazha A, Adelstein DJ, Nasr C, Maciejewski JP, Majhail NS, Sekeres MA, Mukherjee S (2018) Risk of hematologic malignancies after radioiodine treatment of well-differentiated thyroid cancer. J Clin Oncol 36(18):1831–1839. https://doi.org/10.1200/jco.2017.75.0232

    Article  CAS  PubMed  Google Scholar 

  46. Hakala TT, Sand JA, Jukkola A, Huhtala HS, Metso S, Kellokumpu-Lehtinen PL (2016) Increased risk of certain second primary malignancies in patients treated for well-differentiated thyroid cancer. Int J Clin Oncol 21(2):231–239. https://doi.org/10.1007/s10147-015-0904-6

    Article  CAS  PubMed  Google Scholar 

  47. Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. CA Cancer J Clin 69(1):7–34. https://doi.org/10.3322/caac.21551

    Article  Google Scholar 

  48. Iyer NG, Morris LG, Tuttle RM, Shaha AR, Ganly I (2011) Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy. Cancer 117(19):4439–4446. https://doi.org/10.1002/cncr.26070

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This manuscript was reviewed and modified by Andrew Murphy, BSEE, JD, Attorney at Law (P.C. 3601 N. Classen Blvd. #106, Oklahoma City, OK 73118). The manuscript was edited by editors at AJE

Funding

This study was supported by the National Key Clinical Specialty Project (awarded to the Departments of Nuclear Medicine and Radiology). This study was supported by Tian** Medical University General Hospital New Century Excellent Talent Program; Young and Middle-aged Innovative Talent Training Program from Tian** Education Committee; and Talent Fostering Program (the 131 Project) from Tian** Education Committee, Tian** Human Resources and Social Security Bureau (to Zhaowei Meng). This study was also supported by the following grants. China National Natural Science Foundation Grant #81571709 and # 81971650 (to Zhaowei Meng); Key Project of Tian** Science and Technology Committee Foundation Grant #16JCZDJC34300 (to Zhaowei Meng); and Tian** Science and Technology Committee Foundation Grant #17JCYBJC25400 (to Yaguang Fan).

Author information

Author notes

  1. ** District, Tian**, 300052, People’s Republic of China

    **angxiang Liu, Jian Tan, Qiang Jia & Zhaowei Meng

  2. Tian** Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tian** Lung Cancer Institute, Tian** Medical University General Hospital, Tian**, People’s Republic of China

    Yaguang Fan

  3. Department of General Surgery, Tian** Medical University General Hospital, Tian**, People’s Republic of China

    Yuanchao Liu & **anghui He

  4. Department of Thyroid and Neck Tumor, Key Laboratory of Cancer Prevention and Therapy of Tian** City, Tian** Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tian**, People’s Republic of China

    **angqian Zheng

Authors
  1. **angxiang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yaguang Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuanchao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. **anghui He
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. **angqian Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jian Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qiang Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zhaowei Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhaowei Meng.

Ethics declarations

Conflict of interest

No potential conflicts of interest relevant to this article exist.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 15 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, X., Fan, Y., Liu, Y. et al. The impact of radioactive iodine treatment on survival among papillary thyroid cancer patients according to the 7th and 8th editions of the AJCC/TNM staging system: a SEER-based study. Updates Surg 72, 871–884 (2020). https://doi.org/10.1007/s13304-020-00773-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00773-y

Keywords

Search

Navigation