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Differentiated Thyroid Cancer
Reexamination of Risk Groups and Outcome of Treatment
Laura E. Sanders, MD;
Blake Cady, MD
Arch Surg. 1998;133:419-425.
Objective To reexamine the age, metastases, extent, and size (AMES) risk criteria for well-differentiated thyroid cancer with the effect of therapy on outcome.
Design Review of patient medical records and direct-contact follow-up.
Setting Two tertiary referral centers.
Main Outcome Measures Recurrence or death.
Patients One thousand nineteen patients with well-differentiated thyroid cancer treated between 1940 and 1990.
Results One thousand nineteen patients with well-differentiated thyroid cancer were treated between 1940 and 1990, with a mean follow-up of 13 years, including a recent group of 264 patients treated from 1980 to 1990 at 2 different institutions with a mean follow-up of 8 years. The AMES criteria were used to designate high- and low-risk patients. The entire group had 229 high- and 790 low-risk patients; the percentage of high-risk patients decreased slightly after 1960. From 1940 to 1960, 1960 to 1979, and 1980 to 1990, the high-risk groups had survival rates of 48%, 62%, and 47%, respectively. For the low-risk patients, survival rates were 96%, 98%, and 98%, respectively. Recurrences occurred in 5% of low-risk patients and were usually curable; in high-risk patients, recurrence was associated with a 75% mortality. In low-risk patients, there was no significant difference in recurrence or death according to type of operation (unilateral or bilateral) or use of radioactive iodine. In high-risk patients, there were trends toward but no significant improvement in survival with bilateral surgery and radioactive iodine therapy; thyroid replacement was associated with a significant improvement in survival.
Conclusions The AMES risk criteria remain highly valid predictors of risk. They define most low-risk patients for whom radical treatment may add excess morbidity but not improve already excellent prognoses.
From the Department of General Surgery, Lahey Hitchcock Medical Center, Burlington (Dr Sanders), and the Department of General Surgery, New England Deaconess Hospital, Boston (Dr Cady), Mass.
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