Hay I D, Grant C S, Taylor W F, McConahey W M
Division of Endocrinology/Metabolism, Mayo Clinic, Rochester, MN 55905.
Surgery. 1987 Dec;102(6):1088-95.
From a multivariate analysis of more than 14,200 patient-years' experience with papillary thyroid carcinoma (PTC), we devised a prognostic scoring system based on patient age, tumor grade, extent, and size (AGES). This scoring system can identify patients at increased risk of PTC mortality and was employed as an adjustment variable for analyzing the role of different types of surgical treatment in 860 PTC patients. Cancer mortality at 25 years in patients with an AGES score of 3.99 or less was 1% after ipsilateral lobectomy (n = 131) and 2% after bilateral resection (n = 603), whether subtotal or total (p = 0.15). Of patients with an AGES score of 4 or more, those who underwent lobectomy alone (n = 30) had a mortality rate from PTC at 25 years of 65%, while those undergoing bilateral resection (n = 86) had a lower rate of 35% (p = 0.06). For patients at minimal risk (score of 3.99 or less) of PTC death, no improvement in survival was demonstrable when patients underwent more than ipsilateral lobectomy. However, in a subgroup (score of 4 or more) identified to be at significant risk of PTC death, the survival after bilateral resection was much higher than after ipsilateral lobectomy alone. In neither the "minimal" nor the "higher" risk subgroup was PTC survival significantly improved by the performance of total thyroidectomy.
通过对超过14200患者年的乳头状甲状腺癌（PTC）病例进行多变量分析，我们设计了一种基于患者年龄、肿瘤分级、范围和大小的预后评分系统（AGES）。该评分系统能够识别PTC死亡风险增加的患者，并被用作分析860例PTC患者中不同类型手术治疗作用的调整变量。AGES评分3.99及以下的患者，同侧叶切除术（n = 131）后25年的癌症死亡率为1%，双侧切除术（n = 603）后为2%，无论是次全切除还是全切除（p = 0.15）。AGES评分4及以上的患者中，仅接受叶切除术（n = 30）的患者25年PTC死亡率为65%，而接受双侧切除术（n = 86）的患者死亡率较低，为35%（p = 0.06）。对于PTC死亡风险最低（评分3.99及以下）的患者，接受同侧叶切除术以上的手术并不能证明生存率有所提高。然而，在一个被确定为有显著PTC死亡风险的亚组（评分4及以上）中，双侧切除术后的生存率远高于仅同侧叶切除术。在“最低”和“较高”风险亚组中，全甲状腺切除术均未显著提高PTC患者的生存率。
