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Abstract：
The prognostic significance of tumor size in T3b differentiated thyroid cancer (DTC) remains debated and underexplored. This study aimed to examine the varying impact of T3b based on tumor size, analyzing disease-specific survival, disease-free survival, and overall survival. A retrospective review of 6282 DTC patients who underwent thyroid surgery at Seoul St. Mary\'s Hospital from September 2000 to December 2017 was conducted. T3b was classified into three subcategories, T3b-1 (≤2 cm), T3b-2 (2-4 cm), and T3b-3 (>4 cm), using the same size criteria for T1, T2, and T3a. T3b-1 showed no significant difference in disease specific survival compared to T1, and both disease-free and disease-specific survival curves were sequentially ranked as T1, T3b-1, T2, T3a, T3b-2, and T3b-3. The modified T category, reclassifying T3b-1 as T1, demonstrated superior staging performance compared to the classic T category (c-index: 0.8961 vs. 0.8959 and AUC: 0.8573 vs. 0.8518). Tumors measuring 2 cm or less within the T3b category may require downstaging, and a modified T category could improve the precision of prognostic staging compared to the current T category.
摘要：
T3b分化型甲状腺癌（DTC）中肿瘤大小的预后意义仍存在争议和不足。本研究旨在根据肿瘤大小检查T3b的不同影响，分析疾病特异性生存，无病生存,和总体生存率。回顾性分析2000年9月至2017年12月在首尔圣玛丽医院接受甲状腺手术的6282例DTC患者。T3b分为三个子类别，T3b-1(≤2cm),T3b-2（2-4厘米），和T3b-3（>4厘米），对T1、T2和T3a使用相同的尺寸标准。T3b-1与T1相比,在疾病特异性生存方面无显著差异,无病和疾病特异性生存曲线依次为T1、T3b-1、T2、T3a、T3b-2和T3b-3。修改后的T类别，将T3b-1重新分类为T1，与经典T类别相比，显示出优越的分期性能(c指数：0.8961vs.0.8959和AUC：0.8573vs.0.8518)。T3b类别中2厘米或以下的肿瘤可能需要降级，与当前的T类别相比，修改后的T类别可以提高预后分期的准确性。
