>Cirugía y Cirujanos
>Year 2002, Issue 4
Rodríguez-Cuevas S, Labastida-Almendaro S, Cortés-Arroyo H, López-Garza J, Barroso-Bravo S
Rational treatment of differentiated thyroid cancer by risk-group assignment
Cir Cir 2002; 70 (4)
PDF: 49.79 Kb.
Background: Many risk factors have been identified in differentiated thyroid cancer; with these in mind, some prognostic scores have been designed to assign risk of recurrence and survival.
Objective: To evaluate usefulness of three different methods of risk assignment in differentiated thyroid cancer in Mexican patients.
Methods: This is a retrospective review of 180 patients with differentiated thyroid cancer completely treated from 1980 to 1990. All prognostic factors were analyzed and a score obtained either by method of AGES, MACIS, or SKMH. Correlation of recurrences and survival was carried out according to score or risk assignment.
Results: According to AGES, 46% were high-risk patients, 49.4% with MACIS and 45.5% with SKMH, respectively. Median follow-up was 8.3 years. There were 67 (37%) recurrences. Ten-year overall survival was 89.4% and disease-free survival was 79.2%. Cox multivariate model showed that age above 45 years, tumor size of 5 cm or more, follicular histology, multiple macroscopic thyroid tumors, and extracapsular node invasion affected 10-year survival.
Conclusions: Nearly one half of our patients belonged to the high-risk group. In Mexican population, with 50% of high-risk patients AGES and MACIS scores are useful to assign risk group. It is mandatory to be familiar with these scores to select individualized therapy adequately.
||, Thyroid cancer, Prognostic factor, Risk scores.
Crile G Jr. Relationship of the age of the patient to the natural history and prognosis of carcinoma of the thyroid. Ann Surg 1953;138:33-38.
Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987;102:1088-1095.
Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma. Development of a reliable prognostic scoring system in a cohort of 1,779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993;114:1050-1058.
Cady B, Rossi R. An expanded view of risk-group definition in differentiated thyroid carcinoma. Surgery 1988;104:947-953.
Byar DP, Green SB, Dor P, et al. A prognostic index for thyroid carcinoma. A study of the EORTC thyroid cooperative group. Eur J Cancer 1979;15:1033-1041.
Shaha AR, Loree TR, Shah JP. Intermediate-risk group for differentiated carcinoma of the thyroid. Surgery 1994;116:1036-1041.
Parker SL. Cancer Statistics CA 1996;46:5-27.
Pelizzo MR, Toniato A, Grigoletto R. Surgical treatment of papillary thyroid carcinoma: uni and multivariate analysis of prognostic factors (TNM system included). J Exp Clin Can Res 1997;16:261-265.
Simpson WJ, McKinney SE, Carruthers JS, Gosporadowicz MK, Sutcliffe SB, Panzarella T. Papillary and Follicular thyroid cancer. Prognostic factors in 1578 patients. Am J Med 1987;83:479-488.
Akslen LA, Haldorsen T, Thorensen SO, Glattre E. Survival and causes of death in thyroid cancer: a population based study of 2479 cases from Norway. Cancer Res 1991;51:1234-1241.
Schindler AM, van Melle G, Evequoz B, Scassiga B. Prognostic factors in papillary carcinoma of the thyroid. Cancer 1991;68:324-330.
Joensuu H, Klemi PJ, Tuominen J. Survival and prognostic factors in thyroid carcinoma. Acta Radiol Oncol 1986;25:243-248.
Schelfhout LJDM, Creutzberg CL, Hamming JF, Fleuren G, Smeen K, Hermans J et al. Multivariate analysis of survival in differentiated cancer: the prognostic significance of age factor. Eur J Cancer Clin Oncol 1988;24:331-337.
Herrera MF, López-Graniel CM, Saldaña J, Gamboa-Domínguez A, Richaud-Patin Y, Vargas Vorackova F et al. Papillary thyroid carcinoma in Mexican patients: clinical aspects and prognostic factors. World J Surg 1996;20:94-100.
Cady B, Ross R, Silverman M, Wool M. Further evidence of the validity of risk-group definition in differentiated thyroid gland. Surgery 1985;98:1171-1178.
Rodríguez-Cuevas SA, Labastida AS, Rodríguez ME, Reyes CJM. Papillary thyroid cancer in Mexico: analysis of 409 cases. Head & Neck 1993;15:537-545.
Rodríguez CS, Labastida AS, Olano NO, Muñoz CML. Morbilidad debida a tiroidectomía por cáncer. Cir Gen 1996;18:92-97.
Hurtado LLM, Pulido CA, Basurto KE, Garza FJH. ¿Cumple su objetivo terapéutico la tiroidectomía subtotal en la enfermedad de Graves-Basedow? Cir Gen 1999;21:57-59.
Fluchsuber P, Loree TR, De la Cure MD, Hicks WL. Differentiated thyroid carcinoma: Risk group assignment and management controversies. Oncology 1998;12:99-105.
Cady B. Our AMES is true: how an old concept still hits the mark: or Risk group assignment points the arrow to rational therapy selection in differentiated thyroid cancer. Am J Surg 1997;174:462-468.
Cady B. Papillary carcinoma of the thyroid gland. Treatment based on risk group definition. Surg Oncol Clin North Am 1998;7:633-644.
Noguchi S, Murakami N, Kawamoto H. Classification of papillary cancer of the thyroid based on prognosis. World J Surg 1994;18:522-528.
>Cirugía y Cirujanos
>Year 2002, Issue 4