editorials January 01, 2019 January 01, 2019

Clinical risk predictors for differentiated thyroid cancer management: what is new?

DOI: 10.20945/2359-3997000000110

Management of differentiated thyroid cancer (DTC) is highly dependent on risk stratification (,). An initial assessment of the risk of mortality and the risk of persistent/recurrent disease are required to guide treatment, follow-up and to set appropriate patients and physicians expectations with regard to the clinical outcomes after initial therapy. Therefore, much effort has been made for the improvement of long-term clinical risk predictors based on the information available at the time of diagnosis. In this issue of the Archives of Endocrinology and Metabolism, two very interesting papers were published concerning this subject.

Nava and cols. () evaluated the impact of the updated American Joint Committee on Cancer; Tumor, Lymph Nodes, Metastasis (AJCC/TNM) system staging criteria on the prediction of persistent disease in DTC. The major changes from the updated TNM 8^th edition were: the age cutoff used for staging was increased from 45 to 55 years of age at diagnosis; minor extrathyroidal extension detected only on histological examination was removed from the definition of T3 disease and therefore has no impact on either T category or overall stage; T3a is a new category for tumors > 4 cm confined to the thyroid gland; T3b is a new category for tumors of any size demonstrating gross extrathyroidal extension into strap muscles (sternohyoid, sternothyroid, thyrohyoid, or omohyoid muscles); level VII lymph nodes, previously classified as lateral neck lymph nodes (N1b), were reclassified as central neck lymph nodes (N1a); and the presence of distant metastases in older patients is classified as stage IVB disease rather than stage IVC disease ().

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