D'Avanzo A, Ituarte P, Treseler P, Kebebew E, Wu J, Wong M, Duh Q Y, Siperstein A E, Clark O H
Department of Surgery, University of California San Francisco/Mt Zion Medical Center, San Francisco, California 94143-1674, USA.
Thyroid. 2004 Jun;14(6):453-8. doi: 10.1089/105072504323150778.
The use of prognostic scoring systems is important for predicting the survival of individuals with thyroid carcinoma. Relatively few studies have addressed this issue for patients with follicular thyroid cancer. The goal of this retrospective study was to establish the best and most pertinent prognostic scoring system to predict survival in patients with follicular thyroid cancer.
We selected 86 patients with follicular thyroid cancer treated at University of California, San Francisco (UCSF) hospitals from January 1954 to April 1998. The mean follow-up time was 11.5 years. There were 60 women (70%) and 26 men (30%), with a mean age if 48.6 years. Prognostic scoring systems included tumor, node, metastases (TNM), European Organization for Research and Treatment of Cancer (EORTC), Age, Grade, Extent, Size (AGES), Age, Metastases, Extent, Size (AMES), and the Metastases, Age, Completeness of resection, Invasion, Size (MACIS). Survival time was calculated using the Kaplan-Meier method. Using Cox proportional hazards analysis, the relative importance of each scoring method was determined by calculating the proportion of variation in survival time explained (PVE).
Kaplan-Meier analysis indicated that all scoring systems were significant predictors of survival time (p < 0.0001). The PVE associated with each system was (from highest to lowest) 0.48 for MACIS, 0.46 for AGES, 0.44 for EORTC, 0.40 for AMES, and 0.33 for TNM. These results indicate that the MACIS scoring system accounted for a great proportion of explained variance in survival and is a more precise predictor of survival compared to the other scoring systems.
TNM, EORTC, AGES, AMES, and MACIS, all provided useful prognostic information about the survival in our 86 patients with follicular thyroid cancers. The MACIS classification, however, was the most accurate predictor using PVE as a method of evaluation. Future scoring systems considering additional prognostic factors, may obtain a higher PVE.
预后评分系统对于预测甲状腺癌患者的生存率非常重要。针对滤泡状甲状腺癌患者的这一问题，相关研究相对较少。这项回顾性研究的目的是建立最佳且最相关的预后评分系统，以预测滤泡状甲状腺癌患者的生存率。
我们选取了1954年1月至1998年4月在加利福尼亚大学旧金山分校（UCSF）医院接受治疗的86例滤泡状甲状腺癌患者。平均随访时间为11.5年。其中有60名女性（70%）和26名男性（30%），平均年龄为48.6岁。预后评分系统包括肿瘤、淋巴结、转移（TNM）、欧洲癌症研究与治疗组织（EORTC）、年龄、分级、范围、大小（AGES）、年龄、转移、范围、大小（AMES）以及转移、年龄、切除完整性、侵犯、大小（MACIS）。生存时间采用Kaplan-Meier方法计算。使用Cox比例风险分析，通过计算生存时间解释变异比例（PVE）来确定每种评分方法的相对重要性。
Kaplan-Meier分析表明，所有评分系统都是生存时间的显著预测因素（p < 0.0001）。与每个系统相关的PVE（从高到低）分别为：MACIS为0.48，AGES为0.46，EORTC为0.44，AMES为0.40，TNM为0.33。这些结果表明，MACIS评分系统在生存解释变异中占很大比例，与其他评分系统相比，是更精确的生存预测指标。
TNM、EORTC、AGES、AMES和MACIS均为我们86例滤泡状甲状腺癌患者的生存提供了有用的预后信息。然而，以PVE作为评估方法时，MACIS分类是最准确的预测指标。未来考虑额外预后因素的评分系统可能会获得更高的PVE。
